1. MTB Step 3 - Ischemic Heart Disease / CAD Flashcards
Cards Complete: Day 1: 4/19/19* Day 2: 4/22/19* Day 3: 4/29/19* Day 4: 5/19/19 Day 5: 6/18/19
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What are (2) Epidemiological Facts about CAD in the United States?
- CAD is the Most Common Cause of Death (by far).
- CAD Kills 10x’s more Women than Breast Cancer does.
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What are (5) Risk Factors for developing CAD?
- Diabetes Mellitus
- Hypertension
- Tobacco use
- Hyperlipidemia
- Peripheral Arterial Disease
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What (2) Useful Pieces of Information does knowing the CAD Risk Factors provide?
Knowing the CAD Risk Factors provides:
- Help with answering Diagnostic Questions in Equivocal Cases.
- Modifying the Risk Factors** can **Lower Mortality.
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What are (5) Descriptors of Chest Pain associated with CAD?
- Chest Pain is Dull: does NOT change with body position or respiration, and there is NO chest wall tenderness.
- Chest Pain occurs on Exertion.
- Chest Pain is Substernal in Location.
- Chest Pain lasts 15 - 30 minutes.
- Chest Pain radiates to the Jaw or Left Arm.
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What are (4) potential Cardiovascular Exam Findings in a patient with CAD?
- S3 Gallop: Dilated LV
- S4 Gallop: Hypertrophied LV
- Jugular Venous Distention
- Holosystolic Murmur: Mitral Regurgitation
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What is (1) potential Pulmonary/Lung Exam Finding in a patient with CAD?
- Rales: suggestive of Congestive Heart Failure (CHF)
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What are (4) potential Clinical / ED Presenting Signs in a patient with Ischemic Chest Pain from CAD?
- Distressed patient
- Short of Breath (SOB)
- Clutching Chest
- Diaphoretic/Sweating
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What is (1) potential Extremity Exam Finding in a patient with CAD?
- Edema
ISCHEMIC HEART DISEASE (a.k.a. CAD)
- What is the Best INITIAL Test for suspected Ischemic Chest Pain?
- What are the (2) Most ACCURATE Tests for suspected Ischemic Chest Pain?
- Best INITIAL Test = ECG
- Most ACCURATE Tests = Troponins and CK-MB
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What is the Best INITIAL Management Step for suspected Ischemic Chest Pain?
Best INITIAL Management Step = M.O.N.A.
- Morphine
- Oxygene
- Nitrates
- Aspirin
ISCHEMIC HEART DISEASE (a.k.a. CAD)
Describe the Similarities/Differences between the (3) Types of Cardiac Enzymes (eg, Myoglobin, CK-MB, Troponins).
- Myoglobin: Rises = 1-4 hrs
- CK-MB: Rises at 3-6 hrs, Peak = 18 hrs, Duration = 1-2 days
-
Troponins: Rises = 3-6 hrs, Duration = 1-2 weeks
- Troponin C: Binds Calcium, Activates actin:myosin interaction.
- Troponin T: Binds to Tropomyosin
- Troponin I: Inhibits actin:myosin interaction.
ISCHEMIC HEART DISEASE (a.k.a. CAD)
In a patient with suspected CAD, under which (3) situations is Exercise Thallium / “Stress” Test or Stress Echocardiography the correct answer?
- Chest Pain is NOT acute
-
Initial ECG is Unreadable for ischemia:
- New LBBB
- Digoxin use
- Pacemaker in place
- LVH
- Any baseline abnormality of the ST-segment on ECG.
- Cardiac Enzyme tests do not establish the Diagnosis.
ISCHEMIC HEART DISEASE (a.k.a. CAD)
In a patient with suspected CAD, under which (7) conditions is Dipyridamole or Adenosine Thallium“Stress” Test or Dobutamine Echocardiography the correct answer?
- Previous Stroke –> Weakness
- Dementia
- COPD
- Deconditioning
- Obesity
- Lower Extremity Ulcer
- Amputation
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What (2) Findings on a Stress Test translate into a Positive Test for CAD?
- Raised HR to 85% of Max
- ST segment Depression on ECG
**A Stress Test is a way of Increasing the Sensitivity of Detection of CAD beyond an ECG and Cardiac Enzymes**
ISCHEMIC HEART DISEASE (a.k.a. CAD)
What is the Next Diagnostic Test for a patient with Ischemic Chest Pain whose “Stress” Test is non-diagnostic or equivocal and shows “Reversible” Ischemia (most dangerous thing a stress test can show)?
Angiography
**No CABG until after an Angiography**