Ischemic Heart Disease II

Question 1

History/Symptoms of CAD

Answer 1

chest pain
dyspnea
risk factors

Question 2

CAD Tests

Answer 2

1) EKG (at rest and exercise)
2) Echo (at rest and exercise)
3) Nuclear perfusion study (at rest and exercise)
4) Ultrafast CT
5) Coronary Angio

Question 3

CAD ECG Changes (resting)

Answer 3

1) ST segment changes (usually depression)
2) T wave inversion
3) Q-waves (indicate prior infarction)

Question 4

CAD ECG Changes (Exercise)

Answer 4

Dynamic ST segment changes

Question 5

ECG Problems

Answer 5

Resting ECG is insensitive

Exercise ECG: still lacking sensitivity and specificity

Question 6

Ischemic Response to Stress EKG

Answer 6

horizontal or downsloping ST depression with exercise

Question 7

What improves stress EKG sens/spec?

Answer 7

Concurrent imaging of myocardial perfusion (radiopharmaceuticals) or wall motion (echocardiography) with EKG

Question 8

CT or Direct Angiography info obtained?

Answer 8

1) Picture of the vessel lumen – but does not tell us about the vessel wall.
2) Good for diagnosis of coronary obstruction causing anginal symptoms; not as good for predicting future events.

Question 9

Treatment of CAD

Answer 9

1) Risk factor modification (Diet, exercise, smoking cessation)
2) Drugs to treat angina, blood pressure, lipids, platelets
3) Revascularization

Question 10

Lipid-modifying Drugs

Answer 10

Statins!

Question 11

Anti-platelet

Answer 11

Aspirin, clopidogrel

Question 12

Anti-anginal

Answer 12

Nitrates, B-Blockers, Ca2+ Channel Blockers

Question 13

LV Dysfunction

Answer 13

ACEIs/ARBs

Question 14

How to determine severity of coronary lesion?

Answer 14

Fractional Flow. Ratio of distal coronary pressure/aortic pressure <0.75 = significant

Question 15

Simvastatin, ACEIs, B-Blockers and aspirin are used for?

Answer 15

Secondary prevention post-MI

Question 16

Problem: acute occlusion

Answer 16

Solution: stents and antiplatelet drugs

Question 17

Problem: Restenosis

Answer 17

Solution: Stents, particularly those that elute antiproliferative drugs

Question 18

Treatment of STEMI

Answer 18

Initiated in the field: aspirin, nitroglycerin, ± beta blocker

Reperfusion therapy ASAP: Usually coronary angioplasty, if unavailable thrombolytic therapy

Question 19

CABG Definition

Answer 19

Coronary artery bypass grafting

Question 20

CABG Types of Grafts

Answer 20

1) Internal mammary artery
2) Saphenous vein
3) Prosthetic materials have not proven successful as coronary grafts