Term
Total > 200 mg/dL
• LDL > 130
• HDL < 35 |
|
Definition
| criteria for dyslipidemia |
|
|
Term
Smoking and hyperglycemia injure endothelium
• Cholesterol deposited at sites of injury
• Poorly controlled cholesterol metabolism
causes plaque to build more rapidly
• Genetics and diet related to amount and type
of cholesterol present in blood and likelihood of
deposits in injured arteries |
|
Definition
| pathogenesis of atherosclerosis |
|
|
Term
Short branches under
high pressure
• Flow is more likely to
become turbulent |
|
Definition
| coronary vessels more susceptible to atherosclerosis bc |
|
|
Term
|
Definition
Caused by fixed atherosclerotic lesion
• Reduces reserve for coronary blood flow
• Not present at rest
• Occurs when oxygen demand is increased
• Reproducible in terms of exertion:
• Intensity of effort
• Length of time of exertion
• Relieved by rest and administration of
nitrate |
|
|
Term
|
Definition
Implies worsening of AS process
• Progressive in terms of:
• Severity of pain
• Less exertion required to elicit it
• May progress to pain at rest
• Considered to be an emergency
• Requires intervention before myocardial
infarction occurs
• Typically caused by thrombosis of a coronary
plaque
18
19 |
|
|
Term
|
Definition
Also called variant angina
• Caused by coronary vasospasm due to a defect in
endothelial function
• More difficult to diagnose due to its unpredictable onset,
occurring even at rest |
|
|
Term
|
Definition
Elicits coronary spasm diagnostically
• Allows it to be imaged
• Diagnosis of Prinzmetal angina can be confirmed |
|
|
Term
|
Definition
Used in manufacturing explosives
• Converted to nitric oxide in vascular smooth muscle cells
• Increase cGMP, causing relaxation
• Decrease preload by venous dilation (major effect)
• Decrease afterload by arterial dilation (minor effect)
• Administered sublingually for rapid onset (emergently)
• Can be administered orally and transdermally for
sustained action (prophylactic effect)
• Side effects: HA, dizziness, orthostatic hypotension |
|
|
Term
|
Definition
Reduce myocardial oxygen
demand by decreasing HR
and myocardial contractility
• Can be used
prophylactically or
emergently
• Caution with
bronchoconstriction or
decreased myocardial
contractility |
|
|
Term
|
Definition
Relax coronary smooth muscle
• Relax peripheral vascular smooth muscle
• Some drugs decrease contractility
• May also cause arrhythmias
• Newer drugs more specific to smooth muscle
• Diltiazem (cardizem), Nifedipine (procardia) |
|
|
Term
|
Definition
Represent injury to cells
• Multiple enzymes are monitored due to several factors:
• Enzymes may appear in blood for reasons other than MI
• Ratios of different enzymes may help rule in or rule out MI
• Different enzymes appear in the blood with different
timing
• Some appear very early, and some very late |
|
|
Term
|
Definition
Specific to cardiac muscle
• Elevated 4-6 hrs after onset of
chest pain
• Reaches peak within 12-24
hours
• Returns to baseline within
24-48 hrs
• Elevated with trauma,
defibrillation, thrombolysis |
|
|
Term
|
Definition
Isozyme specific for cardiac
muscle
• Also elevated in CHF and
CRF
• Elevated early—2-4 hr for it to
rise
• Peaks at 10-24 hr
• Returns to normal in 5-7 days |
|
|
Term
|
Definition
Elevated within 1-2 hours
• Peaks in 4-8 hours
• Returns to baseline within 24 hr
• Not sufficiently specific to be used
alone
• Also released from damaged
skeletal muscle
• High negative predictive value
within 4-8 hrs; can be used to rule
out MI
40 |
|
|
Term
|
Definition
Present in skeletal muscle
• Indicator of skeletal muscle damage
• Ratio of myoglobin to carbonic anhydrase can be used to
distinguish between skeletal and cardiac muscle injury
• If myoglobin high, but carbonic anhydrase low, MI is likely
• If both high elevated myoglobin likely to be due to muscle
injury |
|
|
Term
|
Definition
Not used much today
