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Block 9; Week 1 & 2-M > EBM-ACS > Flashcards

EBM-ACS Flashcards

(47 cards)

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1
Q

What is prevalence?

A

how many people have it right now

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2
Q

What is incidence?

A

how many people will get it

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3
Q

What is the average age of onset of CAD for men & women?

A

men: 62
women: 72

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4
Q

What is atherosclerosis?

A

deposits of lipids, macrophages, calcifications in arteries leading to plaque formation

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5
Q

What is the cause of CAD?

A

atherosclerosis of coronary arteries-lumens narrow–compromised blood flow. Can rupture & get thrombosis, platelet cap, vessel occlusion.

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6
Q

What is the range of coronary artery disease?

A

asymptomatic
stable angina-transient reversible ischemia
acute coronary syndrome

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7
Q

What are the risk factors for CAD?

A 
Elevated plasma levels of low-density lipoprotein cholesterol (LDL-C)
Low plasma levels of high-density lipoprotein cholesterol (HDL-C)
Hypertension
Cigarette smoking
Diabetes mellitus
Age greater than 65 **
Male gender
Family history *
Obesity / overweight
Sedentary life style
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8
Q

When is family hx important?

A

1st degree relative
less than 55 in men CAD or CAD equivalent-stroke, MI, peripheral artery disease, diabetes
less than 65 in women

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9
Q

What is the most important risk factor?

A

age!!

over 65

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10
Q

What are the commonly used risk calculators?

A

Framingham Risk Calculators

ACC/AHA/ASCVD (New)–expands outcomes to stroke, MI, heart failure, accounts for ethnic diversity

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11
Q

What falls into ACS?

A 
acute coronary syndrome
STEMI
NSTEMI
unstable angina
underlying this: coronary artery disease
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12
Q

What is ACS?

A

Any group of clinical syndromes consistent with myocardial ischemia (or patients with symptoms suggesting an unstable cardiac condition due to ischemia)

It’s a spectrum of conditions resulting in myocardial ischemia including unstable angina (UA), NSTEMI and STEMI

Secondary (usually) to ruptured plaque or erosion of a plaque leading to thrombus formation and secondary partial or complete occlusion of the vessel

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13
Q

What is angina?

A

chest pain that is relieved by rest if stable
chest pain with rest if unstable
REVERSIBLE ISCHEMIA

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14
Q

What are other weird ways to get unstable angina?

A

out of the blue chest pain

increased severity after hx of stable angina

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15
Q

What are some EKG & lab findings that you may or may not find w/ unstable angina patients?

A

EKG: may or may not see T wave inversion or ST depression

Lab findings: won’t see messed up myoglobins or troponins b/c no myocardial necrosis.

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16
Q

How does NSTEMI differ from unstable angina?

A

looks the same clinically
EKG: st segment depression, T wave inversion
WILL see elevated biomarkers due to damaged myocardium

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17
Q

What do you see in STEMI?

A

EKG: ST segment elevation
at that point–get them to the cath lab
the biomarkers will also be elevated

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18
Q

What are sources of chest pain aside from ACS that could kill someone?

A

aortic dissection
PE
tension pneumothorax
esophageal rupture

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19
Q

What are some other non-MI causes of chest pain?

Study These Flashcards
A 
Pneumonia
Pleurisy
Pericarditis
Myocarditis
Hypertrophic cardiomyopathy
PUD
GERD
Esophageal spasm
Panic attack
Biliary or pancreatic disease
20
Q

What are the most important things to get from hx?

Study These Flashcards
A 
Nature of chest pain (PPQRST)
History of CAD
Gender/Sex
Age
Number of traditional risk factors for CAD
21
Q

What is a typical presentation of ACS?

Study These Flashcards
A

‘heavy’ or ‘pressure’ sensation in the sternum or epigastrium

Radiates to jaw, neck, throat, back or left arm

Lasts at least 15-20 minutes

Not relieved by rest

22
Q

What is an atypical presentation of ACS?

