IHD - CSAP treatment generalities

Question 1

The management plan should include what components?

Answer 1

1. explanation of the problem and reassurance about the ability to formulate a treatment plan
2. identification and treatment of aggravating conditions
3. recommendations for adaptation of activity as needed
4. treatment of risk factors that will decrease the occurrence of adverse coronary outcomes
5. drug therapy for angina
6. consideration of revascularization

Question 2

A patient with IHD is anxious about what his life ahead would be. What must be explained to patients regarding their condition?

Answer 2

A long and productive life is possible even though they have angina pectoris or have experienced and recovered from an acute myocardial infarction

Question 3

Conditions that aggravate condition in IHD patients and thus should be excluded or treated

Answer 3

• LVH, aortic valve disease, and HCOM may cause or contribute to angina and should be excluded or treated
• Obesity, hypertension, and hyperthyroidism should be treated aggressively to reduce the frequency and severity of anginal episodes
• Decreased myocardial oxygen supply may be due to reduced oxygenation of the arterial blood (e.g., in pulmonary disease or, when carboxyhemoglobin is present, due to cigarette or cigar smoking) or decreased oxygen-carrying capacity (e.g., in anemia)

Question 4

Many tasks that ordinarily evoke angina may be accomplished without symptoms simply by ____

Answer 4

Reducing the speed at which they are performed

Question 5

Patients must appreciate the diurnal variation in their tolerance of certain activities and should reduce their energy requirements when?

Answer 5

• In the morning
• Immediately after meals
• In cold or inclement weather

Question 6

Type of exercise recommended

Answer 6

Isotonic exercise that is within the limits of the individual patient’s threshold for the development of angina pectoris and that does not exceed 80% of the heart rate associated with ischemia on exercise testing should be strongly encouraged

Question 7

A family history of premature IHD is an important indicator of increased risk and should trigger a search for treatable risk factors such as:

Answer 7

• Hyperlipidemia
• Hypertension
• Diabetes mellitus

Question 8

Obesity often is accompanied by three other risk factors:

Answer 8

• Diabetes mellitus
• Hypertension
• Hyperlipidemia

Question 9

Diet for patients with IHD which are cornerstone
in the management of chronic IHD

Answer 9

• Low in saturated and trans-unsaturated fatty acids
• Reduced caloric intake

Question 10

Cardiovascular effects of cigarette smoking

Answer 10

• Accelerates coronary atherosclerosis in both sexes and at all ages
• Increases the risk of thrombosis, plaque instability, myocardial infarction, and death
• Aggravates angina by increasing myocardial oxygen needs and reducing oxygen supply

Question 11

T/F. Noncombustible tobacco in the form of electronic cigarettes (nicotine delivery systems) does not affect the frequency of anginal episodes

Answer 11

• False
• Noncombustible tobacco in the form of electronic cigarettes (nicotine delivery systems) may also increase the frequency of anginal episodes

Question 12

Relationship of IHD and hypertension

Answer 12

• Hypertension is associated with an increased risk of adverse clinical events from coronary atherosclerosis as well as stroke
• LVH that results from sustained hypertension aggravates ischemia

Question 13

Relationship of IHD and DM

Answer 13

• DM accelerates coronary and peripheral atherosclerosis
• DM is frequently associated with dyslipidemias and increases in the risk of angina, myocardial infarction, and sudden coronary death

Question 14

Target in management

• Target LDL cholesterol
• Target blood pressure

Answer 14

• Target LDL cholesterol
  
  • <70 mg/dL
• Target blood pressure
  
  • 120/80 mmHg