Coronary Heart Disease

Question 1

What is atherosclerosis?

Answer 1

lipid deposition, calcification, plaque formation in vessels

Question 2

If you have atherosclerosis in the coronaries what do you get?

Answer 2

ischemic heart disease

Question 3

Atherosclerosis in the brain causes?

Answer 3

stroke

Question 4

Atherosclerosis in the mesentary causes?

Answer 4

mesenteric infarction

Question 5

Atherosclerosis in the lower extremities causes?

Answer 5

claudication, PVD

Question 6

What are the 7 Framingham risk factors?

Answer 6

male gender, increased age, diabetes, smoking, family hx of atherosclerosis, HTN, hyperlipidemia/hyperchloresterolemia

Question 7

What are some other diseases that are independent risk factors for atherosclerosis?

Answer 7

lupus, RA, HIV, chronic kidney disease

Question 8

What does metabolic syndrome consist of?

Answer 8

at least 3 of the following: abdominal obesity, traiglycerides over 150, HDL less than 40 in men and 50 in women, fasting glucose over 110, hypertension

Question 9

What are signs and symptoms of angina?

Answer 9

chest pain, dyspnea, nausea/vomiting, diaphoresis

Question 10

What characterizes stable angina?

Answer 10

symptoms relieved with rest or SL nitroglycerin

Question 11

What is the treatment for stable angina?

Answer 11

exercise, weight control, low fat/low cholesterol diet, nitrates/BB/CCB except nifedipine because it causes reflex tachycardia

Question 12

What classifies unstable angina?

Answer 12

new onset anginal symptoms, increased intensity of stable angina, increased frequency of angina

Question 13

What is the mechanism for acute unstable angina?

Answer 13

ruptured coronary plaque leading to bleeding, platelet aggregation and thrombus formation

Question 14

What does complete occlusion of a coronary vessel cause?

Answer 14

acute MI

Question 15

Which populations are at a higher risk for atypical presentations of MI?

Answer 15

women, elderly, diabetics–may not have pain, just dyspnea, diaphoresis, nausea, weakness, syncope, ect.

Question 16

What are the two types of post MI pericarditis?

Answer 16

post-MI pericarditis w/ friction rub (after 24 hours) and Dressler’s syndrome (autoimmune form) 1-2 months later

Question 17

What do leads V1 and V2 correlate to?

Answer 17

septal or posterior wall

Question 18

What do leads V3 and V4 correlate to?

Answer 18

anterior wall

Question 19

What do leads V5, V6, 1 and aVL correlate to?

Answer 19

lateral wall

Question 20

What do leads 2, 3, and aVF correlate to?

Answer 20

inferior wall

Question 21

What does a posterior MI look like on EKG?

Answer 21

ST depression, tall Rs and upright T in leads V1 and V2

Question 22

What should a new LBBB with concerning symptoms be treated as?

Answer 22

STEMI

Question 23

What are 3 main biomarkers that can be ordered when concerned about MI?

Answer 23

myoglobin, CPK-MB, troponin

Question 24

When do cardiac biomarkers rise?

Answer 24

only with infarction, not ischemia

Question 25

What is the gold standard test for acute coronary syndrome and occlusive disease?

Answer 25

coronary angiography

Question 26

What is the treatment for acute coronary syndrome/ MI?

Answer 26

oxygen, cardiac monitor, nitroglycerin, morphine, aspirin (chew immediately), heparin, beta blockers (oral within 24 hours)

Question 27

When can patients not get nitroglycerin?

Answer 27

when they are on viagra

Question 28

Patients with STEMI or new LBBB should be treated with what?

Answer 28

percutaneous coronary intervention (PCI-stenting or baloon angioplasty) or fibrinolytics

Question 29

When is fibrinolytics preferred over PCI?

Answer 29

when you can’t get the patient to the cath lab before 90 minutes