4: CAD intro

Question 1

CAD sxs

Answer 1

cold extremities, perspiration, weakness
lethargy, dizziness, difficult concentration
high BP, Hx MI/embolism, heart palpitations/flutter
anxiety, N
chest/leg pain on exertion

Question 2

Angina atypical presentations

Answer 2

Women: left jaw, GI sxs
Diabetics: silent (glycosylation of nerves)
Triggers: cold weather, meal, anxiety, dehydration

Question 3

Variant/Prinzmetals angina

Answer 3

ST elevation (rather than depression) on ECG

Question 4

Angina versus MI sxs

Answer 4

MI: crushing, intense, 10-15 minutes or longer

very anxious

Question 5

Lidocain/Maalox

Answer 5

will soothe esophageal rupture, GERD

won’t touch MI

Question 6

Chest pain EMERGENCIES

Answer 6

ACS, aortic dissection, PE, tension pneumothorax, pericardial tamponade, esophageal rupture

Question 7

To Dx chronic stable angina

Answer 7

exercise stress test with ECG

chemical stress if cannot tolerate exercise-COPD, arthritis, etc

Question 8

Infarct ECG findings

Answer 8

ST elevation-acute injury

signifcant Q wave- acute injury or historical MI

Question 9

Ischemia ECG findings

Answer 9

T wave inversion
ST depression
downsloping =most ischemia, worst prognosis

Question 10

Cardiac markersq

Answer 10

CK-MB: 4-6 hours to 72 hrs

Troponin: 4hrs to 10 days

Question 11

ND Office MI Protocol

in this order!

Answer 11

1. 911
2. aspirin
3. oxygen
4. IV access
5. Nitro SL (after EKG)
6. Morphine (usu in ambulance)

Question 12

Labs for CAD

Answer 12

lipid panel
Lp(a)
CRP-hs
insulin
homocysteine
lipid fractionation
fibrinogen
bleeding time

Question 13

Familial Hypercholesterolemia

Answer 13

LDL >190 mg/dL

lower LDL- statin, niacin, fenofibrate (if also high TG)

Question 14

High TGs Tx

Answer 14

Lower carbs to <200g/day
plant diet, high protein
niacin
RYR
omega 3s
B5

Question 15

Lp(a)

Answer 15

transports cholesterol and binds with blood clots, raises risk of MI, stroke
contributes to plaque, foam cells
*best indicator for cerebral infarct, carotid atherosclerosis

Question 16

elevated Lp(a) Tx

Answer 16

Niacin
NAC
omega 3s
ASA
coQ10
aerobic exercise

Question 17

High homocysteine RFs

Answer 17

inadequate B9, B6, B12, smoking
MTHFR/COMT, hypocholorohydria, PPIs, stress
kidney dz
elderly
hypothyroid

Question 18

Fibrinogen

Answer 18

glycoprotein essential for clot formation

hyperviscosity of blood, plaques, thrombus, endothelial injury

Question 19

Elevated fibrinogen RFs

Answer 19

smoking, OCPs, obesity, stress, aging