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TxWes Spring '25: Health assessment > Ischemic heart disease Exam 2 > Flashcards

Ischemic heart disease Exam 2 Flashcards

1
Q

What chemical mediators are released from ischemia that activate cardiac nociceptors?

A

Adenosine and Bradykinin

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2
Q

What is the path for cardiac pain signals to reach the spinal cord?

A

Cardiac nociceptors → Afferent Neurons → T1 - T5 SNS ganglia.

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3
Q

Differentiate stable vs unstable angina.

A

Stable - No change in chest pain severity or frequency in 2-mo period.
Unstable - Increasing frequency and severity of chest pain without increase in biomarkers

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4
Q

Are cardiac biomarkers (troponin) present with unstable angina?

A

NO. If they were, that would be an MI.

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5
Q

What 12 lead EKG changes might be seen in someone with an MI?

A
  • ST segment depression
  • T-wave inversion
  • ST elevation
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6
Q

What is nuclear stress testing utilized for?

A

Coronary Perfusion assessment
* tracer activity in perfused vs ischemic areas
* Greater sensitivity
* Size of perfusion abnormality = significance of CAD detected
* Estimates LV systolic size and function
* Differentiates new perfusion abnormality vs. “old” MI

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7
Q

What determines the significance of CAD during a nuclear stress test?

A

Size of the perfusion abnormality
Arrows point to arrows of lesser perfusion.

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8
Q

What test can differentiate a new vs an old perfusion abnormality?

A

Nuclear Stress Testing

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9
Q

What nuclear stress test tracers are used with exercise?

A

Thallium

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10
Q

What nuclear stress test drugs are used without exercise?

A
  • Atropine, Dobutamine, Pacing (increases HR)
  • adenosine, dipyridamole (coronary dilator)
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11
Q

When are adenosine and dipyridamole used with nuclear stress testing? Why?

A
  • For patients who cannot undergo normal stress testing
  • They dilate normal coronary arteries but not atherosclerotic ones (shows as abnormality in reading)
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12
Q

What test would be useful for imaging wall motion abnormalities or valvular function?

A

Echocardiography

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13
Q

What is coronary angiography?

A
  • Determines location of occlusive disease through IV injection of dye
  • daignose prinzmetal angina
  • assess results of angioplasty/stenting
  • does NOT measure stability of plaque
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14
Q

What is Prinzmetal Angina?

A

Coronary vasospasm causing angina

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15
Q

What is the mechanism of action for aspirin?

A

COX-1 Inhibition → TXA2 inhibition → Plt aggregation inhibition.

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16
Q

How can aspirin be reversed?

A

Trick question. It can’t be, platelets are damaged until they die and are replaced. (7-14 days)

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17
Q

What is the mechanism of action of abciximab, eptifibatide, and tirofiban?

A
  • Platelet glycoprotein IIb/IIIa receptor antagonists
  • Inhibit platelet activation, adhesion, and aggregation.
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18
Q

How do P2Y12 inhibitors work?

A

Inhibit ADP receptor P2Y12 and thus inhibit platelet aggregation.

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19
Q

What drugs (discussed in lecture) are P2Y12 inhibitors?

A
  • Clopidogrel
  • Prasugrel (Effient)
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20
Q

What common drug class will antagonize P2Y12 inhibitors?

A

PPIs

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21
Q

How does Prasugrel compare to Clopidogrel?

A
  • More predictable pharmacokinetics
  • greater bleeding risk
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22
Q

What drug classes are synergistic with nitrates?

A
  • β-blockers
  • CCBs
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23
Q

What are benefits of nitrates?

A
  • Increase exercise to produce ST-segment depression
  • Dilate coronary arteries and collaterals
  • Decrease peripheral vascular resistance
  • Decreases preload
  • Potential anti-thrombotic effects
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24
Q

When are nitrates contraindicated? (2)

A
  • Aortic Stenosis
  • Hypertrophic Cardiomyopathy
  • Decreased preload and afterload = hypotension
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25
Q

What drug class is the only one proven to prolong life in CAD patients?

A

β-blockers

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26
Q

What properties do β-blockers have?

A
  • Anti-ischemia
  • Anti-HTN
  • Anti-dysrhythmic
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27
Q

Which β blockers are cardioselective? (beta 1)

A
  • Atenolol
  • Metoprolol
  • Acebutolol
  • Bisoprolol
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28
Q

Which β blockers are non-selective? (beta 1 & 2)

A
  • Propanolol
  • Nadolol
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29
Q

What risk is associated with non-selective β blockers in asthma patients?

A

↑ risk of bronchospasm in reactive airway disease patients.

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30
Q

What drug class is uniquely effective in decreasing the severity/frequency of coronary vasospasm?

A

CCBs

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31
Q

What are ACE inhibitors used for?

A
  1. Hypertension
  2. Heart failure
  3. Cardioprotective
32
Q

Angiotensin II will increase what four things?

A
  • Myocardial hypertrophy
  • Interstitial myocardial fibrosis
  • Coronary vasoconstriction
  • Inflammatory responses
33
Q

What are statins used for?

A

Coronary plaque stabilization
Reduces mortality noncardiac surgery and vascular surgery
Decreases:
* Lipid oxidation
* Inflammation
* Matrix metalloproteinase
* Cell death

34
Q

Whne is revascularization indicated?

A
  • Failure of medical therapy
  • > 50% L main coronary artery
  • > 70% epicardial coronary artery
  • Impaired EF < 40%
35
Q

What are the 3 categories of ACS?

