Cv-Ischemic Heart Disease

Front 1

What are some risk factors for ischemic heart disease?

Back 1

1. age
2. family history
3. tobacco abuse
4. HTN
5. hyperlipidemia
6. DM
7. obesity

Front 2

What are some common signs and symptoms of ischemic heart disease?

Back 2

1. chest pain/pressure (can also radiate)
2. diaphoresis
3. nausea
4. dyspnea
5. dizziness
6. heartburn/epigastric pain
7. any complaint that is same as in previous cardiac event

Front 3

What are some signs and symptoms that are probably not cardiac in nature?

Back 3

1. feels like room is spinning
2. perioral numbness
3. pain radiating into legs
4. tingling in fingers and face
5. sharp, stabbing pain w/inspiration
6. reproduceable pain
7. rating of cardiac pain on 1-10 scale

Front 4

In HF, which side will cause pulmonary edema in general?

Back 4

left-sided HF

Front 5

What is the clenching chest sign known as?

Back 5

levine sign

Front 6

What is the most common cause of right-sided HF?

Back 6

left-sided HF

Front 7

What is the normal BP in the right heart? Left heart?

Back 7

1. 25/10
2. 120/80

Front 8

What signs might be found during physical exam of patient with ischemia?

Back 8

1. diaphoretic
2. clenching chest (Levine sign)
3. rales on lung auscultation
4. new heart murmurs
5. S3 gallop
6. jugular venous distention
7. peripheral edema
8. pulsus alternans
9. hypotension and tachycardia
10. tender liver

Front 9

What are the age risk factors for ischemic heart disease in males and females?

Back 9

1. males >45 y/o
2. females >55 y/o or premature menopause or HRT

Front 10

What are the family history risk factors for ischemic heart disease in males and females?

Back 10

1. must occur before 55 y/o in father or 1st degree male relative
2. must occur before 65 y/o in mother or 1st degree female relative

Front 11

What are high homocysteine levels associated with?

Back 11

increased incidence of ischemic heart disease

Front 12

What 2 drug combo is used for HTN with known CAD?

Back 12

BB's (cardioprotective) and ACE-I's

Front 13

T or F: folic acid, vitamin E, and anti-oxidants have all been proven to treat ischemia.

Back 13

false

Front 14

What will oxidized LDL do to the risk factors for ischemic heart disease?

Back 14

amplify them

Front 15

What is the 10 year risk calculator based upon?

Back 15

1. age
2. gender
3. total cholesterol
4. HDL
5. systolic BP
6. smoking history

Front 16

T or F: CRP has been linked to symptomatic atherosclerosis.

Back 16

true

Front 17

What are the LDL goals in high risk CHD? Moderately high risk CHD? Moderate risk CHD? Low risk CHD?

Back 17

1. high risk goal=<100mg/dL (optional goal=<70mg/dL)
2. moderately high risk goal= <130mg/dL (optional goal=<100mg/dL)
3. moderate risk goal=<130mg/dL
4. low risk goal=<160mg/dL

Front 18

What defines high risk CHD? Moderately high risk? Moderate risk? Low risk?

Back 18

1. 10 year risk>20%
2. >2 risk factors (10 year risk=10-20%)
3. >2 risk factors (10 year risk=<10%)
4. <1 risk factor

Front 19

What are the 3 determinants of oxygen supply to the coronary aa.?

Back 19

1. coronary perfusion pressure
2. time available for coronary blood flow
3. coronary vessel quality

Front 20

What are the 3 determinants of oxygen demand to the coronary aa.?

Back 20

1. HR
2. contractility
3. afterload

Front 21

What is the formula for coronary perfusion pressure?

Back 21

CPP=diastolic pressure-LVEDP

Front 22

Which MI cardiac marker usually appears in <6 hours? After 12-36 hours? 2-3 days?

Back 22

1. myoglobin
2. troponin and CKMB
3. LDH and AST

Front 23

What is an exercise stress test looking for?

Back 23

ST changes during max HR

Front 24

When would you order an exercise stress test? Heart cath? Stress/chemical ECHO?

Back 24

1. if patient can tolerate exercise and MI risk is low
2. if patient MI risk is high
3. in-between patients

Front 25

What are the sequential treatments for acute ischemia?

Back 25

1. oxygen
2. ASA-inhibits platelet activation
3. plavix-inhibits platelet aggregation
4. heparin-inhibits factor X and thrombin
5. morphine-analgesic and vasodilator
6. NO
7. BB
8. ACE-I's
9. glycoprotein 2B3A inhibitors

Front 26

For ST elevations to be valid, how often should they be present in an ECG?

Back 26

must be present in 2 contiguous leads for 3 or more beats

Front 27

If you can't get ischemic patient to cath lab in ____ minutes, you must give thrombolytics.

Back 27

90

Front 28

What are the indications for thrombolytics in AMI?

Back 28

1. can't get to cath lab <90 minutes
2. 1mm ST elevation in 2 contiguous leads
3. new LBB
4. patient has presented <12 hours from sx onset
5. no contraindications

Front 29

What are absolute contraindications for thrombolytics?

Back 29

1. prior intracranial hemorrhage
2. cerebral AVM
3. malignant cranial neoplasm
4. ischemic stroke < 3 months
5. suspected aortic dissection
6. active bleeding
7. significant closed head or facial trauma < 3 months

Front 30

What are relative contraindications for thrombolytics?

Back 30

1. severe or poorly controlled HTN
2. hx of ischemic stroke > 3 months
3. prolonged resucitation > 10 minutes
4. major surgery < 3 weeks
5. recent internal bleeding < 3 weeks
6. noncompressible vascular punctures
7. allergies to thrombolytics
8. pregnancy
9. active peptic ulcer
10. current use of anticoagulants
11. patient is stable and symptoms began > 12 hrs ago

Front 31

What is the rule of thumb for interventions if 2 or less coronary aa. are atherosclerotic? 3 or more?

Back 31

1. percutaneous coronary intervention (drug-eluting stents)
2. coronary artery bypass graft

Front 32

If a drug-eluting stent is chosen for treatment of CAD, what drug should be given with it?

Back 32

plavix

Front 33

What is a possible adverse effect of CABG?

Back 33

cognitive problems

Front 34

How does a non-STEMI differ from a STEMI?

Back 34

non-STEMI has no ST elevation on ECG

Front 35

Non-STEMI's have s/s of what ischemic condition?

Back 35

unstable angina

Front 36

What drug can produce an intense coronary vasospasm?

Back 36

cocaine

Front 37

What is used to treat prinzmetal's angina?

Back 37

CCB's

Front 38

What are some possible post-MI complications?

Back 38

1. ruptures
2. stents close
3. pericardial tamponade
4. arrhythmias
5. pericarditis

Front 39

What is a possible therapeutic intevention for someone post-MI with a weakened heart?

Back 39

intra-aortic balloon pump: balloon inflates during diastole to allow heart to work better

Front 40

What therapy is indicated to prevent the brain from swelling in cases of post-MI reperfusion?

Back 40

therapeutic hypothermia