Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Assessment > Exam 2 - Ischemic Heard Disease > Flashcards

Exam 2 - Ischemic Heard Disease Flashcards

(66 cards)

Start Studying
1
Q

What are the 2 most important risk factors for development of atherosclerosis?

A
  • Male gender
  • Increasing age

Non-modifiable risk factors

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

What are the first 3 manifestations of IHD?

A
  • Angina pectoris
  • Acute MI
  • Sudden death (dysrhythmias)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the modifiable risk factors for IHD?

A
  • High cholesterol
  • HTN
  • Smoking
  • DM
  • Obesity
  • Sedentary lifestyle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What chemical mediators are released during ischemia that activate cardiac nociceptors?

A

Adenosine and Bradykinin

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

What is the path for cardiac pain signals to reach the spinal cord?

A

Cardiac nociceptors → Afferent Neurons → T1 - T5 SNS ganglia.

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

What is the CNS response to cardiac ischemia?

A
  • ↓ AV conduction and thus ↓HR
  • ↓ Contractility

This decreases myocardial oxygen demand (good)

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

Differentiate stable vs unstable angina.

A
  • Stable - No change in chest pain severity or frequency in 2-mo period.
  • Unstable - Increasing frequency and severity of chest pain (chest pain at rest)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Are cardiac biomarkers (troponin) present with unstable angina?

A

NO. If they were, that would be an MI.

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

What EKG abnormality is associated with old MI’s and/or current ischemia?

A

T-wave inversion

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

Tropnin levels bump in ____ , remain elevated for ____

A

3-4 hours
2 weeks

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

What is nuclear stress testing utilized for?
How is this done?

A
  • Assessment of coronary perfusion
  • Injection of thallium or technetium during exercise; decreased tracer activity = decreased blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What test can differentiate a new vs and old perfusion abnormality?

A

Nuclear Stress Testing

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

What nuclear stress test drugs are used without exercise?

A

Atropine
Dobutamine
Pacing
Dipyridamole

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

What test would be useful for imaging wall motion abnormalities or valvular function?

A

Echocardiography

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

What is Prinzmetal Angina?
How can it be diagnosed?

A
  • Coronary Spasm
  • Angiography
  • EKG will show ST segment elevation during angina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What test determines the location of occlusive disease and assesses results of stenting?

A

Coronary angiography

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

What test can measure the stability of plaques?

A

There is no satisfactory test to measure this yet

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

Most AMI occurs from rupture of a plaque that produced ____ stenosis of the coronary artery.

A

< 50%

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

Treatments for coronary atherosclerosis?

A
  • Stop smoking
  • Lose weight
  • Diet changes
  • Statins
  • Treating HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the mechanism of action for aspirin?

A

COX-1 Inhibition → TXA2 inhibition → Plt aggregation inhibition.

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

How can aspirin be reversed?

A

Platelet transfusion

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

What is the mechanism of action of abciximab, eptifibatide, and tirofiban?

A

Platelet glycoprotein IIb/IIIa receptor antagonists

Inhibit platelet activation, adhesion, and aggregation.

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

What drugs (discussed in lecture) are P2Y12 inhibitors?
MOA?

A
  • Clopidogrel, Prasugrel, and Ticagrelor
  • Prodrugs that inhibit ADP and platelet aggregation (irreversable)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What common drug class will antagonize P2Y12 inhibitors?

