Cardio: MI, angina, endocarditis, ASD Flashcards Preview

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Flashcards in Cardio: MI, angina, endocarditis, ASD Deck (36):
1

What is the pathophysiology of stable angina?

Fixed atherosclerotic lesion that narrow major coronary arteries. Imbalance btw blood supply and O2 demand leading to inadequate perfusion.

2

What are the risk factors for ischemic HD?

- DM
- Hyperlipidemia
- Low levels of HDL
- Family history
- Smoking
- Age, men >45 women >55
- Obesity/lifestyle
- Excessive alcohol use
- Stress

3

Clinical features of stable angina

- Chest/substernal pressure/pain/heaviness/tightness
- Gradual in onset
- Brought on by increased myocardial demand: excertion, emotion
- Releived w/ rest og nitroglycerin
- Does not change w/ breathing or change in body position

4

How to DX stable angina?

1) Physical exam usually normal
2) Resting ECG: Q waves/normal/ ST, T abnormalities during pain
3) Stress test: ECG and echo
4) Pharmacologic stress test if patient cannot exercise
5) Holter monitoring: ambulatory ECG
6) Cardiac catheterization w/ coronary angiography = definite test for CAD

5

Tx for stable angina

1) Risk factor modification
2) Drugs: Aspirin + B-blockers + nitrates (+ Ca-channel blockers). If CHF: ACEi's
3) Revascularization for high-risk patients ( >70% of left main occluded)

6

What is variant (prinzmetal) angina?
Clinical?
Tx

- Transient coronary vasospasm, usually accompanied by a fixed atherosclerotic lesion
- Happen at night and at rest
- Associated w/ ventricular dysrhythmias
- ST elevation during pain
- Ca-channel blockers, nitrates

7

What is unstable angina?

Enlarged stenosis, chronic angina w/ increse in frequency/duration/intensity, new onset angina that is severe and worsening, patients w/ angina at rest

8

Dx of unstable angina

1) Exclude MI
2) Stabilize medically before stress test
Like angina:
3) Stress test: ECG and echo
4) Pharmacologic stress test if patient cannot exercise
5) Holter monitoring: ambulatory ECG
6) Cardiac catheterization w/ coronary angiography = definite test for CAD

9

Tx of unstable angina

1) Hospital admission w/ scope: O2, Iv access, pain control w/ nitrates and morphine
2) Agressive medical treatment- as MI w/o fibrinolysis
Aspirin, clopidogrel, bblockers, LMWH, abciximab/tirofiban
3) Cardiac catheterization/revascularization
4) After acute phase: continue aspirin, bblockers, nitrates, reduce risk factors

10

What is an MI ?

Necrosis of myocardium as a result of an interruption of blood supply

11

What is the mortality rate for MI?

30%

12

What kind of patient typically gets an MI?

Patients w/
- Angina
- Risk factors of CAD
- Arrhythmia history

13

What is the characteristic chest pain in MI?

- Substernal pressure (crushing elephant on chest)
- Similar to angina but more severe and do not respond to nitroglycerin
- Radiation to neck/jaw/arms/back of the left side

14

What other symptoms than pain might be present during a MI?

- Dyspnea
- Diaphoresis(sweating)
- Weakness/fatigue
- Syncope
- N/V
- Sense of impending doom

15

How to Dx a MI?

1) ECG: peaked T waves, St- segment elevation, Q-waves, T wave inversion, ST-segment depression
2) Cardiac enzymes: troponins, CK-MB

16

Tx of MI

1) Hospital admission: O2, nitrates, morphine
2) Meds: aspirin, bblockers, ACEi's, statins, heparin(?)
3) Revascularization: thrombolysis (alteplase), PCI, CABG

17

What is the complications after MI?

- Pump failure: HF, cardiogenic shock
- Arrhythmias
- Recurrent infarct: Dx often difficult
- Mechanical injury: rupture of wall/ septum / papillary muscle, ventricular aneurysm
- Acute pericarditis
- Dressler syndrome

18

What is endocarditis?

