56. Ischemic Heart Disease Flashcards
1
Q
Describe diagnosis of ischemic heart disease (2)
A
- Ischemic heart disease diagnosis is based on pretest probability (symptoms, risk, noninvasive testing)
- CAD diagnosis is established if history of ACS or presence of obstructive lesions on angiography
2
Q
Describe : Classical chest pain (4)
A
- Dull RSCP (discomfort, heaviness, aching, pressure; not changing in intensity with inspiration, cough or position change; with or without radiation into jaw, neck, shoulders, arms)
- Provoked by exertion or emotional stress (lying down, post-prandially)
- Relieved within <5 min by rest or Nitroglycerin.
- Non-classical symptoms might include: SOB(OE), N/V, diaphoresis, fatigue, dizziness
3
Q
Describe : Atypical chest pain in DM, women, patients without risk factors (eg. young) (3)
A
- New CP
- Duration >20 min
- Occurrence at rest
4
Q
Name modifiable risk factors (9)
A
- Smoking
- DLP
- DM2
- CKD
- HTN
- Obesity or Metabolic syndrome
- Physical Inactivity
- Diet
- Depression
5
Q
Name non-modifiable risk factors (4)
A
- Age
- Sex (male)
- Ethnicity (Hispanic, Native American, African American, Asian)
- Family history of premature CVD (1st degree relative, <55yo men, <65yo women)
6
Q
Name CV Co-morbidities (4)
A
- Valvular disease
- Cerebrovascular disease
- Peripheral vascular disease
- Renal disease
7
Q
Name investigations : Ischemic heart disease (7)
A
- 12-lead ECG
- Hemoglobin
- Full lipid panel (Total cholesterol, LDL, HDL)
- Fasting blood glucose or HbA1c
- Creatinine
- AST, ALT, Total Bilirubin
- TSH
8
Q
A
9
Q
Name findings consistent with CAD in EKG (5)
A
- Evidence of left ventricular hypertrophy
- ST-T wave changes consistent with ischemia
- Previous Q-wave myocardial infarction (MI)
- Bundle branch block
- Conduction/rhythm disturbances
10
Q
A
11
Q
Name Choice of non-invasive testing (2)
A
- Exercise ECG test preferred if able to exercise and interpretable ECG
- Alternatives to exercise include vasodilators (adenosine, dipyridamole, regadenoson) and cardiac stimulants (dobutamine)
12
Q
Name invasing testing (1)
A
coronary angiography
13
Q
Invasive testing (coronary angiography) indicated if what ? (5)
A
- High pretest probability of stable ischemic heart disease
- High-risk features on non-invasive testing
- Persistent symptoms or inadequate QOL despite optimal medical treatment
- History of ACS
- Life-threatening arrhythmias
14
Q
Describe counselling in management of stable disease (9)
A
- Review treatment options, Medication adherence for symptom relief and prevent disease progression
Explanation of CV risk - Treat any concurrent DM2 or DLP or HTN
- Lifestyle
- Smoking cessation
- Weight loss
- Diet (high intake of vegetables, whole grains, fresh fruit; reduce salt, saturated/trans fat)
- Physical activity (150 min/week of moderate or vigorous activity)
- Assess and manage stress/depression
- Red flags when to seek medical care
15
Q
Describe tx to improve prognosis in stable disease (4)
A
- ASA 81mg (or Clopidogrel 75mg if ASA intolerance)
- High-intensity Statin (eg. Rosuvastin 20-40mg daily, Atorvastatin 80mg daily)
- ACEI (or ARB) if HTN, DM2, CKD, LVEF ≤ 40%
- Revascularization therapy (PCI or CABG) in patients who underwent coronary angiography
