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Clin Med - Cardio Exam #2 > CAD > Flashcards

CAD Flashcards

1
Q

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

A

CAD

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2
Q

Usual onset of CAD for Females vs. Males

A

F 55

M 45

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3
Q

Define Coronary Artery Disease

A

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

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4
Q

Define Cardiovascular Disease

A

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

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5
Q

Define atherosclerosis

A

buildup of plaque within blood vessels

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6
Q

Define angina pectoris

A

Myocardial 02 demand exceeds supply

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7
Q

define MI (myocardial infarction)

A

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

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8
Q

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

A 
Age 
Sex 
Elevated BP
Cholesterol 
Cigarette smoking
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9
Q

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

A

Early CAD

Family hx

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10
Q

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

A

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

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11
Q

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

A

50

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12
Q

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

A

Smoking

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13
Q

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

A

Increased demand
decreased O2 to tissues
Hyper coagulable state
damaged endothelium

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14
Q

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

A

Main component of atherosclerotic plaques

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15
Q

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

A

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

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16
Q

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

A

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

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17
Q

Why does DM contribute to the risk of CVD?

A
  • 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
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18
Q

How does HTN contribute to the risk of CVD?

A
  • 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
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19
Q

How does Sleep Apnea contribute to the risk of CVD?

A

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
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20
Q

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

A

Sleep study

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21
Q

What aggravating factors may a pt report on Hx?

A

Symptoms aggravated by:

  • exertion (less than before)
  • Supine
  • emotional
  • AM symptoms
  • Post prandial
  • Cold exposure
  • intercourse
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22
Q

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

A

Cessation of activity (less than 3 min)

NTG

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23
Q

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

A

How long after cessation of activity do their symptoms resolve?

How often do they use their NTG?

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24
Q

What descriptors might a patient c/o?

A 
Tightness
Squeezing
Burning
pressing
choking
aching
gas
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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 ```
31
What might be seen on EKG in the presence of CAD
Normal, LVH. ST elevation/depressions, T inversions during pain
32
What might be seen in CXR in the presence of CAD?
Normal or cardiomegaly, assess for non-cardiac etiology
33
What non-cardiac DDX are possible?
``` Derm-Zoster MSK-chostochondritis, CA Lung-PE, Pna, Ca GI-GERD, ulcer Psych-drug/attention, anxiety ```
34
How many stages does the Canadian Cardiovascular Society have for Angina Pectoris?
I-IV
35
What is the difference between stage 1 and 4?
Stage 1 is least effected | Stage 4 is most effected
36
Workup for CAD?
Stress test Exercise or Dobutamine, stress Echo-adds US Sestamibi (nuclear) (myocardial perfusion sinctography) MUGA (radionuclide angiography) CTA
37
What are contraindications for stress test?
Pain at rest of with minimal activity, aortic stenosis
38
What would a positive result on a Stress test be?
1mm horizontal or downsloping ST depression measured 80msec past the J point
39
Indications for sestamibi?
``` Resting ST-segment depression Complete LBBB Ventricular paced rhythm ventricular pre-excitation syndrome Prior revascularization with PCI or CABG Inability to exercise Renal or allergic patients unable to have dye ```
40
What is the benefit of a sestamibi?
Provides simultaneous assessment of myocardial perfusion and function in one study
41
What is MUGA best used for?
``` Evaluates Ventricle contractility monitor cardiotoxic (chemotherapy) drug effects during tx. ```
42
Is it safe to do MUGA on a renal pt?
Yes-MUGA is safe in renal pt's nucleotide excreted via liver to GI
43
What can be determined with CT angio?
Coronary artery stenosis Stent and bypass graft patency venous anatomy calcified and non-calcified plaque burden
44
Is CTA contraindicated in renal failure?
YES-this is a dye study---not good for those with renal dz
45
What test might be ordered for a pt with unstable angina who requires further work-up after positive stress test, and requires a final r/o after other causes of pain have been excluded and stress negative?
Cardiac Catheterization (with or without angioplasty)
46
What general medical management must be done for a pt with CAD?
BP control DM Control Lifestyle changes (smoking, diet, exercise)
47
What medications are suggested for pt's with CAD?
``` Platelet inhibitors (ASA) NTG B-Blockers Ranolazine Statin ```
48
Define MI?
Blockage of flow to one or more coronary arteries not relieved by decreased demand. Results in damage to myocardium.
49
Define STEMI
Acute occlusion of an atherosclerotic area resulting in FULL THICKNESS necrosis of myocardium
50
Etiology of STEMI
``` Thrombus or plaque rupture most common Vasospasm Hypotension Coronary artery dissection Cocaine ```
51
HX of STEMI
``` same as Angina Increased severity of angina diaphoresis nausea dyspnea arrhythmia sudden death 1/3rd may be completely asymptomatic/have vague symptoms ```
52
PE of pt with STEMI
``` anxious uncomfortable Brady/tachy/arrhythmia HS WNL gallops or mitral regurg possible JVD possible with large infarct ```
53
What cardiac lab is the most specific to MI
Troponin
54
What will be seen on EKG in the event of an STEMI
-ST segment elevation Greater than 1 mm in 2 or more precordial leads or adjacent limb leads OR -New or presumed L bundle branch block Pathologic Q waves -Hyperacute T-waves
55
What can "hide" an MI on EKG?
A new or presumed L bundle branch block
56
What must be done in the event of a STEMI?
``` Emergent percutaneous coronary intervention (PCI) While waiting for this..... Oxygen ASA 325 NTG Morphine Hemparin B-blocker Fibrinolytic After the event...... lifestyle mods and meds ```
57
Define NSTEMI
Acute occlusion of an atherosclerotic area resulting in PARTIAL THICKNESS necrosis of myocardium
58
What is the most reliable way to diagnose NSTEMI?
Cardiac enzymes
59
What may appear on EKG in the event of an NSTEMI
Normal or subtle change possible ST-stement depression 0.5mm or greater OR Dynamic T wave inversion with pain or discomfort/transient ST elevation of 0.5mm or greater for less than 20 minutes
60
Tx for NSTEMI
``` Oxygen ASA 325 NTG Morphine GIIb/IIIa inhibitor Anticoag (heparin, fondaparinux) Cath lab if unable to get pt pain free Post event-lifestyle mods and meds ```
61
Define Printzmetal angina
Coronary artery spasm generally in the setting of clean coronary arteries. More common in younger pt/s and women and generally occurs in early AM.
62
Etiology of Printzmetal angina?
``` Cold stress cocaine smoking vasconstricitng meds (B-blocker, antihistamine, decongestant, ADHD stims) ```
63
What might the EKG of Printzmetal Angina look like on EKG?
STemi
64
Work up for Printz. angina?
Cardiac cath (usually comes back clean but has to be done to rule out STEMI).
65
tx for Printz. Angina?
Generally responds well to NTG, | Prophylax with CCB's/long acting nitrates
66
MI complications (4)
Cardiogenic shock Heart failure Dressler's syndrome Arryhthmias
67
Define Cardiogenic shock
Large L vent infarct leads to significant decrease of contractility. This leads to very low BP and inadequate systemic perfusion
68
Define Dressler's syndrome?
Fever Pleuritis Pericarditis Caused by autoimmune reaction to damaged heart muscle
69
When can Dressler's syndrome occur?
weeks-months after an MI
70
What surgical options exist for a pt who can't be catheterized?
CABG

Clin Med - Cardio Exam #2 (12 decks)

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