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What is the leading cause of death in the US? Accounts for __/__ of all deaths over the age of 35.
What are the risk factors for CAD?
- elevated cholesterol
- family history
Acute Coronary Syndrome (ACS) is applied to patients in whom there is suspicion of ____. Name the 3 types:
- 1) STEMI
- 2) NSTEMI
- 3) Unstable angina
Myocardial necrosis caused by ischemia.
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
What populations might not recognize or have "typical ischemia symptoms"
- DM- due to neuropathy
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
Define Cardiac failure:
Failure of heart to maintain a cardiac output sufficient to meet the metabolic demands of the body.
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
Canadian CVS ANGINA grading scale:
sim to NYHA scale (I - IV) but based on angina
Modified Framingham criteria for HEART FAILURE:
Major and minor sx. 2 major or 1 major and 2 minor that have no other cause.
Causes of heart failure:
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
What are two signs of poor perfusion of the limbs?
Why might pulse not be a good indicator of dz?
may reflect a local occurance
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
What should you look for a blood test for heart failure?
- cardiac enzymes
- venous blood
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
what can cause a decrease in venous sat?
- decreased arterial sat
- decreased hemoglobin
- decreased CO
- increased consumption
What can cause an increase in venous sat?
- increased arterial sat
- decreased extraction as in liver failure, sepsis
Where is "mixed venous blood" best obtained from?
- distal port of PA catheter
- second best is central line
What do art lines measure?
preload (pulse pressure variation), CO
What drug classes are used to treat cardiac failure?
- phosphodiesterase inhibitors
- inhalation therapy
What four drugs listed in the lecture cause vasodilation?
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
What is norEPI's mech of action and what are indications for use?
- a/b agonist- increasing B with dose
- vasodilation with decreased contractility
What is DOPAMINE mech of action?
- "renal dose dopamine"
What is DOBUTAMINE mech of action and what are indications for use?
- synthetic catecholamine
- PURE BETA
- heart failure, not as bad as for epi
What is MILRINONE mech of action and what are indications for use?
- increases contractility synergistic with catecholamines
- heart failure with increased systemic vasc resistance
What is HOCM? __________ septal hypertrophy causes outflow tract _________ and _____.
- hypertrophic obstructive cardiomyopathy.
- SAM- systolic anterior motion
what is the treatment HOCM? tight, slow, full!
B blocker, fluid, increased SVR.
outflow blocked negative pressure moves leaflet (LV)?