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Clin Med 2 - CARDS > Ischemic Heart Disease - Nate > Flashcards

Ischemic Heart Disease - Nate Flashcards

1
Q

What are capillaries

A

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

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2
Q

what do areterioles regulate

A

blood pressure and flow - greatest vascular resistance

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3
Q

What does the LAD supply

A

RV, LV and intraventricular septum

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4
Q

what does the RCA supply

A

perfuses RA, RV, apex

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5
Q

What is Ischemic Heart disease

A

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

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6
Q

What is angina pectoris

A

ischemia causes pain but insufficient to cause myocyte death

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7
Q

what is myocardial infarction

A

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

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8
Q

what is the best initial tests for patients with chest pain

A

EKG
chest x-ray
CTA

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9
Q

ACS refers to

A

unstable angina, NSTEMI and STEMI
assess via EKG

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10
Q

what are cardiac enzyme elevation distinguishes

A

troponin

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11
Q

what is the common cause of death post MI

A

arrhythmias - v.fib

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12
Q

what is the framingham study

A

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

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13
Q

What are risk factors for IHD

A

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

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14
Q

what are ischemic symptoms

A

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

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15
Q

how do you diagnose IHD

A

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

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16
Q

What is stable angina

A

chest dicomfort is reproducible with exertion or stress and relieve with rest and/or nitrates

17
Q

what is unstable angina

A

angina with symptoms at rest, lasts > 10minutes, severe /new onset
distinctly more severe, prolonged or frequent

18
Q

What is a NSTEMI

A

UA + myocardial necrosis

19
Q

What is STEMI

A

NSTEMI + ST elevations

20
Q

What is acute ACS treatment

A

reduce ischemia, open artery
anticoag
antiplatelet
beta blockade
nitrate
re-perfusion

21
Q

what is the long term treatment of ACS

A

ACEi
statins
nitrates
antiplatelets
rehab
risk factors

22
Q

What is the treatment for NSTEMI

A

bed rest with continuous ECG telemetry
meds: anti-schemic and antithrombic treatments, Nitrates, BB, CCB, Statin, COXi, P2Y12I

23
Q

what are absolute contraindications of thrombolytic therapies

A

any prior intracranial hemorrhage
known intracranial malformation or neoplasm
ischemic stroke < 3 months
suspected dissection
recent surgery
recent head trauma
bleeding diathesis

24
Q

what are relative contraindications for thrombolytic therapies

A

> 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

25
Q

what is door to device time

A

< 30 minutes

26
Q

What is door in and door out time at a non-PCI hosptial

A

< 30 minutes

27
Q

if presentation to a PCI hospital is not capable within 120 minutes what should the treatment be

A

administer fibrinolytics

28
Q

What is the timeline for STEMI patient

A

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

29
Q

when are thrombolytics useful for STEMI patients

A

far from PCI center
PCI contraindicated
Delayed presentation

30
Q

when should thrombolytics be given with STEMI patients

A

Provide within 6 hours of pain onset
standard: within 30 minutes of ED arrival

31
Q

what are consequences of MI

A

contractile dysfunction
papillary muscle dysfunction
RV infarction
myocardial rupture/free wall rupture
arryhthmia
chamber dilation
mural thrombus
ventricular aneurysm
HF

32
Q

What is the therapy treatment for ACS patients who were medically managed/CABG

A

DAPT therapy(1 year) + monotherapy(lifelong)

33
Q

What is the therapy treatment for ACS patients with PCI with a low HAS_BLED

A

triple therapy (6 months)
DAPT (6 months)
monotherapy life long

34
Q

what is the therapy treatment for ACS patients with PCI with High HAS_BLED score

A

DAPT (4 weeks)
DAPT (until 1 year)
Monotherapy lifelong

35
Q

What is prinzemetal variant angina

A

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

Clin Med 2 - CARDS (11 decks)

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