56. Ischemic Heart Disease 52% Flashcards
Describe diagnosis of ischemic heart disease (2)
- 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
Describe : Classical chest pain (4)
- 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: shortness of breath, N/V, diaphoresis, fatigue, dizziness
Which population should we look out for that may present with ATYPICAL chest pain ? (4)
- Women
- Those with DB
- Young
- Those at no risk
Describe : Atypical chest pain in DM, women, patients without risk factors (eg. young) (3)
- New CP
- Duration >20 min
- Occurrence at rest
Name modifiable risk factors (9)
- Smoking
- DLP
- DM2
- CKD
- HTN
- Obesity or Metabolic syndrome
- Physical Inactivity
- Diet
- Depression
Name non-modifiable risk factors (4)
- Age
- Sex (male)
- Ethnicity (Hispanic, Native American, African American, Asian)
- Family history of premature CVD (1st degree relative, <55yo men, <65yo women)
Name CV Co-morbidities (4)
- Maladie valvulaire
- Maladie cérébrovasculaire
- Maladie vasculaire périphérique
- Maladie rénale
Name investigations : Ischemic heart disease (7)
- 12-lead ECG
- Hemoglobin
- Full lipid panel (Total cholesterol, LDL, HDL)
- Fasting blood glucose or HbA1c
- Creatinine
- AST, ALT, Total Bilirubin
- TSH
Name findings consistent with CAD in EKG (5)
- Evidence of left ventricular hypertrophy
- ST-T wave changes consistent with ischemia
- Previous Q-wave myocardial infarction (MI)
- Bundle branch block
- Conduction/rhythm disturbances
Name Choice of non-invasive testing (2)
- Exercise ECG test preferred if able to exercise and interpretable ECG
- Alternatives to exercise include vasodilators and cardiac stimulants
Name invasing testing (1)
L’angiographie coronaire (ou coronarographie)
Name vasodilators agents for non-invsaive testing (3)
- adénosine
- dipyridamole
- régadénoson
Name cardiac stimulants agents for non-invsaive testing (1)
dobutamine
Invasive testing (coronary angiography) indicated if what ? (5)
- 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
Describe counselling in management of stable disease (9)
- 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
