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CVD > 02a: CAD > Flashcards

02a: CAD Flashcards

1
Q

Myocardial oxygen demand has 3 major determinants. List them. Star the one used in clinic.

A
  1. Rate-pressure product* (product of HR and systolic BP)
  2. LV contractility
  3. LV wall stress
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2
Q

LV wall stress is dependent on which properties?

A

s = PR/T

LV pressure, radius, and thickness

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3
Q

Coronary circulation (R dominant): the “septals and diagonals” include (X) vessel and its branches, which supply (Y) wall(s).

A 
X = LAD
Y = LV anterior septum and anterolateral wall
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4
Q

Coronary circulation (R dominant): the “obtuse marginals” include (X) vessel and its branches, which supply (Y) wall(s).

A 
X = L circumflex
Y = LV's inferolateral and anterolateral walls (the part that's not supplied by LAD)
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5
Q

Coronary circulation: The artery that supplies (X) portion/wall is referred to as the “dominant artery”. 85% of the time, (Y) does this.

A 
X = inferior septum
Y = RCA and its branches
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6
Q

T/F: In R dominant system, the RCA supplies the inferior LV wall.

A

True

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7
Q

T/F: In R dominant system, the L circumflex artery gives off some branches to the R ventricle.

A

False - entire R heart supplied by RCA and its branches

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8
Q

T/F: It is now widely accepted that the occurrence of angina is an early sign in the sequence of observed consequences of ischemia.

A

False - late (ischemia typically silent clinically or non-specific symptoms)

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9
Q

Myocardial ischemia initially manifest by (X) then (Y) on ECG before presenting clinically.

A 
X = wall motion abnormality
Y = classic ECG ischemic change
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10
Q

Classic angina is (rest/exertional) pain that starts at (X) and may radiate to which common locations?

A

Exertional (except Class IV);
X = chest

Arm, neck, back

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11
Q

Which symptoms may be associated with classic angina?

A

Nausea, palpitations, diaphoresis

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12
Q

Classic angina is relieved when patient does what?

A

Rest and/or nitroglycerin

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13
Q

What’s atypical angina?

A

Chest pain thought to be of cardiac origin but not presenting like classic angina

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14
Q

What’s unstable angina?

A

Angina that is increasing in severity over short period of time

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15
Q

(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.

A

X = unstable

  1. Platelet aggregation at site of fixed stenosis (acute coronary obstruction)
  2. Coronary a spasm superimposed on fixed lesion
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16
Q

List the classes of angina.

A

I: Upon marked exertion
II: Upon moderate exertion
III: Upon mild exertion
IV: Upon rest

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17
Q

(X) changes seen on ECG while patient is having angina episode is indicative of active MI. (Y) is indicative of old MI.

A 
X = ST elevation/depression
Y = Q wave
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18
Q

In which patients is exercise testing most commonly indicated?

A

Intermediate probability of significant CAD (based on gender, age, symptoms)

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19
Q

List cases in which exercise testing is indicated, even if patient not presenting with CAD symptoms.

A

Pt has multiple risk factors and is about to start:

  1. Vigorous exercise program
  2. Occupation affecting public safety
20
Q

Exercise testing has both

sensitivity and specificity of approximately (X)% for the detection of underlying (Y).

A

X = 70;
Y = obstructive CAD (i.e. 75%
coronary stenosis).

21
Q

A “MET” is a unit of (X). It allows allows comparison of intensity of (Y) relative to rest.

A 
X = resting E expenditure (1 kcal/kg BW/hour)
Y = any physical activity
22
Q

Exercise echo: images must be taken (before/after) exercise.

A

Both before (at rest) and immediately (1-2 min) after

23
Q

What are the advantages of exercise echo over nuclear imaging test?

A
  1. Absence of exposure to ionizing radiation

2. Shorter test time

24
Q

The sensitivity of exercise echocardiography is approximately (X)% and the
specificity is approximately (Y)%.

A

X = Y = 90

25
Q

Exercise nuclear imaging: Perfusion defects that are present during exercise but not seen at rest suggest (X).

A

X = ischemia

26
Q

Exercise nuclear imaging: Perfusion defects that are present during exercise and persist at rest suggest (X).

A

X = previous MI or scar

27
Q

The sensitivity of exercise nuclear imaging is approximately (X)% and the
specificity is approximately (Y)%.

A 
X = 90
Y = 80
28
Q

T/F: One benefit of exercise nuclear imaging over exercise echo is higher sensitivity.

A

False - both have same sensitivity (90%)

29
Q

Pharmacologic stress test: (X) is a(n) (alpha/beta) (agonist/antagonist) that’s administered and increases (HR/BP/contractility).

A 
X = Dobutamine
Beta agonist;
All three (thus increasing myocardial oxygen demand)
30
Q

A nuclear perfusion scan involves administration of (X), a(n) (direct/indirect) (Y) of the coronary arteries.

A

X = Adenosine or Dipyridimole
Direct;
Y = vasodilator

31
Q

CAD more common etiology for (systolic/diastolic) HF.

A

Systolic

32
Q

HT more common etiology for (systolic/diastolic) HF.

A

Diastolic

33
Q

Diabetes more common etiology for (systolic/diastolic) HF.

A

Systolic

34
Q

Cardiomegaly more common exam finding in (systolic/diastolic) HF.

A

Systolic

35
Q

S3 gallop more common exam finding in (systolic/diastolic) HF.

A

Systolic

36
Q

S4 gallop more common exam finding in (systolic/diastolic) HF.

A

Diastolic

37
Q

Rales more common exam finding in (systolic/diastolic) HF.

A

Both

38
Q

Peripheral edema more common exam finding in (systolic/diastolic) HF.

A

Systolic

39
Q

Atorvastatin is (X) class of drugs that works by (stimulating/inhibiting) (Y).

A

X = statin
Inhibiting
Y = HMG CoA reductase (thus reducing hepatic cholesterol synthesis)

40
Q

Side effects of atorvastatin.

A

Myopathy, hepatic dysfunction, teratogenic

41
Q

(X) drugs are the most effective lipid-lowering agents for preventing future CV events.

A

X = statins (improve survival)

42
Q

T/F: Statins are only lipid-lowering drugs consistently proven to reduce risk of atherosclerotic coronary disease.

A

True

43
Q

(X) is the most effective drug for increasing HDL, by (Y)%.

A 
X = niacin
Y = 30
44
Q

List some side effects of niacin.

A
  1. Flushing (prostaglandin-mediated)
  2. Hyperglycemia and hyperuricemia
  3. Hepatotoxicity (liver enzymes must be monitored)
45
Q

One downside of (X) lipid-lowering drug is increase in serum TGs via (increased/decreased) (production/degradation) of (Y).

A

X = cholestyramine (bile-acid binding resin)

Increased hepatic production of
Y = VLDL

46
Q

Cholestyramine used to treat (high/low) (X) levels and has which side effects?

A

High
X = LDL (but not if high TG present as well!)

Constipation/bloating

47
Q

Ezetimibe is in (X) class of drugs. What’s its mechanism of action?

A

X = cholesterol absorption inhibitor

Reduces intestinal cholesterol absorption by inhibiting sterol transporter

CVD (8 decks)

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