Rheumatic Heart Disease, Endocarditis, And Cad

Front 1

Rheumatic Heart Disease is caused by this.

Back 1

Group A beta-hemolytic Streptococcal infection

Front 2

Which valve is most commonly affected with rheumatic heart disease?

Back 2

Mitral valve

Front 3

Diagnosis is made by what?

Back 3

Jones Criteria

Front 4

In terms of Jones Criteria, what do you need to be diagnosed with rheumatic heart disease?

Back 4

Presence of:
- 2 major OR
- 1 major and 2 minor

Front 5

What is Sydenham's chorea?

Back 5

Choreoathetoid movements usually of the face, tongue, and upper extremities.

(A Jones "Major" Criteria)

Front 6

What are some lab findings of rheumatic heart diease?

Back 6

Elevated ESR
High titers of antistreptococcal antibodies (ASO)

Front 7

What is the treatment for rheumatic heart disease?

Back 7

- Penicillin for infection (erythromycin if PCN allergy)
- Salicylates for arthritis and fever
- Prophylaxis

Front 8

What does prophylaxis of rheumatic heart disease consist of?

Back 8

- Continued for 5-10 years after primary disease (10 years if had high exposure rate)
- Includes 1.2 million U of benzathin PCN monthly

Front 9

What does prophylaxis of endocarditis consist of?

Back 9

2 grams amoxicillin

Front 10

What is the first event of CAD?

Back 10

Injury to the vascular endothelium (due to tobacco use, hyperlipidemia, and hypertension)

Front 11

What are the 10 events that lead up to CAD?

Back 11

1. Endothelial injury
2. Macrophage and lipid accumulation
3. Formation of foam cells (by the ingestion of LDLs by macrophages)
4. Formation of the "fatty streak" by the aggregation of foam cells.
5. Endothelial denudation by enzymes released by macrophages
6. formation of a fibrous cap (over the lipid core)
7. Plaque formation
8. Plaque rupture
9. Thrombus
10. ACS/NSTEMI/STEMI

Front 12

What are the 4 discussed modifiable risk factors for CAD?

Back 12

1. Hyperlipidemia
2. Diabetes Mellitus
3. Tobacco Use
4. Hypertension

Front 13

What are some types of nonatherosclerotic cardiac ischemia?

Back 13

- Acute embolization
- Aortic Dissection
- Arteritis
- Kawasaki disease
- Spontaneous coronary thrombosis (DIC, Sickle cell)
- Cocaine
- Syndrome X
- Mismatch of myocardial oxygen supply and demand

Front 14

What is Kawasaki diease?

Back 14

Characterized by coronary vasculitis with coronary aneurysms.

It is a mucocutaneous lymph node syndrome (common in children)

Front 15

Which type of dysfunction results first from ischemia?

Back 15

Diastolic (impaired relaxation)

Front 16

_________ is the prolonged period after ischemia of reversible dysfunction.

Back 16

Myocardial stunning

Front 17

What is myocardial hibernation?

Back 17

It occurs with chronic ischemia where the myocardium maintains VIABILITY but cannot FUNCTION normally

Front 18

Which is worse, chronic or actue myocardial infarction? Why?

Back 18

Acute; because there is not enough time for collateral vessels to develop, resulting in a more extensive infarction.

Front 19

What is angina?

Back 19

Chest pain resulting from myocardial ischemia

Front 20

What are the 3 types of angina?

Back 20

1. Stable
2. Unstable
3. Prinzmetal's (Variant) angina

Front 21

This type of angina occurs in a predictive and chronic pattern and can be induced by activity or stress. It lasts about 5-10 minutes.

Back 21

Stable angina

Front 22

What helps alleviate stable angina?

Back 22

Nitroglycerin

Front 23

This type of angina is associated with a fissured plaque, pain at rest, and a lack of response to nitroglycerin. ST elevation may or may not be present.

Back 23

Unstable angina

Front 24

How do you treat unstable angina?

Back 24

- Aspirin
- Heparin/Lovenox
- Glycoprotein IIb/IIIa inhibitors

Front 25

What causes the pain of variant angina?

Back 25

A vasospasm, often involving the right coronary artery.

Front 26

Which type of angina should NOT be tested via stress testing?

Back 26

UNSTABLE ANGINA

Front 27

What is the benefit of electron beam CT?

Back 27

It can determine the presence or absence of coronary artery calcification and can determine if further workup is needed.

Front 28

What diagnostic test is helpful in assessing LV function?

Back 28

Radionucleotide Ventriculography and Echocardiogram

Front 29

What is the goal for HDLs for men and women with angina?

Back 29

> 40 (men) and > 50 (women)

Front 30

What are 3 ways to lower LDL levels?

Back 30

1. exercise
2. phenophibrate
3. statins

Front 31

For angina, what is the goal of SBP and DBP?

Back 31

SBP: < 135

DBP: < 85

Front 32

What are the drug classes used to treat angina?

Back 32

- Nitrates
- Beta blockers
- Calcium channel blockers (dihydropyridines or nondihydropyridines)

Front 33

Patients with known CAD should take _______ and/or __________.

Back 33

Aspirin, Plavix

Front 34

When is revascularization for angina indicated?

Back 34

- Medical therapy doesn't help
- Patient has unstable angina
- Positive noninvasive test results

Front 35

What are the 3 types of revascularization?

Back 35

- Coronary artery bypass grafting (CABG)
- Percutaneous transluminal coronary angioplasty (PTCA)
- Stent placement

Front 36

What is beneficial about using both the PTCA and a stent?

Back 36

It significantly lowers the rate of restenosis

Front 37

CABG involves which vessels to bypass an area of stenosis?

Back 37

Saphenous vein or radial artery

Front 38

When is CABG indicated?

