(Nisha) Cardiology p 55-63 Flashcards
CAD is also known as
atherosclerotic heart disease or ischemic heart disease
Chest pain can be of two etiologies
Cardiac or GI
Protective effect of menstruation and estrogen wears off at what age?
After 55-60
Do more women or men die of heart disease ?
Women
Name some risk factors for CAD
DM, Tobacco smoking, HTN, hyperlipidemia, family history of premature CAD, age above 45 in men and 55 in women
What is the worst risk factor for CAD?
DM
What is the most common risk factor for CAD?
HTN
Premature coronary artery disease is defined as being in a family member who is men age < _____ and women age < _____
55,65
What portion of a lipid profile is most dangerous risk factor for CAD ?
Elevated TG, elevated total cholesterol, decreased HDL, elevated LDL, obesity
Elevated LDL
Tako Tsubo cardiomyopathy is acute myocardial damage that occurs in _______ women after an overwhelming, emotionally stressful event.
Postmenopausal. Examples of stressful events - divorce, financial issues, earthquake lightning strike, and hypoglycemia
Ballooning and left ventricular dyskinesis ?
Tako Tsubo Cardiomyopathy
How do you treat Tako Tsubo cardiomyopathy ?
Beta blockers, ACE inhibitors
Correcting which of the following risk factors for CAD will result in the most immediate benefit for the patient?
a. DM
b. Tobacco smoking
c. HTN
d. Hyperlipidemia
e. Weight loss
Tobacco smoking. Within a year after stopping smoking, risk of CAD decreases by 50%. Within 2 years, risk is reduced by 90%
Describe ischemic pain
Dull or sore, Squeezing or pressure like
Ischemic pain is not tender, positional and pleuritic (respiration). True or false?
True. If pain is described using these 3, do not answer ischemia or CAD
Most common cause of chest pain that is not ischemic in nature is ?
GI disorders
Ischemic pain duration? Stable angina vs ACS?
Stable angina - 2-10 min
ACS - 10-30 min
Provoking factors of ischemic pain?
Physical activity, cold, emotional stress
Symptoms associated with ischemic pain?
SOB, nausea, diaphoresis, dizziness, lightheadedness, fatigue
Quality of ischemic pain?
Squeezing, tightness, heaviness, pressure, burning, aching.
NEVER - sharp, pins, stabbing, knifelike
Location of ischemic pain?
Substernal
Alleviating factors for Ischemic pain ?
Rest
Radiation for Ischemic pain?
Neck, lower jaw and teeth, arms and shoulders
Chest wall tenderness ? DX and test?
Costochondritis, PE
Radiation to back, Unequal pressure between arms ? DX and test?
Aortic dissection, Chest x-ray with widened mediastinum, chest CT, MRI, or TEE confirms the diagnosis
Pain worse with lying, flat, better when sitting up, young ? DX and test ?
Pericarditis. ECG with ST elevation everywhere, PR depression
Epigastric discomfort, pain better when eating ? DX and test ?
Duodenal ulcer disease, Endoscopy
Bad taste, cough, hoarseness ? DX and test ?
GERD, Response to PPI
Cough, sputum, hemoptysis ? Dx and test ?
Pneumonia, Chest x-ray, CTA
Sudden onset SOB, tachycardia, hypoxia ? Dx and test?
Pulmonary embolism, Spirat CT, V/Q scan
Sharp, pleuritic pain, tracheal deviation ? Dx and test ?
Pneumothorax, Chest X-ray
best initial test for chest pain?
ECG
In an emergency setting, what do you order after ECG?
Cardiac enzymes (CK-MB, troponin)
If etiology is not clear and EKG is not diagnostic, what test should you order?
Exercise tolerance testing, based on 2 factors - you can read the EKG and the patient can exercise
How do you calculate the maximum heart rate?
220 - (age of patient)
How do you detect ischemia on EKG?
ST segment depression
How can you detect ischemia without the use of EKG?
Nuclear isotope uptake (thallium or sestamibi)
Echocardioagraphic detection of wall motion abnormalities
How can you detect abnormalities with thallium uptake?
Decreased thallium uptake in abnormalities
How can you differentiate between ischemia and infarction with thallium uptake?
In ischemia, you have decreased thallium uptake and decreased wall motion that will return to normal after a period of rest
What if the patient cannot exercise ?
Persantine (dipyridomole) or adenosine in combination with nuclear isotopes such as thallium and sestamibi
Dobutamine + echo
Dypridamole side effect?
Bronchospasm. avoid in asthmatics
coronary steal syndrome
