S2 L2.5: Syndromes of CAD Flashcards
T/F
1. CAD can be classified into acute or chronic
2. There are 5 types of MI under actue
- T
- T
Most commonly caused by obstruction by atherosclerotic plaque (chronic)
CHRONIC STABLE ANGINA
Risk factors similar to atherosclerosis
CHRONIC STABLE ANGINA
Progressive if not managed optimally and progresses if not managed early
CHRONIC STABLE ANGINA
T/F
Natural course of chronic stable is that pain worsens over time, which
means progression in blockage of arteries →
progression in Canadian Classification (ex. Class 1 to Class 2) but does not suffer from any heart attack or acute myocardial injury (only d/t the obstruction getting bigger)
True
Tantamount to “heart attack”/myocardial infarction
ACUTE CORONARY SYNDROME
Pain is longer than 30 min or shorter but with severe damage as compared to angina pectoris
ACUTE CORONARY SYNDROME
Prolonged ischemic discomfort
ACUTE CORONARY SYNDROME
What is the WHO criteris for MI?
WHO criteria for MI (2 out of 3):
○ characteristic ischemic symptoms
○ significant ECG changes (also blood test to confirm
diagnosis of myocardial infarction)
○ typical rise and fall of cardiac biomarkers
REVISED DEFINIONT OF MYOCARDIAL INFARCTION (MI)
CRITERIA FOR ACUTE, EVOLVING, OR RECENT MI
EITHER OF THE FF CRITERIA SATISIFIES THE DIAGNOSIS FOR ACUTE, EVOLVING, OR RECENT MI:
1. Typical ______ and/or ______ of biochemical markers of
myocardial ______
2. _______ findings of an acute myocardial infarction
- Typical rise and/or fall of biochemical markers of
myocardial necrosis - Pathological findings of an acute myocardial infarction
In the revised criteria for diagnosis for acute, evolving, or recent MI, at least one (1) of the following should be detected:
a) _____ symptoms
b) development of ______ __ waves in the ECG
c) ECG changes indicative of ischemia (___ _____ ______ or _____)
d) Imaging evidence of new _____ of ____ _______ or new _______ ___ motion abnormally
a) Ischemic symptoms
b) Development of pathological Q waves in the ECG
c) ECG changes indicative of ischemia (ST segment
elevation or depression)
d) Imaging evidence of new loss of viable myocardium or new regional wall motion abnormally
The following are signs and symptoms of ACS, EXCEPT:
a. Incessant anginal pains
b. Diaphoresis
c. Pale cool skin
d. Sinus tachycardia
e. A third and/ or fourth heart sound (rales/crackles)
f. Basilar rales
g. Hypertension
h. none of the above
G. HyPOtension not hypertension
THE REST ARE SIGNS AND SYMPTOMS OF ACUTE CORONARY SYNDROME
T/F regarding signs and symptoms of ACS
- Basilar rales (weak heart → heart failure; there’s already fluid flooding the pulmonary bed)
- Hypotension (sign of medical emergency if occurred
during assessment; coronary angiography is done; ↓ CV, ↓ CO, ↓ BP)
TT
Also a form of heart attack
Unstable angina and NSTEMI
Less severe ischemia and myocardial damage (still managed as a heart attack)
Unstable angina
More severe ischemia and myocardial damage
NSTEMI
Clinical features of UA
NSTEMI
ECG changes may be ischemic or nonspecific (CKMB
blood test, Troponin I, C & T)
NSTEMI
Evidence of myocardial necrosis, as reflected in elevated cardiac biomarkers
NSTEMI
Angina pectoris or equivalent ischemic discomfort with at least one of what features? Enumerate them
○ It occurs at rest (or with minimal exertion), usually lasting >10 min
○ It is severe and of new onset (i.e., within the prior 4–6 weeks)
○ It occurs with a crescendo pattern (i.e., distinctly more severe, prolonged, or frequent than previously)
*Inform MD immediately that the pt needs to be brought to the ER even if it was just the first time you observed it worsen on the pt; Stop therapy and bring the pt to ER
T/F regarding NSTEMI:
1. There is elevated troponin I & T
2. We use Troponin I & Troponin T to tell us if there is a myocardial injury
3. With ECG na not specific for an acute MI we call is ST elevation MI or STEMI
4. We check an ECG and check for a specific segment in the ECG and that will tell us if it’s an ST elevation MI or non ST elevation MI
5. Checking of ECG results of the patient is not important in PT
1-2. True
3. False. With ECG na not specific for an acute MI we call is non ST elevation MI or NSTEMI
4. T
5. F. Important to know because it will tell us what intervention to do
The following are ECG changes in UA/NSTEMI, EXCEPT (there can be more than 1 answer):
A. Major diagnositc tool in heart and
B. ST-segment depression (50%)
C. TG-wave inversion (40%)
D.Transient ST-segment elevation (10%)
E. None of the above
B, C, D
It should be:
ST-segment depression (30%)
TG-wave inversion (20%)
Transient ST-segment elevation (5%)
Complete occlusion of an epicardial artery
STEMI
Worse, prolonged anginal pains at rest or precipitated by exertion
STEMI
T/F about STEMI:
Re-establish perfusion right away because if we don’t
do that the heart muscle will die immediately
True
What is the golden period when we can do an intervention and
prevent permanent necrosis?
