week 1 required learning objectives Flashcards
What causes coronary artery disease (CAD)?
Endothelial damage leading to inflammation and lipid deposition, resulting in vessel narrowing.
What happens when coronary artery narrowing exceeds 70%?
It can cause ischemic pain, especially during increased oxygen demand (angina).
How does acute myocardial infarction (MI) occur in acute coronary syndrome (ACS)?
Due to plaque rupture or endothelial erosion.
Why are new plaques with thinner caps more prone to rupture?
They are more prone to rupture, often causing acute events in less stenotic arteries (<50% narrowing).
What are the two types of clots formed in ACS and their characteristics?
Platelet-rich (white clots) or fibrin-rich (red clots), leading to partial or complete occlusion, respectively.
List three risk factors for coronary artery disease.
Diabetes Mellitus (DM), Hypercholesterolemia, Hypertension (HTN).
What are other risk factors for coronary artery disease?
Tobacco use, Family history, Increased age, Male sex, Peripheral arterial disease (PAD), Renal insufficiency.
What is the goal timing for an Electrocardiogram (EKG) in a patient with chest pain?
<10 minutes from presentation.
What should be included in blood work for chest pain?
CBC, BMP, Magnesium and Phosphorus levels, Coagulation studies (aPTT, PT/INR), Cardiac biomarkers (preferably cardiac troponin).
What imaging studies are recommended for a patient with chest pain?
Chest X-ray, and other tests as needed (e.g., urinalysis, urine drug screen, pregnancy test).
What subjective characteristics suggest ACS?
Left-sided or retrosternal chest pain, shortness of breath, nausea, or syncope.
What physical exam signs may indicate acute MI?
S4, paradoxical splitting of S2, or new murmurs.
What EKG findings suggest ischemia?
ST-elevation, new ST-segment depression, T-wave inversion.
What laboratory finding indicates myocardial injury?
Elevated cardiac troponin levels.
How is a STEMI identified on EKG?
New ST-elevation at the J-point in two contiguous leads, with elevation of ≥1 mm/box (other than V2-V3).
What are hyperacute T-waves on EKG?
Prominent, symmetrical T-waves in at least two contiguous leads.
How does ST elevation change over time?
It becomes concave over time.
What is reciprocal ST depression?
Seen in 70% of inferior and 30% of anterior infarctions.
When do Q-waves appear on EKG?
Hours to days after MI, can be transient.
How does T-wave inversion indicate ischemia?
Symmetric inversion suggests ischemia, while asymmetric inversion is less concerning.
What medications are used in the treatment of NSTEMI/UA?
Antiplatelet therapy, anticoagulation, beta-blockers, statins, and possibly revascularization.
What are some contraindications for these treatments?
Bleeding risks and existing comorbidities.
What is the ideal timing for reperfusion therapy in STEMI?
Within 90 minutes of first medical contact.
What are some contraindications for reperfusion therapy?
Active bleeding, history of hemorrhagic stroke, or recent major surgery.
List cardiac causes mistaken for ACS.
Aortic dissection, Pericarditis, Myocarditis, Aortic stenosis, Pulmonary hypertension, Hypertrophic cardiomyopathy.
List non-cardiac causes mistaken for ACS.
Pulmonary (e.g., pulmonary embolism, pneumothorax), Gastrointestinal (e.g., gastritis, GERD), Musculoskeletal (e.g., costochondritis), Psychogenic (e.g., anxiety disorders).
What are the three main causes of CHF?
Coronary artery disease, Hypertension, Valvular heart disease.
What are three exotic causes of CHF?
Infiltrative diseases (e.g., amyloidosis), Metabolic disorders (e.g., glycogen storage disease), Neuromuscular disease.
What physical exam findings indicate CHF exacerbation?
Displaced PMI, presence of S3, JVD, lung crackles, and wheezing.
What lab work is helpful for diagnosing CHF exacerbation?
Elevated BNP.
What imaging studies are used to diagnose CHF exacerbation?
Chest X-ray (alveolar and interstitial pulmonary edema, cardiothoracic ratio > 0.50) and Echocardiogram.
What factors in history might lead to CHF exacerbation?
Recent infections, medication noncompliance, increased salt intake, use of NSAIDs.
What echocardiogram findings indicate CHF?
EF < 50%, reversed E/A ratio, valvular abnormalities (aortic stenosis/regurgitation, mitral stenosis/regurgitation).
What is Heart Failure with Reduced Ejection Fraction (HFrEF)?
EF < 40%.
What is Heart Failure with Preserved Ejection Fraction (HFpEF)?
EF ≥ 50%.
What is Mid-range Ejection Fraction?
EF 40-49%.
What is the acute treatment for pulmonary edema in CHF?
Oxygen therapy, diuretics, vasodilators, positioning (elevate head of bed).
What are some long-term treatments for CHF?
ACE inhibitors or ARBs, beta-blockers, diuretics, aldosterone antagonists, lifestyle modifications.
How does acute onset/exacerbation CHF differ from chronic CHF?
Acute onset has rapid symptoms; medications include IV diuretics and vasodilators. Chronic CHF has gradual onset; medications include oral diuretics, ACE inhibitors, beta-blockers.
What lifestyle changes can help decrease CHF exacerbations?
Low-sodium diet, regular physical activity, smoking cessation, limiting alcohol intake, monitoring weight daily.
