Ischemic Heart Disease - Nate

Question 1

What are capillaries

Answer 1

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

Question 2

what do areterioles regulate

Answer 2

blood pressure and flow - greatest vascular resistance

Question 3

What does the LAD supply

Answer 3

RV, LV and intraventricular septum

Question 4

what does the RCA supply

Answer 4

perfuses RA, RV, apex

Question 5

What is Ischemic Heart disease

Answer 5

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

Question 6

What is angina pectoris

Answer 6

ischemia causes pain but insufficient to cause myocyte death

Question 7

what is myocardial infarction

Answer 7

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

Question 8

what is the best initial tests for patients with chest pain

Answer 8

EKG
chest x-ray
CTA

Question 9

ACS refers to

Answer 9

unstable angina, NSTEMI and STEMI
assess via EKG

Question 10

what are cardiac enzyme elevation distinguishes

Answer 10

troponin

Question 11

what is the common cause of death post MI

Answer 11

arrhythmias - v.fib

Question 12

what is the framingham study

Answer 12

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

Question 13

What are risk factors for IHD

Answer 13

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

Question 14

what are ischemic symptoms

Answer 14

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

Question 15

how do you diagnose IHD

Answer 15

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

Question 16

What is stable angina

Answer 16

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

Question 17

what is unstable angina

Answer 17

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

Question 18

What is a NSTEMI

Answer 18

UA + myocardial necrosis

Question 19

What is STEMI

Answer 19

NSTEMI + ST elevations

Question 20

What is acute ACS treatment

Answer 20

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

Question 21

what is the long term treatment of ACS

Answer 21

ACEi
statins
nitrates
antiplatelets
rehab
risk factors

Question 22

What is the treatment for NSTEMI

Answer 22

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

Question 23

what are absolute contraindications of thrombolytic therapies

Answer 23

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

Question 24

what are relative contraindications for thrombolytic therapies

Answer 24

> 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

Question 25

what is door to device time

Answer 25

< 30 minutes

Question 26

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

Answer 26

< 30 minutes

Question 27

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

Answer 27

administer fibrinolytics

Question 28

What is the timeline for STEMI patient

Answer 28

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

Question 29

when are thrombolytics useful for STEMI patients

Answer 29

far from PCI center PCI contraindicated Delayed presentation

Question 30

when should thrombolytics be given with STEMI patients

Answer 30

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

Question 31

what are consequences of MI

Answer 31

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

Question 32

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

Answer 32

DAPT therapy(1 year) + monotherapy(lifelong)

Question 33

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

Answer 33

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

Question 34

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

Answer 34

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

Question 35

What is prinzemetal variant angina

Answer 35

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