Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clinical Medicine Lecture - Professor Kramer > Cradio ppt. 1 - Exam 6 > Flashcards

Cradio ppt. 1 - Exam 6 Flashcards

(92 cards)

Start Studying
1
Q

Angina Types

A

Stable angina - w/ exertion

Unstable angina - @ rest

Coronary spasm:
Prinzmetal angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Angina Patho? Atherosclerosis

A
  • Atherosclerosis
  1. Lipid deposition
  2. Atheroma
  3. Calcification / fibrosis

Fat gets stucky and sits on the surface and accumulates -
HTN usually involved so we have high pressure hitting this hunk of lipids and it can rupture or embolism and then there is a tear in the endothelial and then body is going to repair ir and then platelets come in and try and fix it and then the entire vessel gets narrowed completely THAT IS WHY IT IS IMPORTNAT TO GIVE THESE PEOPLE ASA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Angina Patho? Coronary spasm

A

Spasm of coronary vessels

Cocaine or Prinzmetal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the most common cause of death in US and world?

A

Atherosclerosis - angina, MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Atherosclerosis /MI is _x higher in men than women?

A

4

By age 70, 1:1 male/female ( normalizing as men start to die)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Atherosclerosis /MI risk factors?

A

Age

Smoking

Total cholesterol >200 - elevated

Family history - did anyone in your family die a sudden
death ?

Diabetes mellitus - coronary
disease, PAD to coronary vessels

Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Common comorbidities with Atherosclerosis / MI ?

A

Hypertension
PAD
Aortic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

You need three of more of what for Metabolic syndrome? risk factor to angina and MI

A

abdominal obesity - central
obesity - waste circumference - >47 cm

triglycerides greater than 150 mg/dL

high-density lipoprotein (HDL) less than 40 mg/dL for men and less than 50 mg/dL for women

fasting glucose greater than 110 mg/dL

HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Angina / MI social Hx?

A

Alcohol

Cocaine vasospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Angina / MI Hx?

A

Chest pressure (squeezing) - “elephant on my chest “

Impending death - “ i feel like im going to die “

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chest pressure location for angina / MI?

A

midsternal or left chest (retrosternal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chest pressure location of radiation for angina and MI?

A

radiates by vertebral nerves

and to the JAW, SHOULDER, arms, wrists, back of hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Stable angina history?

A

occurs only with activity

lasts less than 3 minutes

Nitroglycerine significantly improves

sits down and goes away - hit them with nitro and then they have improvement - probably has like 30% occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Unstable angina history?

A

occurs at rest

lasts more than 30 minutes

Nitroglycerin improves, but not significantly

started stable but it got worse - atheroma is not about 50% - more an issue - nitro wont help as much

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Prinzmetal angina history?

A

More common in females and in the morning

issues in the heart and vessels but the pathophys is different

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Angina Physical exam findings?

A

May be normal

Levine sign - clenching chest

Hypertension

Tachycardia

Xanthelasma - fatty yellow deposits - indicating high cholesterol

always watch a patient VITALS! - do not ignore them - which risk management ( young can get toasted if you did not address abnormal vitals) - tachycardia does not just happen… it is trying to compensate for something - you always want to normalize the vitals if and before you send them home or to ED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diagnostic Studies for angina ?

A

Screening - EKG

Provocative screening - stress test

Gold standard test - Coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Options studies for angina ( definitive) ?

A

Myocardial perfusion scintigraphy

Radionuclide angiography

Echocardiography

Positron emission tomography

CT Angiography

MRI with gadolinium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Angina EKG findings?

A

25% normal

  1. ST segment depression
  2. T wave inversion
  3. Nonspecific T wave abnormalities

get any of these and we have to move on to more testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What angina diagnostic test is the most useful and cost effective and noninvasive?

A

Exercise stress test

may be done with medications like Dobutamine

high risk - chest pain, stenosis = no stress test here we go right to angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Angina - Exercise stress test positive findings?

A

1mm depression or greater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

For angina, which test is selectively used because of cost and invasiveness?

A

Coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is coronary angiography selected ?

A

Life-limiting stable angina despite tx

Unstable angina

Aortic valve disease

Suspected MI

Recurrent symtpoms after revascularization

Unknown cause of chest pain

Survivors of sudden death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Coronary angiography is the definitive test for what?

