Clinical Medicine (IHD--Part I)51 cards

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4

4. Define CAD and its other “names”

4. AKA Ischemic Heart Disease or Atherosclerotic CAD; Disease of the arteries supplying blood to the heart

5

5. What is the pathophysiology of IHD (Ischemic Heart Diesase)?

5. Abnormal lipid metabolism and excessive intake of cholesterol and saturated fats

6

6. What is the initial step in IHD?

6. Initial step is the “fatty streak” or subendothelial accumulation of lipids and lipid-laden monocytes (macrophages)

7

7. What are the 3 main lipid types?

7. LDL, HDL, Triglycerides

8

8. Define each.

8. LDL – major atherogenic lipid; HDL – protective, removes cholesterol from the vascular wall; Triglycerides – role in atherosclerosis is less clear but high levels have been linked to increased risk for IHD


10

10. What types of plaques are more likely to rupture? (ie: content it contains)

10. Higher lipid content, higher concentration of macrophages, very thin fibrous cap




14

14. Explain patho/physio of a ruptured plaque.

14. Rupture causes turbulent flow, extrusion of lipids and fatty gruel and exposure of tissue factor that results in a cascade of events culminating in intravascular thrombosis

15

15. What can occur with a ruptured plaque?

15. Partial or complete vessel occlusion may occur; Plaque may become restabilized with more severe stenosis of the artery

16

16. What are the modifiable risk factors for CAD?

16. Hypertension, Dyslipidemia, Cigarette smoking, DM, physical inactivity, and obesity

17

17. Which ones from number 16, above, is considered a major risk factor?

17. Hypertension, Dyslipidemia, Cigarette smoking, DM

18

18. What are the un-modifiable risk factors for CAD?

18. Male gender, Age (> 55 = Males & >65 = Females), Family Hx of premature CAD (male = >45, female = > 55)


20

20. Who sets the goals for Dyslipidemia? What is the goal for a patient with CAD or DM?

20. Goals are set by AHA (lower LDL, raise HDL); Goal = LDL <70 if CAD/DM

21

21. What is considered the correct risk modification for smoking? Who sets this standard?

21. According to the World Health Organization, 1 year after quitting, the risk of CAD decreases by 50%


23

23. How is Metabolic syndrome diagnosed?

23. Constellation of 3 or more of the following: Abdominal obesity: women >35 inch waist, men >40 inch waist Triglycerides greater than or equal to 150 mg/dL HDL <40 mg/dL men; <50 women Fasting glucose greater than or equal to 110 Hypertension

24

24. Define Angina Pectoris.

24. A precoridal chest pain, usually precipitated by stress or exertion


26

26. How can one relieve angina pectoris?

26. Rapid rest or nitrates

27

27. What are the 3 types of Angina?

27. Stable, Unstable, and Prinzmetal’s Variant Angina




31

31. What is the cause of the diagnosis in the question above? (question 30)

31. Caused by an occlusive spasm in a normal or minimally diseased artery



34

34. What diagnostic imaging is the definitive diagnostic procedure for CAD?

34. Cardiac catherterization (angiography of the coronary arteries)

35

35. What does the test above demonstrate?

35. May demonstrate significant obstruction of major coronary vessels

36

36. There are 7 specific people that we should cath, who are they? (ie: what type of patients)

36. Fail medical mgmt, Clinical presentation suggests high-risk disease, AV disease (Is CAD or AS causing sx);History of CABG or PCI (determine patency); Suspected structural heart disease; History of cardiac arrest or life-threatening arrhythmia; Ch

37

37. What are the goals in management of angina?

37. Attain acceptable exercise tolerance Improve quality of life Prevent frequent or severe ischemia Prevent infarction (by stabilizing plaque)


39

39. PTCA is best used for what type(s) of lesions?

39. lesions that are relatively proximal, noneccentric, free of significant calcification, or plaque dissection



42

42. DES stands for what?

42. Drug-eluting stents

43

43. What is a complication of DES?

43. Late stent thrombosis






49

49. What is this condition called?

49. Painless Infarction


51

51. What does a Chest X-ray reveal to us when a patient is having chest related s/s?

51. Heart failure, pulmonary edema, pleural effusions, Kerley B lines