Case Analyses in Cardiology

This set of flashcards covers key concepts, diagnostics, pathophysiology, and management strategies regarding various cardiovascular conditions discussed in the lecture notes.

What is the mnemonic for risk factors in Acute Coronary Syndrome?

SHED: Smoking, Hypertension, Elderly/Age, Diabetes & Dyslipidemia.

What happens during plaque rupture in Acute Coronary Syndrome?

Unstable atherosclerotic plaque breaks, leading to thrombus formation.

What are the differences between STEMI and NSTEMI?

STEMI: Total occlusion causing transmural injury; NSTEMI: Partial occlusion causing subendocardial injury.

What is the 'gold standard' biomarker for cardiac muscle injury?

Troponin, as it is highly specific to cardiac muscle and remains elevated for up to 2 weeks.

What does an ECG show for STEMI?

ST Elevation.

What does an ECG show for NSTEMI?

ST Depression or T-wave inversion.

What is the immediate management mnemonic for Acute Coronary Syndrome?

MONA GAP: Morphine, Oxygen, Nitrates, Aspirin, GP IIb/IIIa inhibitors, Anticoagulants, P2Y12 Inhibitors.

What is the role of morphine in Acute Coronary Syndrome?

It helps with pain relief and anxiety.

What should be done for STEMI within 90 minutes?

Percutaneous Coronary Intervention (PCI) or stent placement.

What is a precaution for dental patients post-myocardial infarction on DAPT?

Beware of bleeding risk; do not stop antiplatelet medications without cardiologist consultation.

How much epinephrine can be used for dental procedures in post-MI patients?

Limit to 2 carpules (0.04mg max) to avoid tachycardia.

What triggers sympathetic/vagal activation during a myocardial infarction?

Conditions like inferior wall ischemia causing nausea and diaphoresis.

What is the definition of Stable Angina?

Pain only on exertion, relieved by rest or nitroglycerin.

What is the effect of fixed coronary stenosis in Stable Angina?

It prevents adequate blood flow during exertion, leading to ischemia.

What does an ST-Depression indicate?

It signifies subendocardial ischemia.

What is the significance of the C-Reactive Protein (CRP) in angina?

High levels suggest an active or unstable plaque.

What is the mnemonic for medications used in Stable Angina treatment?

A-B-C-S: Antiplatelet, Beta-blockers, Cholesterol, Symptom relief.

What condition leads to the release of endogenous catecholamines?

Corresponding dental anxiety that raises heart rate and blood pressure.

What is the major caution regarding dental procedures for hypertensive patients?

A higher risk of post-operative hemorrhage and hypertensive crisis.

What is the mnemonic used to recall risk factors for Stage 2 Hypertension?

S-S-S-F-O: Salt intake, Sedentary lifestyle, Smoking, Family history, Obesity.

What is the role of renin in the RAAS system?

Renin converts Angiotensinogen to Angiotensin I.

What is the consequence of high sodium intake on blood pressure?

It causes water retention, leading to increased blood volume.

How is pulmonary pressure altered in Ventricular Septal Defect (VSD)?

Left-to-right shunt leads to an overload of blood in the lungs.

What symptom indicates a baby may be experiencing feeding difficulties from VSD?

Sympathetic overdrive causing diaphoresis during feeding.

What is a common sign of Tetralogy of Fallot?

Tet spells, characterized by exertional cyanosis and irritability.

What is the significance of the 'boot-shaped heart' in imaging?

It indicates right ventricular hypertrophy often seen in Tetralogy of Fallot.

What is the purpose of knee-chest positioning in Tetralogy of Fallot?

It increases systemic vascular resistance (SVR) to redirect blood flow to the lungs.

What is the long-term complication of untreated VSD?

Eisenmenger Syndrome, where a left-to-right shunt becomes right-to-left.

How does dilated cardiomyopathy typically present?

Systolic dysfunction with enlarged heart chambers and reduced ejection fraction.

What does the S3 gallop indicate in heart failure?

Volume overload due to a dilated and non-compliant ventricle.

What role do beta-blockers play in treating dilated cardiomyopathy?

They protect the heart from excessive adrenaline effects and help remodeling.

What are the main characteristics of acute viral myocarditis?

Viral etiology leading to inflammation and potential heart failure symptoms.

What are the common diagnostic tools for acute viral myocarditis?

Troponin levels, cardiac MRI, and echocardiogram.

What happens to heart function in myocarditis compared to myocardial infarction?

Myocarditis is structural/inflammatory, while MI is an electrical/plumbing issue.

What dental precautions should be considered for patients with myocarditis?

Defer dental procedures until stable to avoid arrhythmias.

What is the treatment mnemonic for managing acute viral myocarditis?

R-E-S-T: Rest, Exclude NSAIDs, Supportive care, Time.

How can chronic periodontal disease affect heart conditions?

It may increase systemic inflammatory markers, exacerbating cardiovascular issues.

Why is antibiotic prophylaxis generally not required for viral myocarditis?

Unless there is structural damage or heart failure deemed high-risk by a cardiologist.

How does smoking affect coronary health?

It leads to endothelial dysfunction, increasing plaque formation.

What is the common effect of pregnancy on the heart?

Peripartum cardiomyopathy may develop, affecting heart function.

What happens when vascular smooth muscle relaxes due to calcium channel blockers?

It leads to decreased vascular resistance and lower blood pressure.

What are the signs of left-sided heart failure?

Shortness of breath and paroxysmal nocturnal dyspnea.

How does obesity affect blood pressure levels?

It increases sympathetic tone and vascular resistance.

What is the role of diuretics in heart failure management?

They remove excess fluid to relieve symptoms of congestion.

What does BNP elevation indicate?

It signals heart failure due to fluid overload on the myocardium.

What could be a dental consideration for patients on anticoagulants?

Increased risk of bleeding during dental procedures.

What does the 'DASHing to Health' mnemonic refer to?

Dietary Approaches to Stop Hypertension and lifestyle modifications.

What is the reason for careful handling of epinephrine in hypertensive patients?

It can cause rapid blood pressure spikes and exacerbate heart failure.

What is the significance of early detection of hypertension?

To prevent irreversible remodeling of the cardiovascular system.

What is a key characteristic of cardiac arrest survivors in terms of lifestyle?

They may require lifestyle changes to support heart health.

What diagnostic tool can be used to evaluate myocardial function?

Echocardiogram is essential for assessing chamber sizes and function.

What are the two main types of myocardial infarction?

STEMI (total blockage) and NSTEMI (partial blockage).

What is an inappropriate dental procedure practice for hypertensive patients?

Laying them fully supine without precautions due to fluid overload risk.

What factors increase myocardial oxygen demand?

Physical exertion, increased heart rate, and stress.

What should be monitored closely in patients with a history of dilated cardiomyopathy?

Ejection fraction and symptoms of heart failure.

What lifestyle modifications support heart failure management in hypertensive patients?

Regular exercise, sodium restriction, and weight management.