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Board Basics Review > Cardiovascular Medicine: Chronic Stable Angina > Flashcards

Cardiovascular Medicine: Chronic Stable Angina Flashcards

1
Q

3 typical components for anginal CP

A
  1. substernal CP or discomfort
  2. worse on exertion or emotional stress
  3. relieved by rest and/or nitroglycerin
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2
Q

what is the definition of atypical CP?

A

2 of 3 components of typical CP

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3
Q

what is the definition of nonanginal CP?

A

1 or none of the components of typical CP

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4
Q

non-coronary artery causes of angina

A
  • AS

- HCM

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5
Q

when should you order a stress test?

A

intermediate (10-90%) risk pts

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6
Q

indications for selecting the correct stress test:

  • exercise ECG WITHOUT imaging
A
  • pts who can exercise
  • normal or nonspecific baseline ECG changes
  • complete RBBB
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7
Q

indications for selecting the correct stress test:

  • exercise ECG WITH myocardial perfusion imaging
A
  • pre-excitation (WPW)
  • > 1 mm STD
  • previous CABG or PCI
  • LBBB (excercise echo)
  • intermediate risk result following exercise ECG
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8
Q

indications for selecting the correct stress test:

  • exercise echocardiography
A
  • pre-excitation (WPW)
  • > 1 mm STD
  • previous CABG or PCI
  • LBBB (excercise echo)
  • intermediate risk result following exercise ECG
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9
Q

indications for selecting the correct stress test:

  • pharmacologic stress myocardial perfusion imaging
A
  • unable to exercise
  • electrically paced ventricular rhythm
  • LBBB
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10
Q

indications for selecting the correct stress test:

  • dobutamine echocardiography
A
  • unable to exercise
  • electrically paced ventricular rhythm
  • LBBB
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11
Q

when should you order coronary angiography?

A
  • high pretest probability pts, or:
  • LV dysfunction
  • class 3 or 4 angina despite tx
  • highly positive stress or imaging test
  • high pretest probability of left main or 3-vessel CAD
  • uncertain dx after noninvasive testing
  • h/o surviving sudden cardiac arrest
  • suspected coronary spasm
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12
Q

LIFESTYLE MODIFICATION for all pts w/ chronic stable angina

A
  • smoking cessation
  • regular exercise
  • heart healthy diet
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13
Q

goal BP in pts w/ chronic stable angina

A

< 140/90

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14
Q

goal HbA1c in pts w/ chronic stable angina

A

< 7

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15
Q

what are the 3 major classes of antianginal medications for pts w/ chronic stable angina?

A
  • BBs
  • nitrates
  • CCBs
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16
Q

what is first-line therapy for pts w/ chronic stable angina?

A

cardioselective BBs

17
Q

what is the goal resting HR for pts w/ chronic stable angina?

A

about 60 bpm

18
Q

absolute CI’s to BBs

A
  • severe bradycardia
  • advanced AVB
  • decompensated HF
  • severe reactive airways disease
19
Q

which med is as effective as BBs and CCBs in reducing angina?

A

nitrates

20
Q

how to prevent nitrate tachyphylaxis when treating pts w/ chronic stable angina?

A

nitrate-free period of 8 to 12 hours per day

21
Q

which meds are CI to use in combination w/ nitrates?

A
  • PDEIs (sildenafil, vardenafil, tadalafil)
22
Q

if absolute CI to BB, which med class should be initiated as first-line therapy?

A

CCBs

23
Q

if angina even w/ BBs and nitrates, what should be added?

A

CCBs (long-acting preferred)

24
Q

which med should be considered if angina persists despite being on BBs, nitrates, and CCBs?

A

ranolazine

25
Q

reduces r/o stroke, MI, and vascular death in pts w/ CAD

A

aspirin

26
Q

reduce r/o cardiovascular and all-cause mortality for most pts

A

ACEIs

27
Q

reduce cardiovascular events, including MI and death

A

high-intensity statins

28
Q

in which pts should revascularization therapy w/ PCI or CABG be considered?

A

persistent sxs despite maximal medical therapy

29
Q

revascularization does not confer additional protection from cardiovascular events except for which pts?

A
  • left-main CAD

- triple-vessel disease w/ LV dysfunction

30
Q

DON’T BE TRICKED

  • in the absence of high-risk features for early mortality or unresponsiveness to medical therapy, which therapies should not be selected in pts w/ chronic stable angina?
A

PCI or CABG

31
Q

DON’T BE TRICKED

  • which treatments should not be selected as tx for pts w/ chronic stable angina?
A
  • HRT (in women)
  • antioxidant vitamins (vitamin E)
  • tx of elevated homocysteine levels w/ folate or B12

Board Basics Review (24 decks)

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