Atherosclerosis/ PVD/ CHD Flashcards
(118 cards)
1
Q
Characterized by lipid deposition, fibrosis, calcification and plaque formation in large and medium vessels
A
Atherosclerosis
2
Q
Atherosclerotic heart disease is the most common cause of..
A
Cardiovascular death and disability
3
Q
Men are more affected by atherosclerosis 4:1 until age….
A
70, where the ratio becomes 1:1
4
Q
Smoking and elevated cholesterol levels (greater than 200) due to diet or familiar dyslipidemias…
A
RISK FACTORS** for atherosclerosis
5
Q
CRP level with atherosclerosis
A
Increased!
Inflammation thought to play a role*
6
Q
Managent of ______ and _______ are essential to the control of vascular disease
A
Blood glucose
Blood pressure
7
Q
Smoking cessation!!**
Control of HTN, tx of diabetes, tx of dyslipidemia
Low BMI, regular exercise
Modified diet..low saturated, low fat, low cholesterol
A
Treatment for atherosclerosis
8
Q
characterized by insufficient oxygen supply to cardiac muscle, most commonly caused by atherosclerotic narrowing
A
Ischemic heart disease
9
Q
Risk factors: HTN, diabetes, increased age, tobacco use, family hx (CV dz in males under 55, females under 65), physical inactivity, obesity, dyslipidemias, ETOH
A
Ischemic heart disease
10
Q
Abdominal obesity Triglycerides above 150 HDL less than 40 (men) or 50 (women) Fasting glucose higher than 110 HTN
A
If a pt has at least 3 of these, MAJOR CONTRIBUTOR TO CORONARY HEART DISEASE***
11
Q
Pts with... Cerebrovascular disease Peripheral artery disease Abdominal aorta aneurysm Chornic/end stage renal dz Diabetes
A
**HIGH RISK! for coronary heart disease
12
Q
_____ use is associated with MI and infarction secondary to vasospasm. Pts often much younger than typical cardiac patients
A
Cocaine
13
Q
What causes angina pectoris?
A
Ischemia
14
Q
characterized by paroxysmal chest “squeezing” or pressure, often accompanied by a sensation of smothering and fear of impending death
A
Angina
15
Q
Predictably exacerbated by physical activity and relieved by rest
A
Stable angina
16
Q
Caused by vasospasm at rest, with preservation of exercise capacity
A
Prinzmetal (variant) angina
17
Q
Closely related to non-ST segment elevation myocardial infarction (NSTEMI) and is a common manifestation of cardiovascular disease
A
Unstable angina
18
Q
- angina at rest
- new onset of angina symptoms
- increasing pattern of pain in previously stable patients
A
Common presentations of unstable angina
19
Q
What is the most common presentation of unstable angina?
A
REST PAIN (ANGINA)
20
Q
What should you suspect when the patients pain is less responsive to Nitro, lasts longer and occurs at rest or with less exertion than previous episodes of angina?
A
Unstable angina
21
Q
_______ sign, which is a clenched fist over the sternum and clenched teeth when describing chest pain, may be seen in patients with ischemia
A
Levine
22
Q
Midsternal but may radiate to jaw, shoulders, arms, wrists, back of neck or any combo of these
A
Angina
23
Q
Who presents more with right shoulder and back pain radiation?
A
Women
24
Q
Stable angina usually lasts less than..
A
3 minutes
25
Angina pectoris lasting longer than 30 minutes suggest....
Unstable angina, MI, or another diagnosis
26
The pain of stable angina can be significantly relieved by..
Sublingual nitro
27
How often can you use sublingual nitro?
Every 5 minutes up to 3 times
| if pain is not completely relieved after these 3 doses, unstable angina, MI or other diagnosis likely!!!!!**
28
Horizontal or downsloping ST segment depression on ECG is amon the most sensitive clinical signs of..
