APIII- ischemic heart dz

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Anonymous
ID:
222098
Filename:
APIII- ischemic heart dz
Updated:
2013-06-02 19:05:46
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aa emory ap
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Description:
ischemic heart dz
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  1. What is the leading cause of death in the US?  Accounts for __/__ of all deaths over the age of 35.
    • Coronary Artery Dz
    • 1/3
  2. What are the risk factors for CAD?
    • Age
    • htn
    • smoking
    • elevated cholesterol
    • diabetes
    • family history
    • obesity
  3. Acute Coronary Syndrome (ACS) is applied to patients in whom there is suspicion of ____.  Name the 3 types:
    • MI
    • 1) STEMI
    • 2) NSTEMI
    • 3) Unstable angina
  4. Define MI:
    Myocardial necrosis caused by ischemia.
  5. What are the criteria for an MI? (4)
    • EKG changes
    • Rise and fall of cardiac biomarkers (e.g. troponin)
    • New wall motion abnormalities (measured with ultrasound)
    • Symptoms of Ischemia
  6. What populations might not recognize or have "typical ischemia symptoms"
    • DM- due to neuropathy
    • women
  7. What are the two steps of medical therapy for CAD?
    anti-anginal therapy: B blockers, Ca channel blockers, nitrates


    preventative therapy: anti-platelet, risk reduction (quit smoking), statins
  8. Define Cardiac failure:
    Failure of heart to maintain a cardiac output sufficient to meet the metabolic demands of the body.
  9. NYHA class symptoms I - IV
    • I- no sx or limitations
    • II- mild symptoms
    • III - marked limitation in activity, comfortable only at rest
    • IV - severe limitations. Mostly bedbound
  10. Canadian CVS ANGINA grading scale:
    sim to NYHA scale (I - IV) but based on angina
  11. Modified Framingham criteria for HEART FAILURE:
    Major and minor sx.  2 major or 1 major and 2 minor that have no other cause.
  12. Causes of heart failure:
    • ischemia
    • alcoholic
    • infectious
    • inflammatory
    • congenital
    • valvular
    • oncological
  13. Physiologic causes of heart failure: (5)
    • Heart rate- too fast or too slow
    • Rhythm- arrythmias: ventricular can be treated with an ICD (40 joules).  Supraventricular can be treated with ablation therapy.
    • intraventricular conduction delay- CRT to synchronize R and L ventricle.  (will show wide QRS, gets narrower with pacing)
    • Pre-load- compliance and volume
    • After-load- resistance to forward flow (high arterial BP)
    • Contractility- ability to contract at certain fiber length. can be affected by ischemia, cardiomyopathy from alcohol, dz, catecholamines
  14. Inotropic
    contractility
  15. Lusitropic
    relaxation
  16. What are two signs of poor perfusion of the limbs?
    cool, mottling
  17. Why might pulse not be a good indicator of dz?
    may reflect a local occurance
  18. S3 can be a sign of heart failure.  explain
    • s3 means decreased compliance of ventricles,as in CHF
    • may be earliest sign of heart failure
    • may be normal
  19. What should you look for a blood test for heart failure?
    • cardiac enzymes
    • acid
    • venous blood
  20. when looking at acid in the blood, what is normal and why is this important?
    • normal lactate- <2
    • >10 = really bad
    • lactate is a global indicator, doesn't tell you where the prob is
  21. what can cause a decrease in venous sat?
    • decreased arterial sat
    • decreased hemoglobin
    • decreased CO
    • increased consumption
  22. What can cause an increase in venous sat?
    • increased arterial sat
    • decreased extraction as in liver failure, sepsis
  23. Where is "mixed venous blood" best obtained from?
    • distal port of PA catheter
    • second best is central line
  24. What do art lines measure?
    preload (pulse pressure variation), CO
  25. What drug classes are used to treat cardiac failure?
    • catecholamines
    • phosphodiesterase inhibitors
    • vasodilators
    • inhalation therapy
  26. What four drugs listed in the lecture cause vasodilation?
    • nitroprusside
    • nitroglycerine
    • nicardipine
    • sildenafil
  27. What is EPI's mech of action and what are indications for use?
    • a/b agonist- increasing a with increasing dose
    • low cardiac index, low bp, anaphylaxis
  28. What is norEPI's mech of action and what are indications for use?
    • a/b agonist- increasing B with dose
    • vasodilation with decreased contractility
  29. What is DOPAMINE mech of action?
    • a/b/dopaminergic
    • "renal dose dopamine"
  30. What is DOBUTAMINE mech of action and what are indications for use?
    • synthetic catecholamine
    • PURE BETA
    • heart failure, not as bad as for epi
  31. What is MILRINONE mech of action and what are indications for use?
    • "inodilator"
    • increases contractility synergistic with catecholamines
    • heart failure with increased systemic vasc resistance
  32. What is HOCM? __________ septal hypertrophy causes outflow tract _________ and _____.
    • hypertrophic obstructive cardiomyopathy.
    • asymmetric
    • obstruction
    • SAM- systolic anterior motion
  33. what is the treatment HOCM? tight, slow, full!
    B blocker, fluid, increased SVR.
  34. explain SAM:
    outflow blocked negative pressure moves leaflet (LV)?

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