SIHD, ACS, & Stroke Important (unfinished) Flashcards
SIHD key concepts:
1) Stable ischemic heart disease (SIHD) is caused by an obstructive atherosclerotic plaque in one or more what?
2) Increases in myocardial oxygen demand when there’s a fixed decrease in myocardial oxygen supply results in _______________.
3) Some patients with SIHD may have a component of __________________ that requires a slightly different pharmacologic approach.
1) epicardial coronary arteries.
2) myocardial ischemia.
3) vasospasm
Key concepts:
Chest pain (angina) from ____________ is the cardinal symptom of myocardial ischemia in patients with SIHD.
exertion; SIHD
SIHD key concepts:
If there’s no contraindications, ___________________ are typically regarded as first-line therapy in the management and control of episodes of angina in patients with SIHD.
β-blockers
SIHD key concepts:
1) What 3 meds often used as additional therapy for angina?
2) What are the 2 first-line therapies in vasospastic disease?
1) Calcium channel blockers, long-acting nitrates, and ranolazine
2) Calcium channel blockers + nitrates
Key concepts:
1) All patients with SIHD should receive sublingual _____________ for acute treatment and should receive education regarding its proper use.
2) How is this dosed?
1) nitroglycerin
2) 0.4mg SL 1 dose every 5 minutes up to 3 doses. Call 911 if you need more than 1 dose.
SIHD: How do you dose SL nitroglycerin?
(He said this is on exam)
0.4mg SL 1 dose every 5 minutes up to 3 doses.
(Call 911 if you need more than 1 dose)
ACS Key concepts:
The predominant cause of acute coronary syndrome (ACS) in more than 90% of patients is acute ___________, __________, or ____________ of an unstable atherosclerotic plaque followed by subsequent thrombus formation that impairs distal blood flow resulting in acute myocardial ischemia.
rupture, fissure, or erosion
ACS Key concepts:
1) What should be considered to alleviate anginal pain?
2) ________ should be administered to patients with hypoxia (oxygen saturation less than 90% [0.90]), and IV ____________ may be considered in patients with refractory anginal pain.
1) Intravenous (IV) nitroglycerin (NTG)
2) Oxygen; morphine
ACS Key concepts:
1) If no contraindications, an oral _________ should be initiated for all patients with ACS and continued for at least 1 and up to ____ years or more to reduce the risk of major adverse cardiac events (MACE)
2) If there are contraindications or if a pt is refractory to the med above, or if there’s vasospasm, what should be considered?
1) β-blocker; 3 years or more
2) CCBs
ACS Key concepts:
Reperfusion of the infarct-related artery in ST-segment elevation myocardial infarction (STEMI) with primary ________________________(PCI) within 90 minutes of first medical contact is preferred to _____________therapy, which should be considered if primary PCI cannot be performed within 120 minutes of presentation.
percutaneous coronary intervention; fibrinolytic
ACS Key concepts:
1) What is a central component to the acute and chronic management of patients with ACS to reduce MACE?
2) Use of what during hospitalization have the ability to reduce MACE?
1) Antiplatelet therapy
2) Parenteral anticoagulant agents
-(unfractionated heparin [UFH], low-molecular-weight heparin [LMWH], fondaparinux, bivalirudin)
ACS Key concepts:
1) What are indicated for all patients post ACS? (3 things)
2) All patients post ACS should receive maximally tolerated _________ therapy to reduce the risk of MACE
1) Dual antiplatelet therapy (DAPT) + aspirin + a P2Y12 receptor inhibitor.
2) statin
ACS Key concepts:
1) To reduce the risk of MACE, all post-MI patients should receive oral treatment with what?
2) When should post-MI pts receive a mineralocorticoid receptor antagonist?
1) An ACEi or ARB (unless contraindicated)
2) If the left ventricular ejection fraction (LVEF) is 40% (0.40) or less and HF symptoms or diabetes mellitus (DM) are also present.
Stroke Key concepts:
1) Stroke can be either _______ (87%) or ___________ (13%) and the two types are treated differently.
2) In which patients does the acute lowering of BP in the first 48 to 72 hours after stroke onset not improve survival or the level of dependency?
3) The acute lowering of SBP to lower than 140 mmHg is safe and may improve functional outcomes for which patients?
1) ischemic; hemorrhagic
2) In patients with an ischemic stroke and a blood pressure (BP) <220/120 mmHg without comorbid conditions requiring acute hypertensive treatment
3) In patients with intracranial hemorrhage and elevated systolic blood pressure (SBP) between 150 and 220 mmHg
Ischemic Stroke Key concepts:
1) Early pharmacologic reperfusion (initiated less than 4.5 hours from symptom onset) with intravenous ___________ has been shown to improve functional ability after ischemic stroke.
2) _______________ therapy is recommended for all ischemic stroke patients, regardless of baseline cholesterol, to reduce stroke recurrence.
1) alteplase
2) Statin
Stroke Key concepts:
1) Antiplatelet therapy is the cornerstone of antithrombotic therapy for the secondary prevention of ________________ ischemic stroke.
2) Oral anticoagulation is recommended for the secondary prevention of ______________ stroke in moderate- to high-risk patients.
1) noncardioembolic
2) cardioembolic
1) ________________ (48%) adult Americans had at least one form of cardiovascular disease (CVD) in 2016.
2) In 2015, CVD was the number one cause of death in the United States with ___________ being the most common cause of CVD death (i.e., 400,000 deaths; 43% of all CVD-related mortality)
1) 121.5 million
2) CAD
Angina pectoris:
1) Which of the 2 subtypes involves plaque rupture?
2) Which has stable plaques?
1) ACS
2) SIHD
Myocardial oxygen supply (coronary blood flow):
Why are nonobstructive coronary plaques more lethal?
More prone to rupture and provoke acute thrombus formation
(not underlined)
Angina pectoris:
1) What is generally the first line Tx?
2) What may be used to reduce symptoms concomitantly or as second line therapies?
3) What is recommended for the immediate relief of angina?
1) Beta-blockers
2) Calcium channel blockers and long-acting nitrates
3) Sublingual nitroglycerin or nitroglycerin spray
Lifestyle modifications for SIHD; how should you target each of the following?:
1) Lipid management
2) BP
1) High-intensity statin
2) Angina + HTN = add dihydropyridine CCBs to beta blockers
Lifestyle modifications for SIHD; how should you target each of the following?:
1) DM
2) Smoking cessation
1) SGLT2 inhibitor: empagliflozin (Jardiance)
GLP-1 agonist: liraglutide (Victoza)
2) Bupropion (Wellbutrin SR), NRT (lozenge, gum or patch) and varenicline (Chantix)
1) What is the first line antiplatelet therapy for SIHD?
2) What dose?
1) Aspirin (ASA) – 1st line
2) 81mg PO Qday indefinitely
