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Cardio Exam 2 Remediation > Ischemic Heart Disease I > Flashcards

Ischemic Heart Disease I Flashcards

1
Q

Percent of population that has had an MI

A

3-4%

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2
Q

MCC of an MI

A

Atherosclerosis

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3
Q

Pathogenesis of IHD

A

Supply that does not meet demand - Can be a blockage, or hypotension, or even anemia or bleeding out

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4
Q

IHD continuum

A

Prinzmetal angina
Stable angina
Unstable angina
Myocardial Infarction: NSTEMI or STEMI

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5
Q

Acute coronary syndrome

A

When there is plaque rupture and thrombus formation

STEMI, NSTEMI, or Unstable Angina all count

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6
Q

How much blood is getting through in ACS

A

USA - No occlusion
NSTEMI - Partial occlusion
STEMI - Complete occlusion

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7
Q

Presentation of stable angina

A

Typical patter with predictability
1-15 minutes persistence
Pain with activity

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8
Q

Presentation of Unstable angina

A

Unexpected - a change from the patients usual pattern
Pain DOES NOT go away with rest or nitroglycerin
MI is imminent

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9
Q

Continuum of myocyte cell death

A

Ischemia - As soon as there is a loss of blood flow - hurts but fine
Injury - Some cells will return to normal some won’t
Infarct - Tissue is fully dead and akinetic

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10
Q

Acute infarct

A

Has happened within 3-5 days

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11
Q

NSTEMI cause and presentation

A

Subendocardial wall of the LV, Septum or Papillary muscle is infarcted
ST depression or T wave inversion or nothing(won’t do that on a test)!!!!
Non Q wave

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12
Q

STEMI cause and presentation

A

Transmural MI
ST elevation and Q waves
Label based on area we are seeing it in
ECG tombstoning

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13
Q

Type I MI

A

Primary coronary event due to rupture of a plaque

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14
Q

Type II MI

A

Secondary to ischemia d/t oxygen demand and decresed supply - Spasm, embolism, anemia, arrhythmias
Atherosclerosis is NOT THE CAUSE

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15
Q

Type III MI

A

Sudden cardiac death

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16
Q

Type IV MI

A

Have had an angioplasty or sent

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17
Q

Type V MI

A

Associated with CABG

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18
Q

Myocardial stunning

A

Heart stops working to save itself - restarts on reperfusion

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19
Q

Hibernating myocardium

A

Tissue is alive but needs to be reperfused - MUGA scan

20
Q

3 Most common patients with silent ischemia

A

Diabetics, elderly, women

21
Q

2 branches of the right coronary artery

A

Marginal and Posterior Descending

22
Q

2 branches of left coronary artery

A

Circumflex and Anterior descending

23
Q

Supply to inferior portion of the heart (LV)

A

Right coronary artery

24
Q

Supply to the SA and AV node

A

Right coronary artery

25
Q

Supply to lateral heart

A

Left circumflex artery

26
Q

Supply to anterior heart (LV)

A

Left anterior descending artery (widowmaker)

27
Q

Supply to posterior heart

A

Right coronary artery - Posterior descending artery
(Tall R wave in leads V1-V3)

28
Q

To questions for initial evaluation of a patient with chest discomfort

A

How likely is ACS?
What is the risk of adverse events?

29
Q

One more time, what qualifies as ACS again?

A

Unstable angina
NSTEMI
STEMI

30
Q

Angina

A

Squeezing, gnawing pain in the chest

31
Q

ACS typical presentation

A

Rarely “pain”
Substernal
Radiation to left shoulder, scapula, jaw
SUDDEN! (Past 1-2 days)
Lasts 2-5 minutes - typically with exertion

32
Q

Aggravating/Alleviating factors for ACS

A

NTG and rest make it better
Activity, meals, stress, sex, morning, supine position make it worse

33
Q

Associate s/s of ACS

A

Impending doom
Fatigue
Nausea

34
Q

Abnormal presentation of ACS in women

A

Pressure, fatigue, weakness
Pay attention to risk factors

35
Q

Physical exam for ACS

A

May have high/low BP
Fast/slow HR
SICK APPEARING - Gray and Diaphoretic
Altered consciousness

36
Q

1 substance that can induce chest pain

A

Cocaine - vasospasms

37
Q

Criteria of TIMI score

A

65+ Age
3+ CAD risk FACTORS
Prior CAD
Aspirin in past 7 days
Severe angina
ST deviation over 0.5 mm
Elevated cardiac markers - CK-MB or troponin

38
Q

TIMI score interpretation

A

0-2 Low risk
3-4 Intermediate risk
5+ High risk

39
Q

HEART score

A

History
ECG
Age
Risk factors
Troponin

40
Q

History measurement for HEART score

A

2 - Highly suspicious
1 - Moderately suspicious
0 - Slightly suspicious

41
Q

ECG measurement for HEART score

A

2 - Significant ST depression
1 - Nonspecific repolarization disturbance
0 - Normal ECG

42
Q

Age measurement for HEART score

A

2 - 65+
1 - 45-65
0 - 45 or less

43
Q

Risk factors for heart score

A

2 - Three risk factors
1 - One or Two risk factors
0 - No risk factors

44
Q

Troponin measurement for HEART score

A

2 - 3+ times the normal limit
1-3 times the normal limit
Normal

45
Q

Interpretation and Intervention for HEarT scores

A

0-3 - Discharge (2.5% likelihood)
4-6 - Admit for observation (22.3% likelihood)
7-10 - Admit with early invasive strategies (72.7% likelihood)

46
Q

Normal troponin level

A

0.04 ng/mL (0.12 is three times normal)

Cardio Exam 2 Remediation (7 decks)

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