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Cardiology (Fall 2023) > Lecture 11 - Ischemic Heart Disease Part 3 > Flashcards

Lecture 11 - Ischemic Heart Disease Part 3 Flashcards

1
Q

Review: what is prinzmetal angina

A

Spasm of the large coronary arteries → decreased coronary blood flow

can occur spontaneously or may be induced by cold, stress, or meds.

Remember MI may occur as a result of the spasm in the absence of visible obstructive CHD

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2
Q

review: what can induce myocardial ischemia and infarction by causing vasoconstriction or increasing myocardial energy requirement

A

cocaine!

may contribute to accelerated atherosclerosis and thrombus!

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3
Q

review: what is the typical presentation of prinzmetal / vasospastic angina

A
  • Chest pain occurs without the usual precipitating factors
  • Associated with ST-segment elevation rather than depression
  • Often affects women under 50
  • Characteristically occurs in the early morning, awakening patients from sleep
  • Associated with arrhythmias or conduction defects
  • No CAD on cardiac catheterization
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4
Q

review: how should you manage prizmetal / vasospastic angina

A
  • if they have associated ST elevation, they should undergo emergent coronary arteriography
  • if stenosis found, do revascularization
  • if no significant lesions are found and spasms are suspected, then you should avoid precipitants such as:
  • cigarettes
  • cocaine
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5
Q

review: what is used for prinzmetal/vasospastic angina symptoms

A
  • nitrates
  • CCB added for chronic therapy
  • BB ARE TYPICALLY NOT USED d/t exacerbated coronary vasospasms
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6
Q

review: what is the suggested general tx for ishcemia or infarction on arrival to the ED

A
  • morphine
  • O2 4L NC
  • NTG SL
  • ASA 160-325
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7
Q

how do ischemic post-MI complications manifest

A
  • angina
  • reinfarction
  • infarct extension
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8
Q

how do mechanical post-MI complications manifest

A
  • heart failure
  • cardiogenic shock
  • mitral valve dysfunction
  • aneurysms
  • cardiac rupture
  • cardiac tamponade
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9
Q

how do arrhythmic post-MI complications manifest

A
  • atrial or ventricular arrhythmias
  • sinus or atrioventricular node dysfunction
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10
Q

how do embolic post-MI complications manifest

A
  • CNS (stroke)
  • peripheral embolization
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11
Q

how do Inflammatory post-MI complications manifest

A

pericarditis

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12
Q

what is dressler’s syndrome

A
  • aka postpericardiotomy, post-MI syndrome, and post cardiac injury sydrome
  • this is a type of pericarditis that occurs post-MI or CABG (1-12 weeks post MI)
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13
Q

what are the symptoms of Dressler’s syndrome and what is it caused by

A
  • symptoms are CP and fever
  • Believed to be caused by an immune system mediated inflammatory response following damage to heart tissue or the pericardium
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14
Q

How common is RV infarction and how does it present

A
  • 1/3 of patients with inferior wall infarction
  • presents as hypotension with relatively preserved LV function
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15
Q

when should RV infarction be considered

A

whenever patients with inferior infarction present with hypotension, elevated venous pressure, and clear lungs (which is different than LV failure from anterior MI)

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16
Q

how do you treat RV infarction

A
  • tx hypotension with IV saline (bolus then continuous infusion)
  • use inotropic agents if necessary
  • hypotension can be made WORSE by nitrates and morphine
17
Q

where is ventricular Free-wall rupture MC? who is it MC in?

A
  • MC in the anterior or lateral wall of the LV
  • associated with elderly patients, poor collateral circulation, ischemic preconditioning and first MI
18
Q

what is the timeline of ventricular free-wall rupture? How does it present?

