Stable Ischemic Heart Disease/Chronic Coronary Artery Disease Flashcards Preview

Cardio 2 > Stable Ischemic Heart Disease/Chronic Coronary Artery Disease > Flashcards

Flashcards in Stable Ischemic Heart Disease/Chronic Coronary Artery Disease Deck (21)
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1
Q

Normal arterial wall

A

Intima - single layer of endothelial cells

Media - thickest layer…contains smooth muscle cells

Adventitia - contains nerves, lymphatics, and BVs

2
Q

Glagov phenomenon

A

Early plaque grwoth shows outward remodeling of the vessel wall so that lumen diameter is preserved

3
Q

ACS vs. SIHD

A

ACS - plauqe…palque rupture…platelet agg and act of caog cascade…thrombus formation…sudden dec in supply…onset of sx

SIHD - atheroscleortic plaque…slow dec in lumen size…gradual dec in myocardial BF…slow progression in sx

4
Q

Typical angina
Atypical angina
Noncardiac chest pain

A

1) substernal chest discomfort with characteristic quality and duration and is 2) provoked by exertion or emotional stress and 3) relieved by rest or nitroglycerin

Atypical - 2 of above

Noncardiac - 1 or none

5
Q

Rest angina

New onset angina

Inc angina

A

Rest - rest and longer than 20 minutes

New - anginga on class 3 with onset within 2 mos of intial presentation

Inc - previously dx that is more frequent, longer in duration, or lower in threshold

6
Q

Other fts of angina

A

Anything that inc demand or dec supply should make worse

Pleuritic, positional, palpable, prolonged is NOT consistent iwth ischemia

7
Q

Men vs. women

A

Older men are more likely related to angina than women

8
Q

ECG indicaiton

A

Everyone with resting chest pain should get resting ECG

9
Q

What to do next?

A

If stable, perform diagnostic test

If unstable, go ahead and tx

10
Q

Group to get stress test with

A

middle - 45 y/o asx man with hypercholesterolemia, HTN, and diabetes

11
Q

Pros and cons of cardiac CT

A

Extremely rapid, non-invasive, phenomenal spaital resolution

Radiation epsoure, neprhotoxic contrast, motion/HR artifacts…ONLY the anatomy, NO physiology

12
Q

Cardiac catheterization

A
Invasive (low but real risk)
Costly
Nephrotiox contrast
Radiation
Can be therapeutic as well with PCI 
Gold standard***

This is another anatomical test

13
Q

Time line of ischemia

A

Normal —-perfusion prob—regional diastolic dys—-regional systolic dys—-ischemic ECG changes—-angina pectoris

14
Q

Able to exercise

A

If you can exercise, you SHOULD for the stressor

15
Q

Prognositc with EKC

A
ST changes - diagnosit
Duke treadmill score
Exercise capacity
HR recorvery (normal over 12 beats)
Drop in BP
16
Q

Nuclear imaging

A

Pros - non-invasive and non-neprhotoxic, primarily perufison, some info on txn, less limited by body abitus

Cons - radiation exposure, expensive upfront, most commonly done with exercise or vasodilator, limited structural info, limited by HR variability

17
Q

How to do nuclear

A

Administer

Resting images

Stress

Re-image

18
Q

Infarction and ischemia on nuclear

A

Infarct - defusion at rest adn at stress

Ischemia - defect at stress only

19
Q

Stress echo pro and ocn

A

No radiation and no neprhotixic, limited risk, non-invasive, echo readily available

Con - tech challenging, exercise or inotrope, more diff to interpret, limited by body habitus

20
Q

Stress MRI

A

Pro - rapid, no radiation, caridac perfusion with both anatomy and physioly, comprehensive

Cons - no anatomy, only vaosdilator challeneges, pt ability, limited by HR and pt tolerance

21
Q

Med tx of SIHD

A
Aspirin (clopidogrel if allergic)
Statins
Antianginals 
Lifestyle mods 
PCI improves chest pain but NOT mortality