Ischemic Heart Disease - Nate Flashcards by Lindsey Dutton

What are capillaries

monolayer of endothelial cells on the basemement membrane lined by pericytes, which are multifunctional including angiogenesis and endothelial proliferation

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what do areterioles regulate

blood pressure and flow - greatest vascular resistance

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What does the LAD supply

RV, LV and intraventricular septum

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what does the RCA supply

perfuses RA, RV, apex

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What is Ischemic Heart disease

imbalance between cardiac blood supply (perfusion) and myocardial oxygen requirements
typically secondary to obstructive atherosclerotic vascular disease

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What is angina pectoris

ischemia causes pain but insufficient to cause myocyte death

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what is myocardial infarction

this occurs when the severity or duration of ischemia is sufficient to cause cardio myocyte death

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what is the best initial tests for patients with chest pain

EKG
chest x-ray
CTA

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ACS refers to

unstable angina, NSTEMI and STEMI
assess via EKG

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what are cardiac enzyme elevation distinguishes

troponin

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what is the common cause of death post MI

arrhythmias - v.fib

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what is the framingham study

LIFETIME risk of IHD with optimal risk 3.6% for men and less than 1% for women

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What are risk factors for IHD

Behavioral: tobacco, inactivity, diet
Metabolic: lipids, HTN, DM, obesity
Non-Modifiable: age, sex, family hx

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what are ischemic symptoms

chest pain/pressure/discomfort
associated dyspnea, diaphoresis
Radiation: Jaw, neck, arm, shoulder, back
N/V

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how do you diagnose IHD

history
telemetry
ECG
CXR
Troponin
CBC, CMP, Lipase, urine tox, PT/INR
Provocative testing

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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