Coroanry Artery Disease And Angina (Johnston) Flashcards Preview

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

Flashcards in Coroanry Artery Disease And Angina (Johnston) Deck (40):
1

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

Supply

2

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

Demand

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

3

What are some mechanical consequences of ischemia?

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)

4

What are some biochemical consequences of ischemia?

FA's cant be oxidized

Increased lactate production

Reduced pH with metabolic acidosis

5

What are some electrical consequences of ischemia?

T wave inversion

Transient displacement of ST segment

Depression-Subendocardial

Elevation-Subepicardial

Electrical instability; VT, VF

6

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

V1-V7 (Johnston slide)

7

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

II, III, aVF; V3R-V6R

8

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

I, aVL, V5-V6

9

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

V1-V3

10

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

NSTEMI

11

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

RCA lesion

12

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

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

13

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

Anginal equivalent

14

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:

Diabetic
Elderly
Women

15

What are some signs of risk factors for angina?

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

16

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

Aortic stenosis
Aortic insufficiency
Pulmonary HTN
Hypertrophic cardiomyopathy

17

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

Unstable angina

18

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

NSTEMI

19

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

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

20

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

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

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

Troponin I in 2-4 hrs

CK-MB after 3-6 hrs

22

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

Increased

23

What are some signs of high risk for coronary events?

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

When is stress testing contraindicated?

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

25

Nuclear myocardial perfusion imaging is useful in these pathologies:

LBBB
LVH
Digitalis effect

26

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

Stress ECG

27

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

CCTA

28

On CXR, what conditions will you see cardiomegaly?

HTN
VHD
Cardiomyopathy
Pericardial effusion

29

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

Coronary angiography (Cardiac catheterization)

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

30

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

Aspirin
B blocker
ACEi
Statins
Nitrates
CCB

31

When are B blockers contraindicated?

Decompensated HF, hypotension, advanced AV block

Can potentially make HF worse

32

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

Diabetic (renal protective) and pts with LV systolic dysfunction

33

What do nitrates do to preload?

Decrease preload (venodilation)

34

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

Verapamil

35

This CCB inhibits inward Na current and decreases intracellular calcium

Ranolazine

36

When should CABG be employed?

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

37

When should PCI be employed?

1 or 2 vessel disease

38

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

Transient ST elevation during chest pain in absence of severe CAD

39

What should you treat Variant/prinzmetal angina with?

DHP CCB --> Amlodipine

Relieved by nitro

40

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

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

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