Coronary Artery Disease

Question 1

Number 1 killer in world

Answer 1

CAD

Question 2

What causes CAD to occur

Answer 2

Abnormal lipid metabolism, too much cholesterol and saturated fats intake, and genetics play a role

Question 3

What risk factors are associated with CAD

Answer 3

Hypertension, hyperlipidemia, diabetes, tobacco abuse, and family history

Question 4

Low risk of CAD

Answer 4

Atypical chest pain, minimal or no risk factors, young

Question 5

Intermediate risk of CAD

Answer 5

AGE (more than 70), GENDER (male), DIABETES hx, PVD/CVA-peripheral vascular disease and cerebrovascular accident or stroke hx, PREVIOUS EKG changes

Question 6

High risk of CAD

Answer 6

Ischemic discomfort, hx of CAD, hx of CHF, new EKG changes, elevated biomarkers

Question 7

Tests/Labs to for diagnosis

Answer 7

EKG, cardiac enzymes, lipid panel, screen for diabetes, (BP history)

Question 8

Stress testing in CAD

Answer 8

Graded exercise stress testing, pharmological stress testing, imaging with echocardiography or nuclear imaging

Question 9

EKG changes in CAD

Answer 9

ST depression, transient ST elevation, and T wave inversion

Question 10

BIomarkers released from necrotic cardiac tissue

Answer 10

myoglobin released in 2-4 hours, CK-MB released 4-8 hours, Troponin I and T released 6-12 hours

Question 11

How long do the cardiac biomarkers stay elevated (released from necrotic tissue)

Answer 11

Myoglobin for 1 day, CK-MB for 2-3 days, and Troponin for 7-10 days

Question 12

PE in someone with large area of myocardium in jeapordy

Answer 12

Hypotension, tachycardia, third and fourth heart sound, and rales

Question 13

Tx of UA/Unstable Angina

Answer 13

Anti-Ischemic medical therapy, anti-thrombotic medical therapy, revascularization therapy, other meds- high dose statin (lipitor)

Question 14

Anti-Ischemic therapy meds

Answer 14

Nitroglycerin, BB, Morphine sulfate

Question 15

Function of nitroglycerin

Answer 15

Vasodilator- increases blood flow, reduces afterload (so less resistance)

Question 16

How is nitroglycerin taken?

Answer 16

Sublingual, topical nitro, or IV nitro

Question 17

How do beta blockers work?

Answer 17

Block adrenergic receptors to decrease HR and contractility- this decreases oxygen demand and decreases ventricular irritability

Question 18

Example of beta blocker and dose

Answer 18

Lopressor

Question 19

Heart rate goal on beta blocker

Answer 19

50-60/min

Question 20

function of morphine sulfate in CAD

Answer 20

analgesic, some vasodilation

Question 21

Dose of morphine sulfate

Answer 21

2-5 mg IV every 5-30 min for comfort

Question 22

Anti-thrombotic therapy meds

Answer 22

ASA, ADP receptor antagonist (Plavix), GpIIb/IIIa receptor inhibitor (Effient, Integrellin), LMW Heparin (Lovenox), Unfractionated Heparin

Question 23

Plavix dosing

Answer 23

600 mg initial dose, then 75 mg every day

Question 24

If coronary artery bypass grafting likely, what should you be careful with (drug)

Answer 24

Plavix

Question 25

Lovenox dose

Answer 25

LMW heparin binds to antithrombin III - inhibits thrombin and Factor X. 1 mg/kg SC every 12 hours

Question 26

UFH dosing

Answer 26

5000 IU IV, then 1000 U/hour

Question 27

PTT in UFH

Answer 27

1.5-2.5 times the control

Question 28

Integrellin dose

Answer 28

180 ug/kg bolus, then 2.0 ug/kg/hr for 3-4 days

Question 29

Lipitor - what is it and dosing

Answer 29

High dose statin for plaque stabilization and anti inflammation- 80 mg PO every day

Question 30

When to initiate angiogram for revascularization

Answer 30

Angiogram within 2 days if NSTEMI or abnormal stress test

Question 31

Percutaneous intervention with revascularization

Answer 31

Angioplasty and stent placement (bare metal or drug-eluting)

Question 32

long term management of CAD

Answer 32

ASA, plavis for 9-12 months, Beta blocker, Ace-Inhibitor, Statin, Cardiac rehab

Question 33

Lifestyle changes for secondary prevention

Answer 33

Tobacco cessation, weight control, exercise, BP control, glycemic control, lipid control