6 - 12 hrs
Also has ST elevation on ECG and elevated cardiac biomarkers
STEMI
*for more info about STEMI, kindly review the figure (yung green na parang concept map :> )
Modified T/F about the STEMI ECG FINDINGS:
1. ST segment elevation of at least 1 mm in two or more limb lead
2. At least 2 mm ST segment elevation in two or more precordial leads
TT
What are the two (2) pathologic and clinical presentations of ACS and their management?
● Non ST elevation - non subtotal occlusion and
management is gamot-gamot lang
● ST elevation total occlusion - coronary angiogram and
possibly coronary angioplasty
Give me the six (6) missing complications of acute myocardial infarction (AMI) from the list:
- LV dysfunction
- Pump failure
- CHF
- Cardiogenic Shock
- RV infarction
- Arrhythmias
- Pericarditis
- LV aneurysm
- Thromboembolism
- Papillary rupture
- VSD (ventricular septum defect)
- Myocardial rupture
- Death
COMPLICATIONS OF AMI
This is caused by a damaged conduction system of the heart; could be
deadly
Arrhythmias
COMPLICATIONS OF AMI
Inflammation of pericardium
Pericarditis
COMPLICATIONS OF AMI
Heart becomes weaker
LV dysfunction
COMPLICATIONS OF AMI
Orthopnea, Dyspnea, Paroxysmal nocturnal dyspnea
CHF
COMPLICATIONS OF AMI
Any part of the muscle is ruptured (e.g. septum)
Myocardial rupture
COMPLICATIONS OF AMI
If not given intervention immediately, this can happen
Death
Give me the 13 complications of AMI
- LV dysfunction
- Pump failure
- CHF
- Cardiogenic Shock
- RV infarction
- Arrhythmias
- Pericarditis
- LV aneurysm
- Thromboembolism
- Papillary rupture
- VSD (ventricular septum defect)
- Myocardial rupture
- Death
The following are complications of AMI, EXCEPT:
A. LV aneurysm
B. LV Dysfunction
C. Thromboembolism
D. Papillary rupture
E. Pump failure
F. CHF
G. Death
H. None of the Above
H. None of the above
HEMODYNAMIC CONSEQUENCES OF ACUTE MI
______ _________ because MI is an inflammatory process pronounce all inflammatory elements (_____, iNOS, NO,
________) → _______ so that you could provide more blood (trying to bring back to normal) → however, because it’s a cycle, it will make heart ____ _____ (_______ ______)
SYSTEMIC INFLAMMATION bc MI is an inflammatory process
pronounce all inflammatory elements (CYTOKINES, iNOS, NO, PEROXYNITRITE) → VASODILATE so that you could provide more blood (trying to bring back to normal) → however, because it’s a cycle, it will make heart PUMP MORE (MYOCARDIAL DYSFUNCTION)
HEMODYNAMIC CONSEQUENCES OF ACUTE MI
Systolic (↓ ____ ______, stroke output) →
________ = blood itself is working hard but not
getting the blood it needs that time (↓ _____
______ _______) → promoting ____ ______
(cycle, promote more myocardial dysfunction) → if left untreated, _____
Systolic (↓ CARDIAC OUTPUT, stroke output) →
HYPOTENSION = blood itself is working hard but not
getting the blood it needs that time (↓ CORONARY PERFUSION PRESSURE ) → promoting MORE ISCHEMIA
(cycle, promote more myocardial dysfunction) → if left untreated, death
HEMODYNAMIC CONSEQUENCES OF ACUTE MI
Diastolic → ↑ pulmonary _____ and _____ →
_____ → _______ (aggravate the hemodynamic
parameters of the heart)
Diastolic → ↑ pulmonary CONGESTION and CHR →
HYPOXEMIA → ISCHEMIA (aggravate the hemodynamic
parameters of the heart)
REVIEW TIP: Try to understand the figure of Hemodynamic Consequences of Acute MI (better na i-understand din yung pic/figure)
