Ischemic Heart Dx EXTRAS Flashcards
What are the two most important risk factors for the development of atherosclerosis?
- Male gender
- Increasing age
What are the first manifestations of IHD?
Angina pectoris
Acute MI
Sudden death –> commonly from dysrhythmias
What % of our surgical patients have IHD?
30%
Other than atherosclerosis, what are three causes of impaired coronary perfusion?
- myocardial hypertrophy
- severe aortic stenosis
- aortic regurgitation
______ exertion, _____ tension, and ______ _________ can induce angina
physical
emotional
cold weather
What is a common presentation of saddle PE?
confusion, syncope, and a line of demarcation over chest (discoloration, cyanosis-like)
Can distal occlusions be re-perfused? What is the result of this?
Not typically; continuous chronic chest pain
What EKG change that is seen during or within 4 minutes of exercise indicates ischemia?
1mm ST depression. The greater the degree of ST depression, the greater the likelihood of significant CAD
Which is more sensitive in detecting ischemic heart disease: exercise ECG or nuclear stress testing?
Nuclear stress testing
What two tracers are used in nuclear stress testing during exercise?
thallium and technetium
Myocardial infarction most often results from rupture of a plaque that had less than ___ % stenosis of a coronary artery
50%
For atherosclerosis, LDL will exceed _____ mg/dL before statins are indicated. What is the goal range for reducing LDL?
160 mg/dL
> 50% reduction or < 70mg/dL LDL
What is the normal lifespan of platelets?
7-14 days
If P2Y12 inhibitors are IRREVERSIBLE antagonists of ADP receptors, what happens to platelets when P2Y12 inhibitors are stopped?
Interestingly, ~80% of platelets recover to normal functions
What percentage of patients prescribed P2Y12 inhibitors are either hyperresponsive or resistant to P2Y12’s?
10-20%
Nitrates reduce preload via venodilation, but what are other observed benefits of nitrates?
- increased exercise tolerance
- decrease peripheral vascular resistance
- decreases LV afterload
What conditions warrant a CABG over a PCI?
- significant LCA disease with more than 50-70% stenosis
- 3-vessel CAD
- DM patients with two or three vessel CAD
What substances contribute to thrombogenesis?
collagen, ADP, epinephrine, serotonin
TXA2
GP2b/3a receptors
fibrin deposit
Do patients with typical ECG evidence of MI need an echo? When is an echo useful?
No; useful in patients in which the only change is an LBBB or abnormal ECG in which an AMI is uncertain OR suspected aortic dissection
Troponin I or T levels will elevate after _____ hours of injury and remain elevated for _____ to _____ days
3 hours; 7-10 days
What can happen to an already inverted T wave in the presence of new-onset ischemia?
Pseudonormalization of the T wave; T wave returns to normal upright position
“The ______ the degree of ST-segment depression, the ______ the likelihood of significant CAD.”
greater; greater
Fibrinolytics (tPA, tenecteplase, alteplase) should be initiated within _____ to _____ minutes of arrival at the hospital and within ______ hours of symptom onset.
30 to 60 minutes
12 hours
How soon should PCI angioplasty be done after onset of ischemia?
Within 90 minutes of arrival at the hospital and within 12 hours of symptom onset.
For what circumstances is an emergency CABG reserved?
- Coronary anatomy inhibits PCI
- failed angioplasty
- infarction related ventricular septal rupture or mitral regurgitation
Is a thrombolytic indicated for unstable angina or NSTEMI?
NO
How long does it take for a coronary vessel to re-endothelialize after balloon angioplasty? After bare metal stent? After drug-eluting stent?
2-3 weeks
12 weeks
1 year
What can we use for rapid reversal of ASA?
Platelet transfusions - only if post-surgical bleeding occurs
In a bleeding patient, what can be given to counteract antiplatelet effects? For plavix, when will giving this agent be effective?
Platelet transfusions. platelet transfusions begin to be effective 4 hours after last dose of clopidogrel, but PEAK effectiveness is 24 hours after last dose of clopidogrel
What is the most significant independent predictor of stent thrombosis?
Discontinuation of P2Y12 inhibitors
What drug is the specific pharmacologic antagonist to excessive Beta blockade?
isoproterenol
What needs to be given with neostigmine to prevent severe or even fatal bradyarrhythmia?
glycopyrrolate
Is neuraxial anesthesia a good idea for patients on DAPT?
No. Hematoma risk on insertion and removal of catheter
Maintenance of the balance between myocardial ______ ________ & ______ is more important than which anesthetic technique or drugs are selected in patients with CAD
oxygen supply & demand
How is hyperventilation detrimental to coronary perfusion?
Hypocapnia may cause coronary artery vasoconstriction
