Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CDM 2 Exam 1 > Lecture 2 - Ischemic Heart Disease > Flashcards

Lecture 2 - Ischemic Heart Disease Flashcards

1
Q

Ischemic Heart Disease occurs due to…

A

increase in myocardial O2 demand

or

Decrease in O2 supply to heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Angina Pectoris is…..

A

characterized by pain or discomfort, primarily in the chest, but may also be described in the jaw/shoulder/back or arm

commonly due to IHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Prinzmetals “Variant” Angina

A

Occurs at rest
Due to coronary Vasospasm
Reversed w/ Nitroglyc and CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Silent Myocardial Ischemia

A

More common in femlaes

Type 1 = less common
Type 2 = more common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Type 1 Silent Myocardial Ischemia

A

Due to defective anginal warning system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Type 2 Silent Myocardial Ischemia

A

Angina poor indicator of ischemia

indicated higher risk patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stable or Exertional Angina

A

Exertional pain lasting < 20 min, relieved by rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Unstable Angina, STEMI, or NSTEMI

A

Pain occurring at rest lasting > 20 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Alterable IHD Risk Factors

A 
Smoking
Dyslipidemia
DM
Hypertension
Physical inactivity
BMI >30
Low fruit/veggie consumption
Alcohol overconsumption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Unalterable IHD Risk Factors

A 
Gender = men + postmenopausal women
Age = Men >45, Women > 55
FH = father <55, mother <65
Environment = climate, air pollution, drinking water
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Subjective symptoms associated with angina

A 
SOB
SOB on exertion
palpitations
Chest pain
Lightheadedness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Objective symptoms associated with angina

A

BP, HR,
decreased Oxygen saturation on ABG
ECG changes
ST seg elevation or depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Measure of MVO2 (non-invasive)

A

Double product

HR X SBP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Determinants of Oxygen Supply (MVO2)

A

Arterial PO2
Diastolic Filling time
Coronary Blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Determinants of Oxygen Demand (MVO2)

A

Heart Rate
Myocardial Contractility
Ventricular wall tension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

IHD is the result of….

A

increase in Oxygen demand and decrease in Oxygen supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treating Angina

A
  1. Get symptoms
  2. Do workup
  3. Control risk factors
  4. Try 1’/2’ prevention
  5. Try antianginal therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Class I suggested wording

A

Is recommended/ is indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Class IIa suggested wording

A

Should be considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Class IIb suggested wording

A

May be considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Class III suggested wording

A

Is not recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management of Angina (for acute attacks) use…

A

SL nitroglycerin for acute attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If Vasospastic angina, BP <130/80 then….

A

add LA nitrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If Vasospastic angina, BP >130/80 then….

