Cardiac diagnostics and stable angina - nate (incomplete)

Question 1

What is ischemia

Answer 1

imbalance between oxygen supply and demand

Question 2

what is a phonocardiogram

Answer 2

heart sounds - calves closing

Question 3

What is NYHA

Answer 3

NY heart association - scoring for heart concerns class 1-4

Question 4

what is CCS scoring

Answer 4

Canadian cardiac scoring for angina scoring 1-3

Question 5

What are the 2021 CHEST PAIN guidelines

Answer 5

Chest pain
High-Sensitivity (troponin)
Early Care
Share (share decision making)
Testing (not routinely needed in low-risk patients)

Pathways (clinical decision pathways)
Accompany (women may be more likely to present with accompanying symptoms)
Identify (further testing)
Non-cardiac
Structured (risk assessment should be used)

Question 6

What is ischemic Heart disease

Answer 6

inadequate supply of blood/O2 to a portion of the myocardium (ie. imbalance of supply and demand)

Question 7

what is the most common cause of IHD

Answer 7

Atherosclerotic disease of coronary artery

Question 8

what controls the coronary circulation

Answer 8

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

Question 9

What is CK-MB

Answer 9

creatinine Kinase
lab work done at admission, 12 hours and 24 hours
supports diagnosis of myocardial muscle injury/infarct
rises in 4-6 hours after infarct
baseline in 36-48 hours

Question 10

What is troponin

Answer 10

lab test
cardiac troponin 1 (cTn1) and Cardiac troponin (cTNT @ DH)
more sensitive and specific for MI than CK
elevate sooner - 80% in 3 hours and remain elevated 3-7 days or longer for cTNT

Question 11

what is the diagnosis for ACS

Answer 11

troponin - also risk stratify unstable angina

Question 12

what is the preferred biomarker to assess myocardial injury

Answer 12

Cardiac troponin (cTn)

Question 13

what are other causes of myocardial damage other than MI

Answer 13

sepsis, septic shock, SIRS
PE, HF, preicarditis/myocaradidits
Cardiotoxic meds/chemo, strenuous exercise
infiltrative disorders ie. sarcoid, amyloid

Question 14

What is a Type 1 MI

Answer 14

small amount of atherosclerotic build up in the artery and a plaque rupture/erosion

Question 15

what is type 2 MI

Answer 15

oxygen supply and demand imbalance
severe HTN
sustained tachyarrhythmia

Question 16

what are examples of acute MI

Answer 16

acute heart failure
myocarditis

Question 17

what are examples of chronic MI

Answer 17

structural heart disease
chronic kidney disease

Question 18

What is LDH

Answer 18

Lactate Dehydrogenase (elevated if lack of O2)
- not a specific indicator of any one disease or organ injury

Question 19

What produces C-reactive protein

Answer 19

liver

Question 20

what is c-reactive protein

Answer 20

acute phase reactant
nonspecific inflammatory marker
not for screening
increase CRP associated with: athero, CV events, recurrent EV events
helps predict mortality

Question 21

What is the BNP

Answer 21

Brain natriuretic peptide
initially seen in the brain - mostly released in ventricles of the heart

Question 22

What does BNP correlate to

Answer 22

LV stress - good marker for CHF

Question 23

when is BNP elevated normally

Answer 23

in women, elderly, renal failure

Question 24

what is assessed with echocardiography

Answer 24

myocardium, chambers, valves, pericardium, great vessels
EF, valve anatomy and function, LV function, RV function, chamber size

Question 25

what is the purpose of a doppler

Answer 25

measures velocity of moving blood- noninvasive alternative for hemodynamics

Question 26

what is the benefit of the 2D surface echo

Answer 26

chamber size, LV function
valve structure, motion
pericardium, masses

Question 27

when is TTE good for

Answer 27

emergencies - reliable, portable, bedside

Question 28

What is TTE

Answer 28

transthoracic echocardiogram

Question 29

what is TEE

Answer 29

transesophageal echocardiogram

Question 30

What is the difference of TTE vs TEE

Answer 30

TTE always first - can be limited in large pts and severe lung disease
TEE is good for posterior structures - aortic dissection, thrombus, vegetations, 3D reconstructions

Question 31

What are different types of stress tests

Answer 31

ECG, Echo, Nuclear imaging, cMRI
Exercise vs pharmacological tests

Question 32

What are the benefits of ECG stress test

Answer 32

cheap, fast, easy
greatest value with moderate to high pre-test probability, normal resting ecg, capable of achieving adequate workload
12 lead before, during and after exercises

Question 33

What is “double product”

Answer 33

HR and sBP

Question 34

what is highlighted on a stress test

Answer 34

stenosed artery cannot increase blood flow like normal arterty coronary steal

Question 35

when are pharmacologic stress tests used

Answer 35

combined with imagine
but used in patients with arthritis, ortho issues, PVD, elderly who cannot exercise much

Question 36

what is an angiogram

Answer 36

cardiac catheterization
opportunity for diagnosis AND treatment concomitantly (PCI)

Question 37

what is the gold standard for atherosclerosis

Answer 37

angiograms/cardiac catheterization

Question 38

What are indications for catheterization

Answer 38

ACS (unstable angina, sSTEMI, STEMI)
SIHD (only after failed GDMT)
pre-op cardiac surgery (sometimes other surgeries)
coronary artery and cardiac hemodynamic evaluation
pHTN
peripheral arterial disease
shock pts - hemodynamic support
electrophysiology studies

Question 39

what type of medication has a survival benefit post MI

Answer 39

Statin medications - for risk reduction: controls lipidemia

Question 40

What are medications used for IHD

Answer 40

Nitrates
Beta Blockers
Calcium Channel Blockers

Question 41

What is MONA for ACS patiens

Answer 41

Morphine, Oxygen, Nitro, Aspirin