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Note: This score documents severity of Sx and can be used to assess response
to treatment
While its use is widespread, NYHA score is not very reproducible and does not
reliably predict walking distance or exercise tolerance on formal testing
"Limitations of the New York Heart Association functional classification system and
self‐reported walking distances in chronic heart failure". Heart. 93 (4): 476–82.
Marc Imhotep Cray, M.D.. 6
Coronary heart disease (CHD) Defined
(Etiologic Dx)
Coronary heart disease (CHD) is a condition in which
proper circulation of blood and oxygen are not
provided to heart and surrounding tissue
cerebrovascular disease
Atherosclerosis is patchy intimal
plaques (atheromas) in medium-
sized and large arteries
plaques contain lipids, inflammatory
cells, smooth muscle cells, and
connective tissue From: Webpath Cardiovascular Pathology image plates
5. Associated w CABG
Online version
Online Version
*Patients at higher risk (risk score ≥ 3) benefit more from enoxaparin (vs
unfractionated heparin), glycoprotein IIb/IIIa inhibitors, and early angiography.
Le T, Bhushan V, Vincent L. Chen VL, King MR. First Aid for the USMLE Step 2 CK ,9th Ed. New York, NY:
McGraw-Hill Education, 2016.
Marc Imhotep Cray, M.D.. 42
ACS: UA vs NSTEMI cont’d.
Treatment
Treat acute symptoms with ASA, O2, IV nitroglycerin, and IV
morphine, and consider β-blockers as hemodynamics allow
MNEMONIC: When your patient is MOANing from an MI, remember— MOAN
Morphine
Oxygen (to maintain saturations)
ASA
Nitrogen
Admit to hospital, and monitor until acute MI has been ruled
out by serial cardiac enzymes
Pts. w CP refractory to medical therapy, a TIMI score of ≥ 3, a
troponin elevation, or ST changes > 1 mm should be given IV
heparin and scheduled for angiography and possible
revascularization (percutaneous coronary intervention [PCI] or
coronary artery bypass graft [CABG])
Marc Imhotep Cray, M.D.. 43
ST-Elevation Myocardial Infarction (STEMI)
STEMI=ST-segment elevations and cardiac enzyme release
2° to prolonged cardiac ischemia and necrosis
History/Physical examination
Presentation: Acute-onset substernal chest pain,
commonly described as a pressure or tightness that can
radiate to left arm, neck, or jaw
Assoc. Sx: Diaphoresis, SOB, lightheadedness, anxiety,
N/V, and syncope
PE: May reveal arrhythmias, hypotension (cardiogenic
shock), and evidence of new CHF
Cardiac enzymes:
o Troponin I is most sensitive and specific cardiac enzyme
o CK-MB and CK-MB/total CK ratio (CK index) are also regularly checked
o Both troponin I and CK-MB can take up to 6 hours to rise following onset
of chest pain
Le T, Bhushan V, Vincent L. Chen VL, King MR. First Aid for the USMLE Step 2 CK ,9th Ed. New York, NY:
McGraw-Hill Education, 2016.
Le T, Bhushan V, Vincent L. Chen VL, King MR. First Aid for the USMLE Step 2 CK ,9th Ed. New York, NY:
McGraw-Hill Education, 2016.
Marc Imhotep Cray, M.D.. 49
STEMI Treatment
Initial treatment:
Key medications: ASA, β-blockers, clopidogrel,
morphine, nitrates, and O2
See next slide for links to tools and resources for further study.
Marc Imhotep Cray, M.D.. 53
Further study
Putting it All Together_ A Clinical & Pathology Correlation
Case .pdf
Downloads
Autonomic and Cardiovascular Pharmacology (ACVP)
Clinical Correlate Articles. pdf_from e-Medicine