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Cardio - Newman > Ischemic Heart Disease I and II > Flashcards

Ischemic Heart Disease I and II Flashcards

1
Q

What are 3 possible steps you could take next in the case of Someone complaining of chest pain on exertion?

A
  • Perform a Stress Test
  • Possible Coronary Catheterization?
  • Give Drugs that reduce Demand
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2
Q

What are you looking for in a stress test of someone who complains of heart pain on exertion?
• what demands are we placing on the heart in a stress test?

A
  • ST depression would be indicative of ischemia occurring from a stable angina
  • Increase Heart Rate and Systolic Blood Pressure (afterload)
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3
Q

What should be your next steps if someone complains of chest tightness while sleeping?

A
  • Perform Stress Test
  • DO NOT catheterize (only do in ST elevation?)
  • Give Drugs that Prevent Clots
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4
Q

What procedure is performed when people have multiple coronary vessels that are occluded?
• Single Vessel

A
  • Coronary Bipass

* Single Vessel then do a stent

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5
Q

If someone walks in with chest pain and ST elevation (II, III, or aVF), what is the 1st thing you should do?

A

GO TO CATH LAB, you need to place a stent now

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6
Q

What is your Dx. if someone wakes up in the middle of the night with “elephant on their chest” but have no EKG abnormalities?
• what if troponins are positive?

A
  • Acute Coronary Syndrome (non-STEMI)

* Troponin often will be elevated in non-STEMI but its still treated the same way

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7
Q

What is your Dx. if someone complains of tightness in their chest on exertion that goes away when they decrease activity?

A

• Chronic Stable Angina

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8
Q

What should happen in a normal heart as you increase demand on the heart?

A

• Coronaries Should Dilate to allow for greater flow

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9
Q

What controls Myocardial O2 supply?

A

• CORONARY BLOOD FLOW

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10
Q

What are 2 factors that play the predominant role in the Myocardium meeting its O2 demands?

A
  • HEART RATE
  • SYSTOLIC BLOOD PRESSURE
  • contractile force
  • ventricular dimensions
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11
Q

What is the very general problem in the myocardium that results in Chronic Stable Angina?

A

• O2 Demand ouweighs O2 Supply

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12
Q

What causes Chronic Stable Angina?

A

• Occlusion of Coronary Arteries with a STABLE ATHEROSCLEROTIC plaque

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13
Q

**What the the KEY things you’re looking for in a patient with Chronic Stable Angina?

A

Many times they have a heaviness in chest, but not always.

ALWAYS, ALWAYS, ALWAYS:
Timing:
• ALWAYS more than 5 min. NEVER greater the 30 min

Sympathetic Response:
• Sweating, Dyspnea

Cutaneous Symptoms:
• “White as a Ghost”

Patients ALWAYS have to DECREASE activity, if Running they’ll need to walk, if walking they’ll need to sit, if sitting they’ll need to lie down

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14
Q

If we suspect Chonic Stable Angina, what do we look for on EKG?

A

• Pts. will have a normal EKG unless walking on a treatmill, in this case they’ll have ST Depression

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15
Q

If we see a normal exercising EKG but still suspect an Chronic Stable Angina, what type of imaging can we do to determine if the patient has CSA?

A

• Nuclear Imaging is good for determining if some part of the heart is not being perfused

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16
Q

What are the steps that lead to ischemia in Chronic Stable Angina?

A
  • Atherosclerotic Lesion present in Vessel
  • Episodic Superimposed Vasospasm
  • Transient Increased Obstruction
  • Ischemia
17
Q

Who is most susceptible for ACUTE coronary syndromes?

• how do you differentiate this from Chronic Stable Angina?

A
  • Men slightly more than Women
  • People OVER 65 years old

Acute Syndrome occurs at rest (at night) with chest pain that last MUCH LONGER than 30 min*

18
Q

What is the Main Cause of ACUTE coronary Syndrome?

