Aquifer Case 9

Question 1

what are the independent risk factors for coronary heart disease?

Answer 1

1. DMII
2. HDL <40
3. obesity
4. smoking

Question 2

what is the differential for palpitations in a 50 year old?

Answer 2

1. anemia
2. anxiety/panic disorder
3. coronary heart disease

4 . dysrhythmia

5. hyperthyroidism
6. prescription or illicit drug use
7. valvular heart disease
8. vasomotor symptoms of climacteric

Question 3

what is the relationship between exercise and angina?

Answer 3

chest pain precipitated by exercise has a positive likelihood ratio of 4.7 for acute coronary syndrome

no clinical trials linking palpitations during exercise to CHD but there is anecdotal mention of palpitations precipitated by exercise being due to CHD – furthermore, the presentation of females with palpitations has been suggested to be a non-chest pain symptom of CHD

Question 4

which pain characteristics argue against the likelihood of angina?

Answer 4

1. palpation reproducing pain
2. pleuritic pain
3. positional pain
4. stabbing pain

only pressure supports cardiac ischemia

Question 5

what are the prodromal symptoms of ACS in women?

Answer 5

95% of women reported prodromal symptoms, but only 29.7% reported chest discomfort

1. fatigue
2. dyspnea
3. neck and jaw pain
4. palpitations
5. cough
6. nausea and vomiting
7. indigestion
8. back pain
9. dizziness
10. numbness

Question 6

when would you order an exercise stress test?

Answer 6

value of a test is based on pretest probability of detecting disease

Question 7

what are the recommendations for aspirin as primary prevention of CHD?

Answer 7

initiate low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk; are not at increased risk for bleeding; have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years (grade B recommendation))

but recent research has called into question the use of aspirin for primary prevention in most patients as its benefits are low to negligible and it increases the risk of serious gastrointestinal bleeding

Question 8

what are the major risk factors for CHD?

Answer 8

1. HTN
2. DMII
3. smoking
4. elevated lipids