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General Medicine I > E1 : Coronary Artery Disease > Flashcards

E1 : Coronary Artery Disease Flashcards

1
Q

best initial treatment of chronic stable angina

A

aspirin

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2
Q

best mortality benefit in chronic angina

A

aspirin + beta-blocker (metoprolol or nebivolol)

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3
Q

given to chronic angina patients if ejection fraction < 40%

A

ACE-inhibitor

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4
Q

given to chronic angina patients w/persistent pain

A

long acting nitroglycerin (PO or patch)

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5
Q

form of nitroglycerin given for ACUTE chest pain only

A

sublingual, paste, IV

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6
Q

indications for CCBs in CAD patients

A
  • severe asthma
  • Prinzmetal
  • cocaine-induced chest pain
  • inability to control pain despite maximal medical therapy
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7
Q

ADRs of CCBs

A
  • edema

- constipation

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8
Q

troponin T value that makes diagnosis of cardiac injury

A

> or = 0.01 ng/mL that is rising

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9
Q

initial vasopressor of choice in septic, cardiogenic and hypovolemic shock WITH HYPOTENSION

A

norepinephrine (vasopressor/alpha-1 adrenergic)

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10
Q

initial agent of choice in cardiogenic shock w/low cardiac output and WITHOUT significant HYPOTENSION

A

dobutamine (inotrope/beta1 adrenergic)

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11
Q

chest pain ddx associated with :

  • pain w/exertion
  • remits w/rest
  • substernal
  • relieved by nitro
  • < 20 min
A

stable angina

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12
Q

chest pain ddx associated with NSTEMI, (+)troponin (takes at least 3-6 hrs to rise)

A

unstable angina / NSTEMI

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13
Q

chest pain ddx associated with ST elevation and (+)troponin

A

STEI

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14
Q

chest pain ddx associated with :

  • positional and pleuritic rub
  • PR depression
  • ST elevation all leads
  • viral illness or autoimmune disease
A

pericarditis

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15
Q

chest pain ddx associated with :

  • tearing pain to back
  • widened mediastinum on CXR
  • false lumen on CT
A

aortic dissection

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16
Q

chest pain ddx associated with :

  • pleuritic
  • sudden onset dyspnea
  • fever
  • cough
  • sputum
  • crackles
  • CXR infiltrate
A

pneumonia

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17
Q

chest pain ddx associated with :

  • sudden onset
  • sharp pleuritic pain
  • hyper resonance
  • decreased breath sounds
A

pneumothorax

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18
Q

chest pain ddx associated with :

  • substernal burning
  • acid taste in mouth
  • cough
  • increased by meals and recumbency
  • decreased by antacids
  • epigastric pain : EGD +/- H. pylori test
A

GERD and PUD (peptic ulcer disease)

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19
Q

chest pain ddx associated with :

  • reproducible localized tenderness to palpation
  • increased w/movement
A

costochondritis

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20
Q

chest pain ddx associated with :

  • sudden onset dyspnea
  • tachycardia
  • hypoxia
A

pulmonary embolus

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21
Q

chest pain ddx associated with food and drinking cold or hot liquids

A

esophageal spasm

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22
Q

condition referring to insufficient oxygen delivery to myocardium secondary to narrowing of coronary vessels

A

coronary artery disease (CAD)

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23
Q

classic triad for angina pectoris

A
  1. substernal chest pain
  2. pain w/exertion
  3. pain relief by rest or nitrates
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24
Q

greatest immediate improvement in patient outcomes associated with CAD

A

stop smoking

25
Q

worst risk factor for CAD

A

diabetes mellitus

26
Q

most common risk factor for CAD

A

hypertension (> 140/90)

27
Q

age that is a risk factor for CAD

A

males > 45, females > 55

28
Q

family hx of premature CAD which are risk factors for CAD

A
  • 1st degree relative

- premature coronary disease in male relative < 55, female < 65

29
Q

optimal values (mg/dL) for LDL, HDL, cholesterol

A

LDL 100-130
HDL M 40-50, F 50-60
Cholesterol < 200

30
Q

most common ADRs of statins

A

muscle pain, liver damage

31
Q

where is ST elevation located on EKG w/inferior wall MI ?

