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Q2 Clin Med Final (Cardiology, Hyperlip) > Ischemic HD > Flashcards

Ischemic HD Flashcards

(48 cards)

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1
Q

IHD same as?

A

coronary HD

coronary artery dx

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2
Q

IHD due to?

Result of?

A

Imbalance b/w myocardial O2 demands and supply

stenosis (narrowing)

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3
Q

Atherogenesis definition?

A

Development of plaques due to:
oxidation of lipids ->
deposited in intima
(innermost layer of artery, made of endothelial cells)
->
inflammatory process that produces foam cells

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4
Q

What properties of HDL make it atheroprotective?

A

anti-inflamm and anti-oxidant

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5
Q

Natural protective process of endothelial cells to inhibit plaque formation?

A

release NO

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6
Q

Myocardial Perfusion primarily occurs during which part of cardiac cycle?

A

diastole

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7
Q

Main coronary arteries located where?

Blood flows from?

A

epicardium

blood flows from epi to endocardium

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8
Q

Plaques U form at which sites in arteries?

A

areas of turbulance

e.g. branching points in epicardial aa

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9
Q

Ischemia is

A

↓ blood flow

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10
Q

IHD presentation?

A

stable angina

acute coronary syndrome (ACS)

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11
Q

Angina Pectoris presentation?

Location
Character
Radiation
Duration
Relief
A

Loc = Substernal (Levine’s Sign: fist over sternum)

Char = (U) not “pain”
heaviness, pressure
squeeze/tight, smothering/choking

Rad = shoulder, arms
neck, jaw, teeth
epigastric, mid-back

Dur = 2-5 min
(U) cresceno-decresc

Rel = <5 min w/ rest or nitro

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12
Q

Angina Pectoris U sign of what kind of ischemia?

A

transient

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13
Q

Atypical Angina presentation?

A 
(More common in elderly and DM)
dyspnea (U) women
nausea
fatigue
faintness
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14
Q

Atypical Angina presentation NOT likely from ischemia or true angina?

A

sharp, fleeting stabs

prolonged, dull ache in L precordial area

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15
Q

IHD physical exam, check for? (8)

A 
BP
xanthomas
A/V nicking
carotid pulses/bruits
cardiac enlargement (by palpation)
murmurs S3/4
Aorta size/bruits (abdom)
extremity pulse/edema
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16
Q

Stable Angina definition?

A

exertional/stress-related chest or arm discomfort
resolves w/ rest or nitro
<10min

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17
Q

Unstable Angina definition?

A

discomfort w/ at least one of the following:

1) at rest, >10min
2) severe and new (w/i last 6wks)
3) crescendo (more severe, longer or frequent than previous)

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18
Q

Prinzmetal’s Angina definition?

A

chest pain at rest
a/w transient ST elevation
sxs 2º to vasospasm
U younger w/ low risks

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19
Q

Prinzmetal’s Angina test?

A

coronary angiography

stress test NOT helpful

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20
Q

Prinzmetal’s Angina tx?

Study These Flashcards
A

nitrates

Ca2+ channel blocker

21
Q

Stable Angina tests?

Study These Flashcards
A

ECG = St-T wave ∆s during chest pain only
Exercise Stress Test = try to reproduce ischemia
Imaging: ECG, Echo, Nuclear

22
Q

Stress Echo + for ischemia if?

Study These Flashcards
A

wall mvmt abnorm w/ stress

23
Q

Coronary Angiography gold standard for?

Study These Flashcards
A

CAD diagnosis

Doesn’t show vulnerable plaques

24
Q

Best test for vulnarable plaques?

Study These Flashcards
A

intracoronary US

25
IHD tx?
tx sxs, not prevention
26
Stable Angina tx?
``` ↓risk factors nitrates β blockers Ca2+ channel blockers anti-platelte meds revascularization ```
27
Nitrates do what?
↓ O2 demand and ↑ O2 supply | thru preload reduction
28
β blockers do what?
FIRST LINE for chronic angina ↓ O2 demand thru ↓ HR, BP, contractility
29
Ca2+ Channel Blockers do what?
For pt's who don't respond to nitrates or β blockers Vasodilators ↓ O2 demand and ↑ O2 supply thru ↓ BP, contractility
30
Anti-platelet med names?
asprin | plavix
31
2 kinds of revascularization?
PCI | CABG
32
PCI is? Do when?
Percutaneous Coronary Intervention: w/ or w/o stent placement angina despite tx evidence of ischemia on stress test
33
CABG is? Do when?
Coronary Artery Bypass Grafting L main coronary stenosis triple vessel dx
34
ACS present as?
unstable angina Non-ST seg elevation MI (NSTEMI) ST-seg elevation MI (STEMI) atypical angina sxs
35
4 UnstbAngina/NSTEMI (P) pathophys processes?
1) plaque erupt w/ nonocclusive thrombus (C) 2) dynamic obstruction (e.g. spasm) 3) progressive mechanical obstruction (athsclero post PCI) 4) UA 2º to ↑ O2 demand or ↓ supply (e.g anemia or tachycard)
36
Tests that differentiate UA from NSTEMI?
UA: no ↑ of CK-MB or Troponin (P) ST depress or T wave invert NSTEMI: ↑ of CK-MB or Troponin (U) no ST elev (P) ST deprss or T wave invet
37
UA/NSTEMI tx? (7)
``` bedrest w/ monitoring and O2 Nitrates β blockers Morphine (PRN) anti-thrombotic (asprin) anti-coag (heparin) (P) revascularization ```
38
STEMI pathophys?
rupture of vulnerable plaque complete occlusion 1/2 have precipitating event
39
(4) Emergent DDX for chest pain?
Aortic dissection PE Pneumothorax Perforated viscous (GI organ perf)
40
ACS tests?
``` ECG Enzymes Echo Angiogram CXR CBC, lipids ```
41
TIMI Risk Score for UA/NSTEMI?
Probability of Thrombolysis (progression from UA/NSTEMI to STEMI)? pt given a point for each risk factor
42
TIMI ratings?
``` 0-1 = 4.7% risk 2 = 8.3% 3 = 13.2 % 4 = 19.9% 5 = 26.2% 6-7 = 40.9% ```
43
ACS management?
``` (MONA) Oxygen Nirto Morphine Asprin ```
44
STEMI tx?
``` MONA β blocker (metroprolol) anti-coag (heparin) anti-arrhyth ACE inhib Statin Reperfusion (cath lab) ```
45
Goal of reperfusion in STEMI?
limit infarct size
46
Thrombolytic tx used for?
(fibrinolytic) | for immediate tx of heart attack or stroke
47
Contraindications for Thrombolytics? (5)
``` hx of brain hemorr strok w/i yr uncontrolled HTN (>180/110) aortic dissection active internal bleeding ```
48
Post MI complications?
``` recurrent ischemia pump failure (leading cause of death inpt) vent arrhy pericarditis (Dressler's) Mural thrombus (in wall of heart) cardiac rupture depression ```

Q2 Clin Med Final (Cardiology, Hyperlip) (8 decks)

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