02a: CAD Flashcards
Myocardial oxygen demand has 3 major determinants. List them. Star the one used in clinic.
- Rate-pressure product* (product of HR and systolic BP)
- LV contractility
- LV wall stress
LV wall stress is dependent on which properties?
s = PR/T
LV pressure, radius, and thickness
Coronary circulation (R dominant): the “septals and diagonals” include (X) vessel and its branches, which supply (Y) wall(s).
X = LAD Y = LV anterior septum and anterolateral wall
Coronary circulation (R dominant): the “obtuse marginals” include (X) vessel and its branches, which supply (Y) wall(s).
X = L circumflex Y = LV's inferolateral and anterolateral walls (the part that's not supplied by LAD)
Coronary circulation: The artery that supplies (X) portion/wall is referred to as the “dominant artery”. 85% of the time, (Y) does this.
X = inferior septum Y = RCA and its branches
T/F: In R dominant system, the RCA supplies the inferior LV wall.
True
T/F: In R dominant system, the L circumflex artery gives off some branches to the R ventricle.
False - entire R heart supplied by RCA and its branches
T/F: It is now widely accepted that the occurrence of angina is an early sign in the sequence of observed consequences of ischemia.
False - late (ischemia typically silent clinically or non-specific symptoms)
Myocardial ischemia initially manifest by (X) then (Y) on ECG before presenting clinically.
X = wall motion abnormality Y = classic ECG ischemic change
Classic angina is (rest/exertional) pain that starts at (X) and may radiate to which common locations?
Exertional (except Class IV);
X = chest
Arm, neck, back
Which symptoms may be associated with classic angina?
Nausea, palpitations, diaphoresis
Classic angina is relieved when patient does what?
Rest and/or nitroglycerin
What’s atypical angina?
Chest pain thought to be of cardiac origin but not presenting like classic angina
What’s unstable angina?
Angina that is increasing in severity over short period of time
(X) angina is important to recognize clinically because of high short-term morbidity and mortality. List the two methods by which it may occur pathologically.
X = unstable
- Platelet aggregation at site of fixed stenosis (acute coronary obstruction)
- Coronary a spasm superimposed on fixed lesion
List the classes of angina.
I: Upon marked exertion
II: Upon moderate exertion
III: Upon mild exertion
IV: Upon rest
(X) changes seen on ECG while patient is having angina episode is indicative of active MI. (Y) is indicative of old MI.
X = ST elevation/depression Y = Q wave
In which patients is exercise testing most commonly indicated?
Intermediate probability of significant CAD (based on gender, age, symptoms)
List cases in which exercise testing is indicated, even if patient not presenting with CAD symptoms.
Pt has multiple risk factors and is about to start:
- Vigorous exercise program
- Occupation affecting public safety
Exercise testing has both
sensitivity and specificity of approximately (X)% for the detection of underlying (Y).
X = 70;
Y = obstructive CAD (i.e. 75%
coronary stenosis).
A “MET” is a unit of (X). It allows allows comparison of intensity of (Y) relative to rest.
X = resting E expenditure (1 kcal/kg BW/hour) Y = any physical activity
Exercise echo: images must be taken (before/after) exercise.
Both before (at rest) and immediately (1-2 min) after
What are the advantages of exercise echo over nuclear imaging test?
- Absence of exposure to ionizing radiation
2. Shorter test time
The sensitivity of exercise echocardiography is approximately (X)% and the
specificity is approximately (Y)%.
X = Y = 90
Exercise nuclear imaging: Perfusion defects that are present during exercise but not seen at rest suggest (X).
X = ischemia
Exercise nuclear imaging: Perfusion defects that are present during exercise and persist at rest suggest (X).
X = previous MI or scar
The sensitivity of exercise nuclear imaging is approximately (X)% and the
specificity is approximately (Y)%.
X = 90 Y = 80
T/F: One benefit of exercise nuclear imaging over exercise echo is higher sensitivity.
False - both have same sensitivity (90%)
Pharmacologic stress test: (X) is a(n) (alpha/beta) (agonist/antagonist) that’s administered and increases (HR/BP/contractility).
X = Dobutamine Beta agonist; All three (thus increasing myocardial oxygen demand)
A nuclear perfusion scan involves administration of (X), a(n) (direct/indirect) (Y) of the coronary arteries.
X = Adenosine or Dipyridimole
Direct;
Y = vasodilator
CAD more common etiology for (systolic/diastolic) HF.
Systolic
HT more common etiology for (systolic/diastolic) HF.
Diastolic
Diabetes more common etiology for (systolic/diastolic) HF.
Systolic
Cardiomegaly more common exam finding in (systolic/diastolic) HF.
Systolic
S3 gallop more common exam finding in (systolic/diastolic) HF.
Systolic
S4 gallop more common exam finding in (systolic/diastolic) HF.
Diastolic
Rales more common exam finding in (systolic/diastolic) HF.
Both
Peripheral edema more common exam finding in (systolic/diastolic) HF.
Systolic
Atorvastatin is (X) class of drugs that works by (stimulating/inhibiting) (Y).
X = statin
Inhibiting
Y = HMG CoA reductase (thus reducing hepatic cholesterol synthesis)
Side effects of atorvastatin.
Myopathy, hepatic dysfunction, teratogenic
(X) drugs are the most effective lipid-lowering agents for preventing future CV events.
X = statins (improve survival)
T/F: Statins are only lipid-lowering drugs consistently proven to reduce risk of atherosclerotic coronary disease.
True
(X) is the most effective drug for increasing HDL, by (Y)%.
X = niacin Y = 30
List some side effects of niacin.
- Flushing (prostaglandin-mediated)
- Hyperglycemia and hyperuricemia
- Hepatotoxicity (liver enzymes must be monitored)
One downside of (X) lipid-lowering drug is increase in serum TGs via (increased/decreased) (production/degradation) of (Y).
X = cholestyramine (bile-acid binding resin)
Increased hepatic production of
Y = VLDL
Cholestyramine used to treat (high/low) (X) levels and has which side effects?
High
X = LDL (but not if high TG present as well!)
Constipation/bloating
Ezetimibe is in (X) class of drugs. What’s its mechanism of action?
X = cholesterol absorption inhibitor
Reduces intestinal cholesterol absorption by inhibiting sterol transporter
