Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiology IPAP > Slide set 7 > Flashcards

Slide set 7 Flashcards

1
Q

What is the levine sign

A

Someone gripping chest in pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk factors for atheroscelrosis (8)

A

Smoking HTN Dyslipidemia Male Age FamHx DM Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Coronary arteries represent how much of total CO

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When coronary artery flow decreases with exercise how stenotic is it

A

70% Stenotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When coronary artery flow decreases with rest how stenotic is it

A

90% Stenotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Atherosclerosis is defined as

A

Chronic inflammatory D/O that leads to hardening of the arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Ischemic heart disease defined as

A

Imbalance of supply and demand of blood/O2 to a portion of myocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Angina is defined as

A

chest pain induced by ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Anginal equivalants

A

In a chest pain free pt the pt experiences SOB, Sweating, Nausea, Claudication, syncope, edema, fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

NL arterial wall is compsed of

A

I-M-A (Intima-Media-Adventitia) Endothelial cells Smooth Muscle cells Extracellular matrix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Atherosclerotic fatty streak is

A

Endothelial dysfunction Lipoprotein entry/modification WBC recruitment (macrophages) Foam cell formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Plaque progression is

A

Fatty streak + smooth muscle recruitment and matrix metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

O2 content is determined by

A

Hgb concentraiton and sys oxygenation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Myocardial oxygenation SUPPLY relies on

A

Oxygen content and coronary blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Coronary perfusion occurs in what phase

A

Diastole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Coronary blood flow relies on

A

Coronary perfusion pressure and coronary vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Perfusion pressure can be approximated by

A

Aortic Diastolic pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If aortic DBP is decreased what happens to myocardial oxygenation

A

Myocardial oxygenation decreases due to decreased coronary artery perfuson

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Coronary vascular resistance is determined by

A

External compression forces Intrinsic regulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Coronary vascular resistance intrinsic regulators are due to

A

Local metabolites Endothelium (V-dil/V-con substances) Neural innervation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Coronary artery Vasodilators

A

Nitric Oxide Prostacyclin Endothelium derived polarizing factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Coronary artery Vasoconstrictors

A

Endothelin 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Coronary vasculature is innervated by

A

SNS with both alpha and beta2 receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Myocardial oxygen DEMAND is determined by

A

Wall stress Contractility HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Heart wall stress is directly related to

A

Systolic ventricular pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Heart wall stress is inversely related to

A

Ventricular wall thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

An increased HR does what to O2 Supply and demand

A

Increases O2 consumption = demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Contractility effects supply and demand how

A

Increases O2 consumption = demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the primary reason for ischemia when concerning vasculature

A

Inappropriate vasoconstriction due to metabolites and damage - not the narrowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Lossing antithrombic properties in the blood vessels causes

A

A decrease in NO and Prostacyclin promoting platelt aggravation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the three basic consequences of Ischemic heart DZ

A

Myocardial injury Acute Symptoms Myocardial necrosis leading to MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the 2 forms of myocardial injury

A

Stunned myocardium Hibernating myocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Acute symptoms of ischemic heart DZ include

A

(Un)Stable angina Variant Angina (AKA prinzmetal angina) Cardiac syndrome X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Myocardial necrosis can manifest as

A

Irreversible Symptomatic ischemia Silent ichemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Variant (Prinzmetal) angina is

A

Coronary artery spasm occuring at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Cardiac syndrome X is

A

Classic Angina, CP, or ischemia during exercise stress test but with no occlusion or atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Stunned myocardium is

A

Short term total/near total reduction of coronary blood flow but is restablished and results in LV dysfx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Hibernating myocardium is

A

Basically your chronic stable angina patients. Persistantly impaired myocardial/LV function at rest but restored with improved blood flow or reducing O2 demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What protective mechanism can you see with chronic stable angina pts

A

Low EF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Hibernating myocardium may require what dx test

A

PET or Dobutamine echo to determine perfusion ability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Stable angina is

A

Chronic predictable and transient during stress angina from a fixed plaque

42
Q

A stable angina can be described as

A

Typical or Atypical

43
Q

Moratility rate of stable angina is better determined by

A

LV fx, exercise capacity, and severity of symptoms

44
Q

Classic angina is described as

A

Retrosternal chest pain (levine sign) Pain radiating to shoulder, arm, neck, Pt may say elephant on chest

45
Q

How long is the typical classic angina

A

<15m

46
Q

What is classic angina relieved by

A

Rest or nitrates

47
Q

Unstable angina is essentially

A

A change in pattern (unpredictable) New onset Intensified S/S Prolonged episodes

48
Q

Variant (Prinzmetal) Angina is

A

Chest pain recurrent at rest or at night and is secondary to a coronary spasm

49
Q

Cardiac syndrome X is

A

Pt has typical S/S of angina pectoris but with no other evidence on myocardial issues

50
Q

Silent ischemia is

A

Cardiac ischemia that occurs in the absence of discomfot or other S/S

51
Q

Silent ischemia is more common with who

A

DM pts due to impaired pain sensations and in (elderly and women)

52
Q

Three key angina questions

A

Is CP substernal, Retrosternal,epigastric Are S/S brought on by exercise Are S/S relieved w/in 5m of rest or NTG

53
Q

Answers to key questions

A

3 yes = typical angina 2 yes = atypical angina <2 Yes = Non-anginal

54
Q

Risk factors for CAD (5)

A

M >55 and F >65 Known CAD or cerebrovascular disease Pain not producible by palpitation Pain worse during exercise pt assume pain is cardiac in nature

