Coronary Artery Disease

Question 1

CAD risk equivalents

Answer 1

DM, AAA, PAD, symptomatic CAD

Question 2

Major CAD risk factors

Answer 2

Hyperlipidemia, smoking, FH (males < 55, females < 65), DM, male gender, age (males >45, females >55), HTN

Question 3

Prinzmetals angina

Answer 3

Vasospasm variant of angina
Classically affects young women in AM at rest
a/w ST elevation in the absence of cardiac enzyme elevation

Question 4

MOA of stress testing

Answer 4

Occluded vessels are already maximally dilated; when exercising or given adenosine/dipyrimadole the others arteries dilate, stealing blood away from the occluded arteries)

Question 5

Which drugs have mortality benefit in angina?

Answer 5

ASA and B-blockers

Question 6

Chronic tx of angina

Answer 6

ASA, B-blockers, nitrates

Question 7

Acute tx of angina

Answer 7

MONA:

morphine, oxygen, nitrates, asa

Question 8

Is hormone replacement therapy beneficial in post-menopausal women?

Answer 8

NO

Question 9

Definition of unstable angina

Answer 9

Chest pain that is new, occurring more often, occurring at rest, or accelerating (less exertion, lasts longer, less responsive to meds)

Question 10

NSTEMI vs STEMI

Answer 10

both have elevations of Troponin I and CK-MB, but NSTEMI has no ST elevation

Question 11

Risk stratification of NSTEMI

Answer 11

TIMI score: all are 1 point
Age > 65
> 3 CAD risk factors (fam hx, DM, smoking, HTN, hypercholesterolemia)
Known CAD
ASA use in past 7 days
Severe angina (>2 episodes in 24 hours)
ST deviation > 0.5 mm
\+ cardiac marker

> /= 3 benefit more from enoxaparin, GP IIb/IIIa inhibitors, and early angiography

Basically a TIMI score tells you whether you should cath them or not

Question 12

Acute tx of unstable angina

Answer 12

clopidogrel, unfractionated heparin, or enox

Question 13

Unstable angina: when to cath?

Answer 13

TIMI >/= 3
chest pain refractory to medical therapy
troponin elevation
ST changes > 1mm

Question 14

Reciprocal changes in STEMI

Answer 14

ST depression and dominant R waves in V1-V2 indicating a posterior wall infarct

Question 15

Ddx of chest pain

Answer 15

CAD
GERD
esophageal pain
musc disorders
pneumonia

Question 16

ST elevation in II, III, aVF

Answer 16

Inferior wall MI
Artery: RCA/PDA and LCA
Should get a right-sided ECG to look for STE in RV

Question 17

ST elevation in V1-V4

Answer 17

Anterior MI

Artery: LAD and diagonal branches

Question 18

ST elevation in I, aVL and V5-V6

Answer 18

Lateral MI

Artery: LCA

Question 19

ST depression in V1-V2

Answer 19

Could indicate an acute transmural infarct in the posterior wall
Get a V7-V9

Question 20

Thrombolytics and MIs

-when, what conditions, which drugs

Answer 20

If PCI can’t be done in 90 minutes, no c/i to thrombolysis, and pt presents within 3 hours of chest pain onset
Drugs: tPA, reteplase, streptokinase

Question 21

Long-term MI tx

Answer 21

ASA, B-blockers, clopidogrel (if PCI was performed), ACEIs, high-dose statins

Question 22

Indications for CABG

Answer 22

Unable to perform PCI 2/2 diffuse disease
Left main coronary artery disease
Triple vessel disease
Depressed ventricular function

Question 23

Timeline of post-MI complications

Answer 23

First day: heart failure
2-4 days: arrhythmia, acute pericarditis
5-10 days: LV wall rupture (causing acute pericardial tamponade: electrical alterans, PEA), papillary muscle rupture (mitral regurg)
Weeks to months: ventricular aneurysm (CHF, arrhythmia, persistent ST elevation, mitral regurg, thrombus formation), Dressler syndrome

Question 24

Mitral regurg s/p MI

Answer 24

5-10 days: 2/2 papillary muscle rupture

Weeks to months: ventricular aneurysm