Study These Flashcards
A

sharp or stabbing pain

Pain reproduced by movement of arms or by touch

Pain that lasts for seconds

Pain described as heartburn or burning in nature

23
Q

What percentage of patients with ACS don’t present with chest pain?

24
Q

How do women w/ ACS typically present?

Study These Flashcards
A

pain in jaw, neck, back

25
T/F Relief by antacids or nitroglycerin are indicative of the diagnosis.
False. Nonspecific
26
T/F Pain to both shoulders makes ACS less likely.
False. More likely 7X!
27
What are some things that make ACS less likely when a patient has chest pain?
pleuritis chest pain chest pain reproduced by palpation sharp or stabbing chest pain positional chest pain
28
WHat is sppin & snnout?
specific test w/ a positive result rules in a disease | sensitive test w/ a negative result rules out a disease
29
What is acanthosis nigricans and axillary skin tags indicative of?
diabetes
30
What is the evidence of cardiomyopathy w/a STEMI?
S3, pulmonary rales, JVD, Hepato jugular reflex, diminished pulses, hypotension look for presence of bruits BP of both arms should be checked if they have hx for dissection, pain that radiates to the back.
31
What is the timeframe for an EKG following presentation of ACS like symptoms?
within 10 minutes
32
TCAs & strokes can cause what on an EKG?
T wave inversion | ST elevation
33
What are the troponins that are specific for cardiac tissue?
Troponin I & Troponin T | present w/i 2 hours of event, but not elevated until 8-12 hours
34
In what other conditions can troponins also be elevated in?
``` Renal disease Tachycardia/atrial fibrillation Myocarditis/pericarditis Severe cardiomyopathy GI bleed Stroke Pulmonary embolism ```
35
PPV is highest in patients with other risk factors?
in older patients Hypertension and Troponin > 1.0 ng/ml
36
What's the deal with CKMB?
Replaced CK as biomarker Can be detected within 2 hrs. of an event Undetectable at 72 hours If initial CKMB is negative, repeat every 6-9 hours
37
What's the deal with myoglobin?
LMW protein skeletal and cardiac muscle Detected within 1 hr after cardiac injury Very sensitive marker if used within first 6 hrs of symptoms Not specific however
38
What are some risk prediction models?
TIMI | GRACE
39
WHat is the TIMI model?
Assign 1 point for each of the following: Age >65 Documented prior coronary artery stenosis > 50% Prior cardiac catheterization with known disease Prior angioplasty or stent Prior bypass (CABG) Documented prior myocardial infarction * Three or more conventional cardiac risk factors Hypertension Diabetes Cholesterol elevation Family history CAD/MI History of tobacco use Use of ASA within the previous 7 days 2 or more anginal events in the past 24 hrs ST segment depression or elevation > 1mm Elevated cardiac biomarkers
40
What is the GRACE model?
``` Advanced age Killip class Systolic blood pressure ST-segment deviation Cardiac arrest during presentation Serum creatinine level Elevation of initial cardiac enzymes ```
41
What is the treatment for unstable angina or NSTEMI?
``` Bed rest Continuous cardiac monitoring (telemetry) Relief of ischemia Nitroglycerin SL or IV Morphine (if unresponsive to NTG) Beta blockade Decrease HR – increase coronary filling Decreased oxygen demand of cardiocytes CCB Adjunct to beta blockade ```
42
What is the risk of using morphine w/ nitro?
hypotensive shock
43
When might you want to do aggressive management of UA?
refractory chest pain or electrical instability
44
What are some options for medical management of UA?
Antithrombotics Anticoagualnts Anti-platelet
45
What is the treatment of STEMI?
Fibrinolytic therapy – Glycoprotein 2b/3a inhibitors Heparins Percutaneous coronary intervention (PCI) Coronary artery bypass grafting (CABG
46
What is the magic number for an a1c?
6.5
47
What are the ABCDs of prevention?
``` A Aspirin, antiplatelet agents, ACEIs/ARBs B Beta blockers and blood pressure control C Cardiac rehab (if applicable), cigarette smoking cessation and cholesterol management D Diet, diabetes control and depression management E Exercise and education ```

Block 9; Week 1 & 2-M (10 decks)

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