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Flashcards in CAD, Angina - Johnston Deck (42):
1

Most common cause of CAD/MI

Atherosclerosis

2

Function of LDL in atherosclerosis

Helps macrophage foam cells produce cytokines that cause vessel wall inflammation

3

Main way to lower LDL in hyperlipidemia/atherosclerosis

Statin

4

A patient has MI w/o major chest pain...think what?

Diabetes mellitus

5

Physical activity amount to recommend?

10-60 min. medium intensity 4-7 days per week

6

2 components of angina/cardiac blood supply

Supply - oxygen/blood getting to heart tissue
Demand - cardiac workload, stress, emotion, LVH, etc.

7

Mechanical consequences of myocardial ischemia (3)

- Heart failure
- Angina/M.I.
- Segmental akinesis/dyskinesis

8

Biochemical consequences of myocardial ischemia (3)

- FA's can't be oxidized
- Lactate production
- Decreased pH w/ metabolic acidosis

9

Electrical consequences of myocardial ischemia (2)

- ST segment displacement (depression or elevation)
- Arrhythmias/electrical instability (tachy, fib)

10

A posterior wall infarction (transmural) will produce what change on EKG?

Reciprocal ST DEPRESSION in V1-V2
- No leads to directly measure posterior wall

11

Non-STEMI on EKG

Inverted T waves WITHOUT ST elevation

12

An S3 heard w/ angina or MI signifies what?

Impending heart failure

13

During an MI/angina, a systolic murmur over the apex would most likely be what?

INFERIOR M.I. --> Ischemic papillary muscle --> mitral regurg.

14

What are the NON-chest pain symptoms of chronic ischemic heart disease?

SoB, diaphoresis, fatigue, dizziness, syncope

15

GI-seeming symptoms that can be suspicious for MI

Heart burn, indigestion, gas

16

Levine's sign

Clinched fist on sternum

17

Anginal equivalent

Elderly, diabetics, women --> ischemia --> elevated LV filling --> pulmonary edema --> dyspnea, fatigue, belching, etc.

18

Skin risk factors for angina/ischemic heart disease

- Xanthelasma (soft yellow spots on eyelids)
- Xanthomas
- Diabetic skin lesions
- Nicotine stains (tar-stained fingers)
- Pale

19

4 things that can mimic angina w/o CAD

- Aortic stenosis
- Aortic insufficiency
- Pulmonary hypertension
- Hypertrophic cardiomyopathy

20

New or worsening chest pain
More severe, prolonged, frequent
Longer than 20 minutes each time
No myocyte necrosis or cardiac enzymes

Unstable angina

21

Chest pain
Elevated cardiac enzymes
No ST elevation

NSTEMI

22

Inverted T waves + severe chest pain

M.I.

23

A stable angina attack can show what on EKG?

ST depression (subendocardial ischemia)

24

How does EKG relate to unstable angina/M.I.?

Lower (more) ST depression = worse prognosis

25

5 signs of HIGH RISK for coronary event during stress test

- Positive at low work load
- ST depression greater than 5 minutes after test
- Hypotension during test
- V. tach during test
- Reduced EF during test

26

Contraindications to stress testing

Any major cardiac issue

27

Useful test for LBBB, LVH, or digitalis

Nuclear myocardial perfusion imaging

28

Useful test for detecting wall motion abnormality and EF

Stress echo

29

Useful test for detecting coronary calcification

Cardiac computer tomographic angiography

30

Useful test for detecting cardiomegaly, VHD, cardiomyopathy, pericardial effusion

Chest X-ray

31

GOLD STANDARD test for coronary artery disease

Coronary angiography

32

A patient being considered for ___ should have coronary angiography done first

CABG (bypass graft)

33

6 drug types found useful in preventing or reducing MIs and death after MI

- Aspirin
- Beta blocker
- ACE inhibitor
- Statin
- Nitrates
- CCB

34

When NOT to give a beta blocker?

- Decompensated heart failure
- Hypotension
- Advanced AV block

35

When TO give a beta blocker?

- Post-MI
- Ischemia
- Compensated heart failure
- Arrhythmia (not a block)

36

When TO give an ACE inhibitor?

- Diabetics (renal protection)
- LV systolic dysfunction (prevent volume overload)

37

When TO give nitrates?

Acute ischemia and angina due to vasoconstriction (Prinzmetal)

38

When do you consider CABG?

- L main vessel disease

39

When do you consider PCI? (percutaneous coronary intervention)

1 or 2 vessel disease

40

In Prinzmetal, what are the 2 things to treat with?

Nitrates
Amlodipine (DHP CCB)

41

Goals for hyperlipidemia treatment

LDL-C 60
TG

42

2 dietary things that are protective against atherosclerosis

- 2-4 g sodium per day max
- Reduce alcohol