Exam 3, intro IHD, MI, angina Flashcards Preview

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Flashcards in Exam 3, intro IHD, MI, angina Deck (53):
1

what are the risk factors for heart disease

increasing age, male, smokine, HTN, DM, high cholesterol, FMH, cocaine use, meth use, physical inactvity

2

what is considered a low risk for heart attacks

<10% 10 year risk off framingham scale

3

what is a high risk for mI

>20% 10 yr risk on framingham scale

4

What scale should you use for sex specificity in risk for MI

reynolds risk score

5

What is metabolic syndrome

insulin R
hyperglycemia
HTN
inc TGs
low HDL cholesterol
obesity

6

metabolic syndrome increases risk of CAD by how much

2 fold

7

what are the conditional risk factors for CAD

homocysteine
lipoprotein(a)
hsCRP
LDL particle size
antioxidants
omega 3 fatty acids intake

8

what conditional risk factors have been shown to dec risk CAD

antioxidants and omega 3 fatty acids

9

what helps reduce risk factors for MI

aspirin, reduction BP, reduction HLD, smoking cessation, regular exercise
weight reduction and reduction of BMI <25

10

What are the Dx testing for MI

serum bio-markers: CK MB, troponin, LDH (1-5)
exercise stress test
pharmacological stress test
imaging augmentation
angiography
CT determined coronary artery calcium score

11

what is a stress test

every 3 min, grade and speed of treadmill goes up so myocardial O2 demand increases

12

what is HR maximum

220-age

13

what are the pharmacological ways for stress test

dobutamine ( inc cardiac O2 demand)
adenosine/dipyridamole (vasodilation)

14

What imaging do you order for suspected MI

nuclear and echo
angiography - golden standard for coronary occlusion
CT/MRI

15

what imaging is most useful for estimating coronary artery calcium scoring

CT/MRI

16

What is central chest pain

substernal discomfort
usually retro sternal
may radiat to shoulder, arms, jaw or back

17

what is visceral chest pain

poorly located, associated with nausea, vomiting, diaphoresis and SOB

18

what is exertional chest pain

brought on increased with activity or emotional stress
25% may be silent ischemia
25% atypical: women, DM, elderly

19

typical chest pain is usually alleviated by what

nitrates or rest

20

at what age are Men with typical chest pain at high risk for CAD

above 39 years old

21

at what age are Females with typical chest pain at high risk for CAD

above 59 yeras old

22

at what age are Men with nonanginal chest pain at intermediate risk for CAD

above 39

23

If patient has intermediate risk for CAD what testing should be done

EKG norma- stress test
EKG abnormal- stress test with possible imagin augmentation, treatment based on findings

24

If patient is at high risk for CAD what testing is done

medical therapy followed by stress test and or coronary angiography

25

Wht is typical chest pain

central visceral and exertional chest pain

26

what is atypical chest pain criteria

have 2 types of chest pain (central, visceral, exertional)

27

What are risk factors for unstable angina

>65 y/o
>3 traditional cardiac risk factors
documented CAD with >50% stenosis
ST segment abnormalities
>2 anginal episodes in last 24 hours
used aspirin in last week
elevated cardiac enzymes

28

how do you Dx unstable angina

new onset chest pain
crescendo pattern
not relieved by NTG

29

what is low risk for unstable angina and NSTEMI

0-2 risk factors. medical therapy and stress test to evaluate therapy
if stress test abnomral- angiography

30

what is intermediate risk for unstable angina and NSTEMI, as well as treatment

3-4 risk factors, medical therapy and early angiography

31

what is high risk for unstable angina and NSTEMI, as well as treatment

5-7 risk factors, medical therapy and early angiography

32

Widened mediastinum on CXR is indicative of what

aortic dissection

33

what are signs of pericarditis

recent viral illness, pleuritic chest pain, paradoxical pulses

34

what are signs of PE

inactivity, new onset A fib

35

what are signs of CHF

SOB and orthopnea

36

What is the most significant determining factor for outcome STEMI

door to balloon time <90 minutes

37

what are absolute contraindications for thrombolytic therapy

intracranial hemorrhage
ischemic CVA in last 3 mo
facial trauma in last 3 mo
bleeding diathesis

38

what are relative contraindications to thrombolytic therapy

chronic, severe HTN
severe uncontrolled HTN
ischemic CVA >3 mo known intracranial path
dementia
internal bleeding within last 4 wks
pregnancy
peptic ulcer disease
anticoagulant use

39

what other syndromes increase death risk of STEMI in patients

new LBBB, anterior wall MI, cardiogenic shock, ventricular arrhythmias, advanced age >75 y/o

40

what are the early complications of MI thrombolytics

bleeding
reperfusion arrhythmias

41

What are the early complications with IWMI

bradycardia and AV block, AV nodal perfusion by right coronary artery
right ventricular infarction, inferior wall
hypotension for volume depletion

42

what are the early complications with aWMI

pump failure and CHF in large area infarcts, cardiogenic shock
intra-aortic balloon pump syncrhonous counterpulsion

43

What are the late complications with MI

cardiogenic shock
VSD
papillary muscle rupture and MR
free wall rupture
L ventricular thrombus

44

What is cardiogenic shock

pump faction loss and thought to have inflammatory part

45

how is VSD detected

new systolic murmur and thrill on L sternal border

46

what are signs of papillary muscl eruptures and MR

new systolic murmur, PE, thrill and cardiogenic shock

47

Where do L vetnricular thrombi occur post MI

L ventricular apex

48

What are indications for angiography

EF <40%
clinically significant ischemia on non-invasive testin
arrhythmias during acute hospital stay
recurrent chest painduring hospital stay
significant heart failure during stay

49

What is PCI

percutaneous intervention

50

when is coronary artery bypass grafting in stable CAD recommended

patients with Left main disease, or left main equivalent

51

what are equivalents to left main disease

high grade stenosis in proximal LAD and circumflex, three vessel disease, two vessels involving proximal LAD and EF<50%

52

When do you use coronary angiography

positive stress test
resusitated for cardiac arrest
life limiting angina despite medical therapy
unclear Dx evaluation
STEMI

53

how do the elderly present with MIs

no chest pain
SOB, exacerbation of existing and new presentation of CHF
confusion/delirium