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2 - CPR (cardio) > Stable Angina, Acute Coronary Syndrome, Aortic Dissection > Flashcards

Stable Angina, Acute Coronary Syndrome, Aortic Dissection Flashcards

1
Q

What is Stable Angina?

A

Chest pain/pressure for at least 2 months that is provoked by exertion or stress

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2
Q

Chest pain/pressure for at least 2 months that is provoked by exertion or stress

A

Stable Angina

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3
Q

What are the 3 options of Acute Coronary Syndrome?

A
  • Unstable Angina
  • NSTEMI
  • STEMI
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4
Q

What is Unstable Angina?

A

New onset angina with minimal exertion or with rest or with increased frequency/severity

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5
Q

What is a NSTEMI?

A

ST segment depression with possible T wave inversion and ABNORMAL cardiac enzymes

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6
Q

What is a STEMI?

A

ST segment elevation with ABNORMAL cardiac enzymes

– or new LBBB or posterior MI

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7
Q

ST depression and/or T wave inversion with NORMAL cardiac enzymes

A

Unstable Angina

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8
Q

Coronary Artery Disease is the leading cause of death in the US. What are some modifiable risk factors?

A

Hypertension, Hyperlipidemia, obesity, smoking, diabetes, stress

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9
Q

Coronary Artery Disease is the leading cause of death in the US. What are some non-modifiable risk factors?

A

Increasing male age, ethnicity, family history

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10
Q

What are 3 other risk factors for Coronary Artery Disease?

A

CKD
Proteinuria
Inflammatory conditions

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11
Q

What are 3 other risk factors for CAD?

A

CKD
Proteinuria
Inflammatory conditions

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12
Q

What is the classic presentation of Acute Coronary Syndrome (unstable angina/NSTEMI/STEMI)?

A
  • Chest pain that radiates to shoulder/arm/neck/jaw
  • Dyspnea and N/V
  • Sweating and fatigue
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13
Q

Atypical or silent (painless) Acute Coronary Syndrome occurs more commonly in what populations?

A

Elderly
Women
Diabetics

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14
Q

Typical Angina chest pain criteria?

A
  • ALL 3 *
    1. Substernal chest pain/discomfort
    2. Provoked by exertion or emotional stress
    3. Relieved by rest and/or Nitroglycerin
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15
Q

Atypical Angina chest pain criteria?

A
  • 2/3 *
    1. Substernal chest pain/pressure
    2. Provoked by exertion or emotional stress
    3. Relieved by rest and/or Nitroglycerin
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16
Q

NON-Angina chest pain criteria?

A
  • < or equal to 1 *
    1. Substernal chest pain/pressure
    2. Provoked by exertion or emotional stress
    3. Relieved by rest and/or Nitroglycerin
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17
Q

In order to diagnose Stable Angina, what should be performed first?

A

ECG and pretest probability of CAD

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18
Q

In order to diagnose Stable Angina, if the pretest probability of CAD is intermediate, what are the 2 options for the patient?

A
  • If able to exercise = Exercise ECG and ECHO
  • If unable to exercise = Pharmacologic testing
    == BOTH: Coronary Angiography
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19
Q

In order to diagnose Stable Angina, if the pretest probability of CAD is high, what is the next step?

A

Medical therapy and Coronary Angiography

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20
Q

What are some types of Cardiac Stress testing?

A
  • Exercise ECG
  • Dobutamine ECHO
  • MPI (myocardial perfusion imaging)
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21
Q

When can you not use an Exercise ECG?

A

In patients with baseline ECG abnormalities

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22
Q

What does the Dobutamine ECHO evaluate?

A

Contractility

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23
Q

What does a MPI (myocardial perfusion imaging) do?

A

Uses vasodilators to add stress to the heart in patients who cannot exercise for cardiac stress testing

24
Q

In order to diagnose Acute Coronary Syndrome (unstable angina/NSTEMI/STEMI), what are the options?

