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The begining=Ddx, meds, SA+Contra, Red flags, SS > PANCE Cardiology > Flashcards

PANCE Cardiology Flashcards

1
Q

Name 3 risk factors for stable angina.

A
  • Hyperhomocysteinemia has been correlated with the occurrence of blood clots, heart attacks and strokes,
  • high LDL
  • low HDL
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2
Q

Name 2 prognostic indicators for CAD

A

1) LVEF <50%

2) which vessels involved-Left Main or 2-3 vessel CAD

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3
Q

Name clinical features of stable angina

A

substernal chest pain lasting <10-15 minutes
chest discomfort described as heaviness, pressure, squeezing.
brought on by exertion, relieved by rest or Nitro

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4
Q

What is syndrome X

A

Exertional angina with normal coronary angiography so no coronary stenosis.
Exercise testing and nuclear imaging show cardiac ischemia. Good prognosis.

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5
Q

Exercise induces ischemia results in …… ischemia, producing ……. on the ECG

A

subendocardial, ST depression

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6
Q

What is the best test to detect coronary heart dz?

A

Coronary Angiography can detect ischemia, assess LV size and function, and diagnose valvular dz.

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7
Q

How much does a coronary artery need to be stenosed to cause angina?

A

> 70%

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8
Q

Name 2 agents for pharmacologic stress test?

A

IV adenosine, dobutamine

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9
Q

Name the only medication indicated to decrease morbidity and reduce risk of developing MI from stable angina?

A

Aspirin

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10
Q

Risk facotr modifications and aspirin are indicated in all pts. But when do you initiate meds?
Define Mild dz

A

normal EF, mild angina, single-vessel dz.

start nitrites and beta blockers, CA+ blockers if those dont work

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11
Q

Define Moderate Heart Dz

A

normal EF, moderate angina, 2 vessel dz.
start the nitrites , BBlockers, CA+ blockers and consider coronary angiography to assess suitability for revascularization.

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12
Q

Define severe Heart Dz

A

decreased EF, severe angina, 3 vessel/left main or left anterior descending dz
start coronary agiography and consider CABG.

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13
Q

Define acute coronary syndrome

A

unstable angina or acute MI

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14
Q

What is the difference between unstable angina and stable angina

A

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)

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15
Q

Whats the difference between unstable angina and non ST-segment elevation MI?

A

They have very similar presentations. Get cardiac enzymes

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16
Q

Treatment for unstable angina? After MONA

A

Beta blockers, LMWH (enoxaparin)Glyoprotein inhibitors (antiplatellets)

17
Q

Folic acid can help treat what cardiac risk factor?

A

hyperhomocystinemia

18
Q

What is the presentation of Variant Angina
What is definitive test.
Tx

A

ST segment elevation.
coronary angiography.
Vaso-dialators nitrates, Ca+ blockers

19
Q

What is classic presentation of acute MI?

A

substernal chest pain >30 minutes

diaphoresis

20
Q

What is classic presentation of right ventricular infarct.

5 things.

A 
Inferior ECG changes.
hypotension.
elevated jugular venous pressure. 
hepatomegaly.
CLEAR LUNGS........
21
Q

MI can be asymptomatic in…

A

Elderly, Diabtic pts, post operative pts, women

22
Q

Other sx’s of MI

A

Dyspnea.
weakness, fatigue
nausea/vomiting
syncope

23
Q

Sudden cardiac death usually due to…

A

VFib

24
Q

Name the markers for ishemia

5 things

A

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

25
Q

When to intitiate thrombolytic therapy.
And what meds?
Contra to these meds
What procedure is of choice if thrombolytics are contra?

A 
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
26
Q

When and how often should you get cardiac enzymes

A

1x on admission, then every 8hrs, until 3 samples obtained

27
Q

What does non-ST segment elevation mean

A

subendocardial infarct, tend to be small, tend to be similar to unstable angina.

28
Q

Cardiac enzymes
CK-MB
Troponin:

A

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

29
Q

Which 3 drugs prove to reduce mortality with MI

A

aspirin, beta blockers(metroprolol, atenolol), ACE inhibitors.

30
Q

Which cardiac enzyme is elevated 1st?

A

Myoglobin

31
Q

What does Aortic stenosis sound like,
Where do you hear it loudest,
can it radiate?
What does it increase as far as preload, afterload

A

Harsh crescendo-decrescendo at the 2nd intercostal on the right side radiating to the carotids.
It increases afterload.

32
Q

Clinical presentation of Aortic stenosis?
plus 2 findings on auscultation.
Sx’s begin when…..

A

DOE, Angina pectoris, PND, orthopnea, syncope paradoxical splitting of S2, ejection early click.
Once peak echo gradient is >64mmHg

33
Q

Best test to dx Aortic stenosis

What is Gallaverdin phenomenon?

A

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.

34
Q

What does Mitral Regurge sound like?
Where do you hear it loudest?
Test that help diagnose?
What does it increase?

A

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.

35
Q

What ia an associated symptoms of blood backed up into the LA?
Clinical findings with chronic MR?
MR can predipose you to what?

A

Acute mitral regurge can lead to pulmonary edema.
DOE, fatigue over time.
Predispose you to infective endocarditis or Afib

36
Q

What does Mitral Prolpase sound like?
Test that help
co-morbidity?

A

Mid-systolic click, late systolic/crescendo murmur at apex.
Echocardiography
Some pts have collagen abnormalities(Marfans, Ehlers Danlos Syn)

37
Q

Clinical findings of ….

Dynamic aucultation?

A

Most pts are female, chest pain, palpitations in young adult with pectus excavatum or scoliosis
These maneuvers can move the click=valsalva, squatting,

The begining=Ddx, meds, SA+Contra, Red flags, SS (7 decks)

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