A

add CCB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
If not Vasospastic angina, heart rate >60 BPM then....
1. Beta-blocker | 2. Non-DHP CCB
26
If angina symptoms not controlled on Beta-blocker & Non-DHP CCB then....
BP < 130/80 = Add Ranolazine/ LA nitrate BP >130/80 = Add DHP CCB
27
Last line therapy for Angina?
Consider PCI or CABG surgery
28
Treatment outline for Angina
1. Risk factor modifications 2. Select appropriate anti platelet 3. Assess comorbidities 4. Select antianginal therapy
29
Nitrates effect on MVO2
HR: dec Myocardial Contractility: 0 Systolic Pressure: dec LV Volume: dec
30
Beta-blockers effect on MVO2
HR: dec Myocardial Contractility: dec Systolic Pressure: dec LV Volume: inc
31
Nifedipine effect on MVO2
HR: inc Myocardial Contractility: 0 or dec Systolic Pressure: 0 or dec LV Volume: 0 or dec
32
Verapamil effect on MVO2
HR: dec Myocardial Contractility: dec Systolic Pressure: dec LV Volume: 0 or dec
33
Diltiazem effect on MVO2
HR: dec Myocardial Contractility: 0 or dec Systolic Pressure: dec LV Volume: 0 or dec
34
How to reduce Myocardial Ischemia/Angina
Pharmacotherapy w/ Anti-Ischemics Improve coronary blood flow mechanically (surgery)
35
Nitrates effects....
Inc coronary blood flow (Oxygen supply) Dec Ventricular wall tension (oxygen demand)
36
Drug interacts w/ nitrates
PDE5 inhibitors contraindicated ``` Sildenafil/Vardenafil = 24hrs Tadalafil = 48 hrs ```
37
What to monitor with nitrates
ADR: Hypotension, headache, flushing Monitor: BP, HR, PRN usage, anginal symptoms
38
Nitrate Mechanism of Action
Converted to Nitric Oxide *Predominantly venous vasodilation*
39
Isosorbide would be ___ line therapy, after....
3rd, after Beta-Blocker and CCB Can use as combo w/ either, but not as mono therapy
40
Nitrate-free interval for Nitrates
should be at-least 10-14 hrs tolerance form use can develop Usually dosed around 7am, and not after 5pm
41
Protocol for using Nitrate tab
Take 1 dose, if pain unimproved or worsening after 5 minutes then call 911. can take 2nd dose at that point Make sure to store in original container
42
Using nitrate for prophylaxis....
take immediately before planned exercise or exertion
43
Nitrate storage considerations
``` Keep in original container Don't dump into prescription bottle Don't dispense w/ safety cap Don't store in Bathroom Remove cotton plug from bottle ```
44
Nitrate admin considerations
``` Keep with you at all times Pt should be sitting when taking Describe how to use SL tab How to use prophylactically Call 911 if 1st tab don't work Have to refill tab every 6 months ```
45
Beta Blockers effect on MVO2
Oxygen supply = 0 Oxygen demand (Dec HR, Myocardial contract, Ventricular wall tension)
46
When are Beta-blockers first line?
Post MI also when no prior MI
47
What to monitor and ADR w/ Beta-blockers
Monitor: HR, BP, PRN nitrate usage, anginal symptoms, rescue inhaler use**, glucose intolerance 9DM)** ADR: Hypotension, bradycardia, high glucose,
48
Which Beta-blockers should you avoid for chronic ischemia?
Those with intrinsic sympathomimetic activity (ISA)
49
Are beta-blockers appropriate for Prinzmetals Variant angina?
No, none other
50
Beta-blocker considerations
Inappropriate for vasospasm Caution in cocaine induced angina Abrupt discontinuation of beta-blockers should be avoided...do over 2-3 weeks..could result in reflex tachycardia + ischemia
51
Which Beta-blocker as renal elimination and should be careful with AKI?
Atenolol
52
CCB effects on MVO2
Oxygen supply (inc Coronary blood flow) Oxygen demand (dec HR, myocardial contractility, ventricular wall tension) *** only Verapamil/Dilt will dec HR, Myocardial contract
53
CCB indication
2nd line to Beta-blockers Drug of choice in Prinzmetals variant angina
54
CCB what to monitor and ADR
Monitor: (HR - non DHP), BP, PRN nitrate usage, anginal symptoms ADR: constipation, lower extremity edema, Hypotension, bradycardia
55
Which CCB are more likely to slow HR?
non-DHP Verapamil and Diltiazem
56
CCB of choice for ischemia in pt with concurrent HF?
Amlodipine, won't dec contractility
57
Which CCB have highest effect of Vasodilation?
Amlodipine or Nifedipine XL Non-DHP (Verapamil/Diltiazem = moderate effect)
58
Captopril Dose Frequency
TID
59
Lisinopril Dose Frequency
Daily
60
Valsartan Dose Frequency
1-2 Doses
61
Atenolol Dose Frequency
Daily
62
Carvedilol Dose Frequency
BID
63
Metoprolol Dose Frequency
BID QD for XL
64
CCBs Dose Frequency
Daily
65
Isosorbide DN Dose Frequency
2-3 X day | 7am/noon/5pm
66
Isosorbide DN SA tab Dose Frequency
1-2 X day | 8am/2pm
67
Isosorbide MN tab Dose Frequency
bid 7hrs apart
68
Isosorbide MN ER Dose Frequency
QD
69
When is Ranolazine (Ranexa) used
3rd/last line When inadequate response with other anti-anginal agents in combo with standard therapy
70
Ranolazine MOA
reduces calcium overload by inhibiting late sodium current Minimal effects on HR and BP
71
Ranolazine Dosing
500 mg po BID, titrate up to 1000mg BID
72
Ranolazine Monitor and ADR
ADR: Constipation, headache, nausea, dizziness Monitor: QT interval, hepatic function
73
Ranolazine Max dose with Diltiazem or Verapamil?
500 mg BID
74
Max simvastatin dose with Ranolazine?
20mg
75
Max Metformin dose with Ranolazine?
1700mg daily, 850 BID Ranolazine can be max 1000 mg BID
76
Ranolazine contraindications
CYP3A4 Inhibitors and inducers
77
Aspirin is 1st line in pt with.....
CAD, class I recommendation Dosed 81mg daily
78
NSAID - Aspirin Interactions
Take ibuprofen/Naproxen at least 30 min after or 8 hr before Aspirin dose interaction with EC unclear
79
Clopidogrel anti platelet therapy is __ Line
2nd line in pt with CAD If cant tolerate aspirin 75 mg daily
80
Risk factors increasing bleeding risk
``` H/x of GI bleeding, peptic ulcer disease >70+ Female Lean body weight Thrombocytopenia Coagulopathy CKD/DM Using other meds that inc bleeding risk ```
81
Only add 3rd anti-anginal drug if.....
2 drugs don't control symptoms pt awaiting revascularization revascularization is not appropriate or acceptable
82
Revascularization options
PCI - improves symptoms and not mortality | CABG

CDM 2 Exam 1 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions