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Flashcards in Cardiology Deck (111)
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1

Goals of primary prevention in CAD

Maintain or achieve ideal weight

Physical activity

Eat healthy diet

Fruits, vegetables, fiber, low glycemic index, unsaturated fats, omega-3 fatty acids (Mediterranean diet)

Refrain from cigarette smoking (and vaping)

Maintain blood pressure at goal

 <140/90 if low risk

<130/80 if risk factors of known CAD

 

Maintain normal ‘bad’ cholesterol levels (LDL)

Glycemic control in diabetes

High risk patients <70 y/o without bleeding risk, should take aspirin daily (*new guidelines)

Small amount of alcohol consumption (less than 2 drinks/day)

2

Risk Factors for CAD

•Age >65yrs

•Gender (male > female until menopause)

•Cigarette smoking

• Dyslipidemia (abnormal cholesterol levels)

• Hypertension (HTN)

• Abdominal obesity (central obesity)

•Family history of 1st degree relative with premature MI (men age <55 women <65)

3

risk factor that is considered a “coronary artery disease equivalent”

Diabetes 

4

Define Metabolic Syndrome

•Constellation of metabolic abnormalities that confer increased risk of CAD

 

Three or more of the following

•Abdominal obesity

•Triglycerides >150mg/dL

•HDL <40mg/dl for men and <50mg/dl for women

•Fasting glucose ≥ 110mg/dL (hyperglycemia/insulin resistance)

•Hypertension

5

what artery supplies blood to left ventricle and atrium

Left main coronary a.

 

The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left 

The circumflex artery branches off the left coronary artery and encircles the heart muscle. This artery supplies blood to the outer side and back of the heart.

6

Which coronary artery supplies blood to the right ventricle, the right atrium, and the SA (sinoatrial) and AV (atrioventricular) nodes

Right coronary artery (RCA).

7

symptoms of chronic stable angina

•Chest discomfort or dyspnea with exertion lasting ~5-15 minutes, predictable & reproducible (due to flow limiting lesion)

•Relieved by rest and/or nitroglycerin

•Description of discomfort varies

•Tightness, squeezing, burning, gas, indigestion or ill characterized

• Typically located central or slightly left side of chest

•Pre-syncope (lightheadedness)

•Fatigue

8

exclusion criteria for ETT

•ST abnormalities

•LVH

•LBBB

•Vent-paced

•WPW

9

when would we include imaging stress tests 

include imaging if patient has known CAD or multiple risk factors 2

10

Name types of imaging and nonimaging stress tests

•Non-Imaging Test

•1. Exercise tolerance testing (ETT) (uses treadmill & EKG)

 

Imaging Tests – include imaging if patient has known CAD or multiple risk factors 2.

•Echocardiography (exercise or pharmacologic)

•Radionuclide myocardial perfusion imaging (exercise or pharmacologic)

•Positron emission tomography (PET) (almost always pharmacologic)

11

first line stress test for most pts

ETT

12

describe Radionuclide myocardial perfusion imaging

Exercise or pharmacologic

 Imaging before and after stress

Inject radioactive nucleotide

Poorly perfused areas of the heart do not take up color, localize lesion to coronary artery

 

Highly sensitive

13

what test would we use to look for stress induced regional wall motion abnormalities (RWMAs

stress echo

 

to localize lesion to particular coronary artery

Wont contract normally with the rest of the heart

 

**operator dependent 

14

when would we use Nuclear Medicine PET CT stress test

Very sensitive

Very expensive

Best test for obese patients

Not readily available

15

classif presentation of ACS

•Early morning

•Substernal chest pressure, “like and elephant sitting on my chest.”

•Severe

•Sense of impending doom

•Radiates to L arm, both arms or jaw

•Associated shortness of breath, nausea, diaphoresis, lightheadedness

•Lasts >20min but <1 hr

•Risk factors

•Poor exercise tolerance at baseline

16

3 types of ACS

•1. Unstable Angina

•2. Non-ST Elevation Myocardial Infarction (NSTEMI)

•3. ST Elevation Myocardial Infarction (STEMI)

•**(most serious of the three)

17

Unstable plaque without plaque rupture is what type of ACS?

 

What would we see on EKG

unstable angina

Ischemic symptoms suggestive of ACS and no elevation of cardiac biomarkers (Troponin).

 

May or may not have ST depressions or non-specific changes (i.e. T wave inversion).

EKG can be normal

18

Potentially same manifestations as UA but do have elevated cardiac biomarkers (Troponin) suggestive of myocardial tissue death

 

sx?

NSTEMI

 

Unstable plaque +/- rupture (incomplete or complete occlusion)

19

Plaque rupture with complete occlusion

STEMI

20

what are the anterior leads and corresponding artery

V2, V3, V4

LAD

21

what are the left lateral leads

I, aVL, V5, V6

Left circumflex a

22

Name inferior leads and corresponding a.

II, III, aVF

Right coronary a.

23

name right ventricular leads and corresponding a.

aVR, V1

Right coronary a

24

name osterior leads and corresponding a

ST depressions in V2-V4

RCA

25

New LBBB in setting of acute CP is ____ until proven otherwise

MI

26

Recall which patients need urgent coronary artery reperfusion (catheterization and percutaneous intervention)

•Hemodynamic instability or cardiogenic shock

•Severe left ventricular dysfunction or heart failure

• Recurrent or persistent rest angina despite intensive medical therapy

•New or worsening mitral regurgitation

•Sustained ventricular arrhythmias

27

Immediate tx of ST elevation in MI

•cute Triage

•Responsiveness, airway, breathing, and circulation

• Evidence of systemic hypoperfusion/cardiogenic shock (hypotension, tachycardia, impaired cognition, cool/clammy)

 

•Congestive heart failure

•Ventricular arrhythmias

•Activate cardiac catheterization lab (cath lab)

•IV heparin bolus then continuous infusion

MONA (morphine, oxygen (if needed), nitrates, aspirin)

•Oxygen if arterial O2 saturation ≤90% or respiratory distress

•Consider Glycoprotein IIb/IIIa inhibitors (Eptifibatide- (Integrilin))

•Percutaneous coronary intervention (PCI) – if available yields highest rates of survival if reperfusion is done within 90min (Door to balloon time). (consider transfer – ?allow 120min)

• Fibrinolytic therapy if PCI not available

•Beta-blocker

•Optimize potassium & magnesium

•* If patient is found to have severe 3 vessel disease during PCI à will need coronary artery bypass graft surgery (CABG)

28

All patients with known CAD should be on

•Asa, BB, and statin if no contraindications

29

recognize demand ischemia

30

Describe the pathophysiology of Prinzmetal angina

Vascular smooth muscle hyper-reactivity

• Generally caused by focal spasm of a major coronary artery

• Results in high grade obstruction

• Transient myocardial ischemia

• Occasionally myocardial infarction

 Spasm occurs in the absence of oxygen supply/demand mismatch

• Can happen in normal or diseased vessels