A
  1. Unstable angina
  2. NSTEMI
  3. STEMI
36
Q

Diagnostic data of STEMI?

A
  • ischemia symptoms
  • eleveated troponin
  • ST-T changes/new LBBB
  • pathological Q-waves on EKG
  • imaging/angiography
37
Q

Is troponin or CK-MB more specific for myocardial injury?

38
Q

How soon will troponin start to increase after myocardial injury? How long might they remain elevated?

A
  • 3 hours
  • 7-10 days
39
Q

What diagnostic studies might indicate a myocardial infarction?

A
  • EKG: abnormality (ex. LBBB)
  • US: Regional wall motion abnormalities
40
Q

What are indications for PCI treatment of an MI?

A
  • Contraindicated tPa therapy
  • Severe HF and/or pulm edema
  • S/S for 2-3 hours
  • Mature clot
41
Q

What risks are associated with PCI (percutaneous coronary intervention)?

A
  • Endothelial destruction
  • Bleeding
  • Thrombosis
  • reocclusion
42
Q

When is CABG indicated?

A
  • Coronary anatomy
  • Failed angioplasty
  • Evidence of infarction-related ventricular septal rupture or mitral regurgitation
43
Q

What is Dual Antiplatelet Therapy (DAPT)?

A

ASA w/ P2Y12

44
Q

How long would one want to wait for elective surgery post angioplasty with no stenting?

A

2 - 4 weeks

45
Q

How long would one want to wait for elective surgery post angioplasty with bare-metal stent placement?

A

30 days (12 weeks preferable)

46
Q

How long would one want to wait for elective surgery post angioplasty with drug-eluting stent placement?

A

At least 6 months (12 months if post ACS)

47
Q

How long would one want to wait for elective surgery post-CABG?

A

At least 6 weeks (12 weeks preferable)

48
Q

In these ACS pts, Is glycopyrrolate or atropine preferred for treatment of bradycardia?

A

Glycopyrrolate

49
Q

Are β blockers or ACE-inhibitors continued peri-operatively?

A

β-blockers

50
Q

Are β blockers or ACE-inhibitors discontinued 24 hours prior to surgery?

A

ACE inhibitors

51
Q

What components are worth 1 point on the Revised Cardiac Risk Index (6)?

52
Q

What % risk of major cardiac events would be conferred by a RCRI score of 0?

53
Q

What % risk of major cardiac events would be conferred by a RCRI score of 1?

54
Q

What % risk of major cardiac events would be conferred by a RCRI score of 2?

55
Q

What % risk of major cardiac events would be conferred by a RCRI score of ≥3?

56
Q

What does 1 MET equal?

A

3.5mLO₂/kg/min

57
Q

What drug is the preferred treatment for tachycardia?

58
Q

What anticholinergic is the better option for treatment of bradycardia in CAD patients?

A

Glycopyrrolate > Atropine

59
Q

What coronary artery would you expect to be affected from abnormalities noted on II, III, and aVF?

60
Q

What coronary artery would you expect to be affected from abnormalities noted on I and aVL?

A

Circumflex artery

61
Q

What coronary artery would you expect to be affected from abnormalities noted on V3 - V5?

62
Q

How would you describe acute coronary syndrome?

A

acute or worsening oxygen supply/demand balance

63
Q

What criteria suggests an NSTEMI diagnosis?

A

NSTEMI has No ST-elevation
Ischemic type chest pain
troponin/CK-MB positive

64
Q

What differentiates unstable angina from MI?

A

Negative troponin & no ST elevation

65
Q

What criteria suggests a STEMI diagnosis?

A

Troponin change &
Evidence of myocardial ischemia:
Ischemic symptoms
EKG changes (ST, LBBB, pathological Q)
wall motion abnormality on imaging
ID of thrombus on angiography

66
Q

What are some contraindications for tPa?

A

Major surgery
uncontrolled HTN
aneurysms
recent thrombolytics
active bleeding

67
Q

Is thrombolytic therapy indicated for NSTEMI?

68
Q

Raking leaves, gardening would be what MET equivalent?

69
Q

Climbing 1 flight of stairs, dancing or bicycling would be what MET equivalent?

70
Q

What are the 3 surgical urgency criteria?

A

Emergency: need sx within 6 hr
Urgent: need sx within 6-24 hr
Time-sensitive: need sx within 1-6 weeks

71
Q

What kind of cardiac criteria would you avoid anesthesia?

A

Recent MI
unstable/severe angina
Decompensated HF
Severe valvular disease
significant dysrhythmias

72
Q

What are the 2 most important non-modifiable risk factors for coronary artery atherosclerosis?

A

Male
Increasing age

73
Q

Stable angina generally suggests occlusion of ____%

74
Q

Chronic stable angina is generally characterized as?

A

Chest pain that doesn’t change in frequency/severity in 2 month period

75
Q

What is pseudonormalization of T waves?

A

When a pt has chronically inverted T waves from previous MI/ischemia and now are upright and “normal” during myocardial ischemia

76
Q

How soon should initiation of tPa be for ischemic event?

A

Within 30-60 min of hospital arrival
Within 12 hours of symptom onset.

77
Q

How soon should PCI occur after an ischemic event?

A

Within 90 minutes of hospital arrival
Within 12 hours of symptom onset.

TxWes Spring '25: Health assessment (10 decks)

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