Cardiac imaging studies and Disease

Question 1

Gold standard to visualize coronary arteries

Answer 1

Left heart catheterization

Question 2

If you want to definitively determine cardiac output, what test do you order?

Answer 2

Right heart catheterization (venous access) to measure intracardiac pressures
Determines cardiac output

Question 3

If you want to definitively identify coronary anatomy, what test do you order?

Answer 3

Left heart catheterization (arterial access). Gold standard to identify coronary anatomy
Uses contrast and radiation

Question 4

Primary versus secondary CAD prevention

Answer 4

Primary: Modify risk factors or prevent development, aim is delaying or preventing new onset CAD
Secondary: For patients who have the established disease, and continue to do factor modification to reduce mortality and decrease subsequent events

Question 5

What are the nonmodifiable risk factors for CAD

Answer 5

Genetics- if someone had MI and died less than 55 if male or 65 if women
Age- Men >45, women >55
Gender- Men > Women

Question 6

At what percent occlusion do you get stable angina during exertion

Answer 6

70%

Question 7

At what percent occlusion do you get stable angina during rest

Answer 7

90%

Question 8

What are the 4 groups that benefit from statin therapy

Answer 8

1. Individuals with clinical ASCVD
2. Individuals with elevations of KDK >190 or familial hypercholesterolemia
3. Individuals 40-75 with diabetes and LDL >70
4. Individuals without clinical ASCVD or diabetes with LDL >70 and estimated ASCVD risk of 7.5% or higher

Question 9

Statins work on which enzyme

Answer 9

Inhibit rate limiting enzyme responsible for cholesterol biosynthesis. Reduction in cholesterol then increases LDL receptors, which increases LDL clerance from blood

Question 10

What is the order that you diagnose lipid lowering medications (classes to perscribe first and later)

Answer 10

1. First Statins (HMG-CoA reductase inhibitors)
2. Then Ezetimibe (Intestinal Cholestorol absorption inhibitors)
3. Then PCSK9 inhibitors

Question 11

What is the purpose of Bile acid sequesterants

Answer 11

Lower LDL, interfere reabsorption of bile acids and reduce the amount returned to the liver

Question 12

What is the purpose of Niacin

Answer 12

Decrease fatty acid mobilization from adipose tissue and reduce synthesis of LDL and VLDL

Question 13

What is the purpose of Fibrates

Answer 13

Increase lipoportein lipases responsible for lipolysis, reduces triglyceride levels

Question 14

What are the 4 systems that regulate blood pressure

Answer 14

Heart: pumping and contractility
Vasculature: peripheral resistance
Kidney: regulates intravascular volume and peripheral resistance
Hormones: Modulates functions of other systems (RAAS)