Ischemic Heart Disease

Question 1

Ischemic Heart Disease is also know as?

Answer 1

Coronary heart disease, or coronary artery disease

Question 2

Ischemic heart disease is primarily cause by?

Answer 2

Artherosclocrosis

Question 3

Artherosclocrosis results from?

Answer 3

From decreases blood flow to the heart and leads to reduced oxygen delivery

Question 4

When does angina occur?

Answer 4

Demand > Supply

Question 5

How does IHD present itself?

Answer 5

• Chest pain or pressure
• Discomfort in
  
  • Neck
  • Jaw
  • Shoulder or arm
• Pain accumanied with nausea or vomiting

Question 6

Female patients often describe symptoms as?

Answer 6

Indigestion or acid feeling

Question 7

IHD occurs in women or men more?

Answer 7

men

Question 8

What forms when someone has Artherosclorosis?

Answer 8

A plaque forms this is what causes the reduced oxygen

Question 9

Stable angina is classified as pain lasting?

Answer 9

less than 10 minutes

Question 10

Angina lasting between 10-15 minutes is known as?

Answer 10

Variant

Question 11

Unstable angina is when the pain lasts for?

Answer 11

more than 20 minutes

Question 12

Chest pain is _____ during stable angina

Answer 12

predictable

Question 13

The onset of variant angina is?

Answer 13

gradual

Question 14

In unstable angina the pain is _____ and there is ____ onset

Answer 14

severe and the onset is new

Question 15

Stable angina or occurs upon?

Answer 15

Exertion

Question 16

Variant angina often occurs ____ and at ____

Answer 16

in the morning and at rest

Question 17

Unstable angina occurs ____ or at _____

Answer 17

exertion or at rest

Question 18

What are the modifiable risk factors of Ischemic heart disease

The Fat Smoker Checked His Glucose Monitor and his head began to BOIL he then Drank some BEER

Answer 18

• Tobacco smoking
• Hypercholesterolemia
• DM
• HTN
• Obesity
• Alcohol

Question 19

What are the non-modifiable risk factors for IHD?

45 + 10 +10

Answer 19

• Men > 45
• Females >55
• FH of CVD
  
  • First degree relative
  • Females < 65
  • Men <55

Question 20

Beta blocker ____ HR

_____ Cardiac contractility

_____ Systolic Pressure

____ Left Ventricle Volume

Answer 20

Decrease all

Question 21

What is 1st line therapy for IHD?

Answer 21

Beta blockers

Question 22

What are the 3 preferred beta blockers?

Answer 22

Carvedilol, metoprolol succinate, bisoprolol

Question 23

Beta Blockers are contra indicated with patients with?

Answer 23

Severe bradycardia (<60 bpm)

AV conduction med Digoxin, verapamil, diltiazem

Asthma, COPD, DM, HF

Question 24

CCBs are second line for IHD decrease?

Answer 24

HR

Question 25

Amlodipine is a preferred \_\_\_\_

Answer 25

CCB

Question 26

CCBs should not be used when?

Answer 26

Digoxin or BB HF same as BBs

Question 27

You should not use ____ in patients with variant angina

Answer 27

BBs

Question 28

What is the 2nd/3rd line for IHD?

Answer 28

Nitrated long acting

Question 29

What do nitrates do? WHat are they limited by?

Answer 29

Decrease wall tension, preload and oxygen demand Limited in tolerance development thats why you need 8-12 hours of non nitrate therapy

Question 30

Nitrates should not be used with? Patients wiht _____ hypotension and cause ____ depletion

Answer 30

PDE-5 inhibitors severe hypotension and can cause volume depletion

Question 31

All patients should use ____ release nitroglycerin

Answer 31

IR

Question 32

How do you educate the patient to use nitroglycerin tablets? 1. ___ \_\_\_ when administering the medication, have phone close by. 2. Place __ tablet under the tongue and allow it to dissolve. 3. If pain persists after ___ minutes, administer the 2nd tablet. 4. Call ____ after administering ___ tablet. 5. May administer a 3rd tablet if pain continues ____ after the 2nd tablet for a max of ___ tablets in 15 minutes.

Answer 32

1. Sit down 2. 1 tablet 3. 5 minutes 4. Call 911 after admin of 2nd tab 5. 5 minutes, max of 3 tabs in 15 minutes

Question 33

1. If a new bottle, prime pump with ____ test sprays 2. When pain occurs, spray 1-2 sprays into mouth while sitting down and phone close by. Do not \_\_\_, ____ or spit out the spray for at least 5- 10 minutes. 3. Wait 5 minutes, if pain persists may spray a ___ spray and call 911 4. Replace cap on the bottle 5. If bottle is not used more than 6 weeks must prime again

Answer 33

1. 5-10 2. swallow or inhale 3. 3rd

Question 34

Ranolazine is ____ line for IHD and it has no effect on?

Answer 34

2nd 3rd line no effect on HR or BP

Question 35

Ranolazine contraindications

Answer 35

* Hepatic cirrhosis * Use with CYP3A inducers * Rifampin, carbamazepine, phenytoin, phenobarbital

Question 36

Revascularization should be used when?

Answer 36

* Max tolerable meds are used and symptoms are still occuring * High risk patients multiple comorbidities

Question 37

What is the antiplatelet therapy used after PCI?

Answer 37

Aspirin 81 mg forever Clopidogrel 75 mg daily, ticogrelor 90 BID or Prasugrel 10 mg for 1 year

Question 38

Want to treat Bp if it is \>?

Answer 38

140/90

Question 39

Consider ____ screening in High risk patients as well as?

Answer 39

DM Depression and Kidney function

Question 40

CCBs like \_\_\_\_, ___ and ____ should be first choice for ____ angina

Answer 40

Verapamil, diltiazem and nifedipine for variant angina