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Number one cause of death in the US and Worldwide
Coronary Heart Disease
LDL and HDL levels causing increased risk for CHD
Higher LDL and lower HDL
Three different cardiac marker tests
Myoglobin, CK-MB, and Troponin
Condition marked by severe pain in the chest, often also spreading to the shoulders, arms, and neck, caused by an inadequate blood supply to the heart.
Angina
Number 1 preventable cause of death and illness in the united states
Tobacco Use
Most common symptoms of Angina
Shortness of breath, nausea, and diaphoresis
Name of characteristic "fist over chest" found in heart attacks
Best two initial cardiac marker tests for someone who recently had an MI and is thought to be having another
Myoglobin and CK-MB (because they would have returned to normal from the previous MI, if it happened over 48 hours prior)
Stress Echocardiography
Most common cause of stable angina
Atherosclerosis
Features of Myoglobin Cardiac marker test
Lacks specificity, Rises in 1-4 hours, and returns to normal within 24 hours
Features of CK-MB
Rises in 4-12 hours, and returns to normal within 36-48 hours
Features of Troponin
Most specific and sensitive test of the cardiac markers, rises in 4-12 hour, and may remain elevated for up to two weeks
Only anti-anginal agents known to prolong life in patients with CHD (post-MI), and is first line therapy for most patients with chronic angina
Beta-Blockers
Definitive diagnostic procedure for Coronary Artery Disease?
Coronary Angiography (narrowing of > 50% is considered hemodynamically and clinically significant)
Persistent contractile dysfunction follwing a prolonged or repetitive myocardial ischemia (often seen after acute MI)
Myocardial Stunning
Clopidogrel use guidelines for stable vascular disease, and for acute coronary syndrome
For stable vascular disease Clopidogrel is used as an alternative to asprin, and for acute coronary syndrome Clopidogrel is to be used in ADDITION to asprin
What form of PCI (percuatneous coronary intervention) is the best for with the lowest chance for need of restenosis?
Coronary stenting with the use of Drug-Eluting Stents (< 10% need restenosis in 6-months) (other forms include Balloon angioplasty and coronary stenting w/ bare metal stents)
What form of therapy can be FATAL in NSTEMI?
Fibrinolytic Therapy (NSTEMI is not usually due to coronary artery occlusion so fibrinolytic therapy is more harmful than helpful)
Timing guidelines for PCI and Fibrinolytic Therapy in the treatment of STEMI
PCI must be initiated withing 90 of first medical contact (and is the superior treatment for STEMI) and Fibrinolytic therapy (generally tPA) must be initiated withing 30 minutes of hospital presentation
(3 or more of the following) 1.) Abdominal Obesity, 2.) Triglycerides 150 or higher, 3.) HDL less than 40 for men or 50 for women, 4.) Fasting glucose 110 or higher, 5.) HTN
When should Asprin therapy be started in men to prevent CHD?
Men with multiple coronary risk factors or concomitant DM starting at age 45-50 years old should be started on daily asprin (81-325mg) if no contraindications are present
Who should be started on a statin for prevention of Coronary Heart Disease
All patients at significant risk for vascular events should receive a statin regardless of their cholesterol levels
Differentiation between Unstable Angina and NSTEMI
In unstable angina, myocardial damage is not enough to cause troponins to be released, while an NSTEMI features the release of troponins
What vessel has the best long-term results as a graft in CABG?
Internal Mammary Glands (have best patency and flow)