Coronary artery disease, Carotid artery stenosis, Intestinal ischemia

Question 1

what is stable angina vs unstable angina

Answer 1

• stable = typical, predictable chest pain occuring during exercise that releives with rest or NTG
• unstable = unexpected, caused by sudded slowed or narrowed bloodvessels, does NOT go away w rest/NTG

Question 2

what causes prinzmetal angina

Answer 2

vasospasms

Question 3

what is the tx for prinzmetal angina

Answer 3

CCB and NTG

mimics STEMI on EKG and MC in middle aged women

Question 4

what EKG changes would you see in the following timespans after an MI
* minutes/hours
* 1-2 days
* 7-10 days
* months

Answer 4

• minutes/hours - ST elevation
• 1-2 days - ST elevation, inverted T wave, Q wave
• 7-10 days - ST flattening, Q wave
• months - persistent Q wave

Question 5

which cardiac biomarker would you use to identify a repeat MI in a patient who just suffered an MI 2 days ago

Answer 5

myoglobin (returns to normal after 36ish hours)

Question 6

after undergoing a PCI what medications should be initiated

Answer 6

ASA + clopidegrol

Question 7

what is the diagnostic study of choice for carotid artery stenosis

Answer 7

CT angiography (carotid angiography)

Question 8

what is the treatment for carotid artery stenosis

Answer 8

revascularization via stenting or endarterectomy

mostly for patients >50% stenosis and symptomatic

Question 9

what is ischemic colitis

Answer 9

Reduction in blood flow to a level insufficient for delivery of oxygen and nutrients for cellular metabolism

Question 10

what are the 3 major arteries supplying blood to the intestines

Answer 10

Superior mesenteric artery
Inferior mesenteric artery
Internal Iliac arteries

Question 11

what surgeries commonly have ischemic colitis as a complication

Answer 11

• AAA repair
• CABG
• other MI revascularization surgeries

Question 12

what is the presentation of ischemic colitis

Answer 12

• abdominal pain out of proprotion to exam

Question 13

what is the diagnostic imaging for ischemic colitis

what will it show

Answer 13

• CT abdomen with contrast
• “Target,” “thumbprinting”, or “double halo” sign on CT: hyperdensity of mucosa and muscularis of bowel wall

Question 14

what is the treatment for ischemic colitis

Answer 14

• NPO
• Fluids
• observation
• cipro+metro or pip/taz alone

Question 15

what are indications for surgery in ischemic colitis

Answer 15

Ongoing pain
Persistent fever
Leukocytosis
Peritoneal irritation
GI bleeding causing hemodynamic instability

involves surgical resection of ischemic segment