A

CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
<50% stenosis on coronary angiography indicates?
Mild
26
>50% stenosis on coronary angiography indicates?
Clinical significance
27
>70% stenosis on coronary angiography indicates?
Very significant - like to cause ischemia - stent is indicated
28
Optional test for angina that involve stress?
Myocardial perfusion scintigraphy Radionuclide angiography Echocardiography
29
Optional test for angina that is looking for perfusion and metabolism?
Positron emission tomography
30
Optional test for angina that is not for low risk individuals and will show a low likelihood of significant CAD to rule out disease?
CT angiography
31
What optional test is used to evaluate degree of damages for angina?
MRI with gadolinium
32
Angina prognosis?
1-25% mortality per year
33
Angina complications?
MI
34
Stable and Unstable angina tx for acute episode?
Nitroglycerin ( fast acting, sublingual)
35
Stable and Unstable angina tx for chronic management?
1. Aspirin- decrease chance of MI, improves mortality 2. Long acting nitrates - decreases episodes during day, but they become less affective over time (periods of break to keep affetc) 3. Beta blocker - improves mortality 4. Ranolazine- SCB - improves exercise capability - help with ability to exercise but still be careful cause it prolongs QT (liver disease) 5. Comorbidities ( treat these!) Statin - high cholesterol (low, moderate or high potency - for high risk) ACEI - for coronary disease + HTN 6. Revascularization - after trying all these above and still symptomatic at rest
36
Prinzmetal tx for acute episode?
Nitroglycerin
37
Prinzmetal tx for chronic management?
CCB - amlodipine
38
Patient education with angina?
Stop smoking treat comorbidity's like DM, HTN and hypercholesterolemia Lose weight if overweight : BMI <25 waist circumference <40 in males and <35 in females Aerobic exercise
39
Patient education diet LOW in what with angina?
Low saturated fat Low cholesterol Low trans fat
40
Patient education diet HIGH in what with angina?
Fiber Vegetables Fruits Whole grains
41
What treatment medication is most important long term and decreases mortality?
Beta blockers , along with ASA
42
When are ACE inhibitors indicated ?
Unstable angina CHF - cormobid
43
What medication do you want to avoid in CHF?
CCB
44
When are CCB indicated?
In place of BB or have already been maximized Dihydropyridine or nondihydropyridines - ejection fraction indicating CHF then avoid CCBs
45
When are CCB contraindicated?
with CHF
46
Platelet inhibitors example treatment for angina?
ASA Clopidogrel significant reduction in infarctions
47
What class is Ranolazine and when is it indicated?
it is a sodium channel blocker and it is used to help increase exercise tolerance
48
Revascularization options for angina?
PCI - percutaneous intervention CABG - coronary bypass bypass graft
49
Indications for PCI?
Unacceptable symptoms despite tx Unstable angina with ischemia despite tx Post-MI w/ continue angina
50
Indications for CABG?
Left main coronary stenosis >50% Three vessel disease w/ LV dysfunction ( EF <50%) - signs of heart failure from disease Restenosis of PCI
51
What is PCI?
Angioplasty OR Stent Stent - angioplasty plus a metal wiring that keeps it open - risk of collapse or showing a clot ( plane metal wiring = 30% restenosis) 10% with eluents on the wiring Plan = ASA + Clopidogrel once a month
52
What is CABG?
redirect another graft artery from mammalian (saphenous vein straight to the heart) the left internal thoracic artery (left internal mammary artery or "LIMA") is diverted to the left anterior descending (LAD) branch of the left main coronary artery.
53
MI patho?
Plaque rupture Thrombus Death of myocardial tissue
54
Types of MI?
NSTEMI - (Non ST segment elevation myocardial infarction) - hard to catch - why we admits these patients STEMI - (ST segment elevation myocardial infarction) - EKG within 10 min
55
MI hx?
last longer than 30 min most common during early morning
56
Elderly sx of MI?
generalized weakness syncope altered mental status
