Cardiology Flashcards
(114 cards)
Acute Coronary Syndrome: Chest Pain Evaluation
- General term for conditions where the blood supplied to the heart muscle is suddenly re____ or b_____
- Chest pain caused by acute coronary syndromes may occur s_____
- Pain can be unpredictable or worsens even with rest, both hallmark symptoms of ______angina.
- General term for conditions where the blood supplied to the heart muscle is suddenly reduced or blocked.
- Chest pain caused by acute coronary syndromes may occur suddenly
- Pain can be unpredictable or worsens even with rest, both hallmark symptoms of unstable angina.
ACS Incidence
- 1/__ of all deaths in the world due to heart disease
- ~ 7.5 million deaths are estimated to be due to (1) (IHD)
- More than 3 million cases per year in US
- A coronary event occurs every 26 seconds, and someone dies from one every ______ in the USA
- 1/3 of all deaths in the world due to heart disease
- ~ 7.5 million deaths are estimated to be due to ischemic heart disease (IHD)
- More than 3 million cases per year in US
- A coronary event occurs every 26 seconds, and someone dies from one every minute in the USA
Cardiac Arrest
- occurs ______
- triggered by an e_______ malfunction in the heart that causes an irregular heartbeat (1).
- P______ action disrupted, the heart cannot pump blood to the br____, l____ and other organs. Seconds later, a person
- loss c______ness and ______ of pulse.
- D_____ occurs within minutes without treatment.
- occurs suddenly
- triggered by an electrical malfunction in the heart that causes an irregular heartbeat (arrhythmia).
- Pumping action disrupted, the heart cannot pump blood to the brain, lungs and other organs. Seconds later, a person
- loss consciousness and absence of pulse.
- Death occurs within minutes without treatment.
Chest Pain Evaluation in outpatient setting
The signs and symptoms of acute coronary syndrome usually begin abruptly. They include:
- Chest pain (1) or discomfort, often described as a____, pr_____, t____ness or b_____
- Pain r_______ from the chest to the sh_____, a____, upper ab_____, b___, n___ or j___
- N_____ or v_____
- In_______
- Shortness of breath (1)
- Sudden, heavy sweating (1)
- ______headedness, d_____ess or f_____
- Unusual or unexplained f______
- Feeling r_____less or appr_______
- Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning
- Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw
- Nausea or vomiting
- Indigestion
- Shortness of breath (dyspnea)
- Sudden, heavy sweating (diaphoresis)
- Lightheadedness, dizziness or fainting
- Unusual or unexplained fatigue
- Feeling restless or apprehensive
Causes of Chest Pain in Outpatient Setting
Chest Pain Assessment Tool (mnemonics)
PQRST =
CHEST =
PAIN =
Chest Pain Assessment Tool
OLDCARTS =
Risk Factors for Heart Disease
- Unsafe lifestyle
- S_______
- Physical _____
- Diet high in ____
- High risk diseases
- Hy_______
- D_______
- Hy_______
- O________
- Unsafe lifestyle
- Cigarette smoking
- Physical activity
- Diet high in fat
- High risk diseases
- Hypertension
- Diabetes
- Hyperlipidemia
- Obesity
Risk Factors for Heart Disease
- Non-Modifiable Factors
- A____
- ______ History of (1)
- End Organ Damage
- H____ disease
- St_____
- P______ artery disease
- Chronic k_____ disease
- E_______ failure
- Non-Modifiable Factors
- Age
- Family History of premature coronary artery disease (CAD)
- End Organ Damage
- Heart disease
- Stroke
- Peripheral artery disease
- Chronic kidney disease
- Eyesight failure
Diabetes and Cardiometabolic Disease
- Approximately 68 percent of people age 65 or older with diabetes die from some form of _____ disease; and 16% die of ____.
- Adults with diabetes are __-__X more likely to die from heart disease than adults without diabetes.
- The American Heart Association considers diabetes to be one of the seven major ____trollable risk factors for cardiovascular disease.
- Approximately 68 percent of people age 65 or older with diabetes die from some form of heart disease; and 16% die of stroke.
- Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.
- The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease.
HTN and HLD
High blood pressure (hypertension): risk for cardiovascular disease ______ with the presence of both HTN and Diabetes (VERY COMMON COMBINATION!)
Hyperlipidemia : ____ LDL (“bad”) cholesterol, ____ HDL (“good”) cholesterol, and high tr_____.
- This triad of poor lipid counts often occurs in patients with (1).
High blood pressure (hypertension): risk for cardiovascular disease doubles with the presence of both HTN and Diabetes (VERY COMMON COMBINATION!)
Hyperlipidemia : high LDL (“bad”) cholesterol, low HDL (“good”) cholesterol, and high triglycerides.
