ischemic heart disease Flashcards
(67 cards)
1
Q
DDx of chest pain: MI
A
atherosclerotic disease anomalous coronary arteries HTN urgency pulmonary HTN aortic valve disease
2
Q
DDx of chest pain
A
acute aortic syndrome (dissection, intramural hematoma) pericarditis PE GERD, spasms, achalasia pulmonary (pneuothorax, pneumonia_ chest wall anxiety
3
Q
cardiac markers good, ECG normal but patient still has chest pain
A
aortic dissection
PE
-want to rule those out
4
Q
chest pain history
A
location character radiation intensity duration frequency associated symptoms exacerbating/relieving factors pattern over time
5
Q
where is it bad for pain to radiate to?
A
neck or arms
6
Q
branches off left anterior descending
A
called diagnol
7
Q
branches off the left circumflex
A
called marginal
8
Q
non-atherosclerotic coronary artery disease
A
coronary vasospasm
anomalous coronary arteries
coronary arteritis (Kawasaki’s, giant cells)
myocardial bridge
coronary dissection: young (30’s), female
coronary embolization
9
Q
metabolic syndrome
A
HTN abdominal obesity HLD 150 fasting plasma glucose >100 associated with inflammation, coagulation abnormalities, progression to type 2 DM
10
Q
risk factors for atherosclerotic heart disease
A
smoking
HTN
diabetes
11
Q
why is it difficult to get BP in optimal range in elderly?
A
stiffer blood vessels
-may get light headed when stand up
12
Q
novel risk factors for atherosclerotic disease
A
- chronic inflammation
- elevated hsCRP
- homocytsteine
- chronic kidney disease
- coagulation abnormalities
- chronic infection
13
Q
MI: secondary causes
A
- severe anemic
- hypoxemia
- uncontrolled HTN
- severe LVH
- uncontrolled tachycardia
- thyrotoxicosis
14
Q
manifestation of coronary artery disease
A
- chronic stable angina
- unstable angina: new or changing chest pain
- MI
- ischemic cardiomyopathy (CHF)
- sudden cardiac death
- silent ischemia
15
Q
which angina needs to be treated?
A
unstable angina
-dynamic process
16
Q
angina
A
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
Q
where does pain radiate to for aortic dissection?
A
to back
18
Q
typical angina
A
sub sternal
brought by exertion
19
Q
angina equivalents
A
- dyspnea
- arm, jaw, or back pain
- nausea
- sweating
- fatigue
- silent ischemia
20
Q
atypical signs in
A
women, diabetics, eldery
21
Q
ischemic heart disease evaluation
A
history
physical
ECG
22
Q
ST elevation means
A
means infarction
-ischemia, cells are dying
23
Q
coronary insufficiency will give
A
ST depression
24
Q
upward ST depression
A
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
