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Cards Ischemia & ACS


2 pathways for ischemic heart dz progression Progressive intraluminal narrowing; Sudden disruption/fissuring of plaques
Progressive intraluminal narrowing tend to: produce collateral blood supply & more likely to cause worsening stable/unstable angina (>75%)
Sudden disruption/fissuring of plaques likely to: rupture, causing ACS (Acute Coronary Syndrome) or Acute MI (25-75%)
Tobacco: CAD risks 2x risk for 1/2 to 1 pack/day; 3x risk for > 1 pack/day; risk declines 50% after one year of tobacco cessation
CAD signs/symptoms Chest pain/pressure/tightness; Jaw/ neck/ throat/scapular/ arm pain; SOB/ Dyspnea on exertion; N&V; Diaphoresis; Fatigue
MI Pathophysiology steps 1 Plaque rupture; 2 Platelet activation/aggregation; 3 Fibrin generation; 4 Thrombus formation
Cardiac ischemia risk factors Age; Gender ? FH; Sedentary Lifestyle; Tobacco; HTN; DM/insulin resistance; Hyperlipidemia
Causes of coronary ischemia leading to chest pain Atherosclerosis; Vasospastic disorders; stenosis or HCM; Coronary thrombosis/ embolization; Acute aortic dissection
Before a dx of CAD, diabetic patients' risk of MI = risk of non-diabetic patient with hx of prior MI
Almost all MI’s result from: coronary atherosclerosis & superimposed coronary thrombosis
What percent of MIs are unrecognized by clinicians? 30%
Most common MI complaint other than chest pain = dyspnea
Which sx of MI is report most commonly in the elderly? Shortness of breath
Symptoms of MI in elderly patients commonly include: confusion, syncope, and vertigo
MI tx: morphine, oxygen, NTG, ASA. What next? Beta blockers
In a 65yo male with hx of CP x7 minutes with SOB, negative TnT, normal ECG, what is next step in mgmt? Repeat TnT in 3 hrs
Elevated troponin is a sensitive AND specific indicator of: cardiac myonecrosis (2/2 troponin release from myocytes into circulation)
In patients with ESRD, what cardiac enzyme changes should be used to define an MI? Dynamic changes in TnT values >20% over 6-9 hours
What is prognostic significance of an elevated troponin level? TnT elevation imparts a worse prognosis, regardless of the underlying etiology
Crushing CP, dyspnea, palpitations, radiation to neck or left arm: Angina (if lasts minutes), AMI if lasts >30 minutes. Acute Ischemia: ST elevation; Injury: T wave depression; Infarct: Q wave
Prinzmetal angina: Vasospastic Angina; W<50 yo; assoc w/migraine, Raynaud; early AM; ST elevation; usually RCA
Tobacco: CAD risks 2x risk for 1/2 to 1 pack/day; 3x risk for > 1 pack/day; risk declines 50% after one year of tobacco cessation
Most common etiology of angina pectoris: atherosclerotic stenosis of coronary arteries
Etiologies of angina pectoris: coronary artery sclerosis; artery spasm; congenital; AS; HCM; pHTN; HTN; collagen vasc dz
Stable angina: sxs substernal pressure with exertion; relieved by rest
Unstable angina: sxs chest discomfort at rest, or new & severe (within 2 months and brought on by exertion), or increasing frequency, duration, intensity
Anginal equivalent = DOE caused by myocardial ischemia
Silent ischemia (evidence on stress test) is more common among: patients with DM
In MI, CK-MB rises within: 4-8 hours; peaks at 12-20 hours; normal in 2-3 days
In MI, LDH rises within: 14-24 h; peak at 2-3 days; normal in 8-14 days
In MI, troponins rise within: 4 hours; normal in (7 days for TnI, 10-14 days for TnT)
Created by: Adam Barnard Adam Barnard