An anginal attack
29
ECG will normal in about ____% of patients with angina
25
30
What is he most useful and cost effective, non invasive test to look at angina?
Exercise stress testing
31
An ST segment depression of 1 mm (0.1 mV) during an exercise stress test...
POSITIVE result!
32
If a person cannot exercise, what is an alternative way of stress testing?
Pharmacologic stress testing
33
Myocardial perfusion scintigraphy, radionuclide angiography, and stress echocardiography can help determine...
Extent and location of ischemia
34
What is the definitive diagnostic procedure to diagnose ischemic heart disease (but should be used selectively because of cost and invasiveness)****
Coronary angiography!***
35
Long acting nitrate should include a daily _________ hour treatment free interval to prevent drug tolerance
8-10 hr
36
Headache, nausea, light headedness, hypotension
ADVERSE effects of Nitro
37
This class of drugs prolongs life in patients with coronary disease and are FIRST LINE THERAPY** FOR CHRONIC ANGINA..they are indicated for treatment of ischemic symptoms
Beta blockers
38
This class of drug are useful in the treatment of UNSTABLE ANGINA, particularly with patients who have symptoms of heart failure
ACE inhibitors
39
This class of drug decreases cardiac muscle oxygen demand but are considered alternative therapy. They re indicated for treatment of ischemic symptoms in patients for whom Beta-blockers are contraindicated or have been maximized
Ca channel blockers
40
Diagnosis of acute MI is based on evolution of..
Cardiac biomarkers
41
1/5 of patients with acute MI will die, usually from..
Ventricular fibrillation
| before reaching a hospital
42
Non traumatic chest pain is the most common presenting factor in
Acute coronary syndrome
43
Crushing retrosternal pain or pressure; heaviness or tightness; unexplained indigestion; epigastric pain
MI
44
Denotes formation of fibro-fatty lesions in the intimal lining of large and medium sized arteries
Atherosclerosis
45
Oxidized LDL within a macrophage helps make up..
Atherosclerosis
46
if the plaque ruptures or fissures...circulating blood gets exposed to contents of the plaque (ie collagen), which is very ....
Thrombogenic
47
a HUGE risk factor for large, medium and SMALL vessels
Diabetes
| if small vessels involved, arteriosclerosis
48
```
Total cholesterol, LDL, HDL, triglycerides
Hypertension
Cigarette smoking
Diabetes****
Fam hx in first degree relative (male under 55, female under 65)
Male gender
Age (men over 45, women 55)
Hypoestrogenemia
Physical inactivity
CENTRAL OBESITY
Elevated plasma homocysteine levels
Elevated CRP
```
Risk factors for Atherosclerosis**
49
CRP under 1 mcg/ml
low risk for atherosclerosis
50
CRP 1-3 mcg/ml
intermediate risk for atherosclerosis
51
CRP over 3 mcg/ml
high risk for atherosclerosis
52
made by the endothelial cells and is PROTECTIVE: vasodilator with anti-atherosclerotic properties
Nitric oxid (NO)
53
What does smoking do to NO levels
Decreased or absent production of NO in smoking (HTN and diabetes also)
54
Risk factor modification- smoking cessation, antihypertensive rx, treatment of dyslipidemia, estrogen replacement, glucose regulation, regular exercise, aspirin prophylaxis
(NO HX OF DISEASE!!)
Primary prevention of atherosclerosis
55
Delay or abort disease progression in patients with documented CHD; risk factor modification
(DO have HX of dz, now trying to slow progression!)
Secondary prevention
56
if we lower lipids, we can prevent
Atherosclerosis
57
What drug is ALWAYS used in secondary prevention. If you have atherosclerosis, you WILL be on this (unless contraindicated)
Aspirin
58
Increased LDL increases risk of...
CAD
PAD
Stroke
59
How long without oxygen until cells begin to die?
