Ischemic Heart Disease

Question 1

IHD

Answer 1

Symptomatic coronary atherosclerotic heart disease, coronary arteries narrowed and less oxygen to the heart

Question 2

Which lipid is bad

Answer 2

LDL

Question 3

Increased level of which lipid reduces the risk

Answer 3

HDL

Question 4

One of the most significant risk factors for IHD

Answer 4

Increased blood pressure

Question 5

Single most important modifiable risk factor of coronary heart disease

Answer 5

Cigarette smoking

Question 6

Physiologic injury to artery occurs when

Answer 6

Disturbed blood flow at bending points or bifurcations

Question 7

Foam cells

Answer 7

Macrophages engulf lipid molecules- fatty streak

Question 8

Covering of lipid debris

Answer 8

Collagen, fibrous covering or cap

Question 9

If less collagen then

Answer 9

Thin fibrous capsule can rupture and lipid debris can travel through blood and cause thrombus formation

Question 10

Thorasic pain, substernal, relieved by vasodilator

Answer 10

Angina Pectoris

Question 11

Episodic chest discomfort, predictable, reproducible

Answer 11

Stable angina pectoris

Question 12

Syndrome between stable angina and acute MI

Answer 12

Unstable angina

Question 13

Unstable angina pain can last for up to

Answer 13

30 mins

Question 14

Unstable angina features

Answer 14

-occurs at rest, lasting more than 20 mins if not interrupted by nitroglycerin
-severe, frank pain, new onset
-Crescendo pattern(more severe, prolonged, or frequent than previously)

Question 15

Crushing, squeezing, heavy feeling more severe than angina. Not relived by nitroglycerin

Answer 15

MI

Question 16

Uncommon form of angina that occurs at rest and by focal spasm of coronary artery

Answer 16

Prinzmetal variant angina

Question 17

Biomarkers of MI

Answer 17

Troponin, creatine kinase isoenzyme(CK-MB)

Question 18

Biomarker More sensitive and specific to heart

Answer 18

Troponin

Question 19

Marker showing cardiac cell injury as well as skeletal muscle injury

Answer 19

CK -MB

Question 20

Stable angina, history of MI >30 days dental considerations

Answer 20

-pre op and 5 min post anesthetic readings
-anxiolytic and sedative drugs
-avoid long stressful appts
-supplemental oxygen
-comfortable chair position
-availability of nitroglycerin

Question 21

Unstable angina, recent history of MI dental considerations

Answer 21

-avoid elective tx
-refer to physician
-only tx emergencies
-all same as stable management but extra is: Administer prophylactic nitroglycerin

Question 22

Drug considerations for IHD

Answer 22

-If pt on CCB then avoid erythromycin and clarithromycin
-NSAIDs use with caution
-do not discontinue aspirin
-minimize epi to 2 carps of 1:100,000
Avoid retraction cords with epi

Question 23

Chest pain alleviated by nitroglycerin but returns then manage as

Answer 23

MI

Question 24

Angina attack management

Answer 24

-Substernal pain radiating, lasts more than 15 mins
-sweating, increased heart rate and blood pressure. Pt anxious

-place in sitting up position
-CAB
-oxygen and nitroglycerin
-repeat 2 more times if pain not gone
-if pain not gone after 3 times then call 911 and give one aspirin 325 mg

Question 25

Acute MI management

Answer 25

-crushing, squeezing pain more than 15 mins
-not gone by nitroglycerin
-cyanotic, pale, weak, cold sweat, coughing, dyspnea

If conscious
-sitting up
-CAB
-MONA:
Oxygen
Nitroglycerin
Aspirin 325mg
N2O 30%
Morphine

Question 26

Nitroglycerin contraindicated when

Answer 26

BP less than 90/60 mm hg
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