Coronary artery Disease - Johnston Flashcards Preview

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Flashcards in Coronary artery Disease - Johnston Deck (24)
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1
Q

Main risk factors for atherosclerosis

A
  • Hyperlipidemia
  • smoking
  • DM
  • HTN
2
Q

Chronic stable angina is a consequence of imbalance between _

A
  1. lack of Oxygen supply ( coronary vasoconstriction, stenosis, platelets release serotonin and thromboxane A2)
  2. Increased O2 requirements (exercise, stress, emotion, fever, thyrotoxicosis, LVH due to AS, anemia.
3
Q

What are the three main disturbances due to ischemia? give examples of each.

A
  1. Mechanical consequence: HF, angina, MI, segmental akinesis/dyskinesis
  2. Biochemical consequnces (FA’s cant be oxidized, lactate production, decreased pH w/ metabolic acidosis
  3. Electrical consequences: inversion of T wave, transient displacement of ST segment, ST depression, /elevaation; electrical instability; VT, VF
4
Q
In what leads are you likely to see ischemia/MI due to:
A. LAD
B. RCA
C. Circumflex
D. Posterior descending
A

A. V1-V5
B. II, III, AVF, V3R-V6R
C. I, aVL; V5-6
D. V1-V3 (reciprocal ST depression)

5
Q

How is Non-STEMI recognized on EKG?

A

inverted T waves WITHOUT ST elevation

6
Q

New onset of S3 heard during angina or MI indicates _

A

impending LV dysfunction leading to heart failure

7
Q

58 yr old caucasian man presents with hx of chest pain described as heaviness and pressure in the retrosternal region. Pain radiates into the base of then eck and into jaw with some discomfort in the L arm. Pain started about 20 minutes. ON PE a systolic murmur was heard over apex with radiation into the left axilla. What is the significance of the murmur in this scenario? What artery is likely involved in the patient’s chest discomfort?

A

Murmur = mitral regurg due to dysfunction of papillary muscle during the chest pain.

RCA

8
Q

What are some cardiac causes of chest pain?

A
  • angina
  • MI
  • pericarditis
  • aortic dissection
  • associated with lung: pneumonia, pneumothorax, pleurisy
9
Q

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

A
  • Dyspnea
  • Mild epigastric or abd
  • diaphoresis
  • excessive fatigue and weakness
  • dizziness and syncope
10
Q

What do pts with any of skin abnormalities have in common: Xanthelasma,xanthomas, diabetic skin lesions, nicotine stains, pale appearing skin

A

Angina/ischemic heart disease.

Xanthelasma (soft yellow spots on eyelids associated with lipid depsoits)
Xanthomas - lipid deposits

11
Q

What four medical CV conditions that can mimic angina w/o CAD?

A
  • AS
  • AI
  • Pul HTN
  • Hypertrophic cardiomyopathy
12
Q

New or worsening chest pain more severe, prolonged, frequent, lasts longer than 20 mins each time with no myocyte necrosis or cardiac enzyme elevation indicates _

A

Unstable angina

13
Q

Chest pain, with elevated cardiac enzymes but no ST elevation indicates _

A

NSTEMI

14
Q

inverted T waves with severe chest pain indicates _

A

MI

15
Q

In unstable angina, he deep of ST segment depression indicates _

A

mortality rate.

1mm or greater in 2 or more leads = 4x likely to die within 1yr
2mm or greater= 6x likely to die within 1 yr
2mm or greater in more than one region of ECG = 10x likely to die within 1 yr

16
Q

What are 5 signs of high risk for coronary even during a stress test?

A
  1. Positive stress test at low work load
  2. ST depression greater than 5 min after completion of test
  3. Decrease in BP - systolic fall > 10mm Hg during exercise
  4. VT during exercise
  5. Reduced EF during exercise
17
Q

List some contraindications for a stress test

A
  • recent MI
  • Acute MI
  • Unstable arrhythmias,
  • acute PE
  • aortic dissection
  • Unstable angina
  • severe AS
    • decmpensated HF
  • endocarditis
  • DVT
18
Q

What kind of imaging are best for diagnosing LBBB, LVH, digitalis effect?

A

Nuclear myocardial perfusion imaging

19
Q

What kind of test is best for diagnosing wall motion abnormality and ejection fraction?

A

Stress ECHO

20
Q

What test is useful for detecting coronary calcification?

A
  • cardiac computer tomographic angiography
21
Q

What tests can be done to determine if a pt is a good candidate for Coronary artery bypass graft or percutaneous coronary intervention?

A

Coronary angiography

22
Q

Beta blockers are contraindicated or should be cautious during what CV issues?

A
  • decompensated heart failure
  • hypotension
  • advanced AV block
23
Q

CABG is a good tx consideration for what disease?

A

L main vessel disease or 3 vessel disease

24
Q

_ is the first choice of drug for patients with LV systolic dysfunction

A

ACEI