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30 Cards in this Set
- Front
- Back
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What is lack of oxygen due to inadequate perfusion?
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ischemia
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3 biochemical effects of ischemia?
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1. FA's can't be oxidized
2. inc. lactate 3. dec. pH (metabolic acidosis) |
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What is the most common cause of ischemia?
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atherosclerosis
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What % blockage or stenosis is considered clinically significant?
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75-80%
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Top 5 risk factors for atherosclerosis in descending order?
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1. hyperlipidemia (inc. LDL)
2. smoking 3. HTN 4. DM 5. physical inactivity (friedlander)/obesity (johnston) |
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5 characteristics of metabolic syndrome (X)?
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insulin resistance, HTN, high TG/low HDL, hyperuricemia, hypercoagulable
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What % of US adults have metabolic syndrome?
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25%... yikes
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BMI ranges for desirable wt., overwt., and obese?
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desirable- 21-24, overwt.- 24-29, obese- 29 +
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What is the target amt. of physical activity to reduce risk for CAD, etc.?
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45-60 min. moderate intensity 5-7 x/week
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What 4 factors control MVO2 (mycoardial oxygen consumption?
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HR, afterload, contractility, & wall tension
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pathognomonic sign for angina?
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levine's sign (substernal, clinched fist)
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Cardiac pt. w/ pain radiating to the neck. First suspicion?
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angina until proven otherwise
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duration of stable angina?
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usually 15-20 minutes
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Pt. comes in and says they have dyspnea on exertion. You suspect anginal equivalent. what is happening pathologically?
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eleveate LV filling pressure (inc. LV-EDV) that leads to pulmonary edema
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Evaluate pt. w/ stable angina for possible CAD. What can you do? What can you do for unstable angina?
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stable: stress test is possible. unstable: no stress test, cath lab instead
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What drugs are the frontline of angina/CAD therapy?
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nitrates
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Pt. comes to the ED w/ symptoms of ACS. What is the protocol of treatment?
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morphine, oxygen, nitroglycerine, and aspirin (MONA)
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Beta-blockers control what two major determinants of myocardial oxygen demand?
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HR and BP
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What are characteristics of STEMI?
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(transmural) complete occlusion, ST elevation > 1mm in 2 or more contiguous limb leads or >2 mm in 2 or more contiguous precordial leads
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What are characteristics NSTEMI?
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(subendocardial) partial or transient occlusion; spontaneous revascularization
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What is the DOC for refractory chest pain?
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morphine sulfate (4 mg IV)
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What are the conraindications for treatment w/ beta-blockers?
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severe sinus brady (<40), 2nd or 3rd degree AV block (other blocks ok), decompensated HF, hypoentions, reactive airway diesease, cocaine-induced MI
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When is TLT (thrombolytic) therapy beneficial?
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Most beneficial if given in first few hours after onset of symptoms for STEMI or LBBB.
NO benefit w/ NSTEMI |
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Pt. presents w/ ischemic pain at rest w/ ST elevation. You suspect spasm as underlying problem. What is the Dx and Rx for it?
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Dx: Prinzmetal's variant angina
Rx: nitrates and CCB |
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In the first few hours of MI, what is the most common cause of death?
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a fatal arrhythmia
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What is the rise, peak, and duration of T1 associated w/ MI?
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Rises 3 hours
Peak 12-24 hours Duration 7-11 days |
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What is the rise, peak, and duration of CKMB associated w/ MI?
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Rises 4 hours
Peak in 12-24 hours Duration 2-3 day |
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How do you treat ventricular dysfunction as a potential mechanical complication of MI?
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ACE-inhibitors (prevents remodeling)
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What is the key treatment for pericarditis?
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ASA
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A post MI (1-2 months ago) pt. presents w/ chest fever, malaise, elevated sed rate and WBC, but cardiac enzymes are ok.
What is the Dx and Rx? |
Dx: Dressler's syndrome (due to inflammatory/immunologic reaction)
Rx: ASA |
