Laflamme- Chapter 2 (CAD and MI) Flashcards
What are the 6 components of the Ischemic cascade?
- Cellular Alterations
- Perfusion Abnormalities
- Relaxation Abnormalities
- RWMA
- ST changes
- Angina
What is ‘high risk’, ‘intermediate risk, and ‘low risk’ for annual rates mortality based on NIV testing?
- > 3%
- 1-3%
- <1%
What are 2 beta blockers with alpha and beta blockers?
- Labetalol
- Carvedilol
What is the only selective beta blocker with ISA?
-Acebutolol
What is the only non selective beta blocker with ISA?
-Pindolol
Name 5 Beta-1 selective BB’s
- Metoprolol
- Bisoprolol
- Atenolol
- Acebutolol
- Esmolol
Name 5 beta blockers that accumulate in renal failure?
Nadolol Sotalol Atenolol Bisoprolol Acebutolol
How do Nitrates work?
Converted to NO in the cell -> increased intracellular cGMP -> smooth muscle relaxation (by decreasing intracellular Ca2+) -> results in venoldilation, coronary vasodilation and systemic arterial vasodilation
How does Ivabradine work?
-sinus node (funny channel) blocker
How does Ranolazine work?
-Decreased myocyte calcium overload by Ina inhibition
What are the three mechanisms that Nicorandil works?
- Opening of potassium channels of ischemic cells (mimics ischemic preconditioning)
- Opening of potassium channels allowing systemic and coronary arterial vasodilation
- Similar property to nitrates
How does Trimetazedine work?
-Fatty acid oxidation inhibitor
What is External counterpulsation?
-35 one hour treatments for 7 weeks, there are cuffs on the lower limbs that inflate in early diastole and deflate in pre-systole, this will increase collateral circulation and or angiogenisis and improvement of endothelial function
What is neuromodulation for angina?
-Spinal cord stimulation for decreased nociceptic transmission to CNS
How does Laser myocardial revacularization during cardiac surgery work?
-Creation of subendocardial channels by left intraventricular laser
What is SYNTAX cut off for CABG in 3VD? LMCA?
- 3VD: 22
- LMCA: 32
What are the 3 biomarkers that increase with infarct? Timing of Initial elevation, peak and duration of each
- Troponin: 3-12h, 24h, 7 days
- CK: 3-12h, 24h, 48-72h
- Myoglobin: 1-4h, 6h, 24h
What are the 5 types of MI?
- Type 1: Plaque rupture
- Type 2: Demand mismatch
- Type 3: Cardiac Arrest
- Type 4: a) secondary to PCI b) secondary to ISR
- Type 5: CABG
How does mortality of STEMI and NSTEMI compare?
Higher in hospital mortality for STEMI (by 50% more) but same at one year
What are the 7 aspects of the TIMI score?
- Age > 65
- 3 or more RFs
- Multiple chest pain
- ECG changes
- Troponin elevation
- ASA use in last week
- Known CAD
What are the 9 aspects of the GRACE score?
- Age
- SBP
- HR
- Kilip class
- HF
- Arrest
- Troponin
- ECG/STD
- Creatinine