CHD

Question 0

Lipid lowering agents

Answer 0

Statins (HMG-CoA reductase inhibitors): atorvastatin, -statin
Bile acid binding resins: cholestyramine
Fibrates: Gemifibrozil
Cholesterol absorption inhibitors: ezetimibe

Question 1

Most common location of infarction from atherosclerosis

Answer 1

LAD (left anterior descending)
renal arteries
carotid bifurcation (brain)

Question 2

ECG finding in stable angina

Answer 2

ST segment DEPRESSION in leads V2-6
(in non-STEMI, ST depression lasts >12hr)

(ST elevation is MI)

Question 3

Functional classification of Stable Angina Pectoris (CCS)

Answer 3

CCS I: ordinary activity does not cause angina, only with strenous activity

CCSII: walking or climbing stairs rapidly, in cold, stress. >2 blocks, >1 flight of stairs

CCSIII: walking 1 or 2 blocks, or 1 flight of stairs causes angina

CCSIV: angina at rest

Question 4

Nitrates
MOA
for

Answer 4

Lowers oxygen demand, vasodilation, preload, afterload
increase coronary dilation

for angina

Question 5

Beta blockers
MOA
contraindications
for

Answer 5

reduce HR, contractility, BP, oxygen demand

CI***: severe bradycardia, AV-block, SSS, unstable LV failure

Question 6

Calcium antagonists
MOA
for

Answer 6

increase O2 supply: dilate vessels, release spasms
decrease O2 demand: negative inotropic, decrease BP
antiplatelet effect

Question 7

antiplatelet agents

Answer 7

ASA (acetyl salicylic acid)
clopidogrel (ADP receptor antagonists)
cilostazol (phosphodiesterase inhibitor)
GP IIb/IIIa receptor inhibitors

Question 8

How unstable angina is defined

Answer 8

occuring at rest, lasts >20min
new onset (within 1 to 2 months)
crescendo pattern (CCSIII at least)

Question 9

Braunwald classification of unstable angina/NSTEMI

Answer 9

I: new onset, but no resting pain within 2 months
II: angina at rest, but not within last 48h
III: angina at rest, within the last 48h

class A: secondary to anemia, hypotension, tachy-arrhythmia
class B: primary unstable angina
class C: post infarction

Question 10

Lab markers for ischemic injury (seen in non-STEMI)

Answer 10

CK-MB (creatine kinase)

Troponin

Question 11

pathology of MI

Answer 11

1-2hr: coronary occlusion
2-3d: necrosis
1-2wks: muscle fibers dissolve, granulation tissue
6-8wks: collagenization
scar

Question 12

STEMI treatment

Answer 12

1. oxygen
   2a. pain relief: morphine
   2b. anti-ischemia: Nitrates (unless hypotension), B-blockers
2. Antiplatelet: aspirin, Clopidogrel
3. anti-coagulation: heparin, LMWH
4. reperfusion (depending on size of infarct): Streptokinase, urokinase
5. surgery: PCI (percutaneous Coronary Intervention) or CABG (coronary artery bypass)

Question 13

Contraindications for thrombolysis in STEMI

Answer 13

internal bleeding
history of cerebrovascular accident
major trauma within 2 weeks
shock
pregnant

Question 14

Right ventricular infarction treatment emphasis

Answer 14

increase blood volume by giving saline 3-6L/24h