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30 Cards in this Set
- Front
- Back
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What is the lifetime risk of atherosclerosis for men and women?
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50%, 32%
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What are the risk factors for coronary heard disease? (6)
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1. Age (#1) 2. cigartte smoking 3. hyperlipidemia 4. diabetes 5. hypertension 6. family Hx of premature CHD
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What is the definition of premature CHD in men? women?
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<55, <65
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What is the definition of angina?
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Symptom of myocardial ischemia due to oxygen demand exceeding supply
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What are the parts of a chest pain history? (4)
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Descibe the pain, aggravating & alleviating factors, severity, change over time
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What kinds of chest pain are NOT characteristic of CHD?
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Location: only middle/lower abdo, radiates into lower extremities or localized to one finger tip
Character: reproduced by movement or palpation or respiration Duration: very brief or constant for many hours |
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What are the aggravating factors associated with CHD chest pain? (5)
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Emotion, exercise, eating, cold, sexual acitivity
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What are relieving factors for CHD chest pain?
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Rest, nitroglycerin
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What are the 4 classifications of the CCS?
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I = no limitation. only angina with very strenuous or prolonged activity
II = slight limitation. Angina with moderate exercise (>2blocks or 1 flight stairs) III = Marked limitation. Angina with little exercise (<2blocks or 1 flight stairs) IV = No activities. May have pain at rest |
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What are anginal equivalent symptoms? (3)
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Dyspnea
Faintness or fatigue Eructations (burping) |
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What are the 3 components of the definition of typical angina?
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1. substernal chest discomfort
2. provoked by exercise or emotion 3. relieved by rest or nitroglycerin |
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What is definite typical angina vs. probable (atypical) vs. noncardiac
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Definite = meets 3 criteria of definition
Probable = meets 2 criteria of definition Noncardiac = less than or equal to 1 criteria |
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What age/sex combo is most likely to present with typical chest pain angina?
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Older male or female (moreso for males)
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What other systems could be in the differential for chest pain? (4)
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MSK & chest wall
GI Pulmonary & mediastinal Psychiatric |
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What are two broad categories of tests that can be used to diagnose CHD and what are their subcategories?
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Structural - Angiogram, CT angiogram
Functional - Exercise stress test, nuclear test, stress echo |
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What is the gold standard for diagnosing CHD?
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Coronary angiography
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What are the disadvantages of coronary angiography?
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Invasive, high risk of serious complications
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What is the "stress" and "test" used in exercise stress test?
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stress = exercise
test = symptoms, response (BP, HR) and ECG |
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What are the determinants of oxygen delivery to heart muscle? (3)
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Hemoglobin, saturation, flow
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How do you increase oxygen delivery to heart muscle?
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Increase flow
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How much coronary stenosis do you need before you feel angina during exercise? at rest?
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70%, 90%
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How much stenosis do you need before you start to lose ability to compensate fully by vasodilation (increasing flow)?
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60-70%
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What different ways can you use to stress the heart for functional testing? (3)
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Exercise
Vasodilators - persantine, adenosine Pharmacologic stress - dobutamine |
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What different ways can you test ischemia following stress induction in a functional heart test? (4)
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Blood flow changes
wall motion abnormalities ECG Pain (symptoms) |
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How does a nuclear stress test work?
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Give tracer (ie - sestamibi) at rest for one test and repeat during exercise
Detect radiation and compare rest and exercise If reversible = ischemia If not reversible = prior infarct |
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What is a wall motion abnormality and when does it signify ischemia?
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Abnormal wall thickening during contraction of heart muscle
Signifies ischemia if only occurs during exercise |
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What is the treadmill procedure for exercise stress test called?
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Bruce Protocol
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What is Bayes Theorum?
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A test's predictive value varies depending on the pretest probability. It is best to use a test if have moderate pretest probability
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How do you treat atherosclerosis to prevent angina?
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Aspirin, modify risk factors
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How do you treat symptoms of angina?
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1)Reduce oxygen demand - decrease wall stress (nitrates, BP), Relax Heart contraction (BB, CCB), slow heart rate (BB, CCB)
2) Increase oxygen supply - vasodilators (nitrates), surgery (bypass, angioplasty) |
