Coronary Heart Disease Flashcards
(288 cards)
1
Q
layers of an artery
A
tunica intima, tunica media, tunica adventitia
2
Q
atherosclerosis
A
pathologic process that causes disease of the coronary, cerebral, and peripheral arteries
3
Q
what causes focal thickening of the tunica intima?
A
foam cells
4
Q
foam cells
A
Macrophages that have consumed lipid, seen in atherosclerosis pathogenesis
5
Q
what type of inflammatory cell is present in a fatty streak?
A
T lymphocytes
6
Q
what initiates the formation of a fatty streak?
A
vascular injury
7
Q
what can develop if the plaque remains stable?
A
fibrous cap
8
Q
fibrous cap
A
dense, collagen-based layer of connective tissue that covers the well defined lipid core of a plaque
9
Q
function of a fibrous cap
A
- provides stability to the plaque
- walls off lesion and prevents blood from coming into contact with the lipid core
10
Q
what will happen if blood comes in contact with the lipid core?
A
clotting will occur and will eventually lead to occlusion of the vessel and ischemia
11
Q
function of microvessels
A
originate from the tunica adventitia of large arteries to provide oxygen and nutrients to the outer layers of the arterial wall
12
Q
as the atherosclerotic plaques expand, ….
A
they acquire their own microvasculature
13
Q
what can result from plaque rupture?
A
microvascular hemorrhage , leading to progression of atherosclerosis
14
Q
fibrous plaque develops as ________ accumulates
A
connective tissue
15
Q
what does the connective tissue of the fibrous plaque consist of?
A
lipid-containing smooth muscle cells and an extracellular lipid pool
16
Q
coronary arteries remodel in response to _____
A
atheroma formation
17
Q
positive remodeling
A
increased vessel size occurring early in CHD to compensate for plaque accumulation in an effort to reduce lumen loss
18
Q
symptoms of positive remodeling
A
unstable angina
19
Q
negative remodeling
A
results in vessel shrinkage
20
Q
symptoms of negative remodeling
A
stable angina
21
Q
intraplaque hemorrhage is a result of …
A
plaque neovascularization
22
Q
Intraplaque hemorrhage is a critical event that leads to …
A
- accelerated plaque progression
- instability
- ischemic vascular events
23
Q
what two factors contribute to the pathogenesis of atherosclerosis?
A
- lipids
- inflammation
24
Q
initial step in the development of atherosclerosis
A
endothelial vasodilator dysfunction
25
why does endothelial vasodilator dysfunction occur?
loss of endothelial-derived nitric oxide
26
the endothelial vasodilator dysfunction process is precipitated by ...
oxidized LDL
27
endothelial dysfunction is associated with...
* hyperlipidemia
* diabetes
* HTN
* cigarette smoking
28
ways to improve endothelial vasodilator dysfunction
* correct HLD
* Give ACEi for HTN
29
role of inflammation in atherosclerosis
* macrophages eat oxidized LDL
* this releases inflammatory substances, cytokines, and growth factors that lead to further plaque proliferation
30
chronic inflammation leads to .... plaques and acute inflammation leads to .... plaques
stable; unstable and ruptured
31
atherosclerosis is asymptomatic until ......% of the vessel become occluded
70-80
32
2 processes of plaque progress
* chronic: slow luminal narrowing
* acute: rapid luminal narrowing associated with plaque hemorrhage or luminal thrombosis
33
plaque erosion
occurs in the absence of rupture when endothelium is missing at the plaque site
34
t/f plaque rupture and erosion may be asymptomatic
true
35
effects of atherosclerosis
* coronaries --> MI and angina
* CNS ---> stroke
* periphery---> limb ischemia and poor healing
* renal---> RAS
* GI---> mesenteric ischemia
36
#1 cause of death in US
cardiovascular disease
37
risk equivalents for CHD
a group of diseases that a person could have that allows you to assume that the patient also has CHD so you can treat them as such
38
examples of risk equivalents for CHD
* symptomatic carotid artery disease
* PAD
* AAA
* DM
39
modifiable risk factors for CHD
* smoking
* HLD
* HTN
* DM
* obesity
* sedentary lifestyle
40
unmodifiable risk factors for CHD
* premature CHD in a 1st degree relative
* age
* male sex
41
what is considered premature age for CHD?
