Coronary artery disease

Question 0

Explain the pathophysiology of lesions

Answer 0

Fatty streak – early – lipid filled smooth muscle
Fibrous plaque – progressing – collagen covers the fatty streak
Complicated lesions – final stage – plaque grows, inflammation, ulceration, rupture

Question 1

Name CAD risk factors that explain 50 to 66% of cardiac events

Answer 1

Family history, diabetes, elevated LDL, low HDL, tobacco use, hypertension, Obesity/physical inactivity

Question 2

Manifestation of CAD includes angina pectoris, acute myocardial infarction, sudden-death. Explain the signs and symptoms of men versus women

Answer 2

Men
Classic chest pain, substernal pain with exertion or emotion, relieved by rest or nitroglycerin, ST elevation is common, larger vessels

Women
Pain is generalized, ST elevation far less likely, increased risk of bleeding, higher re-current infarction and mortality rate, more likely to delay seeking treatment

Question 3

What is the PQRST assessment of angina

Answer 3

P – precipitating events
Q – quality of pain
R – radiation of pain
S – severity of pain
T – timing

Question 4

The goal in managing ACS is to reduce the amount of myocardial necrosis and treat acute life-threatening complications. How is ACS managed

Answer 4

Nitrates
Pain – morphine
Fibrinolytic therapy
Anticoagulation therapy
Antidysrhythmic therapy
Early invasive strategies

Question 5

In an acute MI

Sustained ischemia > __________ Minutes leads to irreversible necrosis of cardiac cells.
A partial muscle thickness necrosis is also called __________.
A full muscle thickness necrosis is also called __________.

Answer 5

20 to 30 minutes

Subendocardial

Transmural

Question 6

Treatment of an AMI

Answer 6

M – marketing – 2 to 8 mg every 5 to 15 minutes
O – oxygen
N - nitroglycerin
A – antiplatelet therapy

ACE or ARB

Question 7

Diagnostic studies for an AMI

Answer 7

Serum cardiac markers
ECG
Coronary angiography
Patient history
Chest x-ray
Thallium scan
Technetium pyrophosphate scan

Question 8

Emergent therapy for an AMI

Answer 8

PCI – percutaneous coronary intervention, stent or angioplasty
Reperfusion therapy – fibrinolytic therapy – within 90 minutes

Question 9

The purpose of left heart catheterization is to access the _________ __________ __________.
The purpose of right heart catheterization is for __________ __________.
Hey left ventriculogram shows _________ _________ __________ __________.
A PTCA is _________ _________ _________ ________.

Answer 9

Coronary artery system
Hemodynamic monitoring
Left ventricular wall motion
Percutaneous transluminal coronary angioplasty

Question 10

Core measure for the treatment of the AMI

Answer 10

Aspirin at arrival and prescribed a discharge
Ace inhibitor for LVSD
Start smoking cessation advice/counseling
Beta blockers at arrival and prescribed at discharge
Nitrates
Thrombolysis within 30 minutes of arrival
PTCA within 90 minutes of arrival
Inpatient mortality

Question 11

Clinical manifestations of AMI

Answer 11

Pain
Nausea and vomiting
Sympathetic nervous system stimulation
Fever
Cardiovascular effects