A

II, III, aVF

32
Q

where is ST elevation located on EKG w/lateral wall MI?

A

I, V5, V6, aVL

33
Q

where is ST elevation located on EKG w/anterior wall MI?

A

V2, V4

34
Q

where is ST elevation located on EKG w/septal MI?

A

V1

35
Q

if a patient has chest pain in the office, what is the next best test after EKG?

A

stress test

  • must be able to read EKG
  • must be able to exercise (85% of max HR = 220 - age)
36
Q

what test should be done if patient has chest pain in office, EKG is performed, but EKG cannot be read w/stress test (LBBB, LVH, digoxin, pacemaker)?

A
  • exercise echo
  • nuclear stress test (exercise and isotope uptake w/Tc99/sestamibi or thallium, which is picked up by normal myocardium)
37
Q

what test should be done if patient has chest pain in office, EKG is performed, but patient cannot exercise w/stress test?

A
  • dobutamine echo

- nuclear stress test (persantine/dipyridamole and isotope uptake w/thallium or Tc99/sestamibi)

38
Q

what condition should persantine be avoided with?

A

asthma (b/c bronchospasm)

39
Q

most accurate test for detection of CAD that determines narrowing of coronary arteries (70% indicates surgery)

A

coronary angiography

40
Q

procedure that is best for ACS, especially w/ST elevation ; does NOT provide clear evidence for mortality benefit in STABLE patients

A

angioplasty (percutaneous coronary intervention)

41
Q

next step in patient with normal EKG and want to r/o rhythm problem

A

holter monitor

42
Q

process that involves continuous EKG monitoring in the hospital

A

telemetry

43
Q

TIMI (thombolysis in MI) score

A
  • > 65 y.o.
  • ASA in past 7 d.
  • angina 2x in last 24 hrs
  • CAD risk factors (HTN, DM, HLD, first degree relative w/MI M < 55, F < 65)
  • CAD history (> 50% stenosis)
    ST elevation of 0.5 mm
  • cardiac marker positive

score of 7 indicates 41% greater chance of MI

44
Q

what may cause false positive troponin levels (high troponin w/normal wall motion on echo)?

A
  • CHF

- renal failure

45
Q

compare rise, peak and duration of CK MB vs troponin

A

rise 3-4 hr, 1-2 hr
peak 12 hr
duration 1-2 days, 2 wks

46
Q

within how many hours of chest pain must thrombolytics be used?

A

12 hours

47
Q

fibrinolytic agent of choice in the U.S. ; as effective as alteplase and a decrease in risk of non-cerebral bleeding

A

Tenectaplase (TNK-tPA)

48
Q

most widely used fibrinolytic agent worldwide - low cost, reasonable efficacy to safety ratio

A

streptokinase

49
Q

number of diseased vessels indicated for angioplasty

A

1-2

50
Q

number/diseased vessels indicate for coronary artery bypass graft (CABG)

A

3+, left main coronary a.

51
Q

complications of coronary angioplasty

A
  • restenosis
  • coronary a. rupture
  • hematoma at entry site
52
Q

grafts used for CABG

A
  • internal mammary a. (lasts 10 yrs)

- saphenous v. (lasts 5 yrs)

53
Q

complications 2-3 days post-MI

A

arrhythmias (monitor pt in ICU)

54
Q

major / comorbid complication 2-3 days post-MI

A

reperfusion arrhythmia - accelerated idioventricular rhythm (looks like v. tach, but not tachycardia) - BENIGN, DON’T TREAT

55
Q

complications several days post-MI

A
  • septal rupture
  • valve rupture

GET ECHO (may need surgery and possible balloon pump)

56
Q

what can all complications of MIs result in?

A

hypotension

57
Q

how do you treat hypotension complication post-MI?

A
  • repeat BP
  • trendelenberg position
  • fluids (250-500 mL NS over 30 min ; repeat q 15-30 min)
58
Q

following steps for post-MI asymptomatic patient

A
  • stress test
  • ACE inhibitor (best for anterior wall MI), ASA, beta blocker, clopidogrel
  • don’t combine nitrates w/sildenafil or tadalafil (hypotension)

General Medicine I (7 decks)

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