coronary artery disease

Question 1

generally speaking what is CAD ?

Answer 1

condition where there is narrowing or blockage of the coronary artery

Question 2

what is the principle cause of CAD ?

Answer 2

atherosclerosis

Question 3

what is the pathogenesiiss behind atheerosclerotic heart diisease ?

Answer 3

plaque buildup in coronary arteries
progressive narrowing which leads to ischemia
the narrowing eventually leads to blockage and infarction

Question 4

what are the modifiable risk factors of CAD ?

Answer 4

smoking and tobacco use
diabetes
hypertension
physical inactivity
obesity
dyslipidemia

Question 5

what are the 2 main coronary arteries ?

Answer 5

the left coronary giving the circumflex and the left anterior descending
the right coronary artery gives the marginal branch

Question 6

what areas are supplied by the right coronary artery ?

Answer 6

right atrium and hence the SA node
right ventricle
interventricular septum and hence the AV node

Question 7

what does the marginal branch off the RCA supply ?

Answer 7

the apex of the heart

Question 8

what does the LCA supply ?

Answer 8

left atrium
left ventricle
interventricular septum and hence the AV bundle

Question 9

what does the left circumflex artery supply ?

Answer 9

Supplies the left atrium and the posterolateral surface of the left ventricle

Question 10

when does myocardial ischemia happen ?

Answer 10

when there is an imbalance between the supply of oxygen and the myocardial demands

Question 11

what are the two main broad reasons for thee causes of IHD ?

Answer 11

increased demand of oxygen
decreased blood supply ( decrease in quality of quantity )

Question 12

what is angina ?

Answer 12

transient clinical syndrome due to transient myocardial ischemia , characterized by chest pain with no cardiac tissue damage

Question 13

what is the clinical presentation/ spectrum of prressentation of IHD ?

Answer 13

asymptomatic
angina
MI
HF
arrhythmia
sudden death

Question 14

what are the three types of acute coronary syndrome ?

Answer 14

unstable angina
STEMI ( full thickness )
non STEMI ( non full thickness I )

Question 15

what is the pathophysiology behind unstable angina?

Answer 15

rupture of an atheroscclerotic plaque and the subsequent formation of a thrombus

Question 16

what are the criteria that need to be fulfilled for unstable angina ?

Answer 16

1- onset (<6 weeks) angina at exertion or at rest.
2-Angina at rest in previously exercise-induced angina.
3- Exertional angina that is not responding to increasing anti-anginal medications.

Question 17

what is stable angina ?

Answer 17

occurs when coronary perfusion is impaired by fixed stable atheroma of the coronary arteries
no symptoms at rest
no ecg changes at rest
provoked by exercise

Question 18

what is variant angina ?

Answer 18

also known as prinzmetal angina
angina with normal coronary arteries

Question 19

what are the clinical features of stable angina?

Answer 19

chest pain , increased by exertion
decreased by rest or nitrates

Question 20

what are the clinical features of variant angina ?

Answer 20

happens usually at rest
often between midnight and early morning
in association with ST segment elevation

Question 21

what is the first line investigation in CAD ?

Answer 21

CT coronary angiography

Question 22

what is the 2nd line investigation for CAD ?

Answer 22

myocardial perfusion scan ( Iv thallium )
stress echocardiography

Question 23

what is the 3rd line investigation for CAD ?

Answer 23

invasive coronary angiography

Question 24

what are the lab investigations for CAD ?

Answer 24

• CBC, U&E, Creatinine, ESR
• Cardiac enzymes (high sensitive troponin)
• Lipid profile
• Blood sugar

Question 25

what are the ECG changes that indicate ischemia ?

Answer 25

pathological q wave inverted t wave st elevation

Question 26

what does echocardiography show us ?

Answer 26

any ventricular abnormalities evidence of structural abnormality

Question 27

what are the indications for Percutaneous coronary angiography

Answer 27

diagnostic : assessment of coronary vessels therapeutic : angioplasty stent insertion

Question 28

what is the coronary calcium score ?

Answer 28

low coronary calcium score makes the presence of CAD unlikely high coronary calcium score makes CAD likely all within the next 2-5 years a low score is 0 a high score is above 100

Question 29

what are the side effect of nitrates ?

Answer 29

flushing headaches hypotension

Question 30

what must be taken into consideration when using nitrates ?

Answer 30

sildenafil ( viagra ) should not be used at the same time

Question 31

how do beta blockers work for CAD patients ?

Answer 31

reducing heart rate reducing BP reducing myocardial contractility

Question 32

what is b blocker withdrawal syndrome ?

Answer 32

they should not be withdrawn abruptly as rebound effects may worsen condition

Question 33

what is the mechanism of actionn of nitratess ?

Answer 33

1- act direectly on vascular smooth muscles andd cause vasodilatation 2- reduce myocardiall oxygen demand by lowerring preload and afterload

Question 33

common side effects of beta blockers ?

Answer 33

bradycardia hypotension bronchoconstriction cold extremities impotence

Question 33

what are the indications for nitrates ?

Answer 33

angina

Question 34

what are the indications for the use of calcium channel blockers ?

Answer 34

hypertension ( amlodipine) angina supraventricular tachycardia ( verapamil )

Question 35

what are the side effectss of ACE and ARBs ?

Answer 35

dry cough postural hypotension hyperkalemia nausea renal impairment

Question 36

what drug does not exhibit the tolerance seen with nitrates ?

Answer 36

nicorandil ( potassium channel activators )

Question 37

what is the management for angina ?

Answer 37

1- confirm that the patient is cardiac 2- determine if its stable or unstable angina

Question 38

what are the results of cardiac enzymes / troponin ?

Answer 38

unstable angina - negative NSTEMI - positive STEMI - positive

Question 39

what are the ECG changes for each of the presentation of ACS ?

Answer 39

unstable angina - ST depression NSTEMI - ST depression STEMI - ST elevation or new LBBB

Question 40

what are the types of MI ?

Answer 40

STEMI ( trans-mural) NSTEMI ( sub-endocardial)

Question 41

what are the sites of MI in STEMI ?

Answer 41

anterior wall infarction : in anterior descending branch lateral wall : left circumflex artery inferior wall : right coronary artery

Question 42

what are the complications of cardiac tamponade ?

Answer 42

pulmonary edema shock death

Question 43

what are the late complications of myocardial infarction ?

Answer 43

myocardial aneurysm and remodelling pericarditis

Question 44

what is seen on examination of a patient with pericarditis ?

Answer 44

friction rub

Question 45

what is the first line therapy for reperfusion ?

Answer 45

Primary Percutaneous Coronary Intervention and give fibrinolysis before PCI

Question 46

what is the best next step in management if PPCI is unavailable for reperfusion therapy ?

Answer 46

thrombolysis

Question 47

what are the contraindications to thrombolysis use ?

Answer 47

previous history of stroke suspected aortic dissection intracranial neoplasm

Question 48

what drugs aree commonly used post MI ?

Answer 48

antiplatelet ACE inhibitors ARB beta blockers statins

Question 49

what is the most common complication following pericardiocentesis procedure ?

Answer 49

pneumothorax so an Xray must be performed

Question 50

what are the two types of CCBb ?

Answer 50

DHP - for hypertension non DHP - morre cardio-selective

Question 51

what are the contraindications too CCB ?

Answer 51

heart failure ( except amlodipine ) concurrent beta blocker usage severe hypotension