Cardiology - CAD, ACS (Exam 1)

ischemic heart 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

coronary artery disease

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

acute coronary syndrome

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 myocardial infarction

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

unstable angina

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

stable angina

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

beta blockers

first line treatment for stable angina

exercise EKG

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

variant angina (Prinzmetal's)

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

CCB and/or nitrates

treatment for prinzmetal's/variant angina

coronary angiography

diagnostic study for variant/prinzmetal's angina

myocardial ischemia

not enough blood flow to the heart

myocardial injury

no blood flow to the heart

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

MONA BASH

MONA BASH

treatment for unstable angina/NSTEMI

fibrinolytics

harmful in unstable angina/NSTEMI

nitroglycerin

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

morphine, nitroglycerin, BB

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

nitroglycerin

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

beta blocker

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

BB, statin, ASA, ACEi

lifelong meds after NSTEMI/UA

history, EKG, age, risk factors, troponin

HEART score

low risk

HEART score 0-3

moderate risk

HEART score 4-6

high risk

HEART score 7-10

benzodiazepines

give this first in cocaine-related ACS

beta blockers

do not give this to cocaine-related ACS patients

right coronary artery

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

LAD

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

distal LAD

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

circumflex

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

RCA or circumflex

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

90 mins

FMC to balloon time in STEMI treatment

aspirin, plavix, heparin, cath lab

STEMI ER treatment plan

30 mins

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

120 mins

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

tPA, TNKase

fibrinolytic drugs used to treat STEMI

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

DARTH VADER complications of MI

ruptured ventricle

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

tamponade

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

hypotension, JVD, muffled heart sounds

beck's triad

ECHO

gold standard for diagnosing cardiac tamponade

pulsus paradoxus

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

pericardiocentesis

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

cardiogenic shock

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

acute MI

most common cause of cardiogenic shock

valve rupture

MI plus new murmur, surgical emergency

aneurysm

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

Dressler's syndrome

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

aspirin, colchicine, glucocorticoids

treatment for Dressler's syndrome

coronary artery bypass graft (CABG)

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.

aspirin, statins, beta blockers, ACEi

recommended daily for all patients after reperfusion therapy

CCB, NSAIDs

contraindicated drugs after reperfusion therapy