57
Atypical MI symptoms?
Diaphoresis - sweaty Dyspnea Nausea/ vomiting Weakness Anxiety/restlessness light-headedness Syncope Cough Orthopnea abdominal bloating
58
History of "silent MI" and occurrence?
1/3 of MI minor pain, often thought to be GI common if females and elderly
59
MI PE?
May be normal Levine sign Diaphoresis - more likely in someone with extremous - tells us something bad is going on Hypertensive Tachycardia Bradycardia New gallop (S3, S4 - stiff heart - chronic HTN, LVH) Mitral regurgitation ( mr. ass, ms. ard) these can all indicate extremous
60
MI PE if severe?
Hypotension Arrhythmia - V- fib Heart failure: JVD, Pulmonary edema
61
PE after MI?
Low grade fever Dressler syndrome : Pericardial friction rub
62
MI diagnostic studies - primary evaluation?
1. EKG 2. Troponin I 3. CXR 4. Coronary angiography - always with STEMI
63
Diagnostic studies to consider with MI?
Ck and CK-MB 9 creatine kinase - myoglobin Myoglobin Echocardiography
64
MI EKG findings with STEMI?
ST dement elevation 1mm or higher in 2 contiguous leads New LBBB
65
MI EKG findings with UA or NSTEMI?
ST-segement depression
66
What is the POST- MI progression on an EKG?
ST-segement elevations leads to Q-waves which leads to T-wave inversions develops over hours to days frowny face - convexity
67
STEMI in leads II, III, AVF, where is the MI location?
inferior
68
STEMI in leads V1 and V2, where is the MI located?
Posterior, anteroseptal
69
STEMI in leads V1 and V2, where is the MI located?
Anterospetal, posterior
70
STEMI in leads V2, V3 and V4, where is the MI located?
Anterior
71
STEMI in leads V5 and V6, where is the MI located?
Anterolateral
72
Troponin onset, peak and duration?
onset: 3-12 hours peak: 18-24 hours duration: 10 days
73
CK- MB onset, peak and duration?
onset: 3-12 hours peak: 18-24 hours duration: 36-48 hours
74
LDH onset, peak and duration?
onset: 6-12 hours peak: 24-48 hours duration: 6-8 days (5-10days)
75
Myoglobin onset, peak and duration?
onset: 1-4 hours peak: 6-7 hours duration: 24 hours
76
MI echo findings?
wall motion abnormality mitral regurgitation
77
MI CXR findings?
Likely normal screen for other conditions complications - Pulmonary edema
78
Gold standard for MI?
Coronary angiography
79
What is the most sensitive test to quantify the extent of MI?
MRI with gadolinium contrast
80
What measures severity of MI?
TIMI score - Thrombolysis In Myocardial Infarction
81
What are the factors of TIMI score to get a point?
> 65 years three or more risk factors for CAD use of aspirin within the last 7 days known CAD with stenosis 50% or greater more than one episode of rest angina within the last 24 hours ST-segment deviation elevated cardiac markers
82
What is considered high risk from TIMI score?
3 or more
83
MI prognosis?
20% mortality
84
MI complications?
Dressler syndrome - pericarditis after MI CHF
85
MI - STEMI plan: starting treatment?
MONA - consider M later 1. Oxygen NC 4L 2. ASA: 160-325 mg po 3. Nitroglycerin SUBL 4. Morphine IV - lower anxiety and vasodilation effect
86
Primary goal of MI- STEMI tx?
PCI within 90 min
87
Consider which medications for MI - STEMI? Me 2 medicines.
Heparin Clopidogrel GIIb/IIIa inhibitors Thrombolytics Beta blockers debated ( not in acute phase, they decrease blood flow, BB are important AFTER acute phase) GET THESE PEOPLE TO THE CATH LAB. STENT! within 90 min
88
MI - NSTEMI and UA conservative tx?
ASA clopidogrel Anticoagulation - LMWH Monitor for progression
89
For MI - NSTEMI and UA consider what treatments?
IV glycoprotein IIb/IIIa inhibitors like : Eptifibatide, Tirofiban
90
MI - NSTEMI and UA invasive treatment?
conservative plus.... cardiac catheterization
91
STEMI reperfusion tx?
Immediate angiography <90 min PCI better than thrombolysis
92
When do we use thrombolysis for STEMI? and what is it?
we only consider it when PCI is unavailable and it is Tissue plasminogen activator - alteplase, streptokinase

Clinical Medicine Lecture - Professor Kramer (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions