Ischemic Heart Disease

Question 1

IHD is classified into two groups:

Answer 1

Stable Coronary Artery Disease
-presenting with CSAP
Acute Coronary Syndrome
-NSTE-ACS (UA,  NSTEMI) 
-STEMI

Question 2

Most common cause of SCAD

Answer 2

Atherosclerotic ds of an epicardiap coronary artery

Question 3

Clinical Manifestations of CSAP

Answer 3

Chest discomfort described as heaviness
Crescendo-decrescendo in nature
Associated with exertion
Radiates to bothto either or both shoulders or arms
Relieved with rest or SL nitrogly

Question 4

What is Typical Angina

Answer 4

Substernal chest discomfort
Provoked by exertion or emotion
Relieved by rest and/or nitrates within minutes

Question 5

Targets for risk factors (BMI, LDL cholesterol, BP, HbA1c)

Answer 5

BMI < 25 kg/m2
LDL cholesterol < 70mg/dL or >50% reduction from baseline
BP < 140/90 mmHg (for DM <140/85)
HbA1c <6.5-7.0%

Question 6

Aspirin, ACE-i and statins (AIA) focus on reducing ________ (i.e. reduce ______ and _____ ) and LV dysfuncton

Answer 6

acute thrombotic events

i.e. reduce PLAQUE PROGRESSION and PLAQUE STABILIZATION

Question 7

These two drugs have been shown to reduce mortality in SCAD with LV dysfuncton

Answer 7

Beta blockers

ACE-i

Question 8

MOA of Aspirin

Answer 8

Interferes with platelet activation (inhibit COX)

Question 9

What other antiplatelets can be used for SCAD?

Answer 9

Clopidogrel and vorapaxar

Question 10

MOA of ACEi and ARBS

Answer 10

reduce LV and vascular hypertrophy, the progression of atherosclerosis, plaque rupture, and thrombosis

Question 11

MOA of statins (Rosu, ator, sim)

Answer 11

Plaque stabilization and anti-inflam effects

Question 12

Pharmacologic treatment for anginal relief

Answer 12

Nitrates
Beta blockers
CCB

Question 13

Nitrates MOA:
___________ with decreased ____________ volume and pressure –> decreased mycoardial wall tension and oxygen requirements

DILATION of ______________

Increased blood flow in __________________

Answer 13

Systemic venodilation; left ventricular
Epicardial coronary vessel
Collateral veins

Question 14

Beta blockers MOA:

Reduce myocardial oxygen demand by _________, _________, and _________ caused by adrenergic activation

Answer 14

Inhibiting increases in HR

arterial pressure and myocardial contractility

Question 15

Cornerstone therapy for angina

Answer 15

beta-blockers!!

Question 16

Clopidogrel is an oral agent that blocks ___ receptor-mediated platelet aggregation

Answer 16

ADP

Question 17

Vorapaxar is a

Answer 17

thrombin receptor (protease activated receptor PAR-1_ antagonist

Question 18

What happens in percutaneous coronary intervention?

Answer 18

Balloon dilatation usually accompanied by coronary stenting