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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
STEMI ECG changes
ST elevation of > 2 mm or new LBBB
26
STEMI involves ____ occlusion
Complete
27
You cannot diagnose a STEMI in the setting of?
Old/known LBBB
28
NSTEMI ECG changes
New ST depression, T wave inversion > 1 mm with a R/S ratio > 1
29
NSTEMI involves ____ occlusion
Partial | -- or if a complete occlusion, there are collaterals developed
30
What 3 therapies improve mortality of CAD?
Beta blockers Aspirin ACEi
31
What are treatment options for Stable Angina?
- Lifestyle modifications, aspirin, statin - Beta and Calcium blockers - Nitrates, Ranolazine
32
What is the initial treatment of Acute Coronary Syndrome?
MONA - Morphine - Oxygen - Nitrates - Aspirin
33
What Anti-platelet therapies are available for Acute Coronary Syndrome?
Aspirin P2Y12 inhibitors Anti-coagulation (Heparin)
34
For a STEMI, what is a specific anti-coagulation medication?
Tissue-plasminogen (+)
35
For Acute Coronary Syndrome, what are the 2 options for revascularization therapy?
PCI - percutaneous coronary intervention | CABG - coronary a. bypass graft
36
If a patient is having a STEMI and they need PCI, what should you do within 90 minutes and within 120?
90 - PCI if available | 120 - transfer to a facility that does it
37
What are the 3 main arteries that come off the aortic arch?
Brachiocephalic -- R. subclavian and R. common carotid Left common carotid Left subclavian
38
Stanford Type A Aortic Dissection
Tear in the Ascending Aorta
39
Stanford Type B Aortic Dissection
Tear in the Descending Aorta
40
Which type of Stanford Aortic Dissection is more common and more deadly?
Type A
41
What are some risk factors for Aortic Dissection, that are sometimes seen in younger patients?
- CT disorders -- marfans and ehlers danlos - Syphilis - Cocaine/meth and trauma
42
What are some risk factors for Aortic Dissection?
Hypertension, dyslipidemia, smoking
43
Most common complaint with Aortic Dissection?
Tearing/ripping chest pain
44
What other cardiovascular symptoms/signs can be seen with Aortic Dissection?
BP asymmetry, pulse deficits Cardiac tamponade, MI Syncope
45
What is seen on CXR with Aortic Dissection?
Widened Mediastinum
46
What is the most common method to diagnose Aortic Dissection?
CT angiography
47
What is the treatment for Aortic Dissection and its purpose?
Anti-impulse therapy to decrease HR/force in order to decrease stress on intima of aorta - - BP < 120 - - HR < 60
48
Besides Anti-impulse therapy, what are the options of treatment for Aortic Dissection?
Opiates for pain control | Surgery
49
Surgical intervention for Aortic Dissection has _____ survival rates
Better
50
What is the way to diagnose an Aortic Dissection?
CT Angiography
51
Inferior MI leads and vessel affected
Leads 2, 3, AVF | RCA vessel
52
Septal MI leads and vessel affected
Leads V1 and V2 | LAD vessel
53
Anterior MI leads and vessel affected
Leads V2 - V4 | LAD vessel
54
Lateral MI leads and vessel affected
Leads 1, AVL, V5 and V6 | Left circumflex vessel
55
Posterior MI leads affected
Tall R waves and ST depression in V1-V3

2 - CPR (cardio) (44 decks)

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