Ischemic Heart Dz Flashcards
What results in typical chest pain of angina pectoris?
thalamic & cortisol stimulation
How is angina relieved?
rest or nitro
What indicates myocardial ischemia with an exercise ecg?
at least 1mm of horizontal or downsloping ST-segment depression during or within 4 min after exercise
Has greater sensitivity for detection of ischemic heart disease
nuclear stress test
Provides the best information about the condition of the coronary arteries
coronary angiography
The most dangerous anatomic lesion
Left main
Aspirin inhibits what enzyme? this is irreversible for the duration of the platelets lifespan, ___ days
cyclooxyrgenase (COX)-1. 7 days
all pt with ischemic heart dz should be on what drug?
aspirin
best drug to give someone with myocardial ischemia
b-blocker
When should you recheck troponin?
within 3 hrs
When should thrombolytic therapy be given for MI
within 30-60 min of hospital arrival and within 12 hrs of symptom onset
all pts with a larger anterior wall MI, clinical evidence of left ventricular failure, and EF < 40%, or diabetes should be treated with?
ACE inhibitors or ARBs
_______ should not be administered routinely but should be reserved for pts with persistent myocardial ischemia despite optimal use of aspirin, blockers, nitrates, and heparin
CCBs
Most significant independent predictor of stent thrombosis
P2Y12 inhibitor discontinuation
How long do you want the pt off of plavix?
7 days
How does exercise stress test detect myocardial ischemia?
ST-segment changes
When would you use a stress (pharmacologic) test over exercise?
pts undergoing non cardiac surgery who cannot perform enough exercise to detect stress induced myocardial ischemia
What do beta blockers do?
reduce myocardial O2 consumption, improve coronary blood flow by prolonging diastole, improve the supply demand ratio, stabilize cellular membranes, improve oxygen dissociation from Hgb, & inhibit platelet aggregation
Suppress perioperative tachycardia & appear most efficacious in preventing perioperative myocardial ischemia
beta blockers
Based on the ACC/AHA guidelines, ______ for prevention of cardiac events are NOT recommended in pts undergoing non cardiac sx
a2 agonists (Clonidine)
The simplest, most cost-effective method for detecting perioperative myocardial ischemia
standard ECG
When should tx of myocardial ischemia be instituted?
when there are 1-mm ST-segment changes on ECG
______ ,______, _____ have similar effects in normal & denervated hearts (transplanted)
Epinephrine, isoproterenol, & dobutamine
indirect-acting sympathomimetics such as _____ have a blunted effect in denervated hearts (transplanted)
ephedrine
Vagolytic drugs such as ______ do not increase the HR in transplanted heart
atropine
Which drugs do not work on denervated hearts?
Ephedrine, Atropine, & Pancuronium
______ do not slow the HR of denervated hearts
neostigmine & other anticholinesterases
intravascular volume must be maintained in heart transplant recipients bc these pts are _______
preload dependent
Anesthetic management of heart transplant recipients must include what?
avoidance of significant vasodilation & acute reductions in preload