A
  • Can occur 1-4 days post-MI, but most commonly w/in 24 hours
  • presents as pericardial effusion or pulseless electrical activity
  • mortality rate is EXTREMELY HIGH
19
Q

what is Post-MI ventricular septal defect? (rare/common, timeline, association, mortality rate)

A
  • a rare post MI complication ocurring a few days following initial cardiac event
  • associated with transmural MI involving the septum
  • Mortality rate is high without surgical intervention.
20
Q

What is MV regurg from ruptured papillary muscle? (rare/common, timeline, presentation, mortality rate)

A
  • rare complication
  • typically occurs 2-7 days post-MI
  • presents as sudden onset
  • mortality rate high w/o surgical intervention
21
Q

what big changes should occur in a patients life after a cardiac event

A
  • Dietary changes
  • Implementation of an exercise regimen
  • Addition of appropriate medications
  • Increased frequency/number of follow up care visits
22
Q

what should detailed discharge instructions include?

A
  • medication education
  • diet education
  • exercise ed
  • smoking cessation counseling ed
  • referral to rehab/secondary prevention program
  • specific instructions on activities that are permissible and activities that should be avoided.
  • ALWAYS address instruction on permissible/avoidance of driving, returning to work, and sexual activity!
23
Q

when should a high risk v low risk post MI patient follow up?

A
  • low risk - 4-6 weeks
  • high risk - 1-2 weeks
24
Q

what general diet changes should Post MI patients make

A
  • limit intake of saturated and trans fatty acids, free sugars, and salt
  • increase fruits, veggies, legumes, nuts and whole grains
  • ex. is ornish diet/lifestyle (diet/lifestyle rich in powerful foods for anti-cancer anti-heart disease ect)
25
Q

what is the exercise reccomendation post MI

A
  • Exercise should use large muscle groups and include aerobic exercise
  • Should include at least 150 minutes of moderate intensity exercise per week or 75 minutes of high intensity exercise per week
  • patients should be able to increase intensity and duration of exercise with time
26
Q

what are some psychosocial issues that you may see in a patient Post-MI

A
  • Debility / Decreased exercise tolerance
  • Activity / Recreation
  • Depression (cardiac blues)
  • Sexual activity
  • Work / Driving
27
Q

what are the cardiac blues?

A
  • Many patients experience a strong emotional reaction at the time of or soon after an acute cardiac event
  • 3x more common in patients after an MI than in the general population (15-20% of MI victims qualify for.a dx of MDD)
  • cardiac blues are associated with increased MI repeat risk and increased risk of dying over the ensuing months/years
28
Q

what are some characteristics of cardiac blues that could lead to poor prognosis after a MI

A
  • Medication non-compliance
  • Continuing to smoke
  • Less physical activity
  • Increased stress hormone levels
  • Increased blood glucose and lipid levels
  • Increased tendency of blood to clot
  • Increased inflammatory cytokine levels
29
Q

what factors into sexual activity in post-MI patients?

A
  • 1/2 to 3/4 patients have deceased libido or less satisfaction in sex after MI
  • contributors to this could be drug SE (BB), depression, fear of triggering another MI
30
Q

when is sexual activity resumption recommended in complicated v uncomplicated MIs

A
  • > 1 week after uncomplicated MI if pt is w/o cardiac symptoms during activity
  • 2-3 weeks after complicated MI as long as asymptomatic!
31
Q

what makes an MI complicated

A
  • Associated CPR
  • hypotension/shock
  • HF
  • arrhythmias
32
Q

who is at intermediate-to high-risk of heart-related problems during sex

A
  • patients with recurrent CP, arrhythmias, or HF
  • these pts need further evaluation and/or treatment before attempting to have intercourse
  • remember!!! they can have ED meds but NO PDE-5 INHIBITORS + NITRO!!!
33
Q

what is included in cardiac rehab and what is the goal?

A
  • includes Exercise, education to help reduce risk factors, counseling for stress, anxiety and depression
  • The program can improve cardiac function and reduce mortality / development of complications

Cardiology (Fall 2023) (45 decks)

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