• Elevated after ~10 hr
• Peaks in 24-72 hr
• Remains elevated longer than other enzymes (14
days)
• Useful if delay in seeking attention occurred and
other enzymes have returned toward normal |
|
|
Term
|
Definition
Breakdown existing thrombi by
converting plasminogen to plasmin,
a natural fibrinolytic substance
• Used for acute MI, ischemic CVA,
PE, and clearing out indwelling lines
• Urokinase: Used mainly for clearing
out lines
• Streptokinase and tPA
• Administered systemically for
CVA, MI and PE
• Streptokinase is cheaper
Must be administered within
first 3 hrs
• Late administration can
cause reperfusion injury
• Can be administered directly
to the site of peripheral
occlusion through a catheter
• Can also be used for frostbite
to prevent amputations |
|
|
Term
| tissue plasminogen activator |
|
Definition
Natural molecule
• More expensive due to
production from recombinant
DNA
• Alteplase, reteplase and
tenecteplase
• Controversial as to whether
tPA is more effective and
justifies cost |
|
|
Term
|
Definition
Wide range of MW 5-40kD
• Isolated from pig intestine or bovine lung
• Less predictable clinically, must be monitored carefully
• Requires continuous IV infusion for ACS
• Can be given subcutaneously for maintenance
anticoagulation
• Warfarin preferred for long-term use.
• Reversible with IV protamine
• Risk of heparin-induced thrombocytopenia and tissue
necrosis
• Can cause large open wounds in fatty tissues. |
|
|
Term
| low molecular weight heparin |
|
Definition
Enoxaparin (Lovenox) and others
• At least 60% is 8kD or less
• More predictable
• Less reversible
• Less effect on thrombin than UFH
• Can be given daily subcutaneously |
|
|
Term
|
Definition
Used for long-term
anticoagulation
• Interferes with recycling
of vitamin K
• Leads to depletion of
certain clotting factors
• Can also cause tissue
necrosis and open
wounds in fatty tissues |
|
|
Term
|
Definition
Used prophylactically
for those at risk
• NSAIDS with low COX
2 activity including
aspirin
• Clopidogrel (Plavix):
inhibits ADP binding to
platelet receptors |
|
|
Term
| thrombolytics > heparin > warafin > Aspirin > cholesterol drugs |
|
Definition
Sequencing of Drugs related
to Thrombosis & Coagulation |
|
|
Term
Detect ischemic heart disease under
controlled conditions
• Detect exercise-induced arrhythmias
• Evaluate hemodynamics during exercise |
|
Definition
|
|
Term
| pharmacologic stress testing |
|
Definition
Dipyridamole and adenosine
• Dilate healthy arteries; unhealthy arteries do not
• Dobutamine
• Increases mVO2
• Echocardiography used to assess for abnormal
wall movement indicative of ischemia |
|
|
Term
|
Definition
Performed during cardiac
catheterization
• Check for valvular dz and
ventricular dysfunction
• Estimates are made of cardiac
output, stroke volume, ejection
fraction, chamber pressures,
and the presence of stenosis
or regurgitation |
|
|
Term
|
Definition
Calculate LV EF
• Imaging timed with
EKG
• Measures emptying
of LV with time
• Noninvasive |
|
|
Term
|
Definition
Single photon emission
computed tomography
• Gamma ray detection
• Myocardial perfusion
imaging
• Tc99 rather than Th |
|
|
Term
|
Definition
Ultrasonographic imaging of the heart
• Noninvasive, real-time imaging of valve function and
dimensions of the heart
• Color Doppler used to measure flow velocity and
direction
• Also used to detect heart motion and estimate SV and
EF
• Rule in/out
• Pericardial effusion
• Cardiac tamponade
• Cardiomyopathy
• Masses in/on heart |
|
|
Term
|
Definition
Creation of bypasses around the
narrowed areas using grafts
• Vein segments are sewn into
(grafted) above and below the
occluded areas
• Harvesting of portions of one or both
saphenous veins
• Depending on the quality of the
vein and the number of bypasses
required
• Typically 2-3 bypasses done at a
time, but 7 or more may be done |
|
|
Term
Minimally-invasive Direct Coronary
Artery Bypass (MIDCAB) |
