Ischemic Heart Disease, Angina, and MI I

Question 1

coronary blood demand exceeds coronary blood flow

Answer 1

ischemic heart disease

Question 2

etiology of IHD

Answer 2

atherosclerosis
hyperthyroid
anemia
stress
variant angina

Question 3

prinzmetal

Answer 3

vasospasm

Question 4

retrosternal, aching or squeezing, radiates to neck, shoulder, back, teeth, and epigastrium

Answer 4

IHD

Question 5

framingham

Answer 5

multigenerational study for risk factors of heart disease

Question 6

risk fx for IHD

Answer 6

age
male
smoker (rapid reduction 2 yrs after quitting)
HTN
DM
hypercholesterol
fam Hx
cocaine
methamphetamine
physical inactivity

Question 7

levels of framingham risk

Answer 7

10 year risk**

low risk 20%
-aggressive risk modification

Question 8

metabolic syndrome

Answer 8

risk fx with 2x increased CAD risk

insulin resistance
hyperglycemia
HTN
elevated trigyceride
low HDL
obesity

Question 9

conditional risk fx

Answer 9

homocysteine
lipoprotein a
hsCRP
LDL particle size
antioxidant size
omega 3 FAs

Question 10

MI risk fx

Answer 10

cholesterol
smoking
stress
DM
HTN
obesity
alcohol
exercise
veggies and fruit daily

Question 11

diagnostic testing for IHD

Answer 11

CPK
troponin
LDH

exercise stress test

pharm stress test

imaging augmentation

angiography

CT - coronary artery calcium score

Question 12

HR max

Answer 12

220 - age

Question 13

dobutamine

Answer 13

increases cardiac stress and oxygen demand

-in stress test

Question 14

used to cause vasodilation coronary steal during stress test

Answer 14

adenosine

dipyridamole

Question 15

gold standard for defining coronary occlusion

Answer 15

angiography

Question 16

need to do other exam for CAD

Answer 16

if LBBB on EKG

Question 17

male typical chest pain >40yo

Answer 17

high risk for CAD

Question 18

female typical chest pain > 60yo

Answer 18

high risk for CAD

Question 19

low probability chest pain eval

Answer 19

no further workup

Question 20

intermediate probability EKG normal chest pain eval

Answer 20

stress test

Question 21

intermediate probability and EKG abnormal chest pain eval

Answer 21

stress test

possible imaging

Question 22

high probability chest pain eval

Answer 22

medical therapy followed by stress test and/or coronary angiography

Question 23

type A dissection extends to right coronary artery

Answer 23

inferior wall MI

widened mediastinum on chest X-ray

Question 24

new onset atrial fib

Answer 24

pulmonary embolism

Question 25

ST elevation MI

Answer 25

cath lab by 90 minutes**

Question 26

absolute contraindications to thrombolysis

Answer 26

intracranial hemorrhage ischemic CVA last 3 months facial trauma last 3 months bleeding diathesis

Question 27

inferior wall MI

Answer 27

bradycardia and AV block AV node - right coronary a hypotension for volume depletion

Question 28

anterior wall MI

Answer 28

pump failure and CHF - large area infarcts cardiogenic shock intra-aortic

Question 29

Intra-aortic balloon pump synchronous counterpulsation

Answer 29

to decrease afterload and increase coronary a flow

Question 30

new systolic murmur and thrill on left sternal border after MI

Answer 30

VSD

Question 31

new systolic murmur, PE, thrill, and cardiogenic shock after MI

Answer 31

papillary musclerupture and MR

Question 32

require revascularization

Answer 32

three vessel disease and left main disease in high risk patients

Question 33

patient treated medically

Answer 33

should have eval for EF and provocative ischemic test

Question 34

EF < 40%, significant ischemia on non-invasive testing, arrhythmia, recurrent chest pain, significant heart failure during stay

Answer 34

angiography indications

Question 35

post acute coronary syndrome mortality reducers

Answer 35

beta blockers aspirin ACE statins - LDL < 100 goal **important to manage hyperglycemia

Question 36

CABG

Answer 36

in stable CAD -only if left main disease, left main equivalent, three vessel disease, or two vessels involving proximal LAD and EF <50%

Question 37

coronary angiography

Answer 37

gold standard -if positive stress test or STEMI, unclear diagnostic eval, left limiting angina after medical therapy

Question 38

females

Answer 38

10 year later diagnosis more vasospastic presentation more atypical presentations hormone replacement - not shown to reduce CAD risk

Question 39

diabetics

Answer 39

2-8x more likely to suffer and die from cardiovascular diseases more advanced and higher grade disease blood glucose control very important

Question 40

elderly

Answer 40

without chest pain