CC exam 3

  1. Describe the pathophysiology of Coronary Artery Disease
    Injury to epithelial cells in intima > platelet aggregation, monocyte migration, lipoproteins enter > monocytes develop into macrophages > Macrophages eat LDL forming foam cells > accumulation of foam cells form fatty streak > fibrotic plaque > collagen cap > ruptured plaque > collagen cascade > thrombus >possible infarct and occlusion
  2. What two drugs are administered to stop process of platelet aggregation and thrombus formation caused by CAD
    • aspirin
    • glycoprotein inhibitors
  3. PQRST exam of chest pain
    • Provocation
    • Quality
    • Radiation/Region
    • Severity
    • Timing
  4. Risk factors for CAD
    • men >55
    • Women >65
    • High LDL, Low HDL
    • Smoking
    • HTN
    • Obesity/Inactivity
    • Diabetes
  5. What things should u ask about the persons HX when diagnosing/treating CAD
    • prior hospitilizations
    • SOB/CP
    • Meds: NO nitro if on sildenifil
    • Stressors
  6. What is the Holter monitor used for
    • detect dysrhythmias,
    • pt wears 24-48 hrs and logs activity & symptoms
  7. What is held the morning before a patient goes for an exercise stress test
    Beta Blockers
  8. What meds may be given to help stimulate response to exercise stress test
    • adenosine
    • regadenoson
    • dipyridamole
  9. What test is noninvasive ultrasound that visualizes cardiac structures, motion, and function of heart valves and chambers
  10. What do u instruct patients to do before TEE exam
    NPO 6-8 hours before except meds
  11. When can a patient eat after TEE
    when gag reflex returns
  12. What is a rare complication of TEE
    esophageal perforation
  13. Difference between cardiac catheterization and arteriography
    • C: heart pressures and CO
    • A: visualize blood vessels
  14. Name some interventions post cardiac-cath
    • bed rest 6-8 hours till discharge
    • immobilize extremity used
    • Look at site for bleeding/hematoma
    • HOB <30
    • Pulses q 15x4, q 30x4, q 1x2
    • Encourage fluids
  15. When can CK total be seen on diagnostics? Peaks?
    • 2-6 hours
    • 18-36
  16. When can CK-MB be seen on diagnostics? Peaks?
    • 4-8 hours
    • 18-24
  17. When can troponin I & T be seen? Peaks?
    • 1 hour
    • 24 hours
  18. When can myoglobin be seen?
    30-60 min
  19. What medication acts to treat cholesterol by inhibiting HMG-COA reductase resulting in lowering LDL
  20. When should Statins be taken
    in the evening because body makes more cholesterol at night
  21. Major side effect of statins
    rhabdomylosis, liver damage
  22. How do u instruct pt to take cholestyramine or colestipol
    • mix with fluid or applesauce
    • wait 1 hour before or 4 hrs after other meds
  23. Initial interventions of high cholesterol
    life-style changes (exercise, low-cholesterol diet, wt loss, smoking cessation)
  24. How long after life-style modifications are made will a physician start a pt on anti-lipid meds if target cholesterol levels are not met
    6 months
  25. Target levels for LDL:
    • No CHD and <2 risk factors: 160
    • No CHD >2 risk factors: <130
    • CAD <100
  26. Side effects of nicotinic acid
    LOTS: flushing, metallic taste in mouth, gout, hyperglycemia
  27. How to instruct pt to take nicotinic acid
    • after meals
    • take with aspirin to reduce flushing
  28. How to instruct pt to take Gemfibrozil
    before bfast and dinner with milk or meals
  29. What condition is bile salts contraindicated in
    billiary obstruction
  30. How do bile salts work to reduce cholesterol
    combine with cholesterol containing bile acids in intestines to be eliminated through feces
