Coronary Artery Disease

Question 1

What is he most common underlying cause of CAD, MI, and Heart Failure?

Answer 1

Atherosclerosis

Question 2

4 top risk factors for atherosclerosis?

Answer 2

High cholesterol, HTN, diabetes, and smoking

Question 3

3 “other” risk factors for atherosclerosis?

Answer 3

Obesity, family history of heart disease, and physical inactivity

Question 4

Good definition of metabolic syndrome?

Answer 4

Cluster of conditions that, when occurring together, increase a person risk for heart disease, stroke, and diabetes

Question 5

What are the 6 conditions under the umbrella of metabolic syndrome?

Answer 5

Insulin resistant, HTN, high cholesterol, high uric acid, hyper coagulable, obese

Question 6

What is supply and demand angina?

Answer 6

Decreased oxygen delivery to the tissue leading to ischemia. Increased demand leading to ischemia

Question 7

2 mechanical consequences of ischemia?

Answer 7

Heart failure and myocardial necrosis

Question 8

3 biochemical consequences of ischemia?

Answer 8

Fatty acids can’t be oxidized, increased lactate, and metabolic acidosis.

Question 9

3 electrical consequences of ischemia?

Answer 9

T wave inversion, ST segment displacement and electrical irritation like V tach or V fib.

Question 10

What is the displacement of the ST segment for subendocardial and subepicardial ischemia?

Answer 10

Endo is depression and epi is elevation

Question 11

LAD occlusion causes what infarction and which leads do we look at for it?

Answer 11

Anterior wall infarction. V1-V7.

Question 12

RCA occlusion causes what infarction and which leads show it best?

Answer 12

Inferior wall infarction or RV infarction. 2,3,F, V3-V6.

Question 13

Circumflex artery occlusion causes which infarction and which leads see it?

Answer 13

Lateral wall infarction. 1, L, V5-6.

Question 14

Posterior descending artery causes what infarction and which leads see it?

Answer 14

Posterior wall infarction. V1-3.

Question 15

What are CV causes of chest pain?

Answer 15

IHD, Pericarditis, Myocarditis, and cardiomyopathies

Question 16

6 non cardiac symptoms of IHD?

Answer 16

Dyspnea, sweating, dizziness, syncope, fatigue and weakness.

Question 17

What is Levine’s sign?

Answer 17

Clinched fist over chest to describe their angina

Question 18

On physical exam, or just looking at the patient, what are signs that they have risk factors for IHD?

Answer 18

Xanthelasma, xanthomas, diabetic skin lesions, nicotine stains, pale, and absent peripheral pulses.

Question 19

What 5 things can mimic angina in the absence of CAD?

Answer 19

AS, AI, Pulmonary HTN, hypertrophic cardiomyopathy, and HF

Question 20

What is acute coronary syndrome?

Answer 20

Unstable angina and non st elevation myocardial infarction because a plaque ruptured or erosion.

Question 21

What do we mean when we say unstable angina?

Answer 21

New or worsening chest pain lasting over 20 minutes and it’s just there now. Nothing needs to provoke it.

Question 22

3 things going on with NSTEMI?

Answer 22

Chest pain, elevated cardiac enzymes, and no st elevation

Question 23

What is so bad about the plaque rupture, how does it lead to ischemia?

Answer 23

The fibrous cap is broken through and everything underneath is thrombogenic. Platelets aggregate and lead to thrombus and occlusion of the artery.

Question 24

What’s going on with cardiac enzymes in unstable angina?

Answer 24

Normal

Question 25

In stable angina, what is the most common st displacement?

Answer 25

Depression, so subendocardial injury/ischemia

Question 26

What are the 5 differential diagnosis for NSTE ACS?

Answer 26

PE, aortic dissection, VHD, myocarditis/pericarditis, stress cardiomyopathy

Question 27

How quickly can we detect Troponin I levels and CKMB levels in NSTEMI?

Answer 27

TI detected within 2-4 hours

CKMB detected within 3-6 hours