PANCE Cardiology #3 Ischemic heart dz Flashcards
Deficiency of oxygen getting to the heart is a function of 3 things.
Cardiac output
hct, hg
%sat
and carbon monoxide poisoning
MCC of ischemic heart dz?
coronary atherosclerotic dz
What is a major risk factor for CAD?
HTN
Whats most important to lower, systolic or diastolic?
both
Typical pain duration with stable angina and important defining factor?
5-15 minutes
relieved by rest.
What does ST-segment depression indicate?
What does ST-segments elevation mean?
Ischemia
Infarction
Criteria for positive stress test, 2 things.
> 2mm ST-segment depression
hypotension of > mmhg in systolic pressure.
When do you use angiogram?
when you suspect CABG
What is the criteria for CABG?
3 vessel dz or left main coronary
When do you place a stent?
1 or 2 vessel dz
70 yo male presents with chest pain and ST elevation. What works best,
MONA and beta blockers.
whats proven to decrease mortality with acute MI?
aspirin, bblockers, tpa, angioplasty
What if you cant use aspirin?
plavix
what 3 things do you se to treat CAD; unstable angina, NSTMI?
ASA, clopidogrel, BBlocker (Metoprolol, Atenolol)
What 6 things can you use for acute MI and what whill decrease mortality?
M.O.N.A.
Tpa and BBlockers
(aspirin and betablockers are the only things that decrease motality)
What test do yo order to tell the difference between unstable angina and NSTMI?
CK-MB, Troponins
What does not decrease mortality with MI tx?
m.o.n
Do you need CK-MB/troponins to dx a STEMI?
No, its a STEMI
Tell me the leads affected with inferior wall MI?
The leads for lateral MI?
the leads for anterior MI?
The posterior wall MI?
2,3,avf
1, AVL, V4, V5, V6
V2-V4
V1-V2, ST-segment depression
difference between RBBB, LBBB.
LBBB assoc with ischemia
RBBB no big deal
Post MI care? (a,b,c,d,e)
aspirin, betblockers, cholesterol, DM, exercise
MCC of abnormal AV conduction of heart?
ischemia
what do you do for symptomatic 3rd degree av block?
what do you give for asymptomatic 3rd degree av block?
atropine (1st)
pacemaker (2nd)
whats dressler syn?
post MI the dead heart muscle gives off antigens and an immune response is initiated=pericarditis
how do you tell the difference between valve rupture and septal rupture?
septal rupture has an increase in saturation from RA to RV.
Inferior wall MI associated with?
best initial test?
best therapy?
right vent=hypotension
right vent chest leads
IV fluids
most sensitive test for prinzmetal angina
angiogram
how do you differentiate prinzmetal from unstable?
stress test, angiogram are normal with prinzmetals
Definative dx for prinzmetal?
tx?
ergonovine during angiography
CCB
chest pain, SOB, hypotension and confusion?
means yor not getting enough profusion
treatment for CHF in order of importance
O2 diuretics nitrates morphine lower pre-load
Whats the test of choice for CHF?
what do you see?
chest x-ray prominent pulmonary vessels cardiac silhoulette kerley B-lines effusions
sx’s of pulmonary edema from CHF
increased R.R productive cough cyanosis PND rales, rhonchi, wheezing
which tx is acute
which is chronic
dobutamine
digoxin.
how do you tell if the pt is in systolic or diastolic heart failure?
whats the difference in management?
echocardiagraphy
systolic gets digoxin, and ace inh
what drug lowers mortality in CHF?
BBlocker, ACE, arb, spirolactone (K+sparing diuretic) pacemaker
what is the MC symptom of digoxin toxicity?
GI upset (n/v) gynecomastia blurred vision, yellow halo arrhythmias (atrial tachycardia most common) HYPERKALEMIA
what is 1st line therapy for any CHF pt with systolic dysfunction..increases survival!!!
ACE!
when do the coronary arteries fill?
in diastolie
how do you die from CHF?
ischemia
tell me some nitrate drugs?
isosorbide=long term drug for CHF
hydralazine
