CAD

Question 1

What is ischemia?

Answer 1

Myocardial ischemia occurs when there is an imbalance between the supply of oxygen (and other essential myocardial nutrients) and the myocardial demand for these substances.

Question 2

Ischemic heart disease divided into to categories?

Answer 2

1- stable coronary syndrome which is
A- obstructive CAD.
B- INOCA (non-Obstructive CAD.)
2- acute coronary syndrome which is:
A- STEMI
B- NSTEMI / USTABLE.
C- MINOCA (MI with INOCA)

Question 3

When a patient has acute cardiopulmonary ( chest pain) what do you think of or what are your ddx?

Answer 3

1- ACS: STEMI , NSTEMI and Unstable angina.

2- AAS: acute aortic syndromes

3- VTE : venothromboembolism.
4- tamponade
5- esophageal rupture
6- spontaneous tension PTX( pneumothorax)

Question 4

How to approach a patient who has chest pain?

Answer 4

Step1- asses symptoms and perform clinical investigation of chest pain.
Step2- consider comobidities and quality of life.

Question 5

What are the clinical classification of suspected Angina?

Answer 5

1- typical angina meets all the three criteria:
A- Heavy and Tight central/retrosternal pain
B- Occurs on exertion or emotions
C- Relieved by rest or Nitrates.

2- atypical angina: meets two of these criteria.

3- non-anginal chest pain: meets only one or none of these criteria.

Question 6

What is the percentage of having angina?

Answer 6

1- typical angina Less the 50%
And atypical and non-anginal chest pain have the majority of the cases.

Question 7

What is levine’s sign?

Answer 7

It’s a clinched fist as it’s a sign of Ischemic chest pain

Question 8

Grades of effort in stable angina severity?

Answer 8

1- angina only with sternous exertion
ll- angina with modrate exertion.
lll- angina with mild exertion.
llll- angina at rest.

Question 9

What are the grades of unstable angina?

Answer 9

i) as rest angina, i.e. pain of characteristic occurring at rest and for prolonged periods (>20 min);

(ii) new-onset angina, i.e. recent (2 months) onset of moderate-to- severe angina.

or (iii) crescendo angina, i.e. previous angina, which progressively increases in severity and intensity, and at a lower threshold, over a short period of time.

Question 10

What do we look in physical examination in patients who have angina?

Answer 10

There are usually no abnormal
findings in angina.
➢ Signs to suggest anemia,
thyrotoxicosis or hyperlipidemia
(e.g. lipid arcus, xanthelasma,
tendon xanthoma) should be
sought.
➢ Blood Pressure Measurement.

Question 11

What is stable CAD?

Answer 11

Stable coronary artery disease is a non-acute condition due to chronic progressive coronary artery atherosclerosis.

Question 12

What are the risk factors of stable CAD?

Answer 12

1-Non-modfiable:
Age ,Sex ,Ethnicity, Genetics , and Diabetes.

Modifiable:
Smoking, Dyslipidemia, Metabolic syndrome ,
Obesity
Hypertension
Physical inactivity,
Diabetes type2

Question 13

HOW TO MODIFY The risk factors of stable CAD?

Answer 13

○ Lifestyle modification.
○ Pharmacological therapies.
○ Revascularization ….which results in either disease stabilization or
regression or progression

Question 14

What are the needed investigations of stable CAD?

Answer 14

Anatomical investigation :
CTCA (CT cardiac angiography) Cardiac cath
SPECT
Stress echo
Stress MRI
————————-
Lab tests includes:
Full blood count
Thyroid function test
Fasting glucose
HbA1c
12- lead
Echo
Chest x-ray

Question 15

Current evidence supports a daily dose of Asprine 75-100
mg for the prevention of ischaemic events in CAD patients
with or without a history of MI.
• The optimal timing of initiation of P2Y12 inhibition before
coronary angiography and possible PCI in patients with
CCS is uncertain.