Ischemic Heart Disease II

Question 1

Techniques used to dx CAD

Answer 1

• history
• physical examination
• ECG
• non-invasive imaging
• coronary angiography

Question 2

History of CAD

Answer 2

• chest pain
• dyspnea
• risk factors

Question 3

Types of non-invasive imaging

Answer 3

• echocardiography
• nuclear medicine (perfusion imaging)
• ultrafast CT

Question 4

Dx of CAD from ECG

Answer 4

• resting ECG: ST segment changes, T wave inversion, Q-waves
• exercise ECG (stress testing): dynamic ST segment changes
• sensitivity of ECG is low
• sensitivity/specificity in stress-testing is improved w/concurrent imaging of myocardial perfusion or echocardiography

Question 5

Dx of CAD via CT or direct angiography

Answer 5

-Picture of the vessel lumen – but does not tell us about the vessel wall.
-Good for diagnosis of coronary obstruction
causing anginal symptoms; not as good for
predicting future events.
-Guides therapeutic intervention (angioplasty,
bypass surgery)

Question 6

Use of fractional flow reserve to estimate severity of coronary lesion

Answer 6

-if ration of distal coronary/aortic pressure stenosis is significant

Question 7

Major types of treatment of CAD

Answer 7

Risk factor modification (for prevention AND
treatment of overt disease)
– Diet, exercise, smoking cessation
• Drugs to treat angina, blood pressure, lipids,
platelets
• Revascularization
– Coronary angioplasty
– Coronary artery bypass surgery

Question 8

Classes of drugs useful in treatment of coronary heart disease

Answer 8

• Lipid-modifying: Statins
• Anti-platelet: Aspirin, clopidogrel
• Anti-anginal: Nitrates, beta blockers,
calcium channel blockers
• LV dysfunction: ACE inhibitors or
angiotensin receptor blocker

Question 9

Acute tx of unstable angina

Answer 9

• Hospitalization
• Intravenous nitroglycerin
• Beta blockers
• Aspirin and other anti-platelet agents
• Anticoagulation (heparin)
• Usually early catheterization and coronary
intervention

Question 10

Major problems with balloon angioplasty

Answer 10

• acute occlusion

- restenosis

Question 11

Tx of acute MI w/ST elevation

Answer 11

• Treatment may be initiated in the field
• Immediate aspirin, nitroglycerin, ± beta blocker
• Reperfusion therapy ASAP: Usually coronary
angioplasty, if unavailable thrombolytic therapy.