PHRD6085 Pharmacotherapy 2 Lecture 2 - Cardiovascular Overview (Part 2)

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daynuhmay
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281256
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PHRD6085 Pharmacotherapy 2 Lecture 2 - Cardiovascular Overview (Part 2)
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2014-08-25 03:57:16
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Cardiovascular
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Cardiovascular
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  1. modifiable risk factors for ASCVD (5)
    • 1) cigarette smoking
    • 2) HTN
    • 3) total cholesterol
    • 4) low HDL-C (<40mg/dL)
    • 5) diabetes
  2. non-modifiable risk factors for ASCVD (4)
    • 1) gender
    • 2) race
    • 3) family hx of CHD
    • 4) age (male: 45yo; female: 55yo)
  3. 2 factors that improve/decrease risk of MI
    • daily fruits/vegetables
    • exercise
  4. clinical presentation of ischemic heart disease (2)
    • 1) sudden cardiac death due to electrical instability 
    • 2) angina
  5. clinical presentation of angina (4)
    • 1) substernal chest pressure sensation
    • 2) radiation of discomfort to shoulder, back, arm, or neck
    • 3) predictable patter - brought on by exertion, relieved w/ rest/meds
    • 4) short duration - 1-15 min
  6. clinical consequences of atherosclerosis (6)
    • 1) stroke
    • 2) transient ischemic attacks in brain arteries
    • 3) stable angina
    • 4) unstable angina
    • 5) MI
    • 6) peripheral artery/vascular disease
  7. test that represents the total of electrical vectors arising from myocardial cells as they depolarize & repolarize; 
    gives info on HR, rhythm, conduction times, ischemia, infarction, hypertrophy
    electrocardiogram (EKG/ECG)
  8. used to evaluate "baseline" heart rhythms; recording durations last 24-48 hrs; typically ordered to evaluate sx of palpitations, dizziness, or syncope
    Holter Monitor (ambulatory EKG)
  9. "real-time" 2D imaging of the heart; non-invasive measurement of LV fcn, valvular morphology, & valve fcn
    echocardiography
  10. significance of Doppler echocardiography
    Doppler technology allows determination of speed & direction of blood flow
  11. used for dx of obstructive CAD, risk assessment/prognosis in pts w/ sx or prior hx of CAD, post MI risk assessment/prognosis
    exercise stress test
  12. advantages of exercise stress test (5)
    • 1) low cost
    • 2) wide availability
    • 3) pt acceptability
    • 4) exercise capacity determined
    • 5) convenience
  13. disadvantages to exercise stress test (4)
    • 1) limited sensitivity/specificity 
    • 2) doesn't localize ischemia
    • 3) no estimate of LV fcn
    • 4) requires cooperation & ability to walk
  14. clinical use for coronary artery calcium (CAC) score
    ASCVD risk assessment in asymptomatic adults w/ intermediate and low to intermediate risk pts
  15. ultrasound image of carotid artery walls, used for ASCVD risk assessment in asymptomatic adults at intermediate risk
    carotid artery intima-media thickness (CIMT)
  16. describe a coronary angiography
    catheter is inserted into a blood vessel in groin or arm -> threaded in to reach the heart/beginning of ateries -> contrast dye is injected -> fluid visible by x-ray to examine blood vessels & chambers of heart
  17. use for coronary angiography
    • document presence/severity of disease in pts w/ suspected CAD & high risk features w/ exercise stress test
    • NOT rec'd in asymptomatic pts
  18. different between coronary angiography & CCTA
    • no catheter threaded through blood vessels 
    • can't receive treatment PCI if needed at time of procedure
  19. describe angioplasty/percutaneous coronary intervention (PCI)
    temporarily insert & expand a tiny balloon at the site of blockage
  20. indications for coronary angioplasty/PCI (3)
    • acute MI
    • significant CAD w/ obstruction
    • significant angina sx
  21. describe coronary artery bypass surgery (CABG)
    surgery bypasses blood around clogged arteries to improve blood flow & oxygen to heart
  22. indications for CABG (3)
    • left main coronary stenosis
    • 2-3 vessel CAD
    • medically refractory angina not amenable to PCI
  23. clinical presentation of ASCVD (7)
    • 1) acute coronary syndromes
    • 2) hx of MI
    • 3) stable/unstable angina
    • 4) coronary revascularization
    • 5) stroke 
    • 6) transient ischemic attack
    • 7) peripheral arterial disease or revascularization

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