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43 Cards in this Set

  • Front
  • Back
T/F Most patients will NOT present with chest pain when suffering from coronary disease?

-say they'll experience pressure, bloating, etc

-Be on the lookout for any discofort of ANY discription within 6 ft of the heart until proven otherwise
Mismatch of supply and demand without any symptoms of pain or discomfort
Silent ischemia
Major presentation of CAD?

Results in?
Coronary atherosclerosis

-other problems include vasospasm, metabolic cardiopathic injury, or congenital

-Resulting in Angina, MI, or Sudden death
Stress (Takotsubo)cardiomyopathy most associated with?
Two things that you must be aware about regarding the problems stemming from vascular plaque
1) Obsturction (not severe is < 60-70% obstructed)

2) Instability
NUMBER 1 most important symptom of CAD?
What does a plaque do when it becomes unstable?
Releases mediators that lead to vasospasm
T/F Give a Thrombolytic agent to patient with ADis?
F, they will bleed to death 10x faster
A 2 month duration of th e same symptoms precipitated by the same effort, of the same duration, and relieved by the same treatment
Stable angina
Sequence of coronary artery occlusion symptoms (5)?
1)Relaxation (diastolic) abnormalities

2)Contraction (systolic) abnormalities

3)functional (hemodynamic) abnormalities

4)ECG changes

5)Angina (doesnt always occur)

-Reverse order for relief of symptoms

-Therefore, ECG is NOT particularly sensitive, should NEVER allow normal ECG to turn away cardiac patient
Silent Ischemia detected in a constant 24hr ECG monitoring change of what ?
ST segment
MANY or ONE vessel affected in CAD
Many vessels offendded...a dynamic process
Good stress test?

Bad stress test?
Good - 6-7 minutes walking on treadmill with HR > 120 w/out dyspnea, fatigue, v BP, or ECG changes

Bad - above symptoms w/ 3-4 minutes or with HR < 120
Type of testing that can give good images without requiring so much from the patient?
Spiral CT
Chest discomfort of new onset at REST, occuring in ABSENCE OF BIOCHEMICAL MARKERS (can have recurrence after MI or revascularization procedure)
Unstable angina

-have THIN CAPS, may rupture and expose the lipid core which is very THROMBOGENIC
Best marker for MI?
Biochemical marker - difference b/w unstable angina and NSTEMI

ECG may not change util more severe ischemia is reached
Varient (Prinzmetal) angina due to what?
Unstable angina/ NSTEMI result in?
either ST depression and/or T wave inversion
Stores of what deplete the fastest in MI?
Within how many minutes must you intervene to save infarcted myocardium?
90 min
Mean infarct size correlation to mode of death?



1)37% = cardiogenic shock

2)20% = primarily arrhythmia

3)14% = primarily danger of rupture
Most of time MI occures from?

Other causes (4)?
Occlusive thrombis

-Vasculitis - Lyme disease or mycoplasma infection

-Coronary spasm - Cocaine

-Conditions that ^ viscosity of blood

-Conditions that ^ coronary requirement
Symptoms of MI?
1)Changes in autonomic regulation due to drop in cardiac fxn (diaphoresis (sweating), clammy skin, N/V, weakness)

2)Inflammatory response

3)Caridac findings - S3, S4, or a buzz in pericardium

4)Elevation of JVP would occur early and mean that RV is also involved
What serum biomarker is highly sensitve for MI injury?

Rising and falling span?

Rises rapidly within 5-6 hours,

Remains positive for 10-14 days
What is the fastest biomarker?

How fast? Problems?

Appears within 1-2 hours (very useful in ER)

Not very specific & Cleared w/in 1-4 hours
What biomarker peaks at 24hrs?

Begins to rise 5-6 hours and lasts for about 3 days (returns to normal)

Also found in skeletal muscles, so lacking some specificity
T/F frequency of presenting symptoms changes as patients age?

Chest pain more frequent in YOUNGER

Dyspnea stays the SAME with ^ age

Syncope more prevalent in OLDER age ranges (also confusion, CNS presentations, and troke)

WOMEN'S symptoms are a lot less typical ("be 10x as suspicious of women")...that's right baby! never trust them! ;)
Time of day most likely to have MI?
Early morning

MI's have Circadian rhythms
Degree/Type of abnormalities caused by MI vary on what 2 facors?
1) Location

2) Availability of collateral vessels
Infarct of the anterior region of the heart most likely involves what vessel?
If patient is obtunded and mentally slow, compensatory mechs are?
Arterial hypotension & Tachycardia

-symptoms caused by v CO/coronary flow
What tends to happen to heart when there is heart failure, dilation, & elevated pressure in atrium
Atrial fibrillation
Cardiogenic Shock defined as?

Other symptoms?
drop of 30mmHg below baseline (~<90mmHg assuming 120mmHg normal)

Heart problem of ULTIMATE severity

Urine output drops to <20mL/Hr

Peripheral vasoconstiction (cool, clammy skin), confusion, coma, agitation, or lethargy
3 Different outcomes of MI:

1)MI =

2)Chronic ischemia w/out infarction =

3)Relief of ischemia =
1)MI = no contractile fxn

2)Chronic (repetitive) ischemia w/out infarction = reduced fxn or "hibernateing myocardium"

3)Relief of ischemia = short transient dysfxn or "stunned myocardium"
Sequence of post-MI heart remodeling?
Area that is not infarcted will activate Angiotensin -> ^ Growth Factors, metalloproteases & apoptosis (all help remodel heart...actually probably a bad thing)
The 2 phases of MI therapy
1) Early phase - try to ^ PERFUSION, reopen arteries (ACE inhibitors, BB)

2) Chronic phase - v REMODELING (also ACE inhibitors, BB)
Systolic murur =

Usually ruptured papillary muscle or chordae tendineae
Hypertension is an imporant risk factor for ___ not ___
HTN important for dissections..

NOT aneurysms
Sequence of events following a MI
1) 24 hrs - wavy fibers, hypereosinophilia of myocytes, contraction bands

2) 24-72 hours - PMN

3) 72 hrs to 1 week - macrophages (WHEN MOST PATIENTS RUPTURE, therefore macros can do some damage too)

3) 1-6 weeks - fibroblasts/myoblasts (granulation tissue) lay down collagen to make scar

4) 6 weeks - scar completely laid down

**ATP levels fall 1-2 minutes
Prominent sweating suggest?
ACUTE INFERIOR MI (as opposed to anterior)

N/V with any MI

also lead II, III, aVF has clear ST elevation
For treatment of STEMI patients give what?
Percutaneous coronary intervention or fibrinolytic drugs(GP IIb/IIIa)
Do NSTEMI give Q waves?
They can but rarely, much more common in STEMI
Dyskinetic impulse?
Feling the impulse @ apex (PMI) on diastyole (instead of systole)