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23 Cards in this Set
- Front
- Back
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Myocardial ischemia: define? most common cause?
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Oxygen supply is less than oxygen demand
>90% of cases caused by CAD |
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What are the 2 paths to thrombus after plaque disruption? How can these be treated pharmacologically?
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Thrombin generation:
Indirect thrombin inhibitors (Heparin) Direct thrombin inhibitors (Bivalirudin) Platelet activation: Aspirin Thienopyridines Glycoprotein IIb/IIIa inhibitors |
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How does the degree of obstruction affect symptoms?
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Fixed obstruction <50-70% has normal perfusion
Obstruction >70% - ischemia may occur with exertion Stenosis >90% - ischemia at rest may occur |
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What are the 5 clinical syndromes from IHD?
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Angina pectoris
Silent Ischemia Acute coronary Syndrome Chronic IHD Sudden cardiac death |
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Define angina pectoris. What are the 3 types?
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Ischemia is present without myocardial necrosis.
Stable Unstable Variant (Prinzmetal's) |
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What symptoms are more common in women with angina pectoris?
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Burning or sharp pain
Loss of appetitie SOB at night Back pain/abdminal pain Nausea and/or vomiting Palpitations or anxiety Indigestion |
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Define silent ischemia.
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Ischemia is present during exertion or at rest but without any symptoms.
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What can silent ischemia cause?
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Left ventricular dysfunction
Arrhythmias Risk of future MI |
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What does the 'acute coronary syndrome' term include?
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Unstable angina
NSTEMI STEMI |
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Describe the clot in STEMI.
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"Red" clot
Platelet aggregation with fibrin mesh at site of plaque rupture |
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Describe the clot in NSTEMI.
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"White clot"
No fibrin, few red cells. Smaller clot that tends to not be fully obstructive |
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Define Chronic IHD.
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Patients may develop progressive heart failure as a result of myocardial damage from previous MI or dysfunction from chronically ischemic myocardium
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What are the causes of sudden cardiac death? What raises the risk?
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Acute coronary occlusion
Myocardial scar (depends on substrate) Chronic ischemia Low LVEF |
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What 2 biomarkers are important for acute MI? How are they different
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Troponin and CKMB
May not elevate for up to 8 hours. CKMB can go down quickly, but troponing can last for a while. |
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What are the 4 acute treatment principles for NSTEMI and unstable angina?
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Treat the underlying clot
Increase myocardial oxygen delivery Decrease myocardial oxygen demand Relieve patient discomfort |
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What is the 'recipe' for treating the clot?
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2-3 antiplatelet's
1 antithrombotic |
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MOA of fondaparinux
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factor Xa inhibitor
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MOA of bivalirudin
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Direct thrombin inhibitors
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What are the advantages of bivalirudin instead of heparin?
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Effective in clot-bound thrombin
Inhibits thrombin-mediated platelet activation Short half life Markedly reduced bleeding |
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What drugs improve oxygen supply/demand relationship?
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Nitrates
Beta blockers CCBs Morphine |
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Clinical affects of nitrates
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Primarily venous dilatation
Decrease LV volume Decrease LV preload Coronary dilation |
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Clinical affects of beta blockers
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Reduce responsiveness to sympathetic agonists, decreasing myocardial oxygen consumption
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Clinical affects of CCBs
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Reduce heart rate
Lower blood pressure through arterial dilatation |