10-20 minutes
60
Temporary reduction of blood flow to an organ, potentially reversible
Ischemia
61
A significant ________ ________ can lead to an in imbalance between blood supply and demand. The reduction in blood flow limits the normal increase in perfusion when there is increased demand (activity, exercise)
Coronary stenosis
62
Significant left ventricular hypertrophy
Aortic stenosis
Tachyarrhythmias
All increase O2 demand, putting patient at higher risk of....
Myocardial Ischemia
63
False negative stress tests are common in what group of people?
Women
| bc they are more likely to have single vessel dz, which may not show up on stress test
64
Chest discomfort- heaviness, tightness, pressure, squeezing, burning, aching or choking; may not be described as “pain”. Classic symptoms of...
Reversible myocardial ischemia
65
Precipitating factors include..Exertion, exercise, emotional duress, cold weather, sexual activity, cigarette smoke, large meals.
*reproducible with activity
Stable angina
66
Xanthelasma, xanthomas- hyperlipidemia.
Funduscopic abnormalities: A-V nicking, hypertensive, diabetic changes
May be seen in PE in patients with..
Angina
67
sharply demarcated yellowish deposit of fat underneath the skin, usually on or around the eyelids. While they are neither harmful nor painful, these minor growths may be disfiguring and can be removed.
Xanthelasma
68
an irregular yellow patch or nodule on the skin, caused by deposition of lipids.
Xanthoma
69
ST segment depression and/or T wave changes are characteristic of..
Ischemic changes
70
Most useful non invasive test for pt with angina?
Exercise stress test
71
What is the GOLD STANDARD**** for assessing severity of coronary artery disease?
Coronary angiography
| used in conjunction with patients symptoms and extent of ischemia, via stress testing
72
Which vessels do Nitro effect?
Healthy veins!..healthy vessels will dilate because nitro relaxes smooth muscle
**nitro will not dilate diseased vessels
73
Venodilates, reducing LV volume (preload), which decreases oxygen consumption
Nitro
74
```
This class of drug prevents angina by decreasing myocardial consumption of oxygen, decreases HR, contractility and BP
*improves exercise tolerance and reduces symptoms
```
Beta receptor blockers
75
Reduce mortality rate post MI
| Reduce mortality rate in patients with heart failure
Beta blockers
76
Decrease myocardial O2 requirements by dilating peripheral arteries/arterioles, reducing BP, LV wall stress and after load!
*result is a lower myocardial O2 consumption
Calcium channel blockers
77
Do we use long or short term acting calcium channel blockers?
LONG!
| short term can cause significant swings in BP
78
Dihydropyridine
Diltiazem
Verapamil
Ranolazine
Ca channel blockers
79
Which is the weakest vasodilator of all Ca channel blockers?
Verapamil
80
Avoid calcium channel blockers in which type of people?
THOSE WITH HEART FAILURE!****
| these drugs decrease contractility
81
Has unique MOA of decreasing late Na current, decreasing intracellular Ca.
*increased QT interval without causing arrhythmias
Ranolazine
82
**ALL PATIENTS WITH CHD SHOULD BE ON....
Anti platelet drugs
| decreases incidence of subsequent MI, cardiac death
83
Inhibits ADP-induced platelet aggregation; option if ASA is contraindicated
Clopidogrel
84
Patients with unacceptable symptoms in spit of optimal medical treatment
Revascularization
85
3 vessel CAD, especially w LV dysfunction
Left main or left main equivalent dz
Pt may be candidate for...
CABG
86
Indicated primarily for single or 2 vessel disease
| *low morbidity, mortality and rapid recovery
Angioplasty
87
Metal scaffolding devices that prevent elastic recoil
Stents
88
Saphenous veins and internal mammary arteries are commonly used in...
