Cardiology
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| 2 pathways for ischemic heart dz progression | Progressive intraluminal narrowing; Sudden disruption/fissuring of plaques
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| Progressive intraluminal narrowing tend to: | produce collateral blood supply & more likely to cause worsening stable/unstable angina (>75%)
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| Sudden disruption/fissuring of plaques likely to: | rupture, causing ACS (Acute Coronary Syndrome) or Acute MI (25-75%)
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| 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
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| CAD signs/symptoms | Chest pain/pressure/tightness; Jaw/ neck/ throat/scapular/ arm pain; SOB/ Dyspnea on exertion; N&V; Diaphoresis; Fatigue
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| MI Pathophysiology steps | 1 Plaque rupture; 2 Platelet activation/aggregation; 3 Fibrin generation; 4 Thrombus formation
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| Cardiac ischemia risk factors | Age; Gender ? FH; Sedentary Lifestyle; Tobacco; HTN; DM/insulin resistance; Hyperlipidemia
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| Causes of coronary ischemia leading to chest pain | Atherosclerosis; Vasospastic disorders; stenosis or HCM; Coronary thrombosis/ embolization; Acute aortic dissection
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| Before a dx of CAD, diabetic patients' risk of MI = | risk of non-diabetic patient with hx of prior MI
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| Almost all MI’s result from: | coronary atherosclerosis & superimposed coronary thrombosis
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| What percent of MIs are unrecognized by clinicians? | 30%
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| Most common MI complaint other than chest pain = | dyspnea
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| Which sx of MI is report most commonly in the elderly? | Shortness of breath
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| Symptoms of MI in elderly patients commonly include: | confusion, syncope, and vertigo
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| MI tx: morphine, oxygen, NTG, ASA. What next? | Beta blockers
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| 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
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| Elevated troponin is a sensitive AND specific indicator of: | cardiac myonecrosis (2/2 troponin release from myocytes into circulation)
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| 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
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| What is prognostic significance of an elevated troponin level? | TnT elevation imparts a worse prognosis, regardless of the underlying etiology
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| 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
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| Prinzmetal angina: | Vasospastic Angina; W<50 yo; assoc w/migraine, Raynaud; early AM; ST elevation; usually RCA
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| 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
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| Most common etiology of angina pectoris: | atherosclerotic stenosis of coronary arteries
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| Etiologies of angina pectoris: | coronary artery sclerosis; artery spasm; congenital; AS; HCM; pHTN; HTN; collagen vasc dz
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| Stable angina: sxs | substernal pressure with exertion; relieved by rest
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| Unstable angina: sxs | chest discomfort at rest, or new & severe (within 2 months and brought on by exertion), or increasing frequency, duration, intensity
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| Anginal equivalent = | DOE caused by myocardial ischemia
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| Silent ischemia (evidence on stress test) is more common among: | patients with DM
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| In MI, CK-MB rises within: | 4-8 hours; peaks at 12-24 hours; normal in 2-3 days
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| In MI, LDH rises within: | 14-24 h; peak at 2-3 days; normal in 8-14 days
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| In MI, troponins rise within: | 4 hours; peak at 36 hours; normal in (7 days for TnI, 10-14 days for TnT)
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| Which med decreases comorbidity and comortality in CAD? | Beta blocker
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| Treatment of choice for Prinzmetal angina | Cardizem (diltiazem)
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| Which coronary artery is associated with a lateral MI? | Left circumflex
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| Which coronary artery is associated with an anterior MI? | LAD (left anterior descending). V2-V4 on ECG
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| Which coronary artery is associated with an inferior MI? | RCA (right coronary artery)
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| Which measure (lipids, BMI, homocysteine level) is the best predictor of cardiovascular mortality? | Homocysteine level
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| Which coronary artery is associated with a septal MI? | LAD (V1-V2 on ECG)
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| Which coronary artery is associated with an anterolateral MI? | left main (V4-V6 on ECG)
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| Which coronary artery is associated with a posterior MI? | RCA (right coronary artery) (ST depression, changes at V1-V2 on ECG)
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| Most specific cardiac enzyme for ACS | troponin I
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| Which cardiac enzyme rises earliest | myoglobin
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| In ACS, which enzymes becomes elevated in 3-12 hours | troponin I, troponin T, CK-MB
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| In MI, myoglobin peaks within | 0-1 hr (normal within 36 hours)
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| CAD risk factors | M>F. AA>W. Lower SES. FH. Obesity. Decreased physical activity. Smoking. HTN. LDL >160. HDL <40. DM. LVH.
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| CAD screening | Smoking. BP. Chol (M>35 yo, F >45yo). AAA: 65-75 if h/o smoking; exam & US
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