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Spr24 Assess Ex1&2 - Cornelius > Ischemic Heart Disease (Exam II) > Flashcards

Ischemic Heart Disease (Exam II) 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.
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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 EKG abnormality is associated with old MI’s and/or current ischemia?

A

T-wave inversion

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6
Q

What is nuclear stress testing utilized for?

A

Coronary Perfusion assessment
-tracer activity in perfused vs ischemic areas

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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

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11
Q

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

A

Used after test to dilate normal, non-ischemic areas of the heart.

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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 Prinzmetal Angina?

A

Coronary vasospasm

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14
Q

What is the mechanism of action for aspirin?

A

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

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15
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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16
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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17
Q

What drugs (discussed in lecture) are P2Y12 inhibitors?

A

Clopidogrel and Prasugrel

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18
Q

What common drug class will antagonize P2Y12 inhibitors?

A

PPIs

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19
Q

How does Prasugrel compare to Clopidogrel?

A

More predictable pharmacokinetics but greater bleeding risk.

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20
Q

How do P2Y12 inhibitors work?

A

Inhibit ADP receptor P2Y12 and thus inhibit platelet aggregation.

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21
Q

What drug classes are synergistic with nitrates?

A
  • β-blockers
  • CCBs
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22
Q

When are nitrates contraindicated?

A
  • Aortic Stenosis
  • Hypertrophic Cardiomyopathy
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23
Q

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

A

β-blockers

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24
Q

What properties do β-blockers have?

A
  • Anti-ischemia
  • Anti-HTN
  • Anti-dysrhythmic
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25
Which β blockers are cardioselective?
- Atenolol - Metoprolol - Acebutolol - Bisoprolol
26
Which β blockers are non-selective?
- Propanolol - Nadolol
27
What risk is associated with non-selective β blockers in asthma patients?
↑ risk of bronchospasm in reactive airway disease patients.
28
What drug class is uniquely effective in decreasing the severity/frequency of coronary vasospasm?
CCBs
29
Angiotensin II will increase what four things?
- Myocardial hypertrophy - Interstitial myocardial fibrosis - Coronary vasoconstriction - Inflammatory responses
30
Is troponin or CK-MB more specific for myocardial injury?
Troponin
31
How soon will troponin start to increase after myocardial injury? How long might they remain elevated?
* 3 hours * 7-10 days
32
What diagnostic studies might indicate a myocardial infarction?
- EKG: abnormality (ex. LBBB) - US: Regional wall motion abnormalities
33
What are indications for PCI treatment of an MI?
- Contraindicated tPa therapy - Severe HF and/or pulm edema - S/S for 2-3 hours - Mature clot
34
What risks are associated with PCI (percutaneous coronary intervention) ?
- Endothelial destruction - Bleeding - Thrombosis
35
What is Dual Antiplatelet Therapy (DAPT) ?
- ASA w/ P2Y12
36
How long would one want to wait for elective surgery post angioplasty **with no stenting**?
2 - 4 weeks
37
How long would one want to wait for elective surgery post angioplasty **with bare-metal stent placement**?
At least 30 days (12 weeks preferable)
38
How long would one want to wait for elective surgery post angioplasty **with drug-eluting stent placement**?
At least 6 months (12 months if post ACS)
39
How long would one want to wait for elective surgery post-CABG?
At least 6 weeks (12 weeks preferable)
40
In these ACS pts, Is glycopyrrolate or atropine preferred for treatment of bradycardia?
Glycopyrrolate
41
Are β blockers or ACE-inhibitors continued peri-operatively?
β-blockers
42
Are β blockers or ACE-inhibitors discontinued 24 hours prior to surgery?
ACE inhibitors
43
What components are worth 1 point on the Revised Cardiac Risk Index (6) ?
44
What % risk of major cardiac events would be conferred by a RCRI score of 0 ?
0.4%
45
What % risk of major cardiac events would be conferred by a RCRI score of 1 ?
1.0%
46
What % risk of major cardiac events would be conferred by a RCRI score of 2 ?
2.4%
47
What % risk of major cardiac events would be conferred by a RCRI score of ≥3 ?
5.4%
48
What does 1 MET equal?
3.5mLO₂/kg/min
49
What drug is the preferred treatment for tachycardia?
Esmolol
50
What anticholinergic is the better option for treatment of bradycardia in CAD patients?
**Glycopyrrolate** > Atropine
51
What coronary artery would you expect to be effected from abnormalities noted on II, III, and aVF?
RCA
52
What coronary artery would you expect to be affected from abnormalities noted on I and aVL?
Circumflex artery
53
What coronary artery would you expect to be effected from abnormalities noted on V3 - V5?
LAD
54
How would you describe acute coronary syndrome?
acute or worsening oxygen supply/demand balance
55
What criteria suggests an NSTEMI diagnosis?
* NSTEMI has **No ST-elevation** * Ischemic type chest pain * troponin/CK-MB positive
56
What differentiates unstable angina from MI?
Negative troponin & no ST elevation
57
What criteria suggests a STEMI diagnosis?
Troponin change & Evidence of myocardial ischemia: * Ischemic symptoms * EKG changes (ST, LBBB, pathological Q) * wall motion abnormality on imaging * ID of thrombus on angiography
58
What are some contraindications for tPa?
* Major surgery * uncontrolled HTN * aneurysms * recent thrombolytics * active bleeding
59
Is thrombolytic therapy indicated for NSTEMI?
No
60
Raking leaves, gardening would be what MET equivalent?
4 METs
61
Climbing 1 flight of stairs, dancing or bicycling would be what MET equivalent?
5 METs
62
What are the 3 surgical urgency criteria?
* Emergency: need sx within **6 hr** * Urgent: need sx within **6-24 hr** * Time-sensitive: need sx within **1-6 weeks**
63
What kind of cardiac criteria would you avoid anesthesia?
* Recent MI * unstable/severe angina * Decompensated HF * Severe valvular disease * significant dysrhythmias
64
What are the 2 most important non-modifiable risk factors for coronary artery atherosclerosis?
* Male * Increasing age
65
Stable angina generally suggest occlusion of ____%
~70%
66
Chronic stable angina is generally characterized as?
Chest pain that doesn't change in frequency/severity in 2 month period
67
What is pseudonormalization of T waves?
When a pt has chronically inverted T waves from previous MI/ischemia and now are upright and "normal" during myocardial ischemia
68
How soon should initiation of tPa be for ischemic event?
* Within 30-60 min of hospital arrival * Within 12 hours of symptom onset.
69
How soon should PCI occur after an ischemic event?
* Within 90 minutes of hospital arrival * Within 12 hours of symptom onset.

Spr24 Assess Ex1&2 - Cornelius (26 decks)

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