Coronary Artery Disease Flashcards
Module 3
What are symptoms of carotid stenosis?
Focal neurological dysfunction, including TIA, ischemic stroke, etc.
The vast majority of strokes (80-90%) are
Ischemic
The risk of ischemic stroke is highest among individuals with CAS greater than
80%
Ischemic stroke involves neurological deficits that persist longer than
24 hours; if <24 hours - TIA
What is the 1st line diagnostic for CAD?
Duplex ultrasound
What is the most accurate diagnostic test for CAD?
Catheter-based angiography
What are 2 diagnostic tests that could be used in adjunct to US?
MRA and CTA
What labs should be ordered when suspecting CAD?
CBC (H/H), BMP or CMP (magnesium), lipid panel, coagulation studies, TSH, CRP, BNP
Name 5 differential diagnoses for CAD
Carotid artery dissection, valvular heart disease (especially aortic valve stenosis), intracranial arterial stenosis, lacunar stroke, fibromuscular dysplasia
All patients who present with amaurosis fugax, TIA, or stroke symptoms should undergo which diagnostic test?
Non-invasive imaging
Non-invasive imaging is indicated for patients who present with amaurosis fugax, TIA, or stroke.. but also for patients who present with
Carotid bruit, or other non-specific symptoms such as dizziness
What medical management is used in CAD?
Aspirin, statins, and management of HTN
Medical management of CAD can be combined with
Carotid revascularization (carotid endarterectomy, CEA), carotid angioplasty, or stenting
What is the primary cause of death for both men and women in the U.S.?
CHD
Microvascular angina is also known as
Syndrome X
What should be considered a working diagnosis while evaluating patients for treatable underlying causes of CAD?
Suspected myocardial infarction with non-obstructed coronary arteries (MINOCA)
What diagnostic tests can be used to evaluate patients for underlying causes of CAD?
MRI, provocative testing, and evaluation for thrombophilia
Rather than actual chest pressure, myocardial ischemia can also be experienced as
Dyspnea, indigestion, nausea, numbness in the upper extremities, and fatigue
Microvascular angina is chest pain that is often
Unpredictable and occurring with rest, routine physical activity, or stressful events
Vasospastic angina can be present with a history of
Spontaneous or unprovoked episodes of typical angina
What 4 things are considered in unstable angina and non-STEMI?
Nature of symptoms, prior history of CAD, age >65, and number of risk factors present for CAD
Consider the timeline of serial cardiac troponin levels
Rises 3-12 hours post injury, peaks at 3-4 hours, and normalizes after 14 days
What are 2 differential diagnoses for CAD that cover integumentary and chest wall discomfort?
Herpes zoster and costochondritis
What are differential diagnoses of CAD that cover pulmonary?
Pneumonia, pneumothorax, pulmonary embolus, pulmonary hypertension
What are differential diagnoses of CAD that cover cardiac?
Aortic stenosis, aortic dissection, mitral valve prolapse, pericarditis, Takotsubo cardiomyopathy
What are differential diagnoses of CAD that cover GI?
Reflux, acute cholecystitis
What medications are used in the management of CAD?
Aspirin, BBs, nitrates, CCBs, ACEIs, and anticoagulants
What medications are used for lipid management in CAD?
Statins and PCSK9 inhibitors
Which gender presents more often with GI symptoms than classic chest pain in CAD?
Women
Which patients should be referred to cardiology for management of CAD?
Patients with comorbidities
When are angina symptoms often present?
Days to weeks before the onset of an acute MI
If BBs are contraindicated for symptom relief of chronic, stable angina, what is another option?
CCBs
ACEIs or ARBs should be used for patients with
<40% LVEF and those with DM, HTN, or CKD