A

*Ruptured Atherosclerotic Plaque

Results in:

  1. Platelet Aggregation
  2. Vasoconstriction
19
Q

Rank the mortality rates of:
• Acute MI
• Acute Coronary Syndrome (unstable angina)
• Stable Angina

A

Acute MI > ACS > Stable Angina

20
Q

What is the Root Cause of Acute Coronary Syndrome?

• what factors increase the risk of this happening?

A

Cause = ENDOTHELIAL DYSFUNCTION that results in DECREASED NITRIC OXIDE ACTIVITY - “the vessel is the culprit”

Factors: 
• Lipoproteins
• Smoking
• Cytokines
• Turbulent Flow
• ROS
• Glucose A1C
• HTN
21
Q

What 2 important things happen as the result of decreased NO production from dysfunctional epithelium?

A
  • VASOCONSTRICTION

* PLATELET AGGREGATION

22
Q

Differentiate a Stable and an Unstable Plaque.

A

Stable Plaque have a small lipid core with lots of overlying epithelium

Unstable Plaque
• Thin Cap
• Large Lipid Core
• High Macrophage Content
• Low Smooth Muscle Cell Count
23
Q

Are antiplatelet and anticoagulation drugs more important in Chronic Stable Angina or in Acute Coronary Syndrome?

A

• Drugs to prevent platelet aggregation or break up clots are more important in ACS. CSA doesn’t involve thrombus formation so these drugs would do much to help these patients

24
Q

What is the Primary Pharmacological Treatment given to patients with Unstable Angina?

A

• Asprin + Heparin

**Drugs like clopdigrel are also sometime used

25
Q

What are some of the pain symptoms of Myocardial Infarction?

A

SUBSTERNAL chest pain that is crusing or squeezing (like indigestion) - Radiation to Arm, Neck, Jaw, Epigastrium, or between Scapulae

26
Q

What are some possible outcomes of MI?

A
  • Syncope
  • Arrhythmia - VENTRICULAR FIBRILLATION
  • Left Heart Failure
  • Cardiogenic Shock
  • Sudden Death
27
Q

How long does an MI last?

• symptoms besides Pain

A

30 minutes to Several Hours

Jugular Venous Distention (MEASURE IT EVERYDAY) 
S3 Gallop (LISTEN FOR IT EVERYDAY) 
Anxiety (impending doom)
Cold Sweats
Nausea
Vomiting
Pale
28
Q

How can we differentiate between Ischemia, Cell Damage, and Necrosis on EKG?

A

Ischemia - Inverted T or ST depression
Cell Damage - ST Elevation
Necrosis - ST elevation with large Q waves

29
Q

Can tropinin tell you if someone is having an MI?

A

Not Really, its VERY sensitive so it may be elevated even in trauma or sepsis so use context

30
Q

What area of infarction leaves people at the highest risk for heart block?

A

• Infarction in AV area and IV septum get heart block after a very bad MI

31
Q

What is the most common cause of sudden cardiac death?

A

• Ventricular Fibrillation

32
Q

What would you hear on auscultation of someone with a rupture of the IV septum?
• what secondary problem would eventually happen?

A
  • Loud Systolic Murmor

* L to R shunting would cause Right Ventricular hypertrophy and pulmonary edema

33
Q

What key problem results from tearing a papillary muscle?

A
  • Regurgitation (or mitral or triscupid valves)

* You may also get pulmonary edema from inability of Ventricle to Handle the high EDV that results from Regurgitation

34
Q

Someone present with a STEMI and systolic pressure below 90 mmHg. State?

A

Cardiogenic Shock

35
Q

When is the only time you’ll ever see diastolic pressure greater than systolic pressure?

A

• Balloon Angioplasty

36
Q

If you are at a primary care facility 100 miles from anything and someone present with an MI what should you do?
• what is the downfall of this therapy?

A
  • Probably Should Give Stretokinase or Alteplas to break up the clot assuming you don’t have a stent lab
  • Downside is that the clot may come back as soon as the thrombolytic wears off

Cardio - Newman (8 decks)

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