Coronary bypass surgery
89
Which surgical procedure has the best long term results of potency and flow
Coronary artery bypass
90
Often induced by exposure to cold, emotional stress, meds, drugs
**chest discomfort AT REST accompanied by ST segment elevation and arrhythmias
Coronary vasospasm
| may progress to MI if spasm does not resolve
91
2 drugs that can prevent spasm or reverse spasm
Ca channel blockers
| Nitrates
92
Coronary ischemia as a result of vasospasm
Symptoms at rest, esp in early AM
Women>men..AKA variant angina
Coronary arteriography often identifies normal appearing vessels- vasospasm can be induced pharmacologically in cardiac cath lab.
Prinzmetal's Angina
93
There is considerable overlap between unstable angina and _____. The pathology is nearly identical.
NSTEMI
94
Difference between NSTEMI and unstable angina (UA)?
NSTEMI has abnormal cardiac markers (CK MB or troponins) that indicate cell necrosis
(NO CELL NECROSIS HAS OCCURRED YET IN UNSTABLE ANGINA)
95
Pathology: complex coronary lesions- stenosis with placque rupture, hemorrhage, thrombus.
Prognosis (untreated): High risk of developing MI in following days/weeks.
Unstable angina
96
Tx: full anticoagulation and anti platelet therapy
Unstable angina
97
Prolonged ischemia resulting from inadequate tissue perfusion leading to tissue necrosis and myocardial cell death.
Myocardial infarction
98
Atypical presentations of MIs (often painless infarcts) in...
Elderly
Diabetics
Women
99
- Pulse and BP variable and change frequently; hemodynamic instability common.
- Irregularities in pulse may represent arrhythmias.
- Lungs usually clear unless heart failure present.
MI
100
- S4 gallop in most; S3 unusual unless CHF.
- Transient apical mitral regurgitant murmurs usually represent papillary muscle dysfunction.
- Extremities: cyanosis/cold indicate low CO.
MI
101
- S4 gallop in most; S3 unusual unless CHF.
- Transient apical mitral regurgitant murmurs usually represent papillary muscle dysfunction.
- Extremities: cyanosis/cold indicate low CO.
MI
102
If ischemia to papillary muscle during MI, what may happen?
Mitral regurg
103
enzyme released from damaged skeletal muscle and heart. Always elevated with MI.
CK (creatine kinase)
104
Cardiac specific troponin will rise within about..
4-6 hours
| peak in 8-12!
105
CKMB levels increase with..
Myocardial damage
106
Pts with ST segment depression are initially considered to have either...
Unstable angina OR
| NSTEMI
107
If deciding between NSTEMI or unstable angina...and cardiac biomarkers become elevated. What is your dx?
NSTEMI
108
ST elevation of greater or equal to 1 mm in 2 contagious leads
**must be readily identified!!
STEMI
109
All patients with acute coronary syndrome with ongoing discomfort should receive...
IV fluids
Oxygen
Nitro
110
An oral ________ should be initiated within the first 24 hours for all patients with ACS, in the absence of contraindications (heart failure, bradycardia, heart block)
Beta blocker
111
If a patient has heart failure and cannot take a beta blocker, which medication should he/she go on within the first 24 hours of ACS
ACE inhibitor
112
Acute STEMI patients need to undergo immediate thrombolytic therapy to promote re-perfusion. Which drugs can you give?
tPA
Aspirin
Clopidogrel
113
Thrombolytic therapy within the first __ hours of the onset of pain reduces mortality and limits size of infarction
3
114
What is the time limit goal of opening the artery after presenting to the hospital?
90 minute "door to balloon time"
115
You want to open the artery how many hours after onset of symptoms
3 hours
116
Infarcts characterized by by prolonged ischemia, small elevations of cardiac markers and EKG changes showing ST depression and/or T wave inversions.
NSTEMI
117
Considered “incomplete infarcts” with lower initial mortality but high risk of re-infarction and with high mortality.
NSTEMI
118
WHICH CLASS OF DRUGS DO YOU ALWAYS AVOID AFTER AN MI???******
NSAIDs
*associated with re-infarction, hinders healing****
