PANCE Cardiology Flashcards
Name 3 risk factors for stable angina.
- Hyperhomocysteinemia has been correlated with the occurrence of blood clots, heart attacks and strokes,
- high LDL
- low HDL
Name 2 prognostic indicators for CAD
1) LVEF <50%
2) which vessels involved-Left Main or 2-3 vessel CAD
Name clinical features of stable angina
substernal chest pain lasting <10-15 minutes
chest discomfort described as heaviness, pressure, squeezing.
brought on by exertion, relieved by rest or Nitro
What is syndrome X
Exertional angina with normal coronary angiography so no coronary stenosis.
Exercise testing and nuclear imaging show cardiac ischemia. Good prognosis.
Exercise induces ischemia results in …… ischemia, producing ……. on the ECG
subendocardial, ST depression
What is the best test to detect coronary heart dz?
Coronary Angiography can detect ischemia, assess LV size and function, and diagnose valvular dz.
How much does a coronary artery need to be stenosed to cause angina?
> 70%
Name 2 agents for pharmacologic stress test?
IV adenosine, dobutamine
Name the only medication indicated to decrease morbidity and reduce risk of developing MI from stable angina?
Aspirin
Risk facotr modifications and aspirin are indicated in all pts. But when do you initiate meds?
Define Mild dz
normal EF, mild angina, single-vessel dz.
start nitrites and beta blockers, CA+ blockers if those dont work
Define Moderate Heart Dz
normal EF, moderate angina, 2 vessel dz.
start the nitrites , BBlockers, CA+ blockers and consider coronary angiography to assess suitability for revascularization.
Define severe Heart Dz
decreased EF, severe angina, 3 vessel/left main or left anterior descending dz
start coronary agiography and consider CABG.
Define acute coronary syndrome
unstable angina or acute MI
What is the difference between unstable angina and stable angina
unstable angina oxygen demand is unchanged. Supply is decreased secondary to reduced resting coronary flow. Stable angina is due to increased demand (oxygen demand exceeds available blood supply)
Whats the difference between unstable angina and non ST-segment elevation MI?
They have very similar presentations. Get cardiac enzymes
Treatment for unstable angina? After MONA
Beta blockers, LMWH (enoxaparin)Glyoprotein inhibitors (antiplatellets)
Folic acid can help treat what cardiac risk factor?
hyperhomocystinemia
What is the presentation of Variant Angina
What is definitive test.
Tx
ST segment elevation.
coronary angiography.
Vaso-dialators nitrates, Ca+ blockers
What is classic presentation of acute MI?
substernal chest pain >30 minutes
diaphoresis
What is classic presentation of right ventricular infarct.
5 things.
Inferior ECG changes. hypotension. elevated jugular venous pressure. hepatomegaly. CLEAR LUNGS........
MI can be asymptomatic in…
Elderly, Diabtic pts, post operative pts, women
Other sx’s of MI
Dyspnea.
weakness, fatigue
nausea/vomiting
syncope
Sudden cardiac death usually due to…
VFib
Name the markers for ishemia
5 things
Peaked T-waves=occur early
S-T segment elevation=acute infarct, transmural
Q-waves=evidence of necrosis, later finding
T-wave inversion=
S-T segment depression=subendocardial injruy
When to intitiate thrombolytic therapy.
And what meds?
Contra to these meds
What procedure is of choice if thrombolytics are contra?
As soon as possible up to 24 hrs of onset of chest pain, Outcome is best if given within first 6 hrs. t-PA, streptokinase. Contra; HTN >180/110 head trauma. PUD. previous stroke. recent surgery dissecting aortic aneurysm (PTCA) percutaneous transluminal coronary angioplasty which is 1st line in some centers for tx of a MI
When and how often should you get cardiac enzymes
1x on admission, then every 8hrs, until 3 samples obtained
What does non-ST segment elevation mean
subendocardial infarct, tend to be small, tend to be similar to unstable angina.
Cardiac enzymes
CK-MB
Troponin:
CK-MB=Increase within 4-8hrs, returns to normal 48-72hrs, reaches peak in 24hrs.
Troponin (most important) increases in 3-5hrs, returns to normal in 5-14 days, peak is 24-48hrs. Greater specificty
Which 3 drugs prove to reduce mortality with MI
aspirin, beta blockers(metroprolol, atenolol), ACE inhibitors.
Which cardiac enzyme is elevated 1st?
Myoglobin
What does Aortic stenosis sound like,
Where do you hear it loudest,
can it radiate?
What does it increase as far as preload, afterload
Harsh crescendo-decrescendo at the 2nd intercostal on the right side radiating to the carotids.
It increases afterload.
Clinical presentation of Aortic stenosis?
plus 2 findings on auscultation.
Sx’s begin when…..
DOE, Angina pectoris, PND, orthopnea, syncope paradoxical splitting of S2, ejection early click.
Once peak echo gradient is >64mmHg
Best test to dx Aortic stenosis
What is Gallaverdin phenomenon?
Echocardiography/Doppler are diagnostic.
BNP to check for cooresponding LVH.
Gallaverdin phenomenon is when the aortic stenosis is heard at the apex and sounds like MR.
What does Mitral Regurge sound like?
Where do you hear it loudest?
Test that help diagnose?
What does it increase?
Holosystolic blowing/pansystolic murmur at the apex radiating to the axilla. And a S3 heart sound
Echocardiography/Doppler.
Increases preload and reduces afterload=INCREASED EJECTION FRACTION.
What ia an associated symptoms of blood backed up into the LA?
Clinical findings with chronic MR?
MR can predipose you to what?
Acute mitral regurge can lead to pulmonary edema.
DOE, fatigue over time.
Predispose you to infective endocarditis or Afib
What does Mitral Prolpase sound like?
Test that help
co-morbidity?
Mid-systolic click, late systolic/crescendo murmur at apex.
Echocardiography
Some pts have collagen abnormalities(Marfans, Ehlers Danlos Syn)
Clinical findings of ….
Dynamic aucultation?
Most pts are female, chest pain, palpitations in young adult with pectus excavatum or scoliosis
These maneuvers can move the click=valsalva, squatting,
