Cardiology - CAD, ACS (Exam 1)

condition where the heart muscle doesn't receive enough oxygen-rich blood due to narrowed or blocked arteries, lack of blood flow can cause chest pain and eventually lead to a heart attack

ischemic heart disease

most common type of IHD, occurs when plaque builds up within coronary arteries

coronary artery disease

condition where the heart muscle doesn't receive enough oxygen-rich blood due to narrowed or blocked arteries, lack of blood flow can cause chest pain and eventually lead to a heart attack

ischemic heart disease

most common type of IHD, occurs when plaque builds up within coronary arteries

coronary artery disease

umbrella term for a range of urgent heart conditions caused by a sudden, severe blockage of the coronary arteries; includes unstable angina and heart attacks

acute coronary syndrome

defined by myocardial necrosis leading to STEMI, elevation of troponin and EKG findings

acute myocardial infarction

acute ischemia that can progress to infarction, evidence of ischemia on history, EKG, etc but no change in troponin

unstable angina

chest wall discomfort precipitated by stress or exertion and relieved by rest or nitrates

stable angina

first line treatment for stable angina

beta blockers

most common non-invasive testing in evaluating for inducible ischemia in a stable patient

exercise EKG

coronary vasospasm, angina pain usually at rest (often between midnight and early morning) with no change in exercise function

variant angina (Prinzmetal's)

treatment for prinzmetal's/variant angina

CCB and/or nitrates

diagnostic study for variant/prinzmetal's angina

coronary angiography

not enough blood flow to the heart

myocardial ischemia

no blood flow to the heart

myocardial injury

MONA BASH

morphine, oxygen, nitroglycerin, aspirin, beta blocker, ACEi, statin, heparin

treatment for unstable angina/NSTEMI

MONA BASH

harmful in unstable angina/NSTEMI

fibrinolytics

contraindicated if PDE-5 inhibitors have been used in the last 24 hours

nitroglycerin

medications that affect BP/HR and lower myocardial oxygen demand in UA/NSTEMI treatment

morphine, nitroglycerin, BB

produces effective improvement in ischemic chest pain, can be used to control severe BP, reduces preload, coronary vasodilation, and might also improve coronary perfusion

nitroglycerin

should be given orally within first 24 hours of UA/NSTEMI to decrease HR and myocardial oxygen demand

beta blocker

lifelong meds after NSTEMI/UA

BB, statin, ASA, ACEi

HEART score

history, EKG, age, risk factors, troponin

HEART score 0-3

low risk

HEART score 4-6

moderate risk

HEART score 7-10

high risk

give this first in cocaine-related ACS

benzodiazepines

do not give this to cocaine-related ACS patients

beta blockers

inferior MI (II, III, aVF) correlates with damage to this coronary artery

right coronary artery

anteroseptal MI (V1, V2) correlates with damage to this coronary artery

LAD

anteroapical MI (V3, V4) correlates with damage to this coronary artery

distal LAD

anterolateral MI (I, aVL, V5, V6) correlates with damage to this coronary artery

circumflex

posterior MI (V1-V3 reciprocal changes) correlates with damage to this coronary artery

RCA or circumflex

FMC to balloon time in STEMI treatment

90 mins

STEMI ER treatment plan

aspirin, plavix, heparin, cath lab

at non-PCI hospital, give fibrinolytic in this time frame

30 mins

at non-PCI hospital, transfer to PCI hospital for cath in this time frame

120 mins

fibrinolytic drugs used to treat STEMI

tPA, TNKase

DARTH VADER complications of MI

death, arrhythmia, ruptured ventricle, tamponade, heart failure, valve rupture, aneurysm, Dressler's syndrome, embolism, recurrence

catastrophic complication of MI that occurs within a few days, rapid decompensation, bedside ultrasound shows pericardial effusion and tamponade

ruptured ventricle

pericardial fluid under pressure, leading to impaired cardiac filling and hemodynamic compromise

tamponade

beck's triad

hypotension, JVD, muffled heart sounds

gold standard for diagnosing cardiac tamponade

ECHO

abnormally large decrease in sBP during inspiration; beats can be auscultated but no radial pulse felt during inspiration

pulsus paradoxus

surgical puncture to aspirate fluid from the sac surrounding the heart; used to treat cardiac tamponade

pericardiocentesis

clinical condition of inadequate tissue perfusion due to the inability of the heart to pump an adequate amount of blood, results in decreased oxygen and nutrient delivery to tissues, can lead to end organ damage and multi-system failurem

cardiogenic shock

most common cause of cardiogenic shock

acute MI

MI plus new murmur, surgical emergency

valve rupture

mimics a STEMI, large Q waves with ST segment elevation in an asymptomatic patient

aneurysm

post MI pericarditis, typically 2-6 weeks post MI, presents with pleuritic chest pain (worse with deep breathing), classically better with leaning forward and worse laying down, pericardial friction rub

Dressler's syndrome

treatment for Dressler's syndrome

aspirin, colchicine, glucocorticoids

surgery performed in multivessel disease, significant left main coronary blockage, surgical correction of MI complications, VSD, ventricular aneurysm, LV dysfunction, NSTEMI and high-risk features, etc.

coronary artery bypass graft (CABG)

recommended daily for all patients after reperfusion therapy

aspirin, statins, beta blockers, ACEi

contraindicated drugs after reperfusion therapy

CCB, NSAIDs