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Therapy year 3- sem 2 > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

What kind of chest pains exist?

A

Acute or Chronic

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2
Q

what does ischemic refere to

A

decreases supply of oxygeeated blood

insuffienct to meet demenads

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3
Q

what angina pectoris

A

chest pain due to IHD

Stable IHD
Chronic Stable angine

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4
Q

what is acute coronary syndrome

A

ST elevation myocardial infarction (STEMI)

non-ST elevation acute cornonary syndrome NSTEACS
- unstable angine
- non ST elevation myocardial infarction (NSTEMI)

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5
Q

locations of atherosclerotic syndrome

A

Coronary arteries -CAD
Peripheral arteries - PAD
cerebral or carotid arteries - cerebrovascular disease
aortic arthosclerosis

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6
Q

non- modified risk factors

A

family history
sex
age
ethnicity

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7
Q

modifiable risk factors

A

smoking
excersise
diet
DM
CKD
HTN
Dyslipdemia
chronic conditions
inflammation
illicit drugs
poor nutrition
obessity
stress

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8
Q

what is ASCVD

A

atherosclerotic cadriac disease includes atherosclerosis, coronary arter disease, myocardial infarction and myocardial ischemia

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9
Q

what is the porblem with myocardial remodeling

A

not as good as intial heart set up so can lead to death

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10
Q

clcinical presenttaion chest pain

A

crushing, squeezing, or tightness

location: beneath sternum - substernal

may radiate to left arm, jaw should or back or could have atypical presenttaion

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11
Q

evaulkation of risk via what two tools

A

1/ coronary artery calium (CAC) score
- CT scan to see amount of calcification
- no contrast
- 0 good

  1. pqrst
    -p - precipating or provoking factors, pallitive measure
    - q - quality of pain
    - r- radiating and region
    - s - severity of pian
    - t- timing or temporal patterm
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12
Q

stadnard diagnostic test

A

12- lead ECG

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13
Q

what is a cardiac cath and when is it used

A
  • gold standrad for diagnosisng CAD
  • dye involved
    0 high risk
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14
Q

diagnosis flow cart

A

Acute pain - yes - ECG - cardiac cause - yes- STEMI - no - ACS

if not acute - evalute for stable

if not cardiac cause evaulte for other ccauses

if STEMI follow STEMI guidlines

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15
Q

Angina vs STEMI or NSTEMI

A

Angina - SOB

STEMI or NSTEMI - Diaphoresis, nausea, SOB, vomiting, syncope

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16
Q

Are angina SIHD and ACS symptoms the same?

A

they can often be indistinguishable

17
Q

what are some precipitating factors of SIHD

A
  • cold
  • exercise
  • activity after a large meal
  • emotions (anger, anxiety, excitement)
  • sexual activity
18
Q

for SIHD after taking nitro how long till sx relief?

A

45 seconds to 5 minutes

or may resolve with rest alone

19
Q

difference between SIHD and ACS

A

SIHD
- stable plaque obstructs blood flow and there is a mismatch between what’s requires and what the body can provide

ACS
- unatavle plaque rupture causing unpredicatble change in coronary blood flow

20
Q

compare SIHD and ACS
Duration
Triggers
Relief
Symptoms

A

SIHD
- 1-15 minutes (variable)
- exercise cold
- nitro and rest
- predictable, stable

ACS
- more then 20 minutes
- can occur at rest
- nitro or rest does not resolve symtpoms
- unpredictable, may worsen with time
***Medical emergency!

21
Q

Threee principle presenttaion of angina for ACS

A

Rest angina
- occurs at rest and is more then 20 minutes within 1 week of first presentation

New onset angina
- angina of class III severity with severity onset within 2 months of initial presentation

Increasing angina
- already had angina and is now more frequent and longer

22
Q

what is vasoplastic angina? Demogrpahic?

A
  • severe pain due to vasospasms in coronary arteries
  • may or may not have atherosclerotic disease
  • angina at rest that may occur in cycles
  • usually for younger patients with or without risk factors
23
Q

Assement of angina:

Typical angina

Probably angina (possible cardiac origin)

non-cardiac chest pain

A

Typical angina
- meets all three
1. subteral chest discomfort of characteristic quality and duration
2. provoked by exertion or emtoional stress
3. relief by rest of nitro

Probably angina (possible cardiac origin)
- meets two of three criteria

non-cardiac chest pain
- meets only one or none of criteria

24
Q

Class of angina

A

class 1
- ordinary activity does not cause only prolonged strenuous activity that causes

class 2
-slight limitation or normal actity

class 3
-marked limited of normal acity

class 4
- inability to do normal activity

25
Q

Goals of therpay

A
  1. Prevent ACS and death (modify risk factors, slow progression of coronary atherosclerosis, stabilize)
  2. alleviate acute sx of MI
  3. prevent recurrent sx of MI
  4. Avoid or minimize adverse treatment effects
26
Q

Pharmacotherapy to prevent sx of ischemic symptoms

  • Strategy
  • Therapy
A

Strategy
- improve O2 balance between supply and demand

Therapy
- B-blockers, CCB, LA nitrates, SA nitrates

27
Q

Pharmacotherapy to ACS and Death

  • Strategy
  • Therapy
A

Strategy:
- modify risk factors
- stabilize atherosclerotic plaque

Therapy:
- antiplatelet
- Statins
- ACEi and ARBs
- B-blockers
- modifiable risk factors (lifestyle and co-morbidities)

28
Q

IHD managment of angina

A

nitro for acute attacks - vasoplatic anginer - can either do LA nitrate if Bp belowe 140/90, if above do CCB - if BPM >60 b- blacoker or non-DHP CCB - if contorl gret if not then condier if BP is below 140/90, if below add la nitrate if above add DHP CCD - last resort would be CABG or PCI

29
Q

B - blocker
-Moa
- porphylaxis or acute
- contraindication when
- type
- dose
- interactions

A

MOA: decrease cardiac output

Prophylaxis or acute: prohylaxis, not effective for acute

Containdiaction: vasoplastic angina or hypotension

Type: B1 and B2 selective versus not selctive, selective would be better for other chonic condituin

dose: lowest possible to reach 55-60 bpm, prevent increas ine xcerise HR more tyhen 20 %,

Interactions: CYP 450 additive effect with other drugs

30
Q

what drug combo should be avoided?

A

Non-DHP CCB and b-blockers
- beacuse same MOA

31
Q

CCB tow types

A
  1. DHP
    - amlodipine, felodipine and nifedipine XL
  2. non-DHP
    - Diltiazem, verapamil
32
Q

when are CCB best?

A

Therapy year 3- sem 2 (9 decks)

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