Back 38

- with left main CAD and decreased LV function
- 3 vessel CAD
- or 2 vessel CAD if one is the left main CA

Front 39

When do most infarctions occur?

Back 39

From 6am to noon

Front 40

What is included under the label "Acute Coronary Syndromes?"

Back 40

Unstable angina
Non-ST Elevation MI
ST Elevation MI

Front 41

STEMI results from what?

Back 41

Complete occulsion of the coronary artery

Front 42

What is STEMI also known as?

Back 42

Transmural MI

Front 43

Which acute coronary syndrome may show symmetrical hyperacute peaked T waves?

Back 43

STEMI

Front 44

Which acute coronary syndrome results from high grade (but NOT occlusive) stenosis and is associated with ST segment depression?

Back 44

NSTEMI (aka. subendocardial infarction)

Front 45

How many sets of serial cardiac enzymes are needed to RULE OUT an MI?

Back 45

3

Front 46

Which cardiac enzyme begins to rise 4-8 hours after an MI, peaks around 24 hours, and returns to normal within several days?

Back 46

CK-MB (Creatine Kinase Muscle Band): this is a myocardial specific isoenzyme that is relatively specific to cardiac injury

Front 47

How many measurements of troponin levels are needed to DIAGNOSE an MI?

Back 47

ONE (troponin proteins should NOT be detected in the blood in normal circumstances)

Front 48

How long are troponin T and I levels available?

Back 48

Rise within 3-4 hours after onset of MI, peaks at 24 hours, and remains detectable for 10-14 days (THE LONGEST).

Front 49

Which cardiac enzyme has its levels rise in 3-5 hours after MI, peaks at 24 hours and normalizes within 28-72 hours?

Back 49

Total CK

Front 50

How long is myoglobin detected in the blood after an MI?

Back 50

Levels elevated in 1-4 hours, peaks in 6-7 hours, and normalizes within 24 hours.

Front 51

How are unstable angina and NSTEMI usually differentiated?

Back 51

Via cardiac enzyme elevations

Front 52

Initial treatment for USA and NSTEMI includes what?

Back 52

MONA: Morphine, Oxygen, Nitroglycerin, and Aspirin

Front 53

When should you add Lovenox/heparin and/or GP IIb/IIa inhibitor for a patient with unstable angina or NSTEMI?

Back 53

If he/she experiences recurrent chest pain or positive EKG changes or enzyme levels.

Front 54

If you put a patient on GP IIb/IIa inhibitor, what is important to monitor?

Back 54

Platelet levels.

Front 55

What is the initial treatment of STEMI?

Back 55

Hemodynamic stabilization and relieving pain/symptoms

Front 56

If a cardiac catheterization facility is not accessible, what should be done to treat a STEMI patient?

Back 56

Thrombolytic therapy

Front 57

What are some ABSOLUTE contraindications to thrombolytic therapy?

Back 57

- Aortic dissection
- Acute pericarditis
- Bleeding
- Brain tumor

Front 58

What does t-PA have a higher incidence of?

Back 58

Intracrainial hemorrhage

Front 59

Should you give someone Streptokinase who has received it before?

Back 59

NO

Front 60

What are 3 mechanical complications of AMI?

Back 60

1. LV Failure
2. RV Failure
3. Cardiogenic shock

Front 61

What are 3 structural complications of AMI?

Back 61

1. Free wall rupture
2. Ventricular septal defect
3. Papillary muscle rupture with acute MR

Front 62

Arrhythmias, ventricular ectopy, sudden cardiac death, and conduction abnormalities are all types of ____________ complications of AMI.

Back 62

Electrical (the most common type)

Front 63

Most deaths from AMI result from what?

Back 63

Sustained VT or VF

Front 64

1st degree AV block and Wenkebach AV block are associated with ________ MI.

Back 64

Inferior

Front 65

Which type of AV block is associated with anterior MIs?

Back 65

Mobitz II

Front 66

What is pump failure associated with?

Back 66

Systemic hypotension
Pulmonary congestion

Front 67

Which type of MI is more hemodynamically unstable?

Back 67

Anterior MIs

Front 68

Which types of MI are most often associated with RV infarctions?

Back 68

Inferior MI (because both supplied by RCA)

Front 69

Hypotension, no pulmonary congestion, elevated JVP, and positive Kussmaul's sign is associated with what?

Back 69

RV Infarction

Front 70

Which type of AMI complications most frequently result in hemodynamic instability?

Back 70

Mechanical

Front 71

Anticoagulation is indicated in what type of STEMI?

Back 71

Anterior and apical

Front 72

What is Dressler's Syndrome?

Back 72

A complication of AMI that occurs 1-2 months post-MI and causes pericarditis, fever, leukocytosis, pericardial or pleural effusion

Front 73

What is the treatment for Dressler's Syndrome?

Back 73

Aspirin

Front 74

78 year old male presents to the ER with chest pain that started about 30 minutes ago. It was accompanied by nausea and vomiting. You obtain an EKG and it shows ST elevations in leads I, AVL, V5 and V6. What is the diagnosis?

Back 74

Lateral wall MI

Front 75

Many thrombolytics are available for use and have been shown to decrease mortality if used early. Which agent should not be used if a patient has previously received it?

Back 75

Streptokinase

Front 76

Patient presents to the ER with complaints of chest pain for 30 min, radiates down left arm, associated with SOB.
What tests would you order?
What if EKG shows ST segment elevation?

What if EKG shows no changes?

What if EKG shows ST segment depression?

Back 76

See notes

Front 77

56 year old female presents with complaints of chest pain, occurs intermittently, with exertion. It lasts for about 5 min each time. It is located substernally, associated with mild SOB. It is relieved with rest. How would you classify this?

Back 77

Stable angina