Lecture 8: Coronary Artery Disease: Angina - Stable/Unstable Flashcards
Which leads can you best see an anterior wall infarction (LAD) in?
V1-V7
An inferior wall infarction is associated with what artery and which leads will show you this best?
- RCA
- Leads II, III, and aVF
Which artery is involved in RV infarction and which leads will show this best?
- RCA
- V3R-V6R
Which artery is involved in lateral wall infarction and which leads will this be seen in best?
- Circumflex artery
- Leads I, aVL + V5-V6
Which artery is involved in posterior wall infarction and will be best seen in which leads?
- Posterior descending artery
- V1-V3
LVH due to AS, anemia, emotion, stress, fever, and thyrotoxicosis can all contribute to what type of angina (supply/demand)?
Demand Angina
What are 3 biochemial consequences of ischemia?
- Fatty acids can’t be oxidized
- ↑ lactate production
- Reduced pH w/ metabolic acidosis
What are some of the ECG abnormalities seen with ischemia; what is ischemia is subendocardial or subepicardial?
- Inversion of T wave
- Transient displacement of ST segment
- Depression = subendocardial
- Elevation = subepicardial
Pt presenting with chest pain that seems like an MI has an S3 gallop, what is the S3?
May be “impending” LV dysfunction leading to HF
Why might you hear a murmur representing MR in a patient who presents to the ED with what seems to be an MI?
Dysfunction of the papillary m. during the chest pain led to MR
List 5 CV causes of Chest Pain
- Ischemic HD (angina, UA, ACS, MI)
- Valvular HD
- Pericarditis
- Myocarditis
- Cardiomyopathies
List some of the non-cardiac causes of chest pain?
- Pleuritis/Pneumonia/PE/Pulmonary infarction/Pneumothorax
- GI —> GERD, PUD, gallstones, esophageal motility disorders
- Chest wall syndromes
- Lung cancer
- Aortic aneursym
List some of the non chest pain sx’s of chronic ischemic heart disease?
- Dyspnea
- Mid-epigastric or abdominal pain
- Diaphoresis
- Excessive fatigue and weakness
- Dizziness and syncope
Systolic murmur or MR due to papillary muscle dysfunction is associated with ischemia in which location and due to what artery?
- Inferior or inferior-posterior ischemia
- Due to RCA
List 5 cardiac dysfunctions which can all mimic angina in the absence of CAD
- Aortic stenosis
- Aortic insufficiency
- Pulmonary HTN
- Hypertrophic Cardiomyopathy
- Heart Failure
Chest pain with elevation of cardiac enzymes (troponin I or CK-MB) and without ST elevation is known as?
NSTEMI
In unstable angina/NSTE ACS the magnitude of what correlates with prognosis?
ST segment depression
Stress cardiomyopathy (Takotsubo syndrome) will have what ECG change and have a similar presentation to what?
- Deeply inverted T wave
- Similar presentation to NSTE ACS
Increase in which labratory marker is associated with an increased mortality in NSTE ACS?
BNP
During stress testing for atherosclerotic CAD what are 5 signs associated with a high risk for coronary event?
- Positive stress test at low work load
- ST depression >5 mins after completing test
- Decrease in BP - syst. fall >10 mmHg during exercise
- Ventricular tachycardia during exercise
- Reduced EF during exercise (stress echo)
Which type of stress test is preferred if patient is suspected to have angina and is also very safe?
Exercise electrocardiography
If patient is unable to exercise/abnormal LBBB on ECG or LVH; what stress test should be used?
Pharmacologic Stress Test
What is used in the pharmacologic stress test?
- Adenosine /regadenosine
- Vasodilators –> ↑ HR
- Dobutamine –> ↑ HR
In which 3 conditions is using nuclear myocardial perfusion imaging (SPECT) during a stress test most useful?
- LBBB
- LVH
- Digitalis effect
