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Flashcards in ischemic heart disease Deck (67):
1

DDx of chest pain: MI

atherosclerotic disease
anomalous coronary arteries
HTN urgency
pulmonary HTN
aortic valve disease

2

DDx of chest pain

acute aortic syndrome (dissection, intramural hematoma)
pericarditis
PE
GERD, spasms, achalasia
pulmonary (pneuothorax, pneumonia_
chest wall
anxiety

3

cardiac markers good, ECG normal but patient still has chest pain

aortic dissection
PE
-want to rule those out

4

chest pain history

location
character
radiation
intensity
duration
frequency
associated symptoms
exacerbating/relieving factors
pattern over time

5

where is it bad for pain to radiate to?

neck or arms

6

branches off left anterior descending

called diagnol

7

branches off the left circumflex

called marginal

8

non-atherosclerotic coronary artery disease

coronary vasospasm
anomalous coronary arteries
coronary arteritis (Kawasaki's, giant cells)
myocardial bridge
coronary dissection: young (30's), female
coronary embolization

9

metabolic syndrome

HTN
abdominal obesity
HLD 150
fasting plasma glucose >100
associated with inflammation, coagulation abnormalities, progression to type 2 DM

10

risk factors for atherosclerotic heart disease

smoking
HTN
diabetes

11

why is it difficult to get BP in optimal range in elderly?

stiffer blood vessels
-may get light headed when stand up

12

novel risk factors for atherosclerotic disease

-chronic inflammation
-elevated hsCRP
-homocytsteine
-chronic kidney disease
-coagulation abnormalities
-chronic infection

13

MI: secondary causes

- severe anemic
-hypoxemia
-uncontrolled HTN
-severe LVH
-uncontrolled tachycardia
-thyrotoxicosis

14

manifestation of coronary artery disease

-chronic stable angina
-unstable angina: new or changing chest pain
-MI
-ischemic cardiomyopathy (CHF)
-sudden cardiac death
-silent ischemia

15

which angina needs to be treated?

unstable angina
-dynamic process

16

angina

visceral discomfort
-feels like pressure
-diffuse and sub-sternal
-dyspnea, sweating, nausea, light headness
-provoked by physical exertion, emotional upset, heavy meal, working in cold temperature
-rest makes better

17

where does pain radiate to for aortic dissection?

to back

18

typical angina

sub sternal
brought by exertion

19

angina equivalents

-dyspnea
-arm, jaw, or back pain
-nausea
-sweating
-fatigue
-silent ischemia

20

atypical signs in

women, diabetics, eldery

21

ischemic heart disease evaluation

history
physical
ECG

22

ST elevation means

means infarction
-ischemia, cells are dying

23

coronary insufficiency will give

ST depression

24

upward ST depression

benign

25

flat ST depression

pathological

26

dynamic ECH changes with chest pain at rest

send to heart catheter lab
-DON'T do stress test

27

can see inverted T waves with

long standing HTN
LVH
previous MI

28

alternatives for ST elevation: non chest pain, stable, in previous heart attack

-aneurysm

29

Q waves instead of R waves

loss of myocardium

30

large p waves means

right atrial enlargement
-caused by pulmonary HTN
-rotates heart, makes R wave progression diminish

31

who can have large P waves

in COPD

32

UAP versus NSTEMI

UAP-> new, rest or worse pain
physical exam often normal
ST changes-> 50% have non

33

high risk chest pain

recurrent pain
positive markers
persistant ECH changes
unstable hemodynamics
arrhythmia (VT)
Low EF
previous CABG
diabetes
renal insufficiency

34

Q wave and T wave inversion, pattern of

inferior MI
-from an occluded RCA

35

treatment for high risk chest pain

-ASA, heparin, beta blockers, morphine, O2, nitrates
-clopidogrel, antithrombin therapy-heparin/Lovenox
-glycoprotein IIb, IIIa receptor target-tirofiban, abciximab, eptifibatide

36

when is reperfusion therapy needed?

only in STEMI with <12 hours pain duration

37

management for STEMI

-ST elevation >1 mm in 2 or more leads
-monitor, O2, ASA, heparin, beta blockers, nitrates, morphine
-pain less than 12 hours-> attempt reperfusion

38

who is at highest risk and needs surgery?

left mains stenosis
3 vessels (reduced LV function)
2 vessel disease (prox LAD)
multi-vessel diabetics

39

diagnostic tests are only as accurate (stress test)

the group you apply it to

40

treatment for STEMI in acute coronary syndrome is

take them to the cath lab

41

NSTEMI acute coronary syndrome

inadequate blood flow to a segment of the myocardium caused by transient or high grade occlusion or epicardial coronary artery
ECG could be normal
elevated cardiac enzyme (troponin)

42

STEMI acute coronary syndrome

complete occlusion
ST elevation in 2 or more ECG or new LBBBB
cardiac enzymes elevation

43

presenting symptoms of acute coronary syndromes

rapidly accelerating exertional angina
unprovoked angina

44

atypical presentation of acute coronary syndromes

women
elderly
diabetics
CHF
-dyspnea

45

diagnosis of ACS

target history, physical exam
ECH within 10 min of arrival
CXR
cardiac markers
echo

46

initial management of ACS

aspirin
morphine
nitrates
blood chemistries, CBC, cardiac markers
ECG

47

ST elevation

injury

48

ST depression

ischemia

49

inferior leads

RCA

50

septal leads

LAD

51

antieror leads

LAD

52

high lateral leads

diagonal or LCX

53

PCI

best treatment if given in a timely manner

54

adjunctive therapies for ACS

aspirin
clopidogrel
anticoagulants
beta bockers
nitrates
morphine
ACE-I or ARB

55

NSTEMI ACS initial management

anti-platelet (aspirin, clopidogrel, IIB/IIIA inhibitors)
anticoagulants (heparin, LMWH)
beta blockers
nitrates
morphine
ACE-I
lipid lowering therapy

56

long term ACS

aspirin for life
clopidogrel for at least 1 year
ACE-I
beta-blockers
S-L nitro
lipid lowering therapy (high dose)
smoking cessation
tight control diabetics
tight control blood pressure

57

complications

recurrent ischemia or infarction
ventricular arrhythmias
conduction disturbances
pericarditis
cardiogenic shock

58

right ventricular infarction

occluded right marginal from RCA-> damage RV
-occurs in inferior STEMI
hypotension
elevated JVP (kussmaul sign)
clear lungs

*give fluids*

59

an inferior infarction can often develop?

heart block
-give atropine

60

right ventricular infarction management

give fluids

61

papillary muscle rupture

usually inferior MI
sudden hypotension and pulmonary edema
MR

62

S4 sound could mean

LVH
-HTN heart disease

63

drug coated stents

less ingrowth
longer blood thinner

64

non drug coated stents

more ingrowth
less duration of taking blood thinner

65

CABG

left internal mammary artery
-LIMA into LAD

66

what vein will never have a balloon?

Left main stenosis
-they go to surgery

67

slight depression of the PR segment

acute pericarditis