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Cardiology Medicine > Ischemic Heart Dz/Angina > Flashcards

Ischemic Heart Dz/Angina Flashcards

1
Q

CAD accounts for _________% of all deaths in persons age 35+

A

33%

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2
Q

What is the leading cause of death in US?

A

CAD

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3
Q

Would you be more concerned about a man or a woman’s risk of CAD at the age 70?

A

Risk is the same. Ages 65-74, risk is equivalent. Men have higher risk before 65, women have higher risk after 74

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4
Q

Men have a ___% chance of developing CAD in their lifetime

A

49%

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5
Q

Women have ____% chance of developing CAD in their lifetime.

A

32%

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6
Q

Diminished coronary perfusion; insufficient to meet myocardial oxygen demand

A

Ischemia

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7
Q

How much fixed stenosis is typically required before patient’s start to have angina symptoms?

A

70% occlusion

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8
Q

What is actually going on in the vessels during ischemia?

A

1) fixed atherosclerotic narrowing of the coronary arteries
2) intra-coronary thrombosis overlying a disrupted atherosclerotic plaque
3) platelet aggregation
4) vasospasm of the artery

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9
Q

What are the 3 clinical diagnoses in ischemic heart disease (these all overlap)

A

chronic stable angina, myocardial infarct, unstable angina

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10
Q

Non specific pattern, secondary to vasospasm rather than atherosclerotic narrowing of the vessels

A

Variant angina

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11
Q

Occurs in a stable pattern, predictable, relieved by rest or nitroglycerin

A

stable angina

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12
Q

ANY CHANGE in the stable angina pattern, brand new angina or angina occurring at rest, may or may not respond to nitro

A

unstable angina

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13
Q

What are the main things that stress the heart?

A

1) heart rate
2) ventricular wall stress (stiffness, increased afterload)
3) contractility

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14
Q

In healthy person, what response would the heart have to stressors like increased HR, ventricular wall stress or increased contractility?

A

Normal heart with dilate the vessels so increased blood supply meets the demand

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15
Q

Why would narrowed arteries put more stress on heart?

A

Vessels will not dilate as well to accommodate need for increased blood flow during stress.

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16
Q

What is the “short list” of modifiable risk factors for CAD?

A 
HTN
Hyperlipidemia
Diabetes Mellitus
Smoking
Metabolic syndrome
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17
Q

What ethnicity has a higher incidence of CAD?

A

AA

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18
Q

Can a patient be having coronary symptoms without having chest pain or chest discomfort?

A

YES. Don’t be that stupid PA that doesn’t know that.

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19
Q

What is a CLASSIC presentation of angina? (Any combo of these symptoms)

A

1) substernal chest discomfort (pressure/radiation/worse w/ exertion, smoking, eating)
2) dyspnea
3) diaphoresis
4) nausea
5) palpitations
6) impending doom. (here we go again)
7) anxiety

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20
Q

If a patient is clutching their chest in cardiac pain, what “sign” would you document?

A

Levine’s Sign

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21
Q

Your patient has chest pain. What is included in your differential? (10)

A

ANGINA (stable, unstable, vasospastic) MI (stemi, nstemi) PERICARDIAL DZ (pericardidits, tamponade) AORTIC DISSECTION, PE, PLEURITIC PAIN (pna, pleurisy) PNEUMOTHORAX, GI DZ (gerd, gallbladder), CHOSTOCHONDRITIS, ANXIETY

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22
Q

What is the pain pattern in patients with angina pectoris?

A

diffuse pain in chest, BUE, neck

23
Q

What is the pain pattern in patients with MI?

A

Centrally located sternally with some radiation to BUE, neck, jaws, back. MI pain/discomfort is typically more intense

24
Q

Your patient has chest pain, what is the FIRST thing you should do?

A

EKG

25
Q

Physical Exam: what are the important things to note for chest pain?

A 
General survey
Vital signs 
Pulmonary exam
Cardiac exam
Abdominal exam
Peripheral vascular exam
26
Q

What things are you asking when taking a history for a patient with CP?

