Coronary Artery Disease

Question 1

Define CAD

Answer 1

Ischemic heart disease caused by narrowing or blockage of the coronary arteries

Question 2

Blockage of coronary arteries is most commonly caused due to?
Which results in?

Answer 2

Atherosclerosis
Results in mismatch between myocardial oxygen supply and demand

Question 3

Pathophysiology of CAD? (What two things occur that can cause it)

Answer 3

Myocardial oxygen supply-demand mismatch
Coronary steal syndrome

Question 4

What factors reduce O2 supply?

Answer 4

Coronary atherosclerosis, vasospasms, increased heart rate, and anemia

Question 5

What factors increase O2 demand?

Answer 5

Increased HR, increased after load, and anemia

Question 6

What is coronary steal syndrome?
- Results in?

Answer 6

Phenomenon of vasodilator induced alteration of coronary blood flow in those with atherosclerosis

- Results in myocardial ischemia and symptoms of angina

Question 7

Clinical features of CAD?

Answer 7

Angina

Question 8

What diagnostics are done to check for CAD?

Answer 8

Coronary CT angiography in pts <65 yrs or Cardiac Stress Test in pt 65 or older and 12 lead

Question 9

Diagnostics of CAD:

Resting ECG will show?

Answer 9

ST depression, inverted T wave, or wellens pattern

Question 10

How is wellens pattern characterized?
What is seen on the ECG?

Answer 10

Characterized by unstable angina

Deeply inverted or biphasic T waves in leads V2-V3 in the absence of significant ST elevation

Question 11

Diagnostics of CAD:
What is an uninterpretable ECG?

Answer 11

One that doesn’t allow identification of stress induced ischemic changes typically due to pre existing conditions

Question 12

What conditions can cause an uninterpretable ECG for CAD?

Answer 12

Resting ST depression (>.1 mm)
Complete LBBB
Digoxin
Pre-excitation (WPW)
V-Paced rhythms
LVH

Question 13

What are some non-invasive diagnostics ran to determine CAD?

Answer 13

Provocative and non provocative

Question 14

Provocative stress test consists of?

Answer 14

Exercise stress test and pharmacological stress test with dobutamine under ECG monitoring

Question 15

Non-provocative cardiac stress test for CAD consists of?

Answer 15

Cardiac anatomic testing

Question 16

What invasive test can be done to determine CAD?

Answer 16

Coronary angiography

Question 17

If a patient is unable to exercise, what test can be ran instead?

Answer 17

Pharmacological stress test with vasodilator or inotropic medication

Question 18

Treatment for all patients with CAD consists of?

Answer 18

Secondary prevention. With anti platelet agents, statins and management of underlying issues

Question 19

Treatment for patients with unstable CAD?

Answer 19

Percutaneous Coronary Intervention (PCI) or Coronary artery bypass grafting

Question 20

Antianginal medication treatment consists of two lines of agents for treatment of CAD, what are they?

Answer 20

First line: Beta Blockers
Second line: CCB’s, Nitrates, and Ranolazine

Question 21

What’s the goal of anti anginal drugs in regards to CAD?

Answer 21

Management of myocardial oxygen demand

Question 22

What’s the action of Ranolazine?

Answer 22

Decreases intercellular calcium levels without affecting HR, contractility, or blood pressure.

Question 23

Adverse affects of Ranolazine?

Answer 23

Arrhythmias and QT prolongation

Question 24

When would you consider using Ranolazine?

Answer 24

If beta blockers, CCB’s, and nitrates are ineffective or not tolerated