Cardiovascular

Question 1

Combination of hypercholesterolemia, hypertriglyceridemia, impaired glucose tolerance, diabetes, hyperuricemia, HTN

Answer 1

Metabolic Syndrome X

Question 2

Exertional angina with normal coronary arteriogram - i.e. chest pain, but no coronary stenosis during cath

Answer 2

Good prognosis - Syndrome X

Question 3

Why would you use stress EKG?

Answer 3

1) Confirm diagnosis of angina
2) Evaluate response of therapy in patients with documented CAD
3) Identify high-risk CAD patients

Question 4

When is a stress test considered positive?

Answer 4

Any of the following:

1) ST depression
2) Chest pain
3) Hypotension (onset of heart failure)
4) Arrhythmia

Question 5

A stress EKG (preferred over pharmacologic) is 75% sensitive if…

Answer 5

Patient can reach 85% of maximum heart rate (= 220-age)

Question 6

A _________ is preferred by many cardiologists to a stress EKG because it is more sensitive in detecting ischemia, can assess LV size and function, can diagnose valvular disease, and can diagnose CAD in the presence of pre-exisiting EKG abnormalities

Answer 6

Stress Echo

Question 7

Outcomes measured by stress test

Answer 7

1) EKG changes
2) Symptoms
3) Nuclear imaging and perfusion uptake
4) Echocardiogram

Question 8

Patients with a positive stress test should undergo _____________

Answer 8

Cardiac catheterization

Question 9

Pros/Cons of stress myocardial perfusion imaging

Answer 9

Pros - sensitive
Cons - radiation, costly, not helpful in LBBB (false positives believed to be 2/2 delayed septal contraction -> constriction of blood flow during early diastole)

Question 10

__________ is the most accurate test for detecting CAD

Answer 10

Angiography - revascularization can occur at same time if not severe (Left main or 3-vessel) disease for which CABG is indicated

Question 11

Smoking cessation cuts CHD risk by _____ after one year

Answer 11

1/2

Question 12

Vigorous BP control reduces risk of CHD, especially in __________

Answer 12

Diabetics

Question 13

Standard of care for stable angina

Answer 13

1) Beta-blocker - reduces frequency of coronary events
2) ASA - decreases morbidity, reducing risk of MI
3) Nitrates PRN - effect on prognosis is unknown, mainly for symptom treatment

Question 14

Side effects of nitrates

Answer 14

1) Headache
2) Orthostatic hypotension
3) Tolerance
4) Syncope

Question 15

First-line beta blockers in CAD patients (shown to reduce frequency of coronary events)

Answer 15

1) Atenolol

2) Metoprolol

Question 16

Do not use these drugs in ACS, considered second-line

Answer 16

CCB - reduce afterload, but increase HR

Question 17

The COURAGE trial showed no difference between medical management and PCI & stents for __________ (measured mortality and non-fatal MIs), though revascularization is still offered to “severe disease” patients

Answer 17

Stable angina

Question 18

Revascularization does/does not reduce the incidence of MI in stable angina

Answer 18

Does NOT - mainly for symptom improvement

Question 19

Main indications for CABG

Answer 19

1) Left main disease > 50% stenosis
2) 2-3 vessel disease > 70%
3) LV Dysfunction