under 55 in men and 65 in women
42
what age is considered a risk factor for CHD?
men: 45
women: 55
43
#1 preventable cause of death and illness in the US
smoking
44
after 1 year of quitting smoking, risk of CHD can decrease by ......%
50
45
smoking promotes atherosclerosis by...
* increasing platelet adhesiveness
* raises endothelial permeability
* SNS stimulation by nicotine
46
risk of atherosclerosis increases as .... increases and ..... decreases
LDL;HDL
47
hypertension causes ..... to the arterial wall
mechanical injury
48
endothelial injury resulting from persistent high BP leads to ...
plaque formation
49
at least 65% of people with diabetes die from ...
some sort of heart or blood vessel disease
50
atherosclerosis has higher incidence and severity in .....
men
51
why are women at lower risk, but their risk increases after menopause?
estrogen has protective qualities, and when you hit menopause, you have a decline in estrogen levels
52
when do fully developed atheromatous plaques usually appear?
40s and beyond
53
....... predispose individuals to high blood lipid levels
hereditary genetic derangements of lipoprotein metabolism
54
what race is higher risk for atherosclerosis and CHD?
african american
55
how to risk stratify for CHD?
ASCVD 10 risk
56
screening for AAA
men aged 65-75 who have ever smoked need screened once
57
Aspirin use recommendations
should not give to CVD patients over 60
58
BP screening recommendations
screen everyone 18 and older at every visit
59
screening for DM
screen in adults 35-70 who are overweight or obese
60
what are the first things ordered when a patient comes in with chest pain?
* EKG
* cardiac enzymes
61
indications for EKGs
* used to assess for heart conditions
* all adults with chest discomfort without an obvious non-cardiac cause
* routinely ordered in elderly, DM, and syncopal patients
62
in patient's with symptoms, and EKG should be done within ____ minutes if the patient's arrival to the facility
10
63
if the initial EKG is not diagnostic but the patient remains symptomatic ...
get serial EKGs every 15-30 minutes for the first 2 hours
64
earliest present of an acute MI
hyperacute T waves
65
t/f hyper acute t waves in an MI are commonly seen in clinical practice
false. they only exist for 20-30 minutes after onset of infarction so they are not often in the facility at that point
66
ST depression and t wave inversion in 2 continuous leads makes you suspicious of a ...
NSTEMI
67
ST elevation makes you suspicious of a ...
STEMI
68
cardiac enzymes evaluate for ...
myocardial damage
69
troponin
contractile protein that normally is not found in the serum and is only released when myocardial necrosis occurs
70
most sensitive and specific cardiac biomarker
troponin
71
timeline of troponin levels
* increase within 3-6 hours
* peak at 24-48 hours
* return to baseline over 5-14 days
72
when do you measure troponin levels ?
* at presentation
* at 90 minutes
* every 6-8 hours after symptom onset x3
* or until trending down
73
....have more weight than a single reading for cardiac enzymes
trends
74
normal troponin level
0
75
CK-MB timeline
* increase 4-6 hours after injury
* peak around 24 hours
* remain elevated for 36-48 hours
76
positive CK-MB
if CK-MB is >5% of total CK and 2x normal
77
false positives for CK-MB
* exercise
* trauma
* muscle disease
* DM
* PE
78
CK-MD is .... sensitive and specific than troponin
less
79
myoglobin has ... sensitivity and .... specificity
high; poor
80
fastest released cardiac enzyme
myoglobin
81
myoglobin can be detected as early as ..... after an MI
2 hours
82
most sensitive early marker for MI
myoglobin
83
LDH for MI detection
not specific
84
possible lab findings of MI
* leukocytosis
* elevated CRP
* elevated ESR
85
why is there leukocytosis in an MI?