|
Definition
• Alternative to open CABG for
some patients
• Much smaller incision than
median sternotomy
• Endoscopic surgery similar
to arthroscopic surgery
• Television camera and
several small incisions
• Specialized hook up to
bypass machine |
|
|
Term
| percutaneous coronary intervention |
|
Definition
Can combine diagnostic testing
with intervention
• More rapid intervention than CABG
and is less invasive
• Long-term results are not as good
as CABG
• May not work, requiring CABG after
PCI is done
• Balloon-tipped catheter is inserted
into the occluded vessel and
inflated to restore patency of vessel |
|
|
Term
Phase I - inpatient covered by DRG
• Phase II – outpatient with monitoring; covered by
good plans
• Phase III – outpatient with less individual
attention; not covered by most plans
• Phase IV – outpatient maintenance program
(never covered) and now some call this phase III |
|
Definition
|
|
Term
|
Definition
Compares the left arm (+) to the right arm (-)
• Lead reads directly horizontally from AV node or 0°
• “Best view” is of mid lateral wall of the left ventricle
• R wave expected to be taller than S wave is deep |
|
|
Term
|
Definition
Compares the right arm (-) to the left ankle (+)
• Lead reads from AV node down and to left (60°)
• “Best view” is of left side of inferior wall,
including septum
• Normal vector is directly along this lead
• QRS should consist almost entirely of R wave |
|
|
Term
|
Definition
Compares the left arm (-) to the left ankle (+)
• Reads from AV node down and to right (120°)
• “Best view” is of right side of inferior wall
• R and S range from equal to either being
somewhat larger |
|
|
Term
|
Definition
Compares the left ankle (+) to the rest of the body
• Reads straight down from AV node
• Best view is of inferior wall slightly to right of apex
• Greater R than S expected |
|
|
Term
|
Definition
Compares the right arm (+) to the rest of the body
• Reads from AV node up and to right 30° above horizontal
• Normal looks inverted compared with I, II, III
• Depolarization moving away from R arm
• Small R, deeper S expected
• Hold upside down in mirror, looks similar to leads I or II |
|
|
Term
|
Definition
Compares the left arm (+) to the
rest of the body
• Reads from AV node up and to
left toward left shoulder, 30°
above lead I
• Best view is upper lateral wall
• Usually small deflections or
equal up and down QRS
• Normal vector is
perpendicular to this lead |
|
|
Term
|
Definition
Located over the atria, RV
• Provides best view of atrial
events
• Particularly important for
identifying atrial fibrillation and
flutter
• Lead reads from AV node away
from ventricular depolarization
• Expect nearly all S wave, with
small R wave |
|
|
Term
|
Definition
Located over the anterior
wall
• Best view is of mid anterior
wall
• Horizontal vector is
normally between V3 and
V4
• Transition from larger S to
larger R |
|
|
Term
|
Definition
Lead reads from AV
node toward apex and
lower lateral wall
• Best view is of lower part
of lateral wall events
• Will consist nearly
entirely of R wave
• Expect small Q wave |
|
|
Term
|
Definition
Variably supplied by
the LAD, the RCA and
Cx
• Problems reflected in
changes in leads II, III,
and aVF |
|
|
Term
|
Definition
Cx and obtuse branch of the Cx
• Problems reflected as changes in leads
I, aVL, V5 and V6
• Proximal occlusion may affect all four
leads
• Occlusion distal to the obtuse branch
causes changes in leads I and aVL
• Lower lateral wall not seen by aVL
• Occlusion of the obtuse branch causes
changes in V5 and V6, possibly I |
|
|
Term
|
Definition
Supplied by the LAD and
diagonal branches of the LAD
• Problems show in leads V3,
V4 and possibly in the other
chest leads |
|
|
Term
|
Definition
Variable supply by the
RCA and Cx
• RV & Posterior wall
problems are more difficult
to interpret
• Reciprocal changes
• ST segment depression
looks elevated instead |
|
|