  31. How does ezetimibe reduce cholesterol?
    blocks absorption of cholesterol from food
  32. Drugs prescribed to CAD people to prevent platelet aggregation
    • Aspirin
    • clopidogril
    • Dipyridimine
    • Ticlopidine
    • prasugrel
  33. name 3 types of angina
    • Stable
    • Unstable
    • Variant
  34. Difference between stable and unstable angina
    • stable: with exertion, relieved by rest
    • unstable: pain at rest, more nitro therapy
  35. How long till a person with diagnosed unstable angina is at risk for MI
    18 months
  36. What type of angina is caused by coronary artery spasms
    Variant (Prinzmetal)
  37. What does unstable angina look like on EKG
    ST depression
  38. What does EKG look like for variant angina
    marked ST elevation that returns to normal after episode
  39. 3 places in chest pain is felt during angina
    • retrosternal
    • left pectoral
    • epigastric
  40. 3 associated symptoms of angina
    • dyspnea
    • light-headedness
    • diaphoresis
  41. how long does angina pain last
    1-5 min
  42. 3 precipitating factors of angina
    • physical/emotional stress
    • temp extremes
    • ingestion of heavy meal
  43. What causes angina
    • myocardial ischemia
    • demand higher than supply
  44. how does fibric acid derivatives help lower cholesterol
    increase VLDL clearance
  45. treatment of variant angina
  46. Name 3 conditions/med that affect afterload
    • HTN
    • Aortic stenosis
    • Vasopressors
  47. What can caused too much increased preload
    volume overload
  48. What type of cardiac meds can mask hypoglycemia
  49. What to teach pt taking Verapamil
  50. MOA of glycoprotein Abciximab
  51. What lab should be monitored with heparin and what should u not do if u inject it
    • aPTT
    • rub the site
  52. Most common meds given for angina
  53. Instructions regarding nitoglycerin
    • take before strenuous exercise
    • tightly capped, away from heat/moisture
    • Replace q 6 months
    • Patch: rotate sites, 12-14 hours/day
  54. two classifications of MI
    • STEMI (Q wave)
    • NONSTEMI (no Q wave)
  55. What causes most AMIs
  56. How long can cardiac cells withstand ischemia
    20 min
  57. What usually causes STEMI? NONSTEMI?
    • S: plaque rupture
    • NS: partial occlusion
  58. Treatment of RV infarct
  59. Paramount symptom of MI
    chest pain
  60. What is the window for thrombolytic therapy following MI
    6 hrs
  61. 3 Thrombolytic meds
    • t-PA
    • Streptokinase
    • Reteplase
  62. 3 criteria for PTCA
    • uncompromised collateral flow
    • noncalcified lesions
    • lesions not on bifurcations of vessels
  63. Initial pain relief of AMI
  64. MONA
    • Oxygen
    • Nitroglycerin
    • Aspirin
    • Morphine
  65. Criteria for thrombolytic therapy
    • <6 hours from onset
    • pain >20 min unrelieved by nitro
    • ST elevation >1 of depression <0.5
  66. When is fibrinolysis not effective
    NONSTEMI or unstable angina
  67. Worst complication of thrombolytics
    intracranial hemorrhage
  68. When should PCI be performed
    within 90 min of hospital, target less than 60 min
  69. How soon should ACE be started to prevent ventricular remodeling
    24 hrs
  70. What has to be started and continued for individuals receiving intrcoronary stent
  71. What 3 vessels can be used for CABG
    • mammory
    • saphenous vein
    • radial
  72. What artery is most commonly used for CABG and what are some benefits
    • Mammary
    • better long term patency
  73. What is the goal of MIDCAB? When it is used
    • avoid cardiopulmonary bypass
    • when only 1-2 arteries will be bypassed
  74. 3 indications for CABG
    • Unstable angina
    • MI
    • Failed percutaneous interventions
  75. What are ICD used for
    treat survivors of sudden cardiac arrest
  76. When is BNP released
    secreted by ventricular myocytes in response to wall stretch
  77. Normal BNP
  78. BNP high indicated?
    decompensated HF
  79. What is a good marker to differientiate between pulmonary and cardiac dyspnea
  80. 4 drugs to improve pump function in HF
    • BB
    • Digoxin
    • Diuretics
    • ACE
  81. What helps lower BNP
  82. Causes of pericarditis
    • uremia
    • After MI
    • Cancers
  83. 3 things pericarditis can lead to
    • Infusion
    • Tamponade
    • scarring
  84. 3 hallmarks of pericarditis
    • friction rub
    • Pulsus paradoxus
    • Initial ST elevation
  85. how long are pacemakers good for? how r they powered
    • 7-10 years
    • lithium batteries
  86. What is the primary underlying cause of HF
  87. Most common type of HF
    Left systolic dysfunction
  88. Most important test to diagnose HF
  89. what is the most common method of diagnosing pericarditis
    detection of pericardial friction rub
  90. Symptoms of pericarditis
    precordial pain radiating to shoulder, neck, arm, back intensified by inspiration, movement, coughing
  91. Treatment of pericarditis
    • pain
    • pericardiocentesis/or window
  92. Most common valve to be affected for endocarditis
  93. 3 types of endocarditis
    • Native
    • Prostetic valve
    • IV drug user
  94. name 4 skin lesions associated with septic emboli following endocarditis
    • Janeway: hemorrhagic palms/soles
    • Olser: red/purple fingers/toes
    • Roth: retinal
    • Splinter
  95. false verse true aneurysm
    • F: complete tear in arterial wall
    • T: fusiform, saccular, dissecting
  96. most common aneurysm? Where is it found
    • Fusiform
    • abdominal aorta
Card Set
CC exam 3