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Clin Med - Cardio Exam #2 > CAD > Flashcards

Flashcards in CAD Deck (70)
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1

What is the Most Common cause of death in high income countries?

CAD

2

Usual onset of CAD for Females vs. Males

F 55
M 45

3

Define Coronary Artery Disease

Narrowing or blockage of the arteries and vessels that provide oxygen and nutrients to the heart

4

Define Cardiovascular Disease

Broader category that includes CAD, arrhythmias, stroke, and heart valve d/o

5

Define atherosclerosis

buildup of plaque within blood vessels

6

Define angina pectoris

Myocardial 02 demand exceeds supply

7

define MI (myocardial infarction)

Heart attack which can be further differentiated into STEMI, or NSTEMI

8

What are the risk factors included in the Framingham Risk Score?

Age
Sex
Elevated BP
Cholesterol
Cigarette smoking

9

What are the most important risk factors for predicting possible cardiac event.?

Early CAD
Family hx

10

What factors are unique to women and put them at risk of Cardiac event?

Smaller coronary arteries
Loss of estrogen-elevated inflammatory state
Lower baseline HDL
Vague symptoms are the norm
Less symptom relief with tx, and poorer outcomes from CABG
Higher rates of post MI heart failure

11

Stop smoking for 1 year and you decrease the risk of MI by _____ %?

50

12

What is the number 1 most preventable cause of death and illness in the US?

Smoking

13

What is the summary - pathological reason behind why smoking raises the risk of CVD?

Increased demand
decreased O2 to tissues
Hyper coagulable state
damaged endothelium

14

What effect can LDL have on contributing to the risk of CVD?

Main component of atherosclerotic plaques

15

What effect can TG have on contributing to the risk of CVD?

Lipid made from converting foods high in carbohydrates or fat. Also a component of plaques

16

What effect can HDL cholesterol have on contributing to the risk of CVD?

Absorbs other cholesterol and carries it back to the liver.
"good" cholesterol-reduces risk of CVD

17

Why does DM contribute to the risk of CVD?

-Tends to lower HDL and raise TG and LDL
-contributes to Hypercoag state
-Nephropathy leads to cardio-renal syndrome
-Neuropathy allows multi vessel atherosclerosis to develop before ischemic symptoms occur resulting in Cardiomyopathy

18

How does HTN contribute to the risk of CVD?

-causes microscopic tears in artery walls allowing for assume. of atherosclerosis
-Causes decreased elasticity of arteries, increased after load, more strain on heart leading to cardiomyopathy

19

How does Sleep Apnea contribute to the risk of CVD?

Paused shallow breathing while sleeping
-Increased neg. intrathoracic pressure increases after-load results in increased demand in an already hypoxic state
-pro-inflammatory promotes atherosclerosis
-Increased platelet activity, reduced fibrinogen, promotes thrombus

20

What can be done to dx a pt with possible sleep apnea?

Sleep study

21

What aggravating factors may a pt report on Hx?

Symptoms aggravated by:
-exertion (less than before)
-Supine
-emotional
-AM symptoms
-Post prandial
-Cold exposure
-intercourse

22

What might a patient report as an alleviating factor for their symptoms?

Cessation of activity (less than 3 min)
NTG

23

What is important to ask the patient about their alleviating factors? (2 questions)

How long after cessation of activity do their symptoms resolve?

How often do they use their NTG?

24

What descriptors might a patient c/o?

Tightness
Squeezing
Burning
pressing
choking
aching
gas

25

What are the descriptors "bursting" or "tearing" usually associated with?

thoracic aneurysm

26

What information might a patient give in regards to the location of their symptoms?

Clenched fist over chest "levine sign"
substernal/left sided
Radiates to shoulder, arm, neck, jaw, back or abdomen

27

What should be looked for on physical exam?

Murmur
DM (retinopathy, neuropathy)
Hypercholesterolemia (xanthelasmas)
Hypothyroid (myxedema, cardiomegaly, fluid retention
Peripheral artery dz: (claudication, diminished pulses)
Active Angina!!! (htn, gallop, tachy-arrhythmia, mital regurg

28

DDX for cardiovascular dz (CARDIAC)

Angina/MI
Pericarditis
Myocarditis
TAA

29

Work up for CAD

Risk stratification (QRISK2, Framingham, HEART, ASCVD)
Labs
EKG
CXR

30

What labs would be drawn for CAD?

CBC
Chem 7
Lipid panel
A1C
Cardiac enzymes for active pain
CRP-inflammatory marker