OnlineMedEd: Cardiology - "CAD" Flashcards
For asymptomatic CAD, go through pain, relief, biomarkers, ST changes, and percent occlusion.
- Pain: absent
- Relief: N/A
- Biomarkers: absent
- ST changes: absent
- Percent occlusion: less than 70%
This would be occlusion discovered incidentally (say, on an angiogram).
For stable angina, go through pain, relief, biomarkers, ST changes, and percent occlusion.
- Pain: with exertion
- Relief: with rest
- Biomarkers: absent
- ST changes: absent
- Percent occlusion: more than 70%, less than 90%
For unstable angina, go through pain, relief, biomarkers, ST changes, and percent occlusion.
- Pain: at rest
- Relief: nothing
- Biomarkers: absent
- ST changes: absent
- Percent occlusion: 90% or more
For NSTEMI, go through pain, relief, biomarkers, ST changes, and percent occlusion.
- Pain: at rest
- Relief: nothing
- Biomarkers: present
- ST changes: absent
- Percent occlusion: 90% or more
For STEMI, go through pain, relief, biomarkers, ST changes, and percent occlusion.
- Pain: at rest
- Relief: nothing
- Biomarkers: present
- ST changes: present
- Percent occlusion: 100% or more
Review Dustyn’s ischemia breakdown for the differences in types of CAD.
- SA, UA, and NSTEMI are types of demand ischemia; when the demand increases beyond the ability of the artery to supply, pain and ischemia result.
- STEMI is supply ischemia (because the vessel is completely blocked).
What are the Diamond criteria?
Features of the HPI that make angina more likely to be cardiac in origin:
- substernal or left-sided
- worse with exertion
- relieved by NTG
- 3/3 = typical angina
- 2/3 = atypical angina
- 0-1/3: nonanginal pain
List the risk factors for CAD.
- DM
- HLD
- HTN
- Obesity
- Family history
- Smoker
- Age (M greater than 45, W greater than 55)
Describe the characteristics that make chest pain more likely to be cardiac.
- Non-positional
- Non-pleuritic
- Non-tender
Review the workup of chest pain.
- 1) ECG: if ST elevations are present (i.e., this is a STEMI), take immediately to the cath lab
- 2) Troponins: if ST elevations are absent but troponins are elevated (NSTEMI), then take to cath lab soon but not immediately
- 3) Stress test: if ECG is normal, troponins are not elevated, but the stress test is positive, then take electively to the cath lab
If all three are negative then it is likely non-cardiac in origin.
Stress echocardiography looks for _______________.
tissue that moves at rest but stays still during the stress test; this indicates at-risk tissue
Describe the indications for catheterization versus bypass.
- 3 or more vessels occluded: bypass
* 1 or 2 vessels occluded: stent
Review the treatment for acute coronary syndrome.
MONA BASH C • Morphine •Oxygen • Nitroglycerin •ASA •Beta-blocker • ACE-inhibitor • Statin •Heparin •Clopidogrel (or another antiplatelet drug)
Note: all people with ACS should get the ABAS portion. Those with pain should be offered nitroglycerin. Those with stents should be given clopidogrel. Heparin for people with high index of suspicion for NSTEMI.
Describe the role of tPA.
The door-to-balloon time is 90 minutes. If you cannot get someone to a cath lab in under 90 minutes, then give tPA. You must give tPA in less than 60 minutes.