Cardio 1/31/07

Front 1

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

Back 1

T

-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

Front 2

Mismatch of supply and demand without any symptoms of pain or discomfort

Back 2

Silent ischemia

Front 3

Major presentation of CAD?

Results in?

Back 3

Coronary atherosclerosis

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

-Resulting in Angina, MI, or Sudden death

Front 4

Stress (Takotsubo)cardiomyopathy most associated with?

Back 4

Vasospasm

Front 5

Two things that you must be aware about regarding the problems stemming from vascular plaque

Back 5

1) Obsturction (not severe is < 60-70% obstructed)

2) Instability

Front 6

NUMBER 1 most important symptom of CAD?

Back 6

Fatigue!

Front 7

What does a plaque do when it becomes unstable?

Back 7

Releases mediators that lead to vasospasm

Front 8

T/F Give a Thrombolytic agent to patient with ADis?

Back 8

F, they will bleed to death 10x faster

Front 9

A 2 month duration of th e same symptoms precipitated by the same effort, of the same duration, and relieved by the same treatment

Back 9

Stable angina

Front 10

Sequence of coronary artery occlusion symptoms (5)?

Back 10

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

Front 11

Silent Ischemia detected in a constant 24hr ECG monitoring change of what ?

Back 11

ST segment

Front 12

MANY or ONE vessel affected in CAD

Back 12

Many vessels offendded...a dynamic process

Front 13

Good stress test?

Bad stress test?

Back 13

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

Front 14

Type of testing that can give good images without requiring so much from the patient?

Back 14

Spiral CT

Front 15

Chest discomfort of new onset at REST, occuring in ABSENCE OF BIOCHEMICAL MARKERS (can have recurrence after MI or revascularization procedure)

Back 15

Unstable angina

-have THIN CAPS, may rupture and expose the lipid core which is very THROMBOGENIC

Front 16

Best marker for MI?

Back 16

Biochemical marker - difference b/w unstable angina and NSTEMI

ECG may not change util more severe ischemia is reached

Front 17

Varient (Prinzmetal) angina due to what?

Back 17

VASOSPASM only!

Front 18

Unstable angina/ NSTEMI result in?

Back 18

either ST depression and/or T wave inversion

Front 19

Stores of what deplete the fastest in MI?

Back 19

ATP

Front 20

Within how many minutes must you intervene to save infarcted myocardium?

Back 20

90 min

Front 21

Mean infarct size correlation to mode of death?

1)37%

2)20%

3)14%

Back 21

1)37% = cardiogenic shock

2)20% = primarily arrhythmia

3)14% = primarily danger of rupture

Front 22

Most of time MI occures from?

Other causes (4)?

Back 22

Occlusive thrombis

-Vasculitis - Lyme disease or mycoplasma infection

-Coronary spasm - Cocaine

-Conditions that ^ viscosity of blood

-Conditions that ^ coronary requirement

Front 23

Symptoms of MI?

Back 23

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

Front 24

What serum biomarker is highly sensitve for MI injury?

Rising and falling span?

Back 24

Troponin

Rises rapidly within 5-6 hours,

Remains positive for 10-14 days

Front 25

What is the fastest biomarker?

How fast? Problems?

Back 25

Myoglobin

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

Not very specific & Cleared w/in 1-4 hours

Front 26

What biomarker peaks at 24hrs?

Back 26

CK-MB

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

Also found in skeletal muscles, so lacking some specificity

Front 27

T/F frequency of presenting symptoms changes as patients age?

Back 27

T

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! ;)

Front 28

Time of day most likely to have MI?

Back 28

Early morning

MI's have Circadian rhythms

Front 29

Degree/Type of abnormalities caused by MI vary on what 2 facors?

Back 29

1) Location

2) Availability of collateral vessels

Front 30

Infarct of the anterior region of the heart most likely involves what vessel?

Back 30

LAD

Front 31

If patient is obtunded and mentally slow, compensatory mechs are?

Back 31

Arterial hypotension & Tachycardia

-symptoms caused by v CO/coronary flow

Front 32

What tends to happen to heart when there is heart failure, dilation, & elevated pressure in atrium

Back 32

Atrial fibrillation

Front 33

Cardiogenic Shock defined as?

Other symptoms?

Back 33

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

Front 34

3 Different outcomes of MI:

1)MI =

2)Chronic ischemia w/out infarction =

3)Relief of ischemia =

Back 34

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"

Front 35

Sequence of post-MI heart remodeling?

Back 35

Area that is not infarcted will activate Angiotensin -> ^ Growth Factors, metalloproteases & apoptosis (all help remodel heart...actually probably a bad thing)

Front 36

The 2 phases of MI therapy

Back 36

1) Early phase - try to ^ PERFUSION, reopen arteries (ACE inhibitors, BB)

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

Front 37

Systolic murur =

Back 37

BIG TROUBLE

Usually ruptured papillary muscle or chordae tendineae

Front 38

Hypertension is an imporant risk factor for ___ not ___

Back 38

HTN important for dissections..

NOT aneurysms

Front 39

Sequence of events following a MI

Back 39

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

Front 40

Prominent sweating suggest?

Back 40

ACUTE INFERIOR MI (as opposed to anterior)

N/V with any MI

also lead II, III, aVF has clear ST elevation

Front 41

For treatment of STEMI patients give what?

Back 41

Percutaneous coronary intervention or fibrinolytic drugs(GP IIb/IIIa)

Front 42

Do NSTEMI give Q waves?

Back 42

They can but rarely, much more common in STEMI

Front 43

Dyskinetic impulse?

Back 43

Feling the impulse @ apex (PMI) on diastyole (instead of systole)