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45 Cards in this Set
- Front
- Back
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What are the modifiable risk factors of CAD?
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hyperlipidemia
HTN DM tobacco use |
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What are the non-modifiable risk factors of CAD?
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Age
Male Sex Family History of CAD in men <55 or women <65 |
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What are the risk factors of CAD?
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Obesity
Physical Inactivity Hyperhomocysteinemia Elevated Lipoprotein,Lipids, Fibrinogen, & CRP levels DM HTN Tobacco |
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An EKG showing nonspecific changes, prior MI, T-wave inversion, and ST depression is characteristic of ________angina
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Stable Angina
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Abnormal findings in patients with stable angina include elevated BP, _______, ______, and other signs of cardiovascular disease.
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tachycardia
S4 |
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Stable angina is usually associated with a ________ stenosis in one or more coronary arteries.
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> 70% stenosis
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How do you treat a patient with stable angina?
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aspirin
nitro long acting nitrates b-blockers calcium channel blockers |
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ST ________is seen on the EKG of a patient with stable angina.
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depression
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ST ________is seen on the EKG of a patient with unstable angina.
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elevation
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Which type of angina is associated with fissured plaque?
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unstable angina
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How do you treat a patient with unstable angina?
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aspirin
heparin/lovenox GP IIB/IIIA |
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What are the characteristic symptoms/signs of Prinzmetal's Angina (Variant Angina)?
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-Chest pain without precipitating factors
-Occurs early morning -More common in women -EKG may show transient ST elevation |
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Prinzmetal's angina is caused by __________. It can also be precipitated by __________.
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vasospasm - often of RT coronary artery
cocaine use |
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What are the diagnostic tools used for evaluation of angina?
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Stress Test
Electron Beam CT Echo Radionucleotide Ventriculography Cardiac Cath |
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What are the contraindications for a routine Stress Test?
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Unstable Angina
Abnormal resting EKG |
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When should you order a pharmacological stress test?
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baseline EKG abnormalities
LVH LBBB pts taking digoxin unable to ambulate |
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Which diagnostic test for angina can determine the presence/absence of coronary artery calcification?
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Electron Beam CT
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Why is it important for a patient with angina to have an echocardiogram and radionucleotide ventriculography?
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can be used to assess LV function. This is an important predictor of survival.
decreased LV ejection fraction = poor prognosis |
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Cardiac Catheterization is indicated for the evaluation of angina in patients with ___________
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1)persistent angina despite meds
2)positive or high risk results of noninvasive tests 3)decreased LV function |
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What are the risk factor modification goals for dyslipidemia in patients with angina?
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HDL >40
Trig <200 LDL <100 for CAD pts LDL <130 w/o CAD LDL <160 w/o CAD and <2 cardiac factors |
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What is the target BP for hypertensive patients with angina?
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< 135/85
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Why should angina patients take the long acting calcium channel blockers rather than short acting?
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short acting worsens angina
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What effect do nitrates have on the body?
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decrease preload & afterload
coronary vasodilation |
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What effects do b-blockers have on the body?
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decrease heart rate, BP, workload & contractility,
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What effects do calcium channel blockers have on the body?
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-decrease heart rate, BP & contractility
-coronary vasodilation |
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What are the types of revascularization for patients with angina?
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CABG
PTCA Stent Placement |
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When is CABG indicated for patients with angina?
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1)left main CAD & decreased LV systolic function
2)3 vessel CAD 3)2 vessel CAD w/stenosis of left main |
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What are the 3 components of Acute Coronary Syndromes
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ustable angina
NSTEMI (non ST elevation MI) STEMI (ST elevation MI) |
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Plaque ruptures, vasospasm, thrombus formation & inadequate O2 supply are all related to _____________syndromes
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acute coronary syndromes
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When do most MIs occur?
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6am-noon
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CK-MB begins to rise _______hours after MI, peaks around ________hours, and returns to normal _________
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rises 4-8 hrs after MI
peaks 24 hrs normal in several days |
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Troponin begins to rise ______hours after MI onset, peaks around _______, and remains detectable for _______
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rises 3-4 hours after onset
peaks 24 hrs detectable 10-14 days |
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Total CK begins to rise in ________hours, peaks at ______hours and normalizes ______
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rises 3-5 hrs
peaks 24 hrs normalizes 28-72 hrs |
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Myoglobin begins to rise in _______hrs, peaks in __________hrs, and normalizes in __________
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rises 1-4 hrs
peaks 6-7 hrs normalizes 24 hrs |
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What is the initial treatment for patients with unstable angina or NSTEMI?
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MONA
Morphine O2 Nitro Aspirin |
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If patients with USA or NSTEMI have recurrent chest pain, EKG changes or positive cardiac enzymes after initial treatment you should add ________
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LMWH/Heparin (Lovenox)
and/or GP IIb/IIIa inhibitor |
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What is the initial focus of treatment for STEMI?
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hemodynamic stabalization
and symptom relief |
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In what way does STEMI treatment differ from NSTEMI treatment?
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Treatment is the same but STEMI also requires:
Percutaneous Revascularization (PCI) Thrombolytics is PCI unavailable |
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What is the criteria for thrombolytic therapy?
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ST elevation >1mV in 2+ leads
New LBBB ST depression w/prominent R wave in V2 & V3 (posterior MI) <12 hrs since MI |
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What are the absolute contraindications for thrombolytic therapy?
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aortic dissection
acute pericarditis active bleeding previous cerebral hemorrhage intracranial neoplasm cerebral aneurysm AV malformation |
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What are the relative contraindications for thrombolytic therapy?
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*bleeding diathesis/coagulopathy
*major trauma/surgery within 6mo *nonhemmorhagic stroke or GI bleed within 6mo *severe HTN *prolonged CPR *pregnancy *proliferative retinopathy |
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What are the mechanical complications seen with AMI?
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LV or RV failure
Cardiogenic shock |
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What are the structural complications seen with AMI?
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-free wall rupture
-ventricular septal defect -papillary muscle rupture with acute MR |
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What are the most common complications of AMI?
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Electrical:
arrhythmias ventricular ectopy sudden cardiac death conduction abnormalities |
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Most deaths from AMI result from ___________
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sustained VT or V-fib
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