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Cardiology: Exam > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

1
Q

What is the leading cause of death for both men and women?

A

Coronary Artery Disease

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2
Q

How many people have Coronary Artery Disease in the United States?

A

17 million

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3
Q

What is the cost of caring for patients with Coronary Artery Disease per year?

A

$150 billion

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4
Q

What are the two majors roles for endothelia cells lining the coronary arteries?

A

Regulate Vascular Tone
Prevent Intravascular Thrombosis

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5
Q

What is the order of Atherosclerotic Plaque Formation?

A
  1. Disruption of Endothelial Cell Integrity
  2. Macrophages coalesce to form fatty streak
  3. Fibrous Cap
  4. Fibrous Cap Rupture
  5. Thrombus Formation
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6
Q

When do most Acute Coronary Syndromes occur?

A

When the Fibrous Cap Ruptures

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7
Q

What determines a plaques vulnerability to rupture?

A

Plaque Characteristics
(not size)

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8
Q

Reproducible angina symptoms such as chest pain or pressure that are precipitated by exertion or emotional stress and relieved by rest or nitroglycerin.

A

Stable Angina

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9
Q

What is the fundamental problem in Stable Angina?

A

Imbalance between myocardial oxygen supply and demand.

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10
Q

What are the strongest risk factors for developing Coronary Artery Disease

A

65+
Male
Postmenopausal Females
Hyperlipidemia
Smoking
Diabetes
Obesity
Family History

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11
Q

Why are the two independent risk factors for Coronary Artery Disease?

A

65+
Diabetes

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12
Q

Chest pain that typically occurs during physical exertion and gradually resolves with exercise cessation.

A

Stable Angina

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13
Q

What symptoms can occur that increase oxygen demand and can cause Angina?

A

Anemia
Fever
Sepsis
Thyrotoxicosis

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14
Q

What patients may present with atypical symptoms of Coronary Artery Disease?

A

Women
Diabetics
Elderly

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15
Q

Can patients with stable angina still have normal EKGs?

A

Yes
(50% do)

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16
Q

What does a pathologic Q Wave represent?

A

Old MI

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17
Q

What three findings on a EKG increase the likelihood of having Coronary Artery Disease?

A

Pathologic Q
LBBB
L. Anterior Fascicular Block

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18
Q

Stress tests are most useful for diagnosing Coronary Artery Disease in what types of patients?

A

Intermediate Pretest Probability

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19
Q

What are the two types of Stress Tests?

A

Exercise
Pharmacologic

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20
Q

What medications are used during a pharmacologic stress test?

A

Dobutamine
Adenosine Agonist

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21
Q

What are the two options for Imaging?

A

Nuclear Isotope
Echocardiography

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22
Q

What nuclear isotopes are used for Nuclear Imaging?

A

Thallium-201
Technetium-99m

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23
Q

A noninvasive and quantitate assessment of coronary artery calcification?

A

Calcium Score Screen CT

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24
Q

What is a higher Coronary Artery Calcium Score associated with?

A

MI + Death

25
Q

Can a Calcium Score Screening CT detect hard or soft plaques?

A

Hard Plaques

26
Q

What is the most accurate noninvasive modality in ruling out Coronary Artery Disease with a very high negative predictive value? (Screening)

A

Coronary CT Angiography

27
Q

What does a Coronary CT Angiography allow for?

A

Direct Coronary Artery visualization of a beating heart with little motion artifact.

28
Q

What is considered the Gold Standard for Diagnosing CAD?

A

Cardiac Angiography

29
Q

What is the First-Line Therapy for Stable Angina? (Anti-Anginal)

A

Beta Blockers
Nitrates

30
Q

What is the Second-Line Therapy for Stable Angina? (Anti-Anginal)

A

Calcium Channel Blockers

31
Q

What are the medications to treat Stable Angina? (Anti-Thrombosis)

A

Aspirin
Clopidogrel

32
Q

How is hypertension in Chronic CAD?