- This triad of poor lipid counts often occurs in patients with premature coronary heart disease.
Obesity and Lack of Exercise
Obesity: Major risk factor for cardiovascular disease
- strongly associated with ______ resistance.
- (1) can improve cardiovascular risk, ______ insulin concentration and _____ insulin sensitivity.
Lack of Exercise:
- _____fiable major risk factor
- Leads to insulin ______ and cardiovascular disease.
- Exercising and weight loss can prevent or delay the onset of type 2 (1), reduce blood (1) and help reduce the risk for heart (1) and (1)
Obesity: Major risk factor for cardiovascular disease
- strongly associated with insulin resistance.
- Weight loss can improve cardiovascular risk, decrease insulin concentration and increase insulin sensitivity.
Lack of Exercise:
- modifiable major risk factor
- Leads to insulin resistance and cardiovascular disease.
- Exercising and weight loss can prevent or delay the onset of type 2 diabetes, reduce blood pressure and help reduce the risk for heart attack and stroke.
Smoking and Genetic Factors
Smoking:
- Damages the arterial _____, leading to ______ or build up of _____ material which leads to the ______ of the arteries
Genetic factors:
- play a role in high blood pressure, heart disease, and other related conditions.
- people with a family history of heart disease share common en_______ and other potential factors that increase their risk.
Smoking:
- Damages the arterial lining, leading to atheroma or build up of fatty material which leads to the narrowing of the arteries
Genetic factors:
- play a role in high blood pressure, heart disease, and other related conditions.
- people with a family history of heart disease share common environments and other potential factors that increase their risk.
Coronary Arteries
Obtuse marginal is on the back off the left circumflex
Coronary Arteries on ECG
Likelihood of Coronary Artery Disease
ST Elevation - NOT ALWAYS MI
ELEVATION Mnemonic =
Diagnosis of Acute Coronary Syndrome (ACS)
- A complete blockage of a coronary artery means you suffered a (1)
- A partial blockage translates to a (1)
- Labs tests: (3)
- E___
- E________
- A complete blockage of a coronary artery means you suffered a STEMI heart attack – which stands for ST-elevation myocardial infarction.
- A partial blockage translates to an NSTEMI heart attack – a non-ST-elevation myocardial infarction.
- Labs tests: Troponin, CPK, CK-MB
- EKG
- Echocardiogram
- ** Troponin is needed every 46 hours inpatient.*
- Echo should be read by cardiology ideally not radiology*
- If high suspicion – troponin shouldn’t really be taken in primary care office – should send to ED*
- NSTEMI = partial blockage, STEMI = complete blockage*
Chest Pain Eval
What does this EKG show?
This EKG was from a patient who went on to develop ST elevation and V-fib arrest. If you are suspicious of hyperacute T waves, get frequent repeat EKG’s to identify ST elevation or other evolution
Beware the Hyperacute T wave in the setting of chest pain. Hyperacute T waves may not always have ST elevation. The real key is the T wave’s size in relation to the QRS complex. This EKG was from a patient who went on to develop ST elevation and V-fib arrest. If you are suspicious of hyperacute T waves, get frequent repeat EKG’s to identify ST elevation or other evolution.
What does this EKG Show?
Cerebral T waves which can be seen in subarachnoid hemorrhage. Subarachnoid hemorrhage can cause changes on the EKG such as deep t wave inversions or ST elevation. -> not everything on an EKG is from a cardiac cause
ECG Findings of Cerebral T Waves
- Inverted, wide T waves are most notable in precordial leads (can be seen in any lead).
- QT interval prolongation.
Pearls
- These are associated with acute cerebral disease, most notably an ischemic cerebrovascular event or subarachnoid hemorrhage.
- They may be accompanied by ST segment changes, U waves, and/or any rhythm abnormality.
- Differential diagnosis includes extensive myocardial ischemia.
- Strongly suspect an intracranial etiology in a patient with altered mental status and these electrocardiographic findings. (Atlas of EM)
What tool is used to assess someone’s CVD risk outpatient?
ASCVD Risk Calculator
(ALWAYS PERFORM)
What is the Inpatient ACS Risk Calculator?
What’s the difference?
Duke Clinical Score
More detailed than ASCVD
NYP STEMI Protocol
NYP STEMI Protocol
- Do NOT give beta blocker if hypotensive
- TNK (we never really give tenecteplase unless neuro thinks they’re having an acute event)
- Stat meds can be given all at once
Long term maintenance
- Plavix common but slowly moving towards ticagrelor-Should not be on nitrate, P2y12, and warfarin at once, will wean off nitrate and be on the other two-LIFETIME beta blocker!