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Cardiology Medicine > Ischemic Heart Dz/MI > Flashcards

Ischemic Heart Dz/MI Flashcards

1
Q

If a patient is dx with Acute Coronary Syndrome, what 3 categories could their disease fall into yet?

A

Unstable Angina (UA)
Non ST Elevation MI (NSTEMI)
ST Elevation MI (STEM)

***Note: Excludes Stable Angina

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2
Q

Approximately 6 million patients present to the ER each year with CP, how much percent of these are diagnosed with ACS?

A

~20-25%

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3
Q

Etiology of ACS

A

Fatty streak –> Foam Cells –> Fibrous Cap with liquid rich core –> Soft plaque

When this plaque ruptures, platelets will aggregate, thrombosis will form and cause a vasospasm.

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4
Q

Which plaques are more at risk for rupture?

A

Smaller than 50% about.

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5
Q

Which plaques will rupture?

A

Soft plaques that are frequently not 70%

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6
Q

A _________ obstruction will cause typical angina (chronic stable angina).

A

Fixed Coronary Obstruction

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7
Q

RYAN NEEDS TO MAKE QUESTIONS FROM

A

THE CHART

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8
Q

In ________ you will see a non-occlusive thrombus.

A

Unstable Angina

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9
Q

In ________ you will see a partially occlusive thrombus, and partial myocardial necrosis.

A

NSTEMI

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10
Q

In ________ you will see a total coronary thrombosis, and transmural myocardial necrosis.

A

STEMI

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11
Q

Risk Factors for ACS

A

Non-modifiable

  1. Age
  2. Gender
  3. Family Hx
  4. Personal Hx. of CAD or Stroke
  5. Ethnicity (AA have higher incidence)

Modifiable

  1. HTN
  2. Hyperlipidemia
  3. Diabetes Mellitus
  4. Smoking
  5. Metabolic Syndrom
  6. Others (lots)

***Same as Stable Angina

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12
Q

A patient comes into clinic with chest discomfort, recent gradual dyspnea with and without exertion. Does complain of some nausea and diaphoresis. What should you do?

A

At the very least do a EKG!!!

Silent Ischemia needs to be in your differential

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13
Q

Pain patterns with the chest and be similar to patients in which two conditions?

A
  1. Angina Pectoris

2. Myocardial Infarction

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14
Q

New onset of Cardiac Symptoms that happen with or without exertion would be indicative of what disease?

A

ACS!

It could be US, NSTEMI, or STEMI

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15
Q

DDx for Angina

A
  1. Stable Angina
  2. Unstable Angina
  3. Vasospastic (Variant)
  4. MI (STEMI or NSTEMI)
  5. Pericardial Dz (Pericarditis or Tamponade)
  6. Aortic Dissection
  7. PE
  8. Pleuritic Pain (Pneumonia and Pleurisy)
  9. Pneumothorax
  10. GI Dz (GERD, Esphogeal Dz, PUD, Gall bladder)
  11. Cosotchondritis
  12. Anxiety/Panic
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16
Q

First line of action when patient comes in presenting with potential ACS?

A

EKG

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17
Q

A 55 year old female patient comes in to clinic with chest discomfort and dyspnea at rest. We do a EKG as soon as it possible and we find that it looks normal with Non-Specific ST-T wave changes.

Based on the combination, what can we think this is?

A

Unstable Angina

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18
Q

A 60 year old male patient comes in to clinic with chest discomfort and dyspnea at rest. We do a EKG as soon as it possible and we find that it looks normal with ST segment depression and T wave inversion.

Based on the combination, what can we think this is?

A

NSTEMI

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19
Q

A 35 year old male patient comes in to clinic with chest discomfort and dyspnea at rest. We do a EKG as soon as it possible and we find ST segment elevation in a regional pattern. About 1 mm or greater in precordial leads or 2 mm or greater in limb leaves. You also notice a new Left Bundle Branch Block.

Based on the combination, what can we think this is?

A

STEMI

20
Q

When take a history of a patient presenting with potential ACS, what are the most important things you need to ask about?

A
  1. Presence/Absence of Risk Factors
  2. Determine temporal sequence
  3. What activities exacerbate or relieve symptoms
  4. Associative Symptoms
21
Q

In a patient with potential ACS based on symptoms, during a Physical Exam, what would you want to do?

A
  1. General Survey
  2. Vital Signs
  3. Pulmonary exam
  4. Cardiac Exam
  5. Abdominal Exam
  6. Peripheral Vascular Exam
  7. 12-lead EKG (looking for ST-T wave changes, Rhythm Disturbances, Evolution of ST-T changes)
  8. Cardiac Biomarkers (CK-MB, Troponin, Myoglobin)
22
Q

What is the most specific cardiac biomarker for checking for cardiac injury?

A

Troponin

23
Q

Which cardiac biomarker would useful for reinfarction? (This is also checking levels in Cardiac and Skeletal muscle.)

A

CKMB

The CKMB > CK because it is more specific to cardiac muscle.

24
Q

When evaluating biomarkers orders, you will want to do ________ blood draws in order to watch a _____.