55
Q

Low risk (0-1) CAD & chest pain

A

Eval pt for noncardiac causes

56
Q

Mod risk (2-3) CAD & chest pain

A

Order EKG if POS then give O2, ASA, and transport

57
Q

High risk (4-5) CAD & chest pain

A

Order EKG and give O2, ASA, and transport

58
Q

Most likely what would you find on a PE of chronic stable angina

A

Nothin on PE

59
Q

Dx tests for high probability CAD

A

1st Stress imaging and if Severe or with high RFs CT angiography and revasc (PCI or CABG)

60
Q

Dx tests for Intermediate probability CAD

A

Stress EKG or Stress imaging

61
Q

Dx tests for Intermediate probability CAD

A

Stress EKG

62
Q

Goals of chronic ischemic disease

A

Decrease freq Prevent acute coronary synd (AMI) Prolong Survival

63
Q

Stable angina is managed by type of episode

A

Acute vs Chronic episode

64
Q

Acute angina episode management

A

Rest Nitrates (SL) (1st line) Relief precipitaing/aggravating factors

65
Q

Chronic angina episode management

A

Primary is to prevent Lifestyle mod Pharm

66
Q

Pharm to prevent anginal attacks

A

Often used in combo (CCB, B-agonist, nitrates)

67
Q

Vasculo-protective TXT regiment of pharm for stable angina

A

Anti-PLT Lower lipids ? Blockers ACEI (high risk pts)

68
Q

What is first line therapy to reduce anginal episodes

A

? Blocker (goal HR is 55-60bpm)

69
Q

What is the only drug to prevent re-infarct and increase survivalability

A

B blocker

70
Q

Efx ?eta-1 have

A

Positive inotropic and chronotropic efx

71
Q

Efx ?eta-2 have

A

V-dil and B-dil efx

72
Q

What are the 4 types of B-Blockers

A

Non selective Beta1/2 (propanolol) Selective beta1 (metoprolol,atenolol) Intrinsic sympathomimetic activity Selective alpha, non selective ? block

73
Q

CI to use B-Blk

A

Bradycardia <55HR or symptomatic PRI >0.24 or 2/3 degree heart block Decompensated HF Hx of severe asthma DM with hypoglycemia episodes

74
Q

Should a BB be used for prinzmetal angina

A

NO

75
Q

CCB are used when

A

Stable angina management in combo with BB or as 1st line if BB is CI

76
Q

Which long acting CCB are preferred

A

Verapamil (Non-DHP) Diltiazem (Non-DHP) Amlodipine (DHP)

77
Q

What does a non-DHP CCB do?

A

Decrease cardiac rate/force V-dil affect decreasing afterload

78
Q

CCB are CI when

A

There is Bradycardia or systolic HF

79
Q

What does a DHP CCB do

A

V-dil affect decreasing afterload 1st line for pts w/ Bradycardia or AV Blk

80
Q

Nitrates are used for

A

Stable angina prevention and are combo w/ BB or w/ CCB

81
Q

Long term use of nitrates causes

A

Nitrate intolerance

82
Q

Ranolazine is a

A

Nitrate that is Na+ channel blocker and is used in combo with BB or when a BB cant be used

83
Q

All pts with stable angina should counseled for

A

Med compliance Risk factor control Regular exercise Annual flu vaccine

84
Q

Stable angina management of anti-PLT therapy consist of

A

ASA or Clopidogrel if there is an ASA allergy or both if there is hx of MI

85
Q

Angina management w/ lipid lowering agents

A

All patients should be on statins >75 mod-high <75 high

86
Q

Those with HTN, previous MI, or exertional angina should be on what med

A

BB

87
Q

Will an ACEI improve an angina

A

NO

88
Q

Who is an ACEI inhibitor good for that has an angina

A

HTN, DM, CKD, LVEF<40%

89
Q

Coronary revascularization is pursed if

A

If angina S/S dont respond Rx therapy Unacceptable SEs from Rx High risk coronary disease

90
Q

When is CABG more appropriate

A

Large amount of myocardium at risk Pts with 3 vessel disease Complexed anatomy of L-main DZ L-ventricular systolic fx

91
Q

When is PCI best managed

A

Pts with one or two vessel disease

92
Q

The COURAGE trial suggests

A

PCI was no better than Rx therapy at reducing mortality/events but was effective at long term symptom relief

93
Q

PCI stands for

A

Percutaneous coronary intervention

94
Q

PCI consists of

A

Percutaneous transluminal CA Coronary artery stents (Drug eluding)

95
Q

What are the names of the drug eluding stents

A

Sirolemus and Paclitaxel

96
Q

PCI concept is

A

Under fluroscopy a balloon tipped cath is manueuvered to the stenotic portion of the coronary artery and inflated

97
Q

CABG concept is

A

Rerouting/bypassing obstructive coronary arteries via a portion of ones own saphenous vein or an internal mammary artery (better prog)

98
Q

Revascularization steps

A

1.Pt needs coronary angiography? 2.Pt needs revascularization? 3.PCI or CABG?

99
Q

In order to revascularize a pt what must be present first

A

Either severe or refractory angina Severe ischemia on stress testing

100
Q

PCI comparison

A

Less invasive than CABG Shorter hospital stay/recuperation Superior to pharm in S/S relief

101
Q

CABG comparison

A

More effective longterm than PCI/Rx Most CABG complete resvascularization Sruvival Advantage

Cardiology IPAP (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions