Gen Med: Lecture 5- Cardiovascular Assessment

Question 1

What are non-modifiable risk factors?

Answer 1

Age
Gender
Family History

Question 2

What are modifiable risk factors?

Answer 2

Blood lipid abnormalities
Hypertension
Smoking
Physical Inactivity
Hyperglycemia
Obesity
Stress
Diet

Question 3

What are some new emerging risk factors?

Answer 3

C-Reactive Protein
Homocysteine
Kidney Disease
Environmental Factors
Infection
Sleep
Gender/Race/Ethnic Disparities

Question 4

What is atherosclerosis?

Answer 4

Progressive inflammatory disease

Question 5

What is stable angina?

Answer 5

Chest pain related to stress or activity that is predictable
Occurs at set level of oxygen demand

Question 6

What can stable angina be relieved by?

Answer 6

Rest
Nitroglycerin

Question 7

What is Prinzmetal Angina?

Answer 7

Variant angina due to coronary vasospasm
Typically occurs at rest
Typically responds to nitrates

Question 8

What is Unstable angina?

Answer 8

Unpredictable angina
May occur at rest, with exercise, stress
Can be new onset or more severe and prolonged
Medical emergency

Question 9

How does palpation differ in stable angina compared to nonanginal discomfort?

Answer 9

Stable: Not palpable
Nonanginal: Muscle soreness, joint soreness, pain with deep breaths

Question 10

How does nitroglycerin affect stable angina compared to nonanginal discomfort?

Answer 10

Stable: Relieves angina
Nonanginal: Generally no effect

Question 11

How do additional symptoms in stable angina compare to that of nonanginal discomfort?

Answer 11

Stable: Feeling of doom, cold sweats, SOB
Nonanginal: Minimal additional symptoms

Question 12

How does the ST segment in stable angina compare to nonanginal discomfort?

Answer 12

Stable: ST depression
Nonanginal: No ST depression

Question 13

What is the single largest killer of men and women?

Answer 13

MI

Question 14

What directly causes an MI?

Answer 14

Prolonged myocardial ischemia

Question 15

How important is time with reperfusion following myocardial ischemia?

Answer 15

Early reperfusion can prevent necrosis
Irreversible changes in 20-30 mins
Some recovery possible if reperfusion in 3-6 hours

Question 16

What are the causes of myocardial ischemia leading to MI?

Answer 16

Thrombus at site of atherosclerotic plaque
Prolonged vasospasm, aortic stenosis, arrhythmia, vasculitis, coronary artery dissection, hypotension

Question 17

What is the area of myocardial necrosis related to?

Answer 17

Time of ischemia
Myocardial oxygen consumption
Collateral blood flow

Question 18

How does the coronary artery differ in a STEMI vs Non-STEMI?

Answer 18

STEMI: Complete blockage
Non-STEMI: Partial blockage

Question 19

How are EKGs different in STEMI vs Non-STEMI?

Answer 19

STEMI: ST elevation, Q wave in 24-48 ours
Non-STEMI: ST depression, T wave changes

Question 20

What is a transmural infarction and what causes it?

Answer 20

Q wave on EKG in 24 to 48 hours
Caused by STEMI

Question 21

What does myocardial remodeling depend on?

Answer 21

Size of infarct
Location of infarct
Ventricular load
Blood supply to area

Question 22

How does scat formation affect the heart?

Answer 22

Restores structural integrity but not function

Question 23

How is morbidity and mortality affected by an uncomplicated course MI?

Answer 23

Decreased

Question 24

What is a complicated course MI?

Answer 24

24-48 hours after MI:
V Tach/ V Fib
A flutter/ A Fib
Second or Third degree heart block
Persistent Sinus Tach
Hypotension
PE
Cardiogenic shock
Persistent Angina
Extension of infarction

Question 25

What is the long term prognosis of an MI related to?

Answer 25

Complications Presence of disease in other coronary arteries Left ventricular function

Question 26

What is the most common cause of death following MI?

Answer 26

Ventricular arrhythmias

Question 27

What is an average EF?

Answer 27

60%

Question 28

What is the equation for EF?

Answer 28

SV/EDV

Question 29

How are MIs identified on EKG?

Answer 29

Abnormal Q waves ST elevation or depresion

Question 30

What labs are used to diagnose MI?

Answer 30

LDH CK-MB Troponin Myoglobin

Question 31

What can be given to patients for treatment of an MI to reduce myocardial demand?

Answer 31

B-blockers Nitrates Ca2+ Channel Blockers

Question 32

What can be given to a patient for treatment of an MI to increase myocardial oxygen supply?

Answer 32

Thrombolytics Aspirin/Antiplatelets/Anticoagulants Ca2+ Channel Blockers Supplemental Oxygen

Question 33

What can be given to patients for treatment of an MI to prevent arrhythmias?

Answer 33

Anti-arrhythmics Pacemaker

Question 34

What can be given to patients for treatment of an MI to relive pain?

Answer 34

Opioids

Question 35

What surgeries can be done for treatment of MI?

Answer 35

Angioplasty Stent placement CABG IABP

Question 36

What lab is used to detect for heart failure?

Answer 36

BNP

Question 37

What labs are used to assess coagulation?

Answer 37

PT aPTT INR

Question 38

What labs are used to assess kidney function?

Answer 38

BUN Creatinine

Question 39

What labs are used as general risk factors?

Answer 39

C-reactive protein Glucose A1C

Question 40

When do CK-MB levels begin to rise following an MI?

Answer 40

4-6 hours after

Question 41

When do CK-MB levels peak following an MI?

Answer 41

12 hours after

Question 42

When do CK-MB levels return to normal following an MI?

Answer 42

1-2 days

Question 43

When do Troponin I levels begin to rise following an MI?

Answer 43

2-3 hours after

Question 44

When do Troponin I levels peak following an MI?

Answer 44

12-24 hours after

Question 45

When do Troponin I levels return to normal following an MI?

Answer 45

4-7 days

Question 46

When do Troponin T levels begin to rise following an MI?

Answer 46

2-3 hours

Question 47

When do Troponin I levels peak following an MI?

Answer 47

10-24 hours after

Question 48

When do Troponin I levels return to normal following an MI?

Answer 48

10-14 days

Question 49

What lab value are many facilities moving to to assess for MI?

Answer 49

High Sensitivity Troponin

Question 50

What should you do if cardiac enzymes are within normal range after the first set of lab?

Answer 50

Wait for all 3 sets

Question 51

What should you do if cardiac enzyme counts are rising following the 3 sets of labs?

Answer 51

PT contraindicated

Question 52

What should you do if cardiac enzyme counts are decreasing following the 3 sets of labs?

Answer 52

Initiate PT with close monitoring