under stress so white count will elevate
86
patients without biochemical evidence of myocardial necrosis but with ...... are at risk of a subsequent ischemic event
elevated CRP
87
most commonly used and recommended initial noninvasive procedure for evaluating ischemia
stress test
88
2 methods of a stress test
* exercise
* pharmacologic
89
exercise stress tests are the preferred form of stress for what type of patients?
patients who can attain an adequate level of exercise
90
how do you determine if a patient can attain an adequate level of exercise?
if a person can walk for 5 minutes on flat ground or up 1-2 flights of stairs without needing to stop
91
indications for exercise stress test
* confirm diagnosis of angina
* determine severity of angina
* assess prognosis
* evaluate response to therapy
92
limitations of exercise stress test
-more false positives
93
exercise stress tests are most useful in...
patients with low pretest likelihood and a normal EKG
94
goal HR of exercise stress test
85% max
95
max HR
220-age
96
the intensity of exercise is periodically increased, continuing until...
* patient reaches max HR
* changes in heart function are detected on the EKG
* patient is symptomatic
97
positive exercise stress test
ST depression of 1 box
98
indications for terminating exercise stress test
* sustained ventricular tachycardia
* ST elevation in leads without diagnostic Q waves
99
CI to exercise stress test
* MI within 2 days
* high risk unstable angina
* uncontrolled arrythmias
* severe symptoms
* PE
* pericarditis
* aortic dissection
* HF
* baseline abnormalities on the EKG
100
indications for stress test with imaging component
* when the resting EKG makes an exercise EKG difficult to interpret
* localize a region of ischemia
101
exercise stress test with nuclear imagine
provides relative perfusion data following injection of a radioactive material before a stress test and then after a stress test
102
SPECT
* provides slices of the heart for imaging
* enable imaging of wall motion and estimation of EF
103
stress echo
Utilizes a echocardiogram along with an exercise stress test to increase the sensitivity and specificity of the stress test
104
what are you looking for in a stress echo?
* regional wall motion abnormalities
* LV dilation
105
pharmacologic stress test
used when a patient is unable to exercise to a sufficient cardiac workload or has a CI
106
pharmacologic stress tests are always combined with....
an imaging modality
107
preferred pharmacologic stress test agent
vasodilators (adenosine, dipyridamole, regadenoson)
108
CI of using vasodilators for pharm stress test
bronchospasm
109
2nd line for pharm stress test
adrenergic stimulating agents
110
coronary angiogram/cardiac catheterization uses
* evaluate or confirm the presence of coronary artery disease, valvular disease, or aortic disease
* evaluate heart muscle function
* determine the need for further treatment
111
right heart Cath is useful in...
pulm HTN
112
left heart Cath is used to assess...
cardiac valves and LV function
113
prep for coronary angiogram
* NPO 4-6 hours
* IV NS for 24 hours to flush out contrast
* hold metformin for 48 hours
114
ventriculogram
x-ray image of the ventricles
115
indications for coronary angiogram
* life limiting stable angina
* high pretest likelihood
* emergent for STEMI
116
relative CI to coronary angiogram
* renal disease
* allergy to contrast
117
risks of coronary angiogram
* stroke
* coronary artery dissection
* hemorrhage
* AKI
* femoral pneudoaneurysm
118
CXR for IHD
* useful to identify pulm causes of chest pain
* see mediastinal widening with aortic dissection
119
chest CT with IV contrast can help exclude ...
PE and aortic dissection
120
Transthoracic echo can be helpful in detecting...
