Ischemic Heart Disease: Part 3 Flashcards
What is prinzmetal/vasospatic angina?
Spasm of the large coronary arteries → decreased coronary blood flow
How can you tell if someone has prinzmetal angina?
PCI
Have to be worked up the same way
What is the classic presentation of vasospastic angina?
Chest pain occurs without the usual precipitating factors
Associated with ST-segment elevation rather than depression
Often affects women under 50
Characteristically occurs in the early morning, awakening patients from sleep
Associated with arrhythmias (afib) or conduction defects
No CAD on cardiac catheterization (only way we know)
May actually be able to induce spasm
Otherwise, a fairly clinical diagnosis
a lot of times on cocaine - only way to know is cath
What is the treatment of prinzmetal angina?
emergent coronary arteriography
aggressive medical therapy or revascularization is indicated, since this may represent an unstable phase of the disease.
If no significant lesions are seen and spasm is suspected, avoidance of precipitants, such as cigarette smoking and cocaine, is the top priority
What are the meds for prinzmetal angina?
Nitrates
CCB (this is different than others, which often has BB)
What are the POST-MI complications
arrythmia (decreased tissue)
ischemia (plaque breaks off and occludes a different vessel)
mechanical (dysfunction)
eombolic (stroke or)
pericarditis (inflammation)
Dressler’s syndrome
RV infarction
What is Dressler’s syndrome?
Aka postpericardiotomy, post-myocardial infarction syndrome and post-cardiac injury syndrome
A type of pericarditis that occurs post MI or CABG
Believed to be caused by an immune system mediated inflammatory response following damage to heart tissue or the pericardium
I.e. MI, cardiac surgery, or traumatic injury
May occurs between 1 to 12 weeks post-MI
Symptoms include CP and fever (know this)
What is right ventricular infarction?
after having an inferior MI
-back up from SVC and IVC leading to
- hypotension, elevated venous pressure, and clear lungs (which is different than LV failure from anterior MI)
Hypotension is often made worse by nitrates and morphine, which are routinely used in ACS cases
treatment of right ventricular infarction
Treat the hypotension with IV normal saline (bolus then continuous infusion) or inotropic agents if necessary. Even if there is edema
What can cause a ventricular free-wall rupture?
Transmural infarcation of anterior or lateral wall of LV
Kept in the ICU
What can cause a post-MI ventricular septal defect
Left to right shunt because the left side is higher pressure
Shoots oxygenated blood from left to right - not a huge deal, it is bad if it is a right to left shunt
also assoaciated with transmural MI, but involving the septum
What is a LV aneurysm s/p anterior infarct?
Fibrotic tissue can lead to a hole in the LV, which can later lead to a thrombosis
what are some post-MI advice?
dietary change (limiting sugar salt)
DM control
Exercise
Increase frequency of visits
Cardiac rehab
Specific mention should be made regarding resumption of driving, return to work, and sexual activity (1 week to drive, 6 weeks for sexual activity)
-if you have chest pain, go the ER right away
When can most patients be discharged from MI?
3-5 days
How often should patients follow up after MI?
Low risk 4-6 weeks
High risk 1-2 weeks
