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