100114 chronic coronary artery disease

Question 1

chronic ischemic heart disease

Answer 1

most commonly caused by obstruction of coronary arteries by atheromatous plaque

Question 2

location, quality, duration, aggravating or alleviating factors, and associated symptoms of angina

Answer 2

retrosternal location: radiates to or occasionally isolated to neck, jaw, shoulders, arms, or epigastrium

pressure, squeezing, tightness, heaviness, burning, indigestion

under 2-10 minutes

made worse by exertion, cold weather, emotional stress

relieved by rest or nitroglycerin

associated symptoms: dyspnea. S3, S4, or murmur of papillary dyxfxn during pain

Question 3

what on EKG signals infarction?

Answer 3

Q wave (although some leads may have small Q waves normally due to their location)

Question 4

in acute STEMI, what would you observe in sequence on EKG?

Answer 4

immediately before MI starts–T wave inversion

within hours after MI–marked ST elevation and upright T wave

hours later–significant Q, ST elevation, upright T

hours to a day or two later–significant Q, less ST elevation, marked T inversion

days to weeks later–significant Q, T wave inversion

weeks, months, years–significant Q only

Question 5

ST elevation signals

Answer 5

injury

Question 6

Q wave signals

Answer 6

infarct

Question 7

if you see Q wave in leads II, III, avF, what does this signal?

Answer 7

infarct in inferior wall

Question 8

V5, V6, I, aVL together-if you see STEMI signs on EKG, represent what location of the heart?

Answer 8

lateral wall

Question 9

anterior wall STEMI would show irregulaties in which leads on EKG?

Answer 9

V2 to V4

Question 10

if II, III, aVF are the leads depicting primary EKG changes, what is the likely vessel involved?

Answer 10

RCA

Question 11

if V1 and V2 are the leads depicting primary EKG changes, what is the likely vessel involved?

Answer 11

LAD

Question 12

if I, aVL, V5-V6 are the leads depicting primary EKG changes, what is the likely vessel involved?

Answer 12

CIRC

Question 13

if infarct is in posterior heart, what lead would you see prominent changes in EKG?

Answer 13

V1–you would see prominent R

Question 14

coronary angiography is used

Answer 14

in diagnosing coronary heart disease-to look at obstruction

invasive procedures

lesions greater than 70% are considered significant

Question 15

white tissue on MRI could indicate

Answer 15

scar tissue (after tissue infarct)

Question 16

revascularization can be used for symptomatic chronic coronary lesions-true or false?

Answer 16

true
-PCI (balloon, stent), surgical bypass

however, for most pts with chronic angina, revascularization shouldnot constitute initial management strategy before evidence based medical therapy (like phamacologic antianginal therapy, therapetuic lifestyle changes) is initiated and optimized

Question 17

if scarring of myocardium has occurred, will balloon angioplasty (PTCA) help?

Answer 17

no

Question 18

bypass graft (an invasive procedure, have to open up chest wall ) may be better than PCI for

Answer 18

left main artery obstruction
multiple vessels involved
diabetics

Question 19

sequela of chronic coronary artery disease

Answer 19

chronic chest discomfort (stable angina)
cardiomyopathy (heart failure)
left ventricular aneurysms
ventricular arrhthmias/sudden death