A

Beta Blockers (unti HR = 55 - 60)
Calcium Channel Blockers
ACE-I

33
Q

What is the goal BP in the treatment of hypertension of a patient with Chronic CAD?

A

< 130/80

34
Q

What is the major indication for revascularization in chronic CAD?

A

Relief of Angina in patients on optimal medical management

35
Q

Does revascularization reduce the risk of death or myocardial infarction?

A

No

36
Q

What are the two components of Revascularization?

A
  1. Percutaneous Transluminal Coronary Angioplasty (Balloon)
  2. Stent Deployment
37
Q

What is recommended for patients with extensive CAD in the LCA or 3 vessels?

A

CABG
(Coronary Artery Bypass Grafting)

38
Q

What pathologies fall under:
Acute Coronary Syndrome

A

Unstable Angina
NSTEMI
STEMI

39
Q
  • Angina at Rest
  • New onset exertional angina
  • Preexisting angina that has increased in frequency or duration or that is now brought on with less exertion than before
  • Post MI angina
A

Unstable Angina

40
Q

Similar to Unstable Angina but has evidence of myocardial necrosis as seen with elevated Troponin.

A

NSTEMI

41
Q

ST-Segment + Elevated Cardiac Enzymes

A

STEMI

42
Q

How much of the vessel is occluded with a STEMI?

A

100%

43
Q

Criteria for STEMI on EKG

A

Greater than 1mm Limb Leads
(2 or more contiguous)

Rather than 2mm Precordial Leads
(2 or more contiguous)

44
Q

What type of clots are seen with STEMI?

A

Red Clot
(Red is Dead)

45
Q

When does Acute Coronary Syndrome occur?

A
  1. Vulnerable Plaque Ruptures
  2. Platelet activation + aggregation
  3. Intracoronary Thrombus Forms
46
Q

What test has the highest sensitivity and specificity for detecting Myocardial Infarction?

A

Troponin T and I
(measurable within 4 hours)

47
Q

One of the earliest enzymes released during a MI (2 - 3 hours)

A

Myoglobin

48
Q

Cardiac enzyme first measurable in the bloodstream at 6 - 10 hours and peaks at 24 hours.

A

Creatine Phosphokinase Myocardial Band (CPK-MB)

49
Q

Findings of abrupt, severe, and tearing chest pain that radiates to the back or abdomen. Unequal pulses and BP in the upper extremities.

A

Aortic Dissection

50
Q

Findings include chest pain that may be pleuritic or is relieved by sitting up. Pericardial friction rub may be present.

A

Acute Pericarditis

51
Q

Sudden onset chest pain and dyspnea.

S Wave in Lead I
Q Wave in Lead III
T Wave Inversion Lead III

S1Q3T3

A

Pulmonary Embolism

52
Q

What are the Anti-Anginal medications given during:
Unstable Angina + NSTEMI

A

Nitrates
Beta Blockers
Morphine

53
Q

What are the Anti-Clot medications given during:
Unstable Angina + NSTEMI

A

Anti-Platelets
Anti-Coagulants
Statins
ACE-I or ARB if EF < 40%
PCI

54
Q

Do you give Thrombolytics for:
Unstable Angina + NSTEMI?

A

NO!

55
Q

Anti-Anginal meds for STEMI

A

Nitrates
Beta-Blockers
Morphine

56
Q

Anti-Clot meds for STEMI

A

Anti-Platelets + Anti-Coagulants
Statins
ACE-I or ARBs if EF < 40%

Thrombolytics or Revascularization

57
Q

What is the preferred method of treating STEMI

A

PCI
Goal = within 90 minutes
Within 2 hours at the most

58
Q

When should Thrombolytic Therapy be given for STEMI?

A

Within first 6 hours
Can be given up to 12 hours after onset

59
Q

Absolute contraindications of Thrombolytics for STEMI

A
  • History of Intracranial Bleeds
  • Cerebral Vascular Lesion
  • Intracranial Malignancy
  • Ischemic Stroke within 3 months
  • Closed head or facial trauma in 3 months
  • Aortic Dissection
  • Active bleeding

Cardiology: Exam (5 decks)

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