Cardio: MI, angina, endocarditis, ASD Flashcards Preview

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

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.


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


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


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


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)


What is variant (prinzmetal) angina?

- 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


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


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


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


What is an MI ?

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


What is the mortality rate for MI?



What kind of patient typically gets an MI?

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


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


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

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


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


Tx of MI

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


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


What is endocarditis?

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


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


What organisms cause endocarditis in native valve?

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


What organisms cause endocarditis in prosthetic valve?

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


What organisms typically cause endocarditis in IV drug users?

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


What are the complications of endocarditis?

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


What do you need to do to DX endocarditis?

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


What are the major duke clinical criteria?

- Sustained bacteremia
- Endocardial involvement: new valvular regurgitation


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


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


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


What are the qualifying procedures requiring prophylaxis for endocarditis?

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


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


What is Libman-Sacks endocarditis?

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


What are the 3 types of ASD?

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


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


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


How to Dx ASD?

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


What are the complications of ASD?

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