A

PPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
This P2Y12 inhibitor has more stable pharmacokinetics but has a higher risk of bleeding?
Prasugrel (Effient)
26
CV effects of nitrates?
- Decreases angina pectoris - ↓ SVR, preload - Dilates coronaries - Decreaes myocardial oxygen consumption
27
What drug classes are synergistic with nitrates?
- β-blockers - CCBs ## Footnote More pronounced hypotension
28
When are nitrates contraindicated?
- Aortic Stenosis - Hypertrophic Cardiomyopathy ## Footnote Reduces preload and CO which is vital for these patients
29
What drug class is the only one proven to prolong life in CAD patients?
β-blockers
30
What properties do β-blockers have?
- Anti-ischemia - Anti-HTN - Anti-dysrhythmic
31
Which β blockers are cardioselective?
- Atenolol - Metoprolol - Acebutolol - Bisoprolol
32
Which β blockers are non-selective?
- Propanolol - Nadolol
33
What risk is associated with non-selective β blockers in asthma patients?
↑ risk of bronchospasm in reactive airway disease patients.
34
What drug class is uniquely effective is decreasing the severity/frequency of coronary vasospasm?
CCBs
35
Angiotensin II will increase what four things in the heart muscle?
- Myocardial hypertrophy - Interstitial myocardial fibrosis - Coronary vasoconstriction - Inflammatory responses
36
ACE inhibitors treat?
- HTN - HF - Cardioprotective
37
These drugs reduce mortality in noncardiac and vascular surgeries?
Statins
38
When is revascularization necessary for IHD?
- Failure of medical therapy - > 50 % L main coronary occlusion - > 70 % occlusion of epicardial coronary - EF < 40%
39
When is a CABG preferred over PCI?
- Significant left main coronary disease - 3 vessel CAD - DM with 2-3 vessel CAD
40
Which substances contribute to thrombogenesis?
* Collagen, ADP, epinephrine, serotonin * Thromboxane A2 * Glycoprotein IIb/IIIa receptors * Fibrin deposit
41
What criteria diagnoses a STEMI?
Detection of troponin **AND** at least one of the following: - Symptoms of ischemia - ECG changes (ST/T, new LBBB) - Pathologic Q waves - Regional wall motion abonormality - Thrombus identified bia angiography
42
Is troponin or CK-MB more specific for myocardial injury?
Troponin
43
When is evaluation of with an echo helpful in patients with angina?
- LBBB - Uncertain AMI diagnosis - Suspected AAA
44
What is the primary goal in patients with a STEMI?
Reestablish blood flow ASAP
45
What 2 drugs should be avoided in patients with an acute STEMI?
- Glucocorticoids - NSAIDs (besides aspirin)
46
When should thrombolytic therapy be given for MI?
- 30-60 mins of hospital arrival - Within 12 hours of symptom onset
47
What are indications for PCI treatment of an MI?
- Contraindicated tPa therapy - Severe HF and/or pulm edema - S/S for 2-3 hours - Mature clot
48
When is CABG an option for MI?
- Failed angioplasty - Coronary anatomy that inhibits PCI - Evidence of MI related septal rupture or mitral regurg
49
What is the treatment goal for NSTEMIs?
- Decreasing myocardial O2 demand - Prevention of progression of plaque formation/rupture
50
What risks are associated with PCI (percutaneous coronary intervention) ?
- Vessel rupture/endothelial injury - Bleeding - Thrombosis
51
How long does reendothelialization take after balloon angio, bare metal stent placement, and drug eluting stent placement?
Balloon angio: 2-3 weeks Bare metal stent: 12 weeks Drug eluting stent: 1 year or more
52
What is Dual Antiplatelet Therapy (DAPT) ?
- ASA w/ P2Y12
53
What is the most significant predictor of stent thrombosis?
P2Y12 inhibitor discontinuation
54
How long would one want to wait for elective surgery post angioplasty **with no stenting**?
2 - 4 weeks
55
How long would one want to wait for elective surgery post angioplasty **with bare-metal stent placement**?
At least 30 days (12 weeks preferable)
56
How long would one want to wait for elective surgery post angioplasty **with drug-eluting stent placement**?
At least 6 months (12 months if post ACS)
57
How long would one want to wait for elective surgery post-CABG?
At least 6 weeks (12 weeks preferable)
58
Is glycopyrrolate or atropine preferred for treatment of bradycardia induced by BB?
Glycopyrrolate Provides less tachycardia which you want to avoid in patients with ischemic heart disease
59
What pressor is preferred in patients who are beta blocked?
Vasopressin Phenylephrine Ephedrine
60
What components are worth 1 point on the Revised Cardiac Risk Index (RCRI) ?
## Footnote more than 2 is considered elevated risk
61
What does 1 MET equal?
3.5 mL O₂/kg/min
62
How many METs preferred prior to surgery?
5 - climbing 1 flight of stairs, dancing, bicycling
63
What drugs can be given to blunt the SNS response to DL in patients with IHD?
- Lidocaine - Esmolol - Fentanyl - Remifentanil - Dexmedetomidine | Want to prevent tachycardia which worsens myocardial ischemia
64
What coronary artery would you expect to be effected from abnormalities noted on II, III, and aVF?
RCA
65
What coronary artery would you expect to be effected from abnormalities noted on I and aVL?
Circumflex artery
66
What coronary artery would you expect to be effected from abnormalities noted on V3 - V5?
LAD

Assessment (23 decks)

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