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Session 2 CMCardio6

CM- Cardio -6- Ischemic Heart Disease CAD

what are the manifestations of Ischemic Heart Disease (coronary artery disease) stable angina acute coronary syndromes CHF sudden cardiac death silent ischemia
Due to fixed coronary lesion leads to mismatch of myocardial metabolic O2 supply and demand increases cardiac work load stable angina
What does Acute Coronary syndrome encompase includes conditions compatible with MI unstable angina STEMI NSTEMI
What happens to atherosclerotic plaque in an acute event it ruptures and creates a thrombogenic surface within blood vessel that leads to platelet aggregation/ fibrin formation limited blood flow distal to lesion mismatch O2 supply/demand tissue ischemia (unstable angina) tissue necrosis (MI)
What are the four grades of Acute Coronary Syndrome class I- angina occurs only with strenous activity Class II- angina occurs with moderate activity Class III- angina occurs withe mild activity Class IV- angina occurs with any activity and may occur at rest
What is unstable angina rapid increase in coronary stenosis but incomplete occlusion chest pain at rest on effort w/ change from previous pattern previous stable angina becoming severe
What are unstable angina patients at definite impending risk of myocardial necrosis
Apart from angina what other conditions lead to supply demand mimatches aortic stenosis thyrotoxicosis profound anemia
What do IHD/CAD predispose patient to heart failure cardiac arrythmias sudden cardiac death
Name 5 risk factors for IHD/CAD age >65 Male>Female Smoking HTN Fam Hx DM obesity sedentary life style elevated cholesterol inflammation
What is the most common cause of IHD/CAD and other causes atherosclerosis spasm Arterial Stenosis Hypertrophic obstructive cardiomyopathy metabolic syndrome/ syndrome X severe HTN
when does initial onset of atherosclerosis occur childhood and adolescence fatty streaks with lipid filled smooth muscle cells and macrophages (foam cells) and intermittent fibrous deposition
What happens to the atherosclerosis generally in third decade of life fibrous plaques appear in the abdominal aorta, coronary and carotid arteries. they are firm, elevated dome shped lesions on surface that bulge into lumen
What are atherosclerotic plaque made of extracellular lipid with cholesterol crystals and necrotic cell debris
What artherosclerotic plaques are usually associated with symptoms complicated lesions of calcified fibrous plaque containing degrees of necrosis, thrombosis and ulceration
What size vessels does atherosclerosis typically effect and how is it characterized disease of large and medium sized muscular arteries characterized by endothelial dysfunction vascular inflammation buildup of lipids, cholesterol, calcium, and cellular debris withing intima of vessel wall
What are the results of plaque formation vascular remodeling acute and chronic luminal obstruction abnormalities of blood flow diminished oxygen supply to target organs
What happens if the enothelium or fibrous cap over a atherosclerotic plaque ruptures you get exposure of the thrombogenic contents of the core to circulating blood. This is an advanced or complicated lession and inflammatory cells localize to the plaque. T-lmphocytes release inflammatory factors
what is the leading mechanism accepted regarding atherogenesis response to injury where endothelial injury causes vascular inflammation and followed by fibroproliferative response
What is the major concern of a plaque rupture that a thrombus will develop and occlude the blood vessel
When is anginal threshold typically lowest More in the A.M.
What type of angina is variable defies any pattern and is prominent at rest. Prinzmetal Angina (variable angina)
What might prinzmetal angina be caused by myocardial ischemia caused by coronary spasm
If you have angina lasting > 20min and it is severe chest discomfort accompanied by profound fatigue what does it often equal acute myocardial infarction or acute coronary syndrome
How long does typical angina pectoris last 2-10 minutes
if angina last for 15-20 minutes what type of angina is it typically representative of unstable angina
If the angina last for hours what might be underlying cause acute MI pericarditis aortic dissection musculoskeletal disease herpes zoster anxiety cocaine abuse
if chest pain is really brief less than 15 seconds is it angina no pain points to musculoskeletal pain, hiatal hernia or functional pain
what can be given to relieve angina pain nitro
If your patient is having chest pain and leaning forward helps relieve the pain more than just quiet standing or sitting what besides angina is likely causing there pain acute pericarditis
in angina what position is best to rest in to relieve pain lying down or standing up standing up or quietly sitting is best lying down does not relieve angina
what are anginal equivalents discomfort is limited to area of secondary radiation such as lower jaw teeth neck shoulders nausea indigestion dizziness diaphoresis
What other s/sx accompanying angina should be concerning profuse sweating- may indicate acute MI or aortic dissection, or Pulmonary Effusion nausea and vomiting- MI SOB-MI, pneumothorax or Pulmonary effusion Palpitations- Acute MI
What is important about angina in women, diabetics and elderly it presents atypically. more vasospastic, microvascular angina
When do women often report chest discomfort at rest during sleep during mental stress
What is dyspnea abnormally uncomfortable awareness of breathing
if you have sudden development of dyspnea what might that indicate pulmonary embolism, pneumothorax, acute pulmonary edema, pneumonia, or airway obstruction
If dyspnea develops slowly overtime what might that indicate suggest chronic heart failure
if you have exertional dyspnea what might that indicate left ventricular failure, ischemic heart disease or chronic obstructive lung disease.
if you have inspiratory dyspnea what might it be suggest upper airway obstruction
if you have expiratory dyspnea what might it be lower airway obstruction
if you have dyspnea at rest what might it be pneumothorax, pulmonary embolism, pulmonary edema, anxiety
if dyspnea is an anginal equivalent what may it be associated with sensation of tightness in the chest present on exertion or emotional stress relieved by rest similar to angina in duration usually responive to or prevented by nitro
What is orthopnea discomfort breathing while lying down patients with left ventricular failure start sleeping with 2 or more pillows to avoid the orthopnea
what are the three types of syncope cardiac syncope aortic stenosis syncope neurocardiogenic syncope/ syncope due to postural hypotension
What are palpitations unpleasant awareness of forceful or rapid beating of the heart
how are palpitations described Pounding Jumping or Skipping a beat Racing Irregularity of the heart beat A "flip flopping" A "rapid fluttering" Pounding in the neck Butterflies in my chest
If your patient has claudications ie Peripheral Vascualr disease what else do they likely have 50% likelihood of having CAD
What might you find on PE in angina could have S3 or S4 xanthomas (cholesterol filled nodules) signs of CHF
what is the most consistent ECG finding during acute ischemia deviation of ST segment from current of injury mechanism
what is the management for angina risk factor modification asa daily NTG prn long actin nitrates BB, CCB PTCA(PCI) CABG
what is the most common cause of MI atherosclertotic palque ruptures stimulating thrombus formation
What is the clinical findings for MI Severe anginal type pains, usually lasting >30 minutes, NOT relieved by NTG or rest SOB Anxiety Diaphoresis N/V Syncope Atypical & silent presentations
Created by: smaxsmith