A

ECG
Cardiac biomarkers
Coronary Angiography

25
Q

STEMI ECG changes

A

ST elevation of > 2 mm or new LBBB

26
Q

STEMI involves ____ occlusion

A

Complete

27
Q

You cannot diagnose a STEMI in the setting of?

A

Old/known LBBB

28
Q

NSTEMI ECG changes

A

New ST depression, T wave inversion > 1 mm with a R/S ratio > 1

29
Q

NSTEMI involves ____ occlusion

A

Partial

– or if a complete occlusion, there are collaterals developed

30
Q

What 3 therapies improve mortality of CAD?

A

Beta blockers
Aspirin
ACEi

31
Q

What are treatment options for Stable Angina?

A
  • Lifestyle modifications, aspirin, statin
  • Beta and Calcium blockers
  • Nitrates, Ranolazine
32
Q

What is the initial treatment of Acute Coronary Syndrome?

A

MONA

  • Morphine
  • Oxygen
  • Nitrates
  • Aspirin
33
Q

What Anti-platelet therapies are available for Acute Coronary Syndrome?

A

Aspirin
P2Y12 inhibitors
Anti-coagulation (Heparin)

34
Q

For a STEMI, what is a specific anti-coagulation medication?

A

Tissue-plasminogen (+)

35
Q

For Acute Coronary Syndrome, what are the 2 options for revascularization therapy?

A

PCI - percutaneous coronary intervention

CABG - coronary a. bypass graft

36
Q

If a patient is having a STEMI and they need PCI, what should you do within 90 minutes and within 120?

A

90 - PCI if available

120 - transfer to a facility that does it

37
Q

What are the 3 main arteries that come off the aortic arch?

A

Brachiocephalic – R. subclavian and R. common carotid
Left common carotid
Left subclavian

38
Q

Stanford Type A Aortic Dissection

A

Tear in the Ascending Aorta

39
Q

Stanford Type B Aortic Dissection

A

Tear in the Descending Aorta

40
Q

Which type of Stanford Aortic Dissection is more common and more deadly?

A

Type A

41
Q

What are some risk factors for Aortic Dissection, that are sometimes seen in younger patients?

A
  • CT disorders – marfans and ehlers danlos
  • Syphilis
  • Cocaine/meth and trauma
42
Q

What are some risk factors for Aortic Dissection?

A

Hypertension, dyslipidemia, smoking

43
Q

Most common complaint with Aortic Dissection?

A

Tearing/ripping chest pain

44
Q

What other cardiovascular symptoms/signs can be seen with Aortic Dissection?

A

BP asymmetry, pulse deficits
Cardiac tamponade, MI
Syncope

45
Q

What is seen on CXR with Aortic Dissection?

A

Widened Mediastinum

46
Q

What is the most common method to diagnose Aortic Dissection?

A

CT angiography

47
Q

What is the treatment for Aortic Dissection and its purpose?

A

Anti-impulse therapy to decrease HR/force in order to decrease stress on intima of aorta

    • BP < 120
    • HR < 60
48
Q

Besides Anti-impulse therapy, what are the options of treatment for Aortic Dissection?

A

Opiates for pain control

Surgery

49
Q

Surgical intervention for Aortic Dissection has _____ survival rates

A

Better

50
Q

What is the way to diagnose an Aortic Dissection?

A

CT Angiography

51
Q

Inferior MI leads and vessel affected

A

Leads 2, 3, AVF

RCA vessel

52
Q

Septal MI leads and vessel affected

A

Leads V1 and V2

LAD vessel

53
Q

Anterior MI leads and vessel affected

A

Leads V2 - V4

LAD vessel

54
Q

Lateral MI leads and vessel affected

A

Leads 1, AVL, V5 and V6

Left circumflex vessel

55
Q

Posterior MI leads affected

A

Tall R waves and ST depression in V1-V3

2 - CPR (cardio) (44 decks)

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