* effusions
* wall motion abnormalities
* aortic dissections
121
HR for CT of coronary arteries
below 50
122
if the CT of coronary arteries is positive, what should follow up?
cardiac cath
123
first line therapy in patients with acute coronary syndrome
nitrates
124
MOA of nitrates
nitrate enters vascular smooth muscle and is converted to nitric oxide, leading to activation of cGMP and vasodilation
125
SE of nitrates
reflex tachycardia
126
long acting nitrites
isosorbide
127
purpose of long acting nitrites
used for long term prophylaxis of angina
128
method of nitrate administration
non-parenteral
* SL
* topical
* IV (if pain persists or recurs)
129
AE of nitrates
HA
130
tolerance of nitrates
prolonged treatment of nitrates may induce a loss of response and decrease angina threshold
131
CI of nitrates
combination of nitrates and PDE5 inhibitors due to cGMP accumulation and dramatic reductions in blood pressure
132
action of morphine for MI
* decreases sympathetic tone
* decreases vascular resistance
* decrease O2 demand
133
use morphine with caution in ...
hypotension, hypovolemia, and respiratory depression
134
aspirin therapy for MI
give high dose aspirin (chewed) to all MI patients to reduce mortality
135
use aspirin with caution in ...
* active PUD
* hypersensitivity
* bleeding disorders
136
after you treat the acute MI with high dose aspirin...
go back to 81mg for long term management
137
..... is used in support of Cath/stent or if unable to take ASA
p2y12 inhibitors
138
how long toes p2y12 therapy need to last?
* 3-12 months
* mostly 12
* 3 is it is an isolated event that we can determine the cause
139
elective CABG and p2y12 dose
* plavix and brilinta: postpone for 5 days after last dose
* efficient: postpone for 7 days after the last dose
140
Glycoprotein IIb/IIIa inhibitors inhibits platelet aggregation at ......
final common pathway
141
.....is used in combo with ASA
heparin
142
..... is more effective than unfractionated heparin in preventing recurrent ischemic events
LMWH
143
.....should be started 24-48 hours after an MI once a patient is stable
beta blockers
144
BB reduce ...
* infarct size and complications
* rate of re-infarction
* rate of life threatening tachyarrythmias and thus reduce mortality
* cardiac remodeling
145
MOA of ranexa
late Na channel blocker, decreases intracellular calcium overload
146
indication of ranexa
stable angina
147
advantages of ranexa
* no effect on HR or BP
* safe to use with ED drugs
148
SE of ranexa
prolonged QT interval
149
you see an increase in ..... post MI
ACE
150
use of ACE/ARBs .... at the scar site and remote to the infarct
reduce fibrosis and remodeling
151
t/f ACE/ARBs can help preserve myocardium in the setting of an MI
true
152
other pharm that can help in IHD
* Statins start immediately following diagnosis of acute coronary syndrome
* warfarin: thrombus history
* aldosterone antagonists: for selected patients with LV dysfunction
153
t/f CCB are first line vasodilators for IHD
false. not shows to favorable affect outcome
154
fibrinolytic therapy is used for ..... only
STEMI
155
SE of fibrinolytic
bleeding
156
anticoagulation post fibrolytic infusion
aspirin and anticoagulation (LMWH) should be continues until revascularization or for the duration of the hospital stay
157
when should you use fibrolytic therapy?
If and only if, cardiac Cath can't be done within a few hours of the ischemic event
158
goal is to initiate fibrinolytic therapy within ......
30 minutes of arrival in ED
159
the greatest benefit occurs if fibrinolytic treatment is initiated within the ....
first 3 hours after onset of presentation
160
all patients with STEMI treated with fibrinolytic should be started on prophylactic .....
PPIs
161
CI of thrombolytic therapy
* any prior intracranial hemorrhage
* any trauma within the last 3 months
162
benefit of PCI (stents) are seen in...
unstable disease
163
stents are more effective than ..... for opening occluded arteries
thrombolysis
164
following PCI, patients should receive...
