28- Ischemic Heart Disease

Question 1

atherosclerosis progression

Answer 1

fatty streak -> fibrous cap -> fibrous plaques -> adanced lesions

Question 2

atherosclerosis risk factors

Answer 2

hyperlipidemia
HTN
smoking
diabetes

Question 3

caused by inability of narrowed atherosclerotic coronary a. to supply oxygen to heart muscle under conditions of increased oxygen demand

Answer 3

angina

Question 4

dynamic plaque disruption which leads to intermittent flow obstruction

Answer 4

unstable angina

Question 5

NSTEMI and STEMI v. unstable angina

Answer 5

no elevated biomarkers with angina

Question 6

what groups are at risk of silent ischemia?

Answer 6

diabetics
women
elderly
cardiac transplant recipients

Question 7

tombstone ST elevation

Answer 7

acute STEMI

a “smiley face” shape to ST elevation is better prognosis

Question 8

most specific and sensitive cardiac enzyme

Answer 8

troponin

Question 9

when does CKMB peak

Answer 9

rises hours after the acute event and peaks at 24 hrs

Question 10

troponin levels may not rise for up to _ hrs after the onset of symptoms. Repeat and get serial troponins.

Answer 10

6 hrs

repeate if initial troponins are negative at 6 hrs

Question 11

treatment for diagnosed STEMI

Answer 11

cath lab or thrombolytics

Question 12

what drug should you give to lower HR and BP

Answer 12

beta blockers

Question 13

TIMI risk assessment

Answer 13

age >65
>3 CAD risk factors
- documented CAD
-ST deviation
- 2 angina in past day
- ASA use in past week
- elevated cardiac biomarkers

5-7 pts = high risk

Question 14

thrombolysis is used ..

Answer 14

ONLY FRO STEMI

Question 15

medical therapy for NSTEMI

Answer 15

ASA
oxygen
B blockers
nitro

Question 16

what effect do b-blockers have?

Answer 16

lower HR and BP
decrease dysrhythmia
decrease myocardial oxygen demand