Coronary Artery Disease Flashcards

1
Q

Non-classic sx of CAD

A
  • Dyspnea
  • Dizziness
  • Syncope
  • Pulmonary edema
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2
Q

Pathophysiology of Coronary artery disease

A
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3
Q

Gold standard dx test for CAD

A

Coronary angioraphy

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4
Q
  • 75% reduction in coronary artery cross-sectional area results in _
  • 90% reductino in coronary artery cross-sectional area resutls in _
A
  • 50% loss of arterial diamter (anginia with activity)
  • 75-80% doss of diamter (angina with rest)
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5
Q

Presenting clinical scenarios for CAD

A
  • Chronic, stable angina
  • Acute coronary syndrome (ACS)
    • ST elevation MI (STEMI)
      • myocardial necrosis with elevated biomarks and ST changes on EKG
    • Non-ST elevatin MI (NSTEMI)
      • myocardial necrosis with elevated biomarkers without ST changes on EKG
    • Unstable angina
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6
Q

Etiology of STEMI

A

Rupture of atherosclerotic plauqe with acute mural thrombus formation and coronary artery obstruction

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7
Q

Etiology of NSTEMI

A
  • Atherosclerotic plaque rupture and thrombosis (MC)
  • Coronary spasm (Prinzmetal’s angina)
  • Progressive coronary obstruction
  • Increased oxygen demand (demand ischemia, tachycardia)
  • Decreased oxygen supply (anemia)
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8
Q
A
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9
Q

3 primary mechanisms through which CAD results in LV dysfunction

A
  1. MI (irreversible) with loss of myocardium
  2. Hybernating myocardium
    1. Myocardial dysfunction at rest due to CAD that partially resolves after revascularization
  3. Stunned myocardium
    1. Transient myocardial dysfunction after reperfusion
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10
Q

AHA/ACC Guidelines for Medical Management of CAD

A
  • Smoking cessation
  • Hypertension (goal < 140/90, or < 130/80 if DM or CKD)
  • Hypercholesterolemia (goal LDL < 100; if TG > 200, then non-HDL < 130)
  • Obesity (BMI 18.5-24.9)
  • DM (goal HgbA1c < 7%)
  • Anticoagulation
    • ASA 81 mg (all patients)
    • ASA 81 + Plavix 75 (ACS or PCI)
  • ACE-I (EF < 40%)
    • ARB if intolerant to ACE-I
  • Beta-blocker (all pts with MI, ACS, LV dysfunction)
  • Aldosterone inhibitor (large MI in patient with low EF, no renal dysfunction)
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11
Q

Summary of SYNTAX Trial

A

NEJM (2009)

  • PCI vs. CABG
  • Non-inferiority (LM or 3v CAD)
  • Primary results:
    • Composite adverse events + cerebrovasc events higher in PCI vs. CABG
      • Primarily driven by higher repeat revascularization in PCI
    • Simlar MI and death rates
    • Stroke rates higher in CABG
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12
Q

General repeat revascularizaton rates for PCI and CABG

A
  • PCI (30% at 1 year and 55% at 5 years)
  • CABG (3-15%)
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13
Q

AHA/ACC Guidelines for CABG

A
  • LM disease (>50% stenosis)
  • LM equivalent diease (pLAD >70% + pCx stenosis)
  • 3v CAD (especially if EF < 50%)
  • 2v CAD with EF < 50%
  • pLAD + 1-2v CAD
  • Disabling angina refractory to medical managment
  • Failed PCI
  • Anatomy not suitable for PCI
    • Total occlusion
    • Circumferential calcification
    • Bifurcation involvment
    • Diffuse or distal lesions
  • Concomitant cardiac lesions requiring surgery
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14
Q

Tx STEMI

A

Non-surgical, usually medical, unless ongoing ischemia or cardiogenic shock despite maximal medical therapy

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15
Q

Hemodynamic instability during OPCAB often due to:

A
  • RV compression (exposure of lateral LV wall)
  • Diastolic dysfunction from excessive downward pressure from coronary stabilizer
  • Intraoperative ischemia from native CAD or coronary snaring
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16
Q

Results of OPCAB versus On pump-CAB

A
  • Surgical outcomes similar
  • OPCAB:
    • Less blood loss and tranfusions
    • Less myocardial enzyme release in 24 hrs
    • Less neurocognitive dysfunction
    • Less renal insufficiency
  • On-pump CABG
    • Higher number of total bypass grafts (more complete revascularization)
    • Easier grafts to posterior (Cx) targets
    • ? better long-term graft patency
17
Q

What are the diagnostic features of an acute ST elevation myocardial infarction (STEMI)?

A

a) ST elevation (>0.1mV except >0.2mV in V1-3 at the J point in two or more contiguous leads) with peaked T wave;
b) pathological Q waves >0.04sec or >25% of total QRS complex;
c) ischaemic type chest pain lasting >20 minutes.

18
Q
A