DAPT (ASA + P2y12) for 3-12 months
165
balloon angioplasty
inflation of a balloon within the coronary artery to compress plaque against the walls of the artery and open the lumen
166
stent angioplasty
similar to balloon angioplasty but involves the use of a small expandable mesh-like tube of thin wire along with the balloon
167
bare metal stents
vascular stent without a coating
168
drug-eluting stents
stent that slowly releases a drug to block cell proliferation
169
preferred stent used in PCI
drug-eluting stent
170
DAPT with drug eluting stents
requires a longer period of DAPT to prevent stent thrombosis so they aren't appropriate for all patients
171
atherectomy
specialized catheter for mechanical removal of plaque from the arterial walls
172
CABG
procedure in which arteries or veins harvested from elsewhere in the body and are grafted to the coronary arteries to bypass atherosclerotic narrowing and improve blood supply to the myocardium
173
CABG is preferred method for revascularation in patients with ...
* left main trunk artery stenosis
* poor LV function
174
On pump vs off pump CABG
on pump: connected to machine that stops the heart and perfuses the body
off pump: heart is still beating
175
Enhanced External Counterpulsation
noninvasive procedure performed on individuals with angina or HF or cardiomyopathy inn order to diminish symptoms of ischemia, improve functional capacity, and quality of life
176
goal of Enhanced External Counterpulsation
reduce cardiac workload and improve blood flow to the heart
177
results of Enhanced External Counterpulsation
relieve angina and decrease the degree of ischemia in a cardiac stress test
178
workup of stable angina
* cardiac enzymes
* EKG
* CBC to rule out anemia
* screen for risk factors
* determine pretest liklihood
179
resting EKG in stable angina
typically normal
180
low to intermediate pretest probability of stable angina
noninvasive stress testing
181
if the stress test in normal...
treat symptoms
182
if the stress test is abnormal ...
refer to cardio and for possible cardiac cath
183
high pretest probability of stable angina
refer for cardiac cath
184
management of stable angina
* manage sx (NTG, BB, CCB, ranexa, revascularization)
* prevent CV events (modify risk factors and anti platelet therapy)
185
prinzmetal angina involves spasm of the coronary arteries, which leads to ...
decreased coronary blood flow
186
what may cause onset of prinzmetal angina ?
* spontaneous
* cold exposure
* emotional stress
* vasoconstriction medications
187
...._ can occur as a result of spasm in the absence of visible instructive CHD
MI
188
......may induce myocardial ischemia and infarction by causing coronary artery vasoconstriction or by increasing myocardial energy requirements
cocaine
189
presentation of prinzmetal angina
* chest pain w/o usual precipitating factors
* ST elevation
* early morning
* no CAD on cardiac cath
190
management of prinzmetal angina
* emergent coronary arteriography (cath)
* nitrates
* CCB
191
order of management of acute coronary syndrome
* ASA
* NTG
* O2 (if needed)
* morphine
192
management of unstable angina and NSTEMI
* admit to hospital
* cardiac monitoring
* O2 if needed
* NTG
193
Primary PCI should be performed w/in .... mins of MI presentation?
90
194
thrombolysis should be administered within ..... of hospital presentation and ..... after onset of symptoms
30 minutes; 6-12 hours
195
all patients with a suspected STEMI should recieve...
* high dose ASA regardless of whether fibrinolytics are being considered or if low dose ASA has already been given
* reperfusion therapy (PCI or fibrinolytic)
196
manifestations of ischemic complications
* angina
* reinfarction
197
manifestations of mechanical complications
* HF
* MV dysfunction
* cardiac rupture
198
manifestations of arrhythmic complications
atrial or ventricular arrhythmias
199
manifestations of arrhythmic complications
atrial or ventricular arrhythmias
200
manifestations of embolic complications
stroke
PE
201
manifestations of inflammatory complications
pericarditis
202
Dressler's syndrome
pericarditis post MI or CABG
203
etiology of Dressler's syndrome
caused by an immune system mediated inflammatory response following damage to heart tissue or the pericardium
204
how long does dressers syndrome occur post MI?
