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Cardiovascular Medicine-Unit 2 > Coroanry Artery Disease And Angina (Johnston) > Flashcards

Coroanry Artery Disease And Angina (Johnston) Flashcards

1
Q

Coronary vasoconstriction, stenosis, platelets releasing 5-HT and TxA2 are examples of __ angina

A

Supply

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2
Q

Exercise, stress, emotion, fever, and thyrotoxicosis can cause ___ angina

A

Demand

Can also add in LVH d/t AS and ANemia (low O2 carrying capacity)

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3
Q

What are some mechanical consequences of ischemia?

A

Heart failure (LVF or RVF or both)

Angina, if ischemia is prolonged or develop coronary occlusion, may lead to myocardial necrosis

Segmental akinesis, bulging (dyskinesis)

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4
Q

What are some biochemical consequences of ischemia?

A

FA’s cant be oxidized

Increased lactate production

Reduced pH with metabolic acidosis

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5
Q

What are some electrical consequences of ischemia?

A

T wave inversion

Transient displacement of ST segment

Depression-Subendocardial

Elevation-Subepicardial

Electrical instability; VT, VF

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6
Q

Anterior wall infarction d/t LAD is best seen in what leads?

A

V1-V7 (Johnston slide)

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7
Q

Inferior wall infarction (RV infarction) d/t RCA is best seen in what leads?

A

II, III, aVF; V3R-V6R

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8
Q

Lateral wall infarction d/t left circumflex artery is best seen in what leads?

A

I, aVL, V5-V6

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9
Q

Posterior wall infarction d/t posterior descending a. (RCA branch) is best seen in what leads?

A

V1-V3

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10
Q

T wave inversion seen in diffuse myocardial ischemia is known as ___

A

NSTEMI

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11
Q

Mitral regurgitation d/t dysfunction of papillary muscle is usually indicative of this lesion:

A

RCA lesion

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12
Q

What are some non chest pain symptoms of chronic ischemic heart disease?

A 
Dyspnea
Non chest locations of discomfort (exertional or rest)
Mid-epigastric or abdominal
Diaphoresis
Excessive fatigue and weakness
Dizziness and syncope
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13
Q

___ is d/t ischemia, but described as dyspnea, fatigue, faintness and gastric eructation’s (belching).

A

Anginal equivalent

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14
Q

The pathogenesis of Anginal equivalent is due to ischemia causing an elevated LV filling pressure that leads to pulmonary edema and seen in these types of pts:

A

Diabetic
Elderly
Women

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15
Q

What are some signs of risk factors for angina?

A 
Xanthelastama (soft, yellowish spots on eyelids)
Xanthomas
Diabetic skin lesions
Nicotine stains
Pale
Absent peripheral pulses
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16
Q

What conditions can mimic angina in the absence of Coronary Artery Disease?

A

Aortic stenosis
Aortic insufficiency
Pulmonary HTN
Hypertrophic cardiomyopathy

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17
Q

The symptoms of this pathology is characterized by New or Worsening chest pain where the tempo has changed, its more severe, prolonged, and more frequent. It may occur at rest and cause the pt to awake from sleep and the pain can last longer than 20 minutes. This type of pt has to use more medication for relief and there is no evidence of myocyte necrosis

A

Unstable angina

18
Q

Chest pain with elevation of cardiac enzymes and without elevation is said to have a ___

A

NSTEMI

19
Q

During an anginal attack (stable angina), what is the most common change seen on EKG?

A

Most common change is ST depression (subendocardial injury-ischemia). May also show old MI

20
Q

In unstable angina/NSTE ACS, what correlates with prognosis?

A

Magnitude of ST segment depression

If ST depressed 1 mm or greater in 2 or more leads- almost 4x likely to die within 1 year

If 2 mm or greater ST depression, almost 6x likely to die within a year

If ST depression > 2 mm or more in more than 1 region of ECG, mortality is 10-fold

21
Q

When is troponin I detected in NSTEMI? CK-MB?

A

Troponin I in 2-4 hrs

CK-MB after 3-6 hrs

22
Q

What BNP levels (increased/decreased) are associated with increased mortality in NSTE ACS?

A

Increased

23
Q

What are some signs of high risk for coronary events?

A

Positive stress test at low work load
ST depression greater than 5 min after test completion
Decrease in BP- systolic fall > 10 mm Hg during exercise
VT during exercise
Reduced EF during exercise (stress echo)

24
Q

When is stress testing contraindicated?

A 
Recent MI or acute MI
Unstable arrhythmias 
Acute PE
Aortic dissection
Unstable angina
Severe aortic stenosis
Decompensated HF
Endocarditis
DVT
25
Q

Nuclear myocardial perfusion imaging is useful in these pathologies:

A

LBBB
LVH
Digitalis effect

26
Q

This test is done with exercise or dobutamine and detects wall motion abnormality and EF

A

Stress ECG

27
Q

This test can detect coronary calcification and specificity only 50% in identifying pts with obstructive CAD

A

CCTA

28
Q

On CXR, what conditions will you see cardiomegaly?

A

HTN
VHD
Cardiomyopathy
Pericardial effusion

29
Q

What is the gold standard test for the anatomic definition of CAD?

A

Coronary angiography (Cardiac catheterization)

PCI-90% successful; stent insertion
CABG-for L main disease or 3 vessel disease

30
Q

What are some pharmacological therapies to prevent MI/death/reduce symptoms?

A 
Aspirin
B blocker
ACEi
Statins
Nitrates
CCB
31
Q

When are B blockers contraindicated?

A

Decompensated HF, hypotension, advanced AV block

Can potentially make HF worse

32
Q

ACEi can be useful in decreasing cardiovascular mortality in these types of pts:

A

Diabetic (renal protective) and pts with LV systolic dysfunction

33
Q

What do nitrates do to preload?

A

Decrease preload (venodilation)

34
Q

This CCB decreases has a negative inotropic effect and should be used with caution

A

Verapamil

35
Q

This CCB inhibits inward Na current and decreases intracellular calcium

A

Ranolazine

36
Q

When should CABG be employed?

A

For L main or 3 vessel CAD multiverse with LV EF < 50%

37
Q

When should PCI be employed?

A

1 or 2 vessel disease

38
Q

What does the ekg show in variant angina or prinzmetal angina?

A

Transient ST elevation during chest pain in absence of severe CAD

39
Q

What should you treat Variant/prinzmetal angina with?

A

DHP CCB –> Amlodipine

Relieved by nitro

40
Q

What is the risk of plaque rupture in chronic stable angina?

A

Low risk of plaque rupture (small lipid core and thick fibrous cap)

Chronic stable angina=consequence of imbalance between O2 supply-demand

Cardiovascular Medicine-Unit 2 (11 decks)

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