CIHD and ACS Clinical Correlates Flashcards Preview

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Flashcards in CIHD and ACS Clinical Correlates Deck (12):
1

What is Levine's Sign?

Holding chest with right hand to indicate angina

2

What is the clinical presentation of angina?
Location
Quality
Duration
Aggravating or Alleviating factors
Associated Symptoms or Signs

Location: Retrosternal region, radiates to or occasionally isolated to neck, jaw, shoulders
Quality: Pressure, squeezing, tightness, heaviness, burning, indigestion
Duration: <2-10 Min
Aggravating or Alleviating Factors: Precipitated by exertion, cold weather, emotional stress
Relieved by rest or nitroglycerin
Variant (Prinzmetal): Angina may be unrelated to exertion often early in the morning
Associated symptoms or signs: Dyspnea, S3, S4, Murmur of papillary dysfunction during pain

3

STEMI Progression on ECG

Immediate before MI: T-wave inversion
Within hours of MI: ST elevation + Upright T-wave
Hours later: Significant Q + ST elevation + Upright T-wave
1-2 Days Later: Significant Q + Less ST elevation + Marked T inversion
Days to weeks later: Significant Q + T-wave inversion
Permanent: Significant Q

4

Elevation in which ECG leads indicates STEMI in the:

Inferior Wall?
Lateral Wall?
Anterior Wall?

Which arteries are associated with each?

Inferior - II, III, aVF: Right Coronary Artery
Lateral - V5/6, I, aVL: Left Circumflex Artery
Anterior: V2-V4: LAD

5

What is the gold standard of coronary imaging?
What lesion size is considered significant?

Angiography is the gold standard
Lesions > 70% blockage are significant

6

What do beta-blockers do for MI?

BIG ONE:
Decreased O2 demand due to HR reduction, BP drop, and contractility drop
Relief of ischemic chest pain

Others:
Decreased risk of ventricular fibrillation
Decreased automaticity, increased electrophysiologic threshold for activation, and slowing of conduction
Prolongs diastole, improving coronary perfusion
Remodeling and improvement in left ventricular hemodynamic function, depending upon infarct size and timing of treatment
Improved left ventricular diastolic function with less restrictive filling pattern
Reduces mortality MI risk by 23%
Slows progression of coronary atherosclerosis
Improved LV diastolic function with a less restrictive filling pattern

7

Which is the important receptor for beta-blockers in MI?
What are the most commonly used beta-blockers in MI?

Beta-1
Metoprolol, Carvedilol

8

What is the important effects of calcium channel blockers?
Which ones are typically used?

BP & Symptom Control
Diltiazem and Amlodipine

9

Is estrogen replacement a useful MI treatment?

No real evidence of it despite estrogen being protective for MI.

10

What are the two types of revascularization techniques?

Percutaneous coronary intervention (Balloon/Stent)
Surgical bypass

11

When is CABG preferable to PCI?

Left Main
Triple vessel
Double vessel w/ proximal LAD and LVEF < 50%
Diabetics

12

When should an implantable cardiac defibrillator be used?

If LVEF < 35% more than 40 days post-MI (or 3 months post-revascularization)