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AP Summer > Ischemic Heart Disease & CHF > Flashcards

Ischemic Heart Disease & CHF Flashcards

0
Q

What are the risk factors for coronary artery disease?

A 
Age
HTN
Smoking
High Cholesterol
Diabetes
Family History
Obesity
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1
Q

What accounts for one third of all deaths in people over the age of 35 in the United States?

A

Coronary artery disease

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2
Q

What is acute coronary syndrome?

A

Acute coronary syndrome is applied to patients in whom there is a suspicion of myocardial ischemia

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3
Q

What are the three types of acute coronary syndrome?

A
  1. STEMI (ST Elevation MI)
  2. NSTEMI (Non ST Elevation MI)
  3. UA (Unstable Angina)
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4
Q

What is myocardial infarction?

A

A clinical advanced consequent to the death of cardiac myocytes that is caused by ischemia

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5
Q

What are the criteria for myocardial infarction?

A

EKG changes
Rise and fall of cardiac biomarkers (troponin)
New wall motion abnormalities
Symptoms of ischemia

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6
Q

What is a biomarker?

A

Cardiac enzymes in the heart

Basically let you know something is happening

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7
Q

What are the two medical therapies for coronary artery disease and how do they differ?

A 
Anti-anginal therapy (Controls symptoms)
Preventative therapy (Stop from recurring)
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8
Q

What are the three types of antianginal therapy?

A

Beta blockers
Calcium channel blockers
Nitrates

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9
Q

How do beta blockers work?

A

By slowing the heart rate and reducing contractility

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10
Q

What is an example of a calcium channel blocker that is a vasodilator with reflex tachycardia?

A

Nifedipine

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11
Q

Which calcium channel blocker is the strongest inotrope and is used in the treatment of Wolff-Parkinson-White?

A

Verapamil

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12
Q

How did nitrates work?

A

They are short acting venous dilators

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13
Q

In what way is ephedrine similar to nitrates?

A

Both have tachyphylaxis

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14
Q

What are the three types of preventative therapy for coronary artery disease?

A

Antiplatelet therapy
Risk reduction
Statins

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15
Q

What is the mainstay form of antiplatelet therapy?

A

Aspirin

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16
Q

How do statins work and what are the risks associated with their use?

A

Lower cholesterol

Risks: Can cause myopathy and liver dysfunction

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17
Q

How is cardiac failure defined?

A

Failure of the heart to maintain a cardiac output sufficient to meet the metabolic demands of the body

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18
Q

How is cardiac output calculated?

A

CO = SV + HR

19
Q

How is the diagnosis of heart failure made?

A

The diagnosis of heart failure requires that 2 major or 1 major and 2 minor criteria are met and not attributed to another medical condition.

20
Q

What are some of the possible MAJOR criteria for heart failure?

A 
Paroxysmal nocturnal dyspnea
Orthopnea
Elevated jugular venous pressure
 pulmonary rales
Third heart sound
Cardiomegaly on chest x-ray
Pulmonary edema on chest x-ray
Weight loss of 4.5 kg in five days in response to treatment of presumed heart failure
21
Q

What are some possible causes of cardiac failure?

A 
Ischemic versus nonischemic cardiomyopathy
Alcoholism
Infectious
Inflammatory
Congenital
Valvular
Oncological
Pharmacological
22
Q

What are the five main causes of cardiac failure that are treated?

A
  1. Heart rate
  2. Rhythm
  3. Preload
  4. Afterload
  5. Contractility
23
Q

Ventricular arrhythmias are attributed to ______ until proven otherwise

A

Ischemia

24
Q

What is cardiac resynchronization therapy?

A

A special pacemaker used to contract both right and left ventricle.
-30% of patients with CHF have asynchronous contractions of the right and left ventricle

25
Q

Practically speaking, preload is synonymous with what?

A

Volume (or CVP)

26
Q

What are some possible causes of impairment to venous return?

A

Hemorrhage
Dehydration
Vascular occlusion
Increased intrathoracic pressure

27
Q

Practically speaking, afterload is synonymous with what?

A

Blood pressure (SVR)

28
Q

What types of drugs are commonly used for afterload reduction?

A

Ace inhibitors

    • nicardapine
    • hydralazine
    • nitroprusside
29
Q

For a patient in cardiac failure, what is the relationship between blood pressure and forward flow?

A

Inversely related

30
Q

Inotropic refers to ______

Lusitropic refers to _______

A

Contractility

Relaxation

31
Q

What is contractility?

A

Intrinsic ability of a cardiac muscle fiber to contract at a given fiber length

32
Q

What are the two main causes of contractility impairment?

A

Ischemia

Cardiomyopathy (congenital or acquired)

33
Q

If a patient presents with mottling of the knees and is cool to the touch this is indicative of what?

A

Poor perfusion and decreased blood flow to the extremities

34
Q

What does a pathologic S III sound indicate?

A

Decreased compliance of the ventricles (as in CHF) and may be the earliest sign of heart failure

35
Q

True or false: The human body produces enough acid to kill us in about seven minutes if not for the body buffers

A

True

36
Q

What is a normal amount of lactic acid as measured in the blood?

A

Less than 2 mg/dL

37
Q

Where is mixed venous blood best obtained?

A

From the distal port of a PA catheter

Second best is from a central line

38
Q

A decrease in venous oxygen saturation can cause what?

A

Decreased arterial saturation
Decreased hemoglobin
Decreased cardiac output
Increased consumption

39
Q

What is HOCM?

A

Hypertrophic obstructive cardiomyopathy

40
Q

How is HOCM different from other forms of cardiomyopathy?

A

Only cardiomyopathy that’s worse when pressure is higher

41
Q

What are three important factors when treating HOCM patients?

A
  1. Tight (decreased afterload)
  2. Slow (decreased HR)
  3. Full (increased volume)
42
Q

What drug is given with patients with aspirin allergies?

A

Chlopitigril (plavix)

43
Q

When do most episodes of angina occur?

A

In early morning

44
Q

What drug class is known to cause hypoxic pulmonary vasodilation?

A

Nitrates

45
Q

What is an ICD?

A

Implantable cardiac defibrillator

46
Q

What is SAM?

A

Systolic arterial/anterior motion

Is caused when a myopathy causes mitral valve to be sucked into aortic valve thus blocking flow

AP Summer (24 decks)

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