Ischemic Heart Disease - Nate Flashcards
What are capillaries
monolayer of endothelial cells on the basemement membrane lined by pericytes, which are multifunctional including angiogenesis and endothelial proliferation
what do areterioles regulate
blood pressure and flow - greatest vascular resistance
What does the LAD supply
RV, LV and intraventricular septum
what does the RCA supply
perfuses RA, RV, apex
What is Ischemic Heart disease
imbalance between cardiac blood supply (perfusion) and myocardial oxygen requirements
typically secondary to obstructive atherosclerotic vascular disease
What is angina pectoris
ischemia causes pain but insufficient to cause myocyte death
what is myocardial infarction
this occurs when the severity or duration of ischemia is sufficient to cause cardio myocyte death
what is the best initial tests for patients with chest pain
EKG
chest x-ray
CTA
ACS refers to
unstable angina, NSTEMI and STEMI
assess via EKG
what are cardiac enzyme elevation distinguishes
troponin
what is the common cause of death post MI
arrhythmias - v.fib
what is the framingham study
LIFETIME risk of IHD with optimal risk 3.6% for men and less than 1% for women
What are risk factors for IHD
Behavioral: tobacco, inactivity, diet
Metabolic: lipids, HTN, DM, obesity
Non-Modifiable: age, sex, family hx
what are ischemic symptoms
chest pain/pressure/discomfort
associated dyspnea, diaphoresis
Radiation: Jaw, neck, arm, shoulder, back
N/V
how do you diagnose IHD
history
telemetry
ECG
CXR
Troponin
CBC, CMP, Lipase, urine tox, PT/INR
Provocative testing
What is stable angina
chest dicomfort is reproducible with exertion or stress and relieve with rest and/or nitrates
what is unstable angina
angina with symptoms at rest, lasts > 10minutes, severe /new onset
distinctly more severe, prolonged or frequent
What is a NSTEMI
UA + myocardial necrosis
What is STEMI
NSTEMI + ST elevations
What is acute ACS treatment
reduce ischemia, open artery
anticoag
antiplatelet
beta blockade
nitrate
re-perfusion
what is the long term treatment of ACS
ACEi
statins
nitrates
antiplatelets
rehab
risk factors
What is the treatment for NSTEMI
bed rest with continuous ECG telemetry
meds: anti-schemic and antithrombic treatments, Nitrates, BB, CCB, Statin, COXi, P2Y12I
what are absolute contraindications of thrombolytic therapies
any prior intracranial hemorrhage
known intracranial malformation or neoplasm
ischemic stroke < 3 months
suspected dissection
recent surgery
recent head trauma
bleeding diathesis
what are relative contraindications for thrombolytic therapies
> 75 years of age
current anticoagulants
pregnancy
cardiopulmonary resuscitation > 10 min
recent internal bleed (2-4 weeks)
Uncontrolled HTN (180/110)
Remote ischemic stroke
major surgery within 3 weeks
what is door to device time
< 30 minutes
What is door in and door out time at a non-PCI hosptial
< 30 minutes
if presentation to a PCI hospital is not capable within 120 minutes what should the treatment be
administer fibrinolytics
What is the timeline for STEMI patient
EMS crews on scene < 8 minutes
EMS to needle time < 30 minute (ECG on route)
STEMI confirmed < 10 minutes - PCI capable hospital; non-PCI hospital < 30 minutes
EMS - device <90 minutes
when are thrombolytics useful for STEMI patients
far from PCI center
PCI contraindicated
Delayed presentation
when should thrombolytics be given with STEMI patients
Provide within 6 hours of pain onset
standard: within 30 minutes of ED arrival
what are consequences of MI
contractile dysfunction
papillary muscle dysfunction
RV infarction
myocardial rupture/free wall rupture
arryhthmia
chamber dilation
mural thrombus
ventricular aneurysm
HF
What is the therapy treatment for ACS patients who were medically managed/CABG
DAPT therapy(1 year) + monotherapy(lifelong)
What is the therapy treatment for ACS patients with PCI with a low HAS_BLED
triple therapy (6 months)
DAPT (6 months)
monotherapy life long
what is the therapy treatment for ACS patients with PCI with High HAS_BLED score
DAPT (4 weeks)
DAPT (until 1 year)
Monotherapy lifelong
What is prinzemetal variant angina
ischemic type pain, at rest. can have ST segment elevations
Spasm of coronary artery with transient ischemia +/- LV dysfunction
younger, fewer risk factors (often smokers)
1/3 may have fixed severe CAD
provocation in cath lab