A

Multiple

Trend

25
Q

Positive Troponin with a borderline EKG and a symptomatic patient, you will diagnose as

A

NSTEMI

26
Q

Normal Cardiac Biomarkers with normal or ST-T wave changes that are non-specific ECG would indicate

A

Unstable Angina

27
Q

If the patient has Unstable Angina, what do you need to do?

A

MONITOR THEM, they can move into STEMI or NSTEMI unknowingly

28
Q

Positive Cardiac Biomarkers with Abnormal EKG (ST elevation or new LBBB) and symptomatic patient.

A

STEMI!

29
Q

What risk stratification test is commonly used for a patient with UA or NSTEMI?

A

TIMI Risk Score Calculation

30
Q

In a TIMI Risk Score Calculation, you assign 1 point for the risk factors they have listed. What are these risk factors?

A
  1. Age 65+
  2. 3+ CAD risk factors
  3. Prior CAD
  4. ASA used in the last 7 days
  5. 2+ anginal events in 24+hours
  6. ST deviation on EKG
  7. Elevated cardiac biomarkers

The higher the number, the greater the risk

31
Q

Management of Acute Unstable Angina

A
  1. Antiplatelet Therapy
  2. Nitroglycerin
  3. Morphine
  4. Beta Blockers
  5. Anticoagulation Therapy (LMWH or UFH)
  6. Oxygen (controversial, changing with research)
  7. Statins

Same as NSTEMI

32
Q

What are common antiplatelet therapeutic drugs?

A
  1. ASA
  2. Thienopyridine Agents (Clopidogrel (Plavix), Prasugrel)
  3. Glycoprotein IIb/IIIa Inhibitors (Abciximab, Eptifbatide)
33
Q

Management of NSTEMI

A
  1. Antiplatelet Therapy
  2. Nitroglycerin
  3. Morphine
  4. Beta Blockers
  5. Anticoagulation Therapy (LMWH or UFH)
  6. Oxygen (controversial, changing with research)
  7. Statins

Same as Unstable Angina

34
Q

When do you do a Cardiac Cath and Revascularization on a patient with UA or NSTEMI?

A
  1. Recurrent symptoms despite optimal medical therapy
  2. Persistent elevations in troponin
  3. Persistent ST segment depression
  4. CHF
  5. Hymodynamic instability
  6. Dysrhythmia
  7. Recent coronary intervention (6 months)
  8. TIMI risk score
35
Q

Management of Acute STEMI

A
  1. Revascularization ASAP
  2. Thrombolytic/Fibrinolysis Therapy ***

***ONLY if no intervention is available within 90 minutes, i.e. not having a hospital with a Cath Lab

  1. THEN Medical Managment (Same as UA and NSTEMI)
36
Q

Medical Management of Acute STEMI

A

Same as UA and NSTEMI

  1. Antiplatelet Therapy
  2. Nitroglycerin
  3. Morphine
  4. Beta Blockers
  5. Anticoagulation Therapy (LMWH or UFH)
  6. Oxygen (controversial, changing with research)
  7. Statins
37
Q

Why don’t we use Thrombolytics or Fibronolytics as soon as we find a clot/thrombosis?

A

Too many contraindications

38
Q

Contraindications of Fibronolytics:

A
  1. Hx of Cerebrovascular Hemorrhage (NEVER GIVE IT)
  2. Cerebrvascular event within the last year
  3. SHTN > 180 and/or DHTN >110
  4. Internal Bleeding
39
Q

How is revascularization completed?

A

Percutaneous Revascularization (PTCA/Stent)

40
Q

Long Term Management of UA

A
  1. ASA
  2. Beta Blocker
  3. ACE Inhibitor
  4. Statin
  5. PRN Nitro
  6. Secondary Prevention
41
Q

What is Long Term Management dependent on?

A

What type of treatment strategy was used in the acute phase.

42
Q

Long Term Management of NSTEMI and STEMI

A
  1. ASA and Clopidogrel (Plavix)
  2. Beta Blocker
  3. ACE Inhibitor
  4. Statin
  5. PRN Nitro
  6. Secondary Prevention
43
Q

If a PCI Stenting occurred in an acute managment of STEMI, what medication do we need to put them on?

A

Clopidogrel

44
Q

What medications do we give to everyone (UA, NSTEMI, STEMI)?

A
  1. ASA (YOU GET AN ASPIRIN AND YOU GET AN ASPIRIN #Oprah)
  2. Beta Blocker
  3. Statin
  4. Nitro PRN
45
Q

When do we give a ACE inhibitor?

A
  1. STEMI

2. UA/STEMI pt with DM, HTN, or CHF

46
Q

When is an aldosterone antagonist used?

A

STEMI patients with good renal function, optimal ACE dose, and low EF, symptomatic CHF or DM

47
Q

What are the potential complications of an acute MI?

A
  1. Ventricular Wall Rupture
  2. Acute Mitral Regurg
  3. Pericarditis/Dressler’s Syndrome

Cardiology Medicine (13 decks)

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