Features of stable angina
Brought on by exertion
lessened by rest
does not change with position
lasts less than 15 min
pressure, heaviness, squeezing
Exertional angina with clean cath. Dx? What will nuclear stress test show?
Syndrome x
Nuclear stress test will show ischemia
How does adenosine work in a cardiac stress test?
Because diseased vessels are already maximally dilated, dilation of other vessels caruses shunting of bloodflow away from diseased vessel.
Main indications for CABG?
3 vessel disease with >70% stenosis in each
Left main disease with >50% stenosis
LV dysfunction
Characteristics of unstable angina
angina at rest
chronic angina with increasing frequency, duration or intensity
New onset angina that is worsening
How to differentiate unstable angina and NSTEMI
Cardiac enzymes
(beacuase both lack ECG changes)
Tx of Unstable angina/NSTEMI
- Aspirin (clopidegrel shown to be superior in CURE trial)
- B Blocker
- LMWH for at least 2 days (enoxaparin is best)
- Nitrates
- O2 if hypoxic
- Morphine
- Replace electrolytes
- Schedule cardiac cath
Classic time for prinzmetal angina to occur?
-At night
How does a RV infarct present?
- Inferior ECG changes
- Hypotension
- Elevated jugular venous pressure
- hepatomegaly
- CLEAR lungs
Earliest ECG change in MI?
Peaking T waves
Which cardiac enzymes are the first to rise? Last to return to normal?
- Troponin I and T increase within 3-5hr and peak at 24-48
- CK-MB peaks first at about 24
- Trp I and T stay longer– 7-10 days
Which Tx for MI has been shown to reduce mortality?
- Aspirin (or eq. antiplatelet)
- B Blocker
- ACE inhibitor
Antiplatelet therapy for ppl who receieve a stent (bare metal and drug eluting)?
- at least 6mo with bare metal
- at least 12mo with drug eluting
Dual antiplatelet with aspirin and clopidogrel
Pt with complete heart block, likely locations of MI? Which is worse?
Anterior or inferior
Anterior has worse prognosis
A re-elevation in this enzyme is more specific for re-infarction dur to its rapid return to basseline…
CK-Mb
Ventricular free wall rupture generally occurs within this time frame following MI…
First 14 days
Septal rupture occurs within this time frame…
10 days
Treatment of acute pericarditis following MI?
Aspirin (should already be on)
NSAIDs and corticosteroids are contraindicated! (prevents myocardial scar formation)
Patient 3 months post MI with fever, malaise, pericarditis, pleuritis, and leukocytosis…Dx?
Dressler syndrome–autoimmune phenomenon following MI
Tx- aspirin or ibuprofen
Causes of high output cardiac failure
- Think: anything that causes the heart to have to work harder to meet the oxygen and metabolic needs
- chronic anemia, pregnancy, hyperthyroidism, AV fistula, wet beriberi, paget disease of bone, mitral regurg, aortic insuffciency
A patient with stable angina presents with new onset chest pain that will not relieve with rest. What are the first steps to management of this patient?
- ECG and cardiac enzymes
- give aspirin
- begin IV heparin or LMWH
Causes of systolic heart failure
- Ischemic heart disease
- cardiomyopathy (hypertensive)
- myocarditis
- Less common things like radiation, hemochromatosis, thyroid dz)
Casues of diastolic dysfunction
- HTN leading to LVH (most common)
- valvular disease
- Restrictive cardiomyopathy (sarcoid, amyloid, hemochomatosis)
Cause of S3 gallop
rapid filling into a noncomplaint LV