1-12 weeks
205
symptoms of Dressler's syndrome
CP and fever
206
presentation of RV infarct
* hypotension
* preserved LV function
207
RV infarctions present in 1/3 of patients with ...
inferior wall infarction
208
treatment of RV infarction
treat hypotension with IV NS and inotropic agents (Epi)
209
MC location for ventricular free wall rupture
anterior or lateral wall of LV
210
ventricular free wall rupture is associated with ...
* elderly
* poor collateral circulation
* first MI
211
ventricular free wall rupture occurs commonly within .... post MI
24 hours
212
mortality rate is .... for free wall ruptures
extremely high
213
how may ventricular free wall rupture present?
* pericardial effusion
* pulseless electrical activity
214
post MI ventricular septal defect is associated with ... MIs involving the ...
transmural; septum
215
MV regurg is a rare complication of MI due to...
ruptured papillary muscle
216
presentation of MV regurg due to ruptured papillary muscle
sudden onset decompensation HF
217
LV aneurysm puts patient at a high risk for ....
rupture
218
changes involved in cardiac event recovery
* diet
* exercise
* addition of appropriate meds
* increased frq of follow up care visits
219
discharge instructions for cardiac event
* education on meds, diet, exercise, and smoking
* referral to cardiac rehab
220
follow up for cardiac event
* follow up with cardio and PCP
* low risk: 4-6 weeks
* high risk: 1-2 weeks
221
dietary changes post-MI
* limit the intake of saturated and trans fatty acids, free sugars, and salt
* increase intake of fruits, veggies, legumes, nuts, and whole grains
222
exercise post MI
* work up to 150 minutes of moderate intensity exercise per week or 75 minutes of high intensity exercise per week
* aerobic exercise
223
psych issues following an MI
* debility
* activity/recreation
* depression
* sexual activity
* work/driving
224
cardiac blues
strong emotional reaction at the time of or soon after an acute cardiac event
225
consequences of depression post-MI
* emotional distress
* increased risk of another MI
* poorer prognosis
226
sexual activity post-MI
* uncomplicated: wait 1 week
* complicated: 2-3 weeks
* must be asymptomatic
227
cardiac rehab
improves cardiac function and reduces mortality / development of complications
228
3 aspects of cardiac rehab
* exercise
* education to help reduce risk factors
* counseling to help patients deal with stress, anxiety, and depression
229
Most common, serious, chronic, life-threatening illness in the US
IHD
230
....% of the population has sustained an MI
3-4
231
MC risk factors for IHD
* genetics
* smoking
* sedentary lifestyle
* poor diet
232
pathogenesis of IHD
demand for blood by the coronary arteries is greater than the supply
233
oxygen supply is determined by the....
blood flow
234
blood flow is regulated by ...
pressure vs resistance ratio
235
most critical factor in oxygen supply
the radius of the blood vessel
236
what can influence the radius of the blood vessel?
* atherosclerosis
* vascular tone
* endothelial cell dysfunction
237
4 different types of IHD
* prinzmetal angina
* stable angina
* unstable angina
* MI (STEMI or NSTEMI)
238
Prinzmetal angina
drop in blood flow through the coronary arteries caused by a vasospasm in the artery, not by atherosclerosis
239
stable angina
chest pain that occurs when a person is active or under severe stress
240
unstable angina
chest pain that occurs while a person is at rest and not exerting himself
241
what does unstable angina result from?
results from plaque rupture and thrombus formation, but is not occluding blood flow
242
NSTEMI vs STEMI
STEMI: ST elevation and q waves
NSTEMI: ST depression and inverted t waves
243
what does NSTEMI result from?
plaque rupture and thrombus formation that partially impedes blood flow through the coronary vessels
244
what does a STEMI result from?