Inf. of the endocardial surface, usually involving the cusps of the valves

19

Classification of endocarditis

- Acute: S. aureus most common, normal heart valve, if untreated-fatal in <6w
- Subacute: S.viridans/enterococcus, damaged heart valve, if untreated >6w to cause death

20

What organisms cause endocarditis in native valve?

- S. virridans most common
- Staph spieces and enterococci
- HACEK: haemophilus, actinobacillus, cardiobacterium, eikenella, kingella

21

What organisms cause endocarditis in prosthetic valve?

- Staph epidermidis (early onset)
- Strep (late onset)

22

What organisms typically cause endocarditis in IV drug users?

- Right sided
- S. aureus
- Other: enterococci, Strep, candida, gram negs (pseudomonas)

23

What are the complications of endocarditis?

- Cardiac failure
- Myocardial abscess
- Various solid organ damage from emboli
- Glomerulonephritis

24

What do you need to do to DX endocarditis?

Use DUKE clinical criteria
- 2 major
- 1 major + 3 minor
- 5 minor

25

What are the major duke clinical criteria?

- Sustained bacteremia
- Endocardial involvement: new valvular regurgitation

26

What are the minor duke clinical criteria?

- Predisposing condition
- Fever
- Vascular phenomena: emboli, aneurysm, hemorrhage, Janeway lesion
- Immune phenomena: GN, Osler nodes, Roth spots, RF
- Positive blood culture: not meeting major criteria
- Positive echo: not meeting major criteria

27

What are the treatment of endocarditis?

- Parenteral AB's based on culture for 4-6 w
- If neg culture but high suspicion: empirical Tx w/ penicillin/vancomycin + aminoglycoside

28

What are the cardiac indications for prophylaxis of endocarditis?

- Prosthetic heart valves
- History of inf. endocarditis
- Congenital HD: unrepaired cyanotic, repaired w/ prosthetic material
- Cardiac transplant w/ valvulopathy

29

What are the qualifying procedures requiring prophylaxis for endocarditis?

- Dental procedures
- Involving biopsy/incision of resp. mucosa
- Procedure involving inf. skin/skeletal muscle

30

What is Marantic endocarditis?

- Also called nonbacterial thrombotic endocarditis
- Associated w/ metastatic cancer
- Sterile deposits of fibrin and plot form on the closure line of valve leaflets
- Vegetations may embolize to the brain

31

What is Libman-Sacks endocarditis?

- Also called nonbacterial verrucous endocarditis
- Involves aortic valve in SLE
- Regurg murmurs
- May embolize

32

What are the 3 types of ASD?

- Ostium secundum: most common, central portion
- Ostium primum: low in septum
- Sinus venosus: high in septum

33

What is the pathophysiology of ASD?

- O2 rich blood from LA -> RA -> increase RH output and pulm. flow
- Increase work og RH -> shunt size increase -> RA and RV dilatation w/ pulm-to-systemic flow ratio > 1,5:1
- Pulm. HT is a serious sequela

34

What is the clinical features of ASD?

- Often asymptomatic until middle-aged (40y)
- After this symptoms may start
- Exercise intolerance, dyspnea on exertion, fatigue
- Mild systolic ejection murmur at pulm. area
- Fixed split S2
- Diastolic flow "rumble" mumur over tricuspid valve

35

How to Dx ASD?

1) TEE : "bubble study"
2) CXR: large pulm. arteries and markings
3) ECG: RBBB, right axis deviation, atrial abnormalities

36

What are the complications of ASD?

- Pulm. HT
- Eisenmenger disease: fainting seplls, thromboembolism, hypovolemia, hemoptysis, preeclampsia
- Right HF
- Atrial arrhythmias
- Stroke (paradoxical emboli/afib)