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Clinical Medicine II > CAD > Flashcards

CAD Flashcards

(52 cards)

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1
Q

Pain between nose and pubis until proven otherwise

A

CAD

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2
Q

What is the progression of CAD?

A

stable angina -> unstable angina -> NSTEMI -> STEMI

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3
Q

What is the leading cause of death for both men and women?

A

CAD

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4
Q

What is the athelerosclerotic buildup in arteries?

A

CAD

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5
Q

What determines rupture risk of a plaque?

A

characteristics, not size

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6
Q

What is caused by rupture?

A

thrombus formation

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7
Q

What are modifiable risk factors for CAD?

A
  • smoking cessation
  • treat sleep apnea
  • weight loss
  • correct illnesses worsen symptoms
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8
Q

What does this define:
- reproducible angina symptoms of at least 2 months (CP, pressure, tightness, gripping, radiating to upper arms, neck, jaw, face) ass w/ SOB, diaphoresis, palpitations, pre-syncope
- precipitated by exertion or emotional stress
- relieved by rest or nitroglycerin?

A

angina pectoris

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9
Q

What groups could have atypical CAD symptoms?

A

women, DM, elderly, that could have DOE, back pain, neck pain, nausea

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10
Q

What are risk factors for angina pectoris?

A

older age, male, post-menopausal females, hyperlipidemia, smoking, HTN, DM, obesity, family Hx
high triglycerides, small LDL, high homocysteine, stress, depression, inflammatory markers
lipoprotein, chlamydia pneumoniae

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11
Q

What causes angina pectoris?

A

imbalance between myocardial oxygen supply + demand

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12
Q

What could an angina pectoris ecg look like?

A

normal OR
pathologic Q waves + conduction abnormalities (LBBB, LAFB which can increase CAD odds), ST depression

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13
Q

What is the first line test for angina pectoris?

A

stress test (physical exercise or meds like dobutamine or adenosine agonists)

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14
Q

When do you get a stress test?

A

when there is intermediate probability of CAD

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15
Q

What do you do after a stress test?

A

angiography if positive

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16
Q

What can nuclear isotope testing distinguish?

A

ischemia from infarction

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17
Q

What can calcium score screening do?

A

help find calcium (hardened plaques) in arteries, good first step

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18
Q

When do you refer for angina pectoris?

A

1) need to confirm or exclude CAD
2) medical therapy fails to relieve anginal symptoms
3) history and noninvasive testing suggests high-risk coronary anatomy

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19
Q

What is the management of angina pectoris?

A

4 drug regimen –
daily aspirin + beta blockers + short acting nitroglycerin PRN + daily statin

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20
Q

If someone is allergic to aspirin what should you use instead?

A

clopidogrel

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21
Q

What’s second line for angina pectoris?

Study These Flashcards
A

anti-anginal = add calcium channel blockers or ranolazine

22
Q

All patients should be on ___ unless clear contraindications

23
Q

How do you treat severe anginal pectoris symptoms?

Study These Flashcards
A

revascularization for relief of anginal symptoms in patients on optimal management –
1) percutaneous transluminal coronary angioplasty
2) stent deployment

consider CABG!

24
Q

What does this indicate:
- angina at rest (>20min)
-new onset exertional angina
-preexisting angina that has increased in frequency or duration
-post MI?

Study These Flashcards
A

unstable angina

25
What does this indicate: -same as UA but + myocardial necrosis -elevation in cardiac enzymes -no ST elevation?
NSTEMI
26
What does this indicate: -ST elevation -elevation in cardiac enzymes
STEMI
27
What risk score is used for evaluating 14 day death, recurrent MI, urgent revascularation?
TIMI risk score
28
What's the difference between STEMI + NSTEMI?
STEMI = complete occlusion
29
What can cause plaques to rupture?
inflammation, shear stress, degradation
30
What is the "catch all" of cardiac enzymes?
troponin
31
What are cardiac enzymes to look at?
troponin, CPK-MB, LDH, myoglobin (earliest)
32
What's the earliest cardiac enzyme?
myoglobin
33
always treat low risk _______ and moderate-high risk______
conservatively, aggressively
34
How do you treat unstable angina + NSTEMI?
anti-angina -- nitrates, beta blockers, morphine + anti-clot antiplatelets + anticoagulants (heparin, thrombin inhibs) + statins + ACE-I/ARB if EF<40% consider PCI **NO THROMBOLYTICS**
35
How do you treat a STEMI?
anti-angina -- nitrates, beta blockers, morphine + anti-clot antiplatelets + anticoagulants (heparin, thrombin inhibs) + statins + ACE-I/ARB if EF<40% PCI is PREFERRED method! thrombolytic therapy
36
PCI vs thrombolytics
PCI is preferred - 90 min or less, or 2 hours or less when traveling If cannot -- thrombolytics
37
MONA BASH in Paris (ACS)
M - morphine O - oxygen N - nitrates A - aspirin + ADP inhibitors B - beta blockers A - ACE inhibitors S - statins H - heparin/anticoagulants
38
Is aspirin the only first line agent in MI?
No, guidelines call for a P2Y12 inhibitor to be added to aspirin for all patients with STEMI, regardless of whether reperfusion is given, and continued for at least 14 days, and generally for 1 year.
39
What ADP/P2Y12s are preferred for STEMIs?
ticregalor or prasugrel
40
What can a dry chronic cough be an ADR of
ACE-I
41
What's the catch all cardiac enzyme?
troponin
42
What may be a sign of angina?
Levine sign—clenched first over the sternum and clenched teeth when describing chest pain
43
What anti-HTN is renoprotective?
ACE-I
44
What anti-HTNs should you not use in renal dysfunction?
diuretics
45
What should you choose in renal dysfunction for HTN?
ACE-I for renal protection and need baseline labs for close monitoring
46
What should you choose with a patient w gout for HTN?
CCBs, losartan
47
What would you choose with osteoporisis or elderly + HTN?
diuretics
48
What would you choose post-MI HTN?
BB or ACE-I
49
what would you choose for angina or A fib and HTN?
BB or CCB
50
What anti-HTN do you use with BPH?
alpha blockers
51
What anti-HTN should you use with DM or CKD?
ACE-I or ARBs
52
What anti-HTN is reno (nephropathy) and cardioprotective?
ACE-I

Clinical Medicine II (50 decks)

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