plaque rupture and thrombus formation that completely impedes blood flow through the coronary vessels
245
characteristics of stable angina
-predictable
-lasts 1-15 minutes
-goes away with rest or NTG
246
characteristics of stable angina
* predictable
* lasts 1-15 minutes
* goes away with rest or NTG
247
characteristics of unstable angina
* unexpected
* goes not go away with rest for NTG
* warning sign of an MI and is an emergency
248
ischemia presents as soon as there is a...
decrease in blood supply to the myocardial tissue
249
cardiac cells can tolerate .... for a short time
mild-moderate anoxia
250
prognosis of ischemia, injury, and infarct on the myocardial cells
* ischemia: cells usually return to normal after blood supply is returned
* injury: damage is reversible and may return back to normal but it also may not
* infarct: cells sustain irreversible injury and die
251
MI
irreversible myocardial injury resulting in necrosis of a portion of the myocardium
252
Acute MI suggests the infarct is .... days old
3-5
253
most severe and complicated type of infarct
transmural: goes through the entire wall of the myocardium
254
area of involvement of a NSTEMI
small area in the subendocardial wall of the LV, ventricular septum, or papillary muscle
255
what part of the myocardium is typically damaged first?
subendocardial area
256
area of injury for a STEMI
extends through the whole thickness of the heart muscle
257
a STEMI is associated with with atherosclerotic plaques in a coronary artery that causes ......
complete occlusion
258
nickname for ST elevation
tombstoning
259
type 1 MI
Spontaneous MI related to ischemia due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection
260
Type 2 MI
MI secondary to ischemia due to either increased oxygen demand or decreased supply
261
examples of type 2 MI
* coronary artery spasm (primzmetal)
* coronary embolism
* anemia
* HTN
262
type 3 MI
sudden cardiac death
263
type 4 MI
Mi associated with coronary angioplasty or stents
264
type 5 MI
Associated with CABG
265
silent ischemia is MC in ..
elderly, women, diabetics
266
myocardial stunning
reversible myocardial dysfunction following re-perfusion of an ischemic insult
267
hibernating myocardium
result in prolonged reduction in blood flow from coronary artery disease and causes ventricular contractile dysfunction that will improve after blood flow improves
268
artery associated with inferior wall MI
right coronary artery
269
artery associated with anterior wall MI
LAD
270
artery associated with lateral wall MI
Left circumflex artery
271
artery associated with posterior wall MI
posterior descending branch of the right coronary
272
artery associated with septal wall MI
LAD
273
inferior wall MI is often accompanied by a ____ due to involvement of the sinus node
decreased HR
274
effects of an anterior wall MI
affects the main pump so it can lead to decreased HR and BP and eventually HR
275
typical presentation of an MI
* episodic chest discomfort
* heaviness
* pressure
276
location of pain for an MI
* substernal
* can radiate to the left arm/shoulder, neck, jaw, back/scapula
277
duration of MI chest pain
2-5 min
278
setting of MI chest pain
typically with exertion
279
aggravating factors for MI chest pain
* exercise
* meals
* stress
* cold exposure
* sex
* morning
280
alleviating factors for MI chest pain
NTG
Rest
281
....test may be less accurate in women
stress test
282
how is prinzmetal angina treated?
CCB and nitrates to vasodilate
283
MC population to get prinzmetal angina
middle aged women
284
important PE assessments for IHD
* vitals
* heart and lung sounds
* neuro
* psych
* abdominal
285
everyone with chest pain CC gets a ..... and .....
EKG
cardiac biomarkers
286
TMI risk score
used to risk stratify patients to help determine who should undergo aggressive evaluation/treatment
287
risk on TMI scale
low risk: 0-2
intermediate risk: 3-4
high risk: 5 or more
288
risk on HEART scale
low: 0-3
intermediate: 4-6
high: 7 or more
