Ischemic Heart Disease (Exam II)

Question 1

What chemical mediators are released from ischemia that activate cardiac nociceptors?

Answer 1

Adenosine and Bradykinin

Question 2

Two most important risk factors for the development of atherosclerosis involving the coronary arteries are ________ and ________.

Answer 2

1. Male gender
2. Increasing age

Question 3

What is the path for cardiac pain signals to reach the spinal cord?

Answer 3

Cardiac nociceptors → Afferent Neurons → T1 - T5 SNS ganglia.

Question 4

What is the CNS response to cardiac ischemia?

Answer 4

• ↓ AV conduction and thus ↓HR
• ↓ Contractility

Question 5

Differentiate stable vs unstable angina.

Answer 5

• Stable - No change in chest pain severity or frequency in 2-mo period.
• Unstable - Increasing frequency and severity of chest pain.

Question 6

Are cardiac biomarkers (troponin) present with unstable angina?

Answer 6

NO. If they were, that would be an MI.

Question 7

What EKG abnormality is associated with old MI’s and/or current ischemia?

Answer 7

T-wave inversion

Question 8

What is nuclear stress testing utilized for?

Answer 8

Coronary Perfusion assessment

Question 9

What determines the significance of CAD during a nuclear stress test?

Answer 9

Size of the perfusion abnormality

Arrows point to arrows of lesser perfusion.

Question 10

What test can differentiate a new vs and old perfusion abnormality?

Answer 10

Nuclear Stress Testing

Question 11

What nuclear stress test tracers are used with exercise?

Answer 11

Thallium

Question 12

What nuclear stress test drugs are used without exercise?

Answer 12

Atropine
Dobutamine
Pacing

Question 13

When are adenosine and dipyridamole used with nuclear stress testing? Why?

Answer 13

Used after test to dilate normal, non-ischemic areas of the heart.

Question 14

What test would be useful for imaging wall motion abnormalities or valvular function?

Answer 14

Echocardiography

Question 15

What is Prinzmetal Angina?

Answer 15

Coronary Spasm

Question 16

What is the mechanism of action for aspirin?

Answer 16

COX-1 Inhibition → TXA2 inhibition → Plt aggregation inhibition.

Question 17

How can aspirin be reversed?

Answer 17

Trick question. It can’t be, platelets are damaged until they die and are replaced.

Question 18

What is the mechanism of action of abciximab, eptifibatide, and tirofiban?

Answer 18

Platelet glycoprotein IIb/IIIa receptor antagonists

Inhibit platelet activation, adhesion, and aggregation.

Question 19

What drugs (discussed in lecture) are P2Y₁₂ inhibitors?

Answer 19

Clopidogrel and Prasugrel

Question 20

What common drug class will antagonize P2Y₁₂ inhibitors?

Answer 20

PPIs

Question 21

How does Prasugrel compare to Clopidogrel?

Answer 21

More predictable pharmacokinetics but greater bleeding risk.

Question 22

How do P2Y₁₂ inhibitors work?

Answer 22

Inhibit ADP receptor P2Y₁₂ and thus inhibit platelet aggregation.

Question 23

What drug classes are synergistic with nitrates?

Answer 23

• β-blockers
• CCBs

Question 24

When are nitrates contraindicated?

Answer 24

• Aortic Stenosis
• Hypertrophic Cardiomyopathy

Question 25

What drug class is the only one proven to prolong life in CAD patients?

Answer 25

β-blockers

Question 26

What properties do β-blockers have?

Answer 26

- Anti-ischemia - Anti-HTN - Anti-dysrhythmic

Question 27

Which β blockers are cardioselective?

Answer 27

- Atenolol - Metoprolol - Acebutolol - Bisoprolol

Question 28

Which β blockers are non-selective?

Answer 28

- Propanolol - Nadolol

Question 29

What risk is associated with non-selective β blockers in asthma patients?

Answer 29

↑ risk of bronchospasm in reactive airway disease patients.

Question 30

What drug class is uniquely effective is decreasing the severity/frequency of coronary vasospasm?

Answer 30

CCBs

Question 31

Angiotensin II will increase what four things?

Answer 31

- Myocardial hypertrophy - Interstitial myocardial fibrosis - Coronary vasoconstriction - Inflammatory responses

Question 32

Is troponin or CK-MB more specific for myocardial injury?

Answer 32

Troponin

Question 33

How soon with troponin start to increase after myocardial injury?

Answer 33

3 hours

Question 34

What diagnostic studies might indicate a myocardial infarction?

Answer 34

- EKG: abnormality (ex. LBBB) - US: Regional wall motion abnormalities

Question 35

What are indications for PCI treatment of an MI?

Answer 35

- Contraindicated tPa therapy - Severe HF and/or pulm edema - S/S for 2-3 hours - Mature clot

Question 36

What risks are associated with PCI (percutaneous coronary intervention) ?

Answer 36

- Endothelial destruction - Bleeding - Thrombosis

Question 37

What is Dual Antiplatelet Therapy (DAPT) ?

Answer 37

- ASA w/ P2Y₁₂

Question 38

How long would one want to wait for elective surgery post angioplasty **with no stenting**?

Answer 38

2 - 4 weeks

Question 39

How long would one want to wait for elective surgery post angioplasty **with bare-metal stent placement**?

Answer 39

At least 30 days (12 weeks preferable)

Question 40

How long would one want to wait for elective surgery post angioplasty **with drug-eluting stent placement**?

Answer 40

At least 6 months (12 months if post ACS)

Question 41

How long would one want to wait for elective surgery post-CABG?

Answer 41

At least 6 weeks (12 weeks preferable)

Question 42

Is glycopyrrolate or atropine preferred for treatment of bradycardia?

Answer 42

Glycopyrrolate

Question 43

Are β blockers or ACE-inhibitors continued peri-operatively?

Answer 43

β-blockers

Question 44

Are β blockers or ACE-inhibitors discontinued 24 hours prior to surgery?

Answer 44

ACE inhibitors

Question 45

What components are worth 1 point on the Revised Cardiac Risk Index (RCRI) ?

Answer 45

Question 46

What % risk of major cardiac events would be conferred by a RCRI score of 0 ?

Answer 46

0.4%

Question 47

What % risk of major cardiac events would be conferred by a RCRI score of 1 ?

Answer 47

1.0%

Question 48

What % risk of major cardiac events would be conferred by a RCRI score of 2 ?

Answer 48

2.4%

Question 49

What % risk of major cardiac events would be conferred by a RCRI score of ≥3 ?

Answer 49

5.4%

Question 50

What does 1 MET equal?

Answer 50

3.5mLO₂/kg/min

Question 51

What drug is the preferred treatment for tachycardia?

Answer 51

Esmolol

Question 52

What anticholinergic is the better option for treatment of bradycardia in CAD patients?

Answer 52

**Glycopyrrolate** > Atropine

Question 53

What coronary artery would you expect to be effected from abnormalities noted on II, III, and aVF?

Answer 53

RCA

Question 54

What coronary artery would you expect to be effected from abnormalities noted on I and aVL?

Answer 54

Circumflex artery

Question 55

What coronary artery would you expect to be effected from abnormalities noted on V3 - V5?

Answer 55

LAD