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27 Cards in this Set
- Front
- Back
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What is the critical factor in ACS?
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acute plaque change
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What are the most acute plaque changes?
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hemorrhage into atheroma, rupture, fissure, ulceration, erosion with exposure of thrombogenic consituents or BM. In most instances, the plaque change causes the formation of a superimposed thrombus that partially or completely occludes the affected artery.
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What do the branches to the SA and AV nodes originate?
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RCA
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What does the LAD perfuse?
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Anterior LV
Anterior 2/3 of IV septum Apical LV |
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What does the LCx perfuse?
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Lateral LV
Posterolateral LV |
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What does the RCA perfuse?
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Posterior LV
Posterior 1/3 of IV septum Posterior papillary muscle |
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Subendocardial MIs are usually the result of what?
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Shock
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Transmural MIs are usually the cause of what?
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Shock
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Describe subendocardial MIs
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inner 1/3 to 1/2 of LV
multifocal circumferential thrombus is rare does not form aneuryisms |
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Describe transdocardial MIs
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Full thickness, unifocal, thrombus common, epicarditis common, may result in aneuryisms
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What are the 4 primary manifestations of ischemic heart dz?
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angina pectoris
myocardial infarction sudden cardiac death chronic ischemic heart dz |
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What is atypical angina?
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Assoc w/ coronary artery spasm. may occur at rest.
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What is sudden cardiac death?
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regional ischemia leading to fatal arrhythmia
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What are some PEx findings of acute MI?
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S4: atrial contraction into a non-compliant LV (almost always present!!!)
S3 sound and pulmonary edema: from volume overload (LV systolic dysfunction) systolic murmur (mitral regurg) from ischemia induced papillary muscle dysfunction or VSD Low grade fever |
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What are the 5 killer chest pains?
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ACS, Aortic Dissection, PE, pneumothorax, esophageal rupture
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What is the Dx of ACS based on?
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Patient's presenting Sx (Hx is most important)
Acute EKG abnormalities Detection of serum markers of myocardial necrosis |
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How do you dx unstable angina?
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Sx, transient EKG abnormalities (ST depression or inverted T waves), absence of serum biomarkers of myocardial necrosis
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How do you dx a NSTEMI?
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detection of serum markers of myocardial necrosis and more persistent ST or T wave abnormalities
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Do you see pathological Q waves weeks after unstable angina or NSTEMI?
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NO
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What happens to the ST and T waves weeks after a NSTEMI?
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They return to normal
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What do you see on EKG weeks after a STEMI?
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ST & T wave are normal, but Q waves persist
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what drug is used for acute relief of stable angina
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nitroglycerin
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what drugs are used for preventing angina
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organic nitrates, beta blockers, calcium channel blockers 2nd line after beta blockers, ranolazine
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what drugs are used in stable angina to prevent cardiac events
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aspirin, clopidogrel (aspirin substitute), statins and ACE inhibitors
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what effect do statins have on preventing cardiac events
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they reduce MI rates and mortality
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what is PTCA
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percutaneous transluminal coronary angioplasty. (balloon angioplasty)
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when should you do a coronary artery bypass graft
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1. >50% left main stenosis
2. 3V CAD 2. 2V CAD with proximal LAD 3. diabetes and multivessel ds |
