CAD

Question 1

C/I to any kind of stress testing:

Answer 1

• acute MI

- cardiac ischemia

Question 2

Vasodilators should not be used in: (4)

Answer 2

• hypotension
• high degree AV heart block
• SSS
• active wheezing (may exacerbate COPD or asthma sxs)

Question 3

Pharmacological stress testing is used in these patients:

Answer 3

• pts who cannot exercise

- used w/ baseline ekg abnormalities (like LBBB) which would obscure the ST segment elevation during exercise

Question 4

Only C/I to MPI:

Answer 4

Pregnancy bc radioactive tracer

Question 5

This test can be used to assess the viability of a hibernating myocardium:

Answer 5

Stress echo using dobutamine

Question 6

What are the appropriate pts for cardiac stress testing: (5)

Answer 6

1- new onset HF or cardiomyopathy w/o planned cardiac catheter
2- pt. W/ CHD w/ worsening or new sxs
3- pt. W/ ACS who was previously treated conservatively w/o cath; risk stratify w/in 3 months
4- sxs suggestive of angina w/ intermediate or high pre-test probability of CHD
5- pts w/ active cardiac conditions as pre-op evaluation for non-cardiac elective surgeries

Question 7

Cardiac stress testing: inappropriate pts (3)

Answer 7

1- active chest pain or ACS sxs
2- pts. w/o coronary dx sxs
3- pts. w/ prior coronary cath and no new sxs <5 years w/ CABG or <2 years w/ PCI

Question 8

Low risk pts. that would not benefit from stress test and need to consider other diagnosis:

Answer 8

• women w/ atypical CP <49 y.o.
• women w/ non-anginal CP <59 y.o.
• males w/ non-anginal CP <39 y.o.

Question 9

High risk pts. unlikely to benefit from a stress test and require immediate coronary angiography:

Answer 9

• men w/ typical CP >40 y.o.

Question 10

When is CABG superior to stenting? (3)

Answer 10

1- >50% stenosis in left main coronary artery
2- multi-vessel dz in DM
3- 3 main epicardial coronary arteries w/ left ventricular systolic dysfx (EF < 50%)

Question 11

Type 1 MI:

Answer 11

Spontaneous MI related to a primary coronary event, such as a plaque rupture

Question 12

Type 2 MI:

Answer 12

MI secondary to ischemia due to either increased oxygen demand or decreased supply e.g. coronary artery spasm, coronary embolism, anemia, arrythmias, hypo/hypertension

Question 13

Type 3 MI:

Answer 13

Sudden unexpected cardiac death

Question 14

Type 4A MI:

Answer 14

MI associated w/ PCI

Question 15

Type 4B MI:

Answer 15

MI associated w/ stent thrombosis as documented by angiography or at autopsy

Question 16

Type 5 MI:

Answer 16

MI associated w/ CABG

Question 17

Tx cocaine induced coronary ischemia

Answer 17

• nitrates and non-DHP CCB

BB C/I