Cardiac Diagnostics and Stable Angina

Question 1

The first clinical manifestation of coronary artery disease maybe _______, it is mandatory to identify high risk patients.

Answer 1

Death

Question 2

What are some possible underlying etiologies of heart defects/disease?

Answer 2

Is the disease congenital?
Hypertensive?
Ischemic?
Inflammatory?
Other?

Question 3

If you hear a grade 3 murmur or higher what should you order for a work-up?

Answer 3

Echocardiogram

Question 4

What is the mneumonic that can help remember the approach to chest pain?

Answer 4

CHEST PAINS

Chest pain means more than just chest pain

High-Sensitivity - order troponin

Early care for acute symptoms

Share - shared decision making

Testing - not usually needed in low-risk patients

Question 5

What is the most common cause of ischemic heart disease?

Answer 5

Atherosclerotic disease of the coronary artery

Question 6

What is stable angina?

Answer 6

Episodic clinical syndrome due to transient myocardial ischemia

Question 7

What is the basic explanation of what is occurring in ischemic heart disease?

Answer 7

Inadequate supply of blood/O2 to a portion of the myocardium (imbalance of supply and demand)

Question 8

Coronary circulation is controlled by what

Answer 8

By the hearts requirement for oxygen, coronary vessels can vary in resistance by dilation

Question 9

What is going to occur if there is a higher demand for O2 in the setting of blood flow limitations?

Answer 9

Ischemia

Question 10

Creatinine Kinase (CK-MB) supports what diagnosis

Answer 10

Diagnosis of myocardial muscle injury/infarct

Can hep quantify timing, degree of MI

Question 11

A CK-MB will rise how long after an infarct?

Answer 11

4-6 hours

Question 12

What test is more sensitive and specific than a CK?

Answer 12

Troponin

Question 13

Does an elevated troponin only occur in an MI?

Answer 13

No, there are other possible causes for troponin to be elevated

Question 14

What are some of the other causes of an increased troponin level besides an MI?

Answer 14

Sepsis, shock
PE, HF, pericarditis/myocarditis
Cardiotoxic meds/chemo, strenuous exercise
Infiltrative disorders

Question 15

What patients are you likely to order a lactate dehydrogenase?

Answer 15

Critically ill patients, shock patients

Question 16

Brain natriuretic peptide (BNP) is continuously released, but rate of release is increased to regulate

Answer 16

Cardiac output

Question 17

BNP’s are usually elevated with what symptom

Answer 17

dyspnea

Question 18

Are BNP’s normally elevated in women, elderly, and renal failure?

Answer 18

Yes

Question 19

What is a normal EF?

Answer 19

55 to 65

Question 20

What are clinical indications to use a 2D ECHO?

Answer 20

Evaluate Cardiac chambers and valves
Effusion/tamponade
Masses
Great vessels

Question 21

What are clinical indications to use a stress ECHO?

Answer 21

Ischemia
Viable myocardium

Question 22

What are clinical indications to use a TEE?

Answer 22

Inadequate TTE
Aortic disease
Ineffective endocarditis
Embolism source
Valve prosthesis
Intraoperative

Question 23

A stress test is used to evaluate

Answer 23

risk of ischemic heart disease and to identify regions of myocardial viability

Question 24

What medication does a pharm stress test use?

Answer 24

Vasodilator (dipyridamole)
or positive inotropes (dobutamine)

Question 25

When is the A wave occurring?

Answer 25

Right atrial contraction, just before systole. Occurs just after the P-wave, before S1.

Question 26

Artherosclerosis is a a spectrum, what are the stages?

Answer 26

Asymptomatic
Stable Angina
Unstable Angina/MI

Question 27

How many types of MI are there?

Answer 27

5

Question 28

What drug class has been shown to improve survival in post-MI patients?

Answer 28

Statins (Astorvostatin and Rovustatin)