A

1) Identify presence/absence of risk factors
2) Determine temporal sequence and activities that exacerbate or relieve symptoms
3) Discover associated symptoms

4) Family Hx of CAD

27
Q

If you feel discrepancy in the peripheral pulses (BP discrepancy in left vs right arm); what is your immediate concern?

A

aortic dissection

28
Q

On EKG, what 3 things are you looking for that would indicate an immediate cardiac threat?

A

ST-T wave changes, rhythm disturbances, EVOLUTION of ST-T changes (on cardiac monitor vs EKG)

29
Q

What are your cardiac biomarkers?

A

CK, CK-MB, Troponin, Myoglobin

30
Q

What agents are used in a pharmacologic stress test?

A

Dobutimine, Adenosine

31
Q

What studies can be performed in addition to EKG and Labs to further evaluate cardiac concerns?

A

stress test (exercise/pharmacologic), echo, myocardial perfusion study, cardiac PET, CXR

32
Q

What agent is used in a myocardial perfusion study?

A

thallium

33
Q

What if you see a wide mediastinum on CXR?

A

dissection

34
Q

What are some things you can see with CXR relating to cardiac pathology?

A

cardiomegaly, CHF, widened mediastinum, pneumothorax, pna

35
Q

Chronic, characteristic unchanged pattern of angina, precipitating factors, and relief

A

chronic stable angina

36
Q

What will an EKG look like for a patient with chronic stable angina?

A

Could be normal, but MAY show NSST changes (nonspecific ST) or Twave abnormalities

37
Q

How much stenosis is required in a vessel to elicit symptoms related to chronic stable angina?

A

70%

38
Q

If your patient has chronic stable angina with no recent changes or variations in symptoms, what would you tell them to do for exacerbations of their angina?

A

SL NTG, PRN

39
Q

What are the symptoms of angina actually caused by (pathophysiologically speaking)

A

symptoms based on supply/demand mismatch of oxygen in the heart

40
Q

Are you worried about a thrombosis in patients with chronic stable angina?

A

No, atherosclerotic plaques are fixed, not ruptured or fissured

41
Q

What medication decreases HR and BP that has recently found favor for angina whose mechanism works by having a delayed blocking of the Na+ channels

A

Ranolazine

42
Q

What medication do you give EVERYONE with angina (assuming no allergy or CI)?

A

ASA!

43
Q

What medications in addition to ASA are often used for angina?

A

NTG PRN, B-blockers, CCB (often patients do well on the ASA, NTG and beta blocker, CCB is not always needed)

44
Q

For patients with chronic stable angina, what 2 factors contribute to the prognosis for the patient?

A

1) left ventricular dysfunction

2) Extent of myocardium at risk (more heart effected = worse prognosis)

45
Q

Your 72 year old female patient has noticed dyspnea on exertion over the last 2 days when climbing stairs. She’s in good shape and walks 3 miles/day. This has hever happened before. She claims to be very healthy and is only taking medication for cholesterol and osteoporosis. You are worried that she may have developed a cardiac problem, so you order some labs and an EKG, all of which are normal. What is your next step?

A

She’d be a great candidate for exercise stress test

46
Q

Sally is 57, she has had chronic stable angina for about 3 years. She usually has great relief with NTG when she experiences an angina attack, but today the NTG didn’t seem to work. She calls the office to see if she should be worried. What will you tell her?

A

ANY change that deviates from typical presentation of her usual stable angina is worrisome. She needs to be worked up.

47
Q

Spasm of the coronary artery.

Obstruction of coronary due to dynamic event (spasm).

A

Variant Angina

48
Q

Cocaine is a big trigger of _________ when no other risk factors are apparent.

A

Variant or Vasospastic Angina

49
Q

When does pain occur in a patient with variant angina?

A

At rest

50
Q

Implications of Variant Angina

A
  1. Usually do just fine
  2. Sudden Death (rare)
  3. MI (rare)
  4. Arrythmia due to ischemia
51
Q

How do you diagnose a variant angina?

A

Ergonovine injected into the coronary arteries and it will evoke a spasm.

52
Q

Treatment of Variant Angina

A

Vasodilators (Nitrates and Calcium Channel Blockers)

53
Q

If an EKG were to capture variant angina, what will you see?

A

Transient ST-segment elevation

Cardiology Medicine (13 decks)

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