Ischemic heart disease II

Question 1

Diagnosis of stable CAD

Answer 1

History: chest pain, dyspnea, risk factors. PE: normal or evidence of heart dysfunction. EKG: at rest and exercise. Echo, perfusion imaging or ultrafast CT, coronary angiography

Question 2

CAD changes in resting and stress ECG

Answer 2

resting: ST depression, T inversion and/or Q waves (previous infarct). Stress test: dynamic ST segment changes

Question 3

Describe the results of stress ECG in ischemia

Answer 3

horizontal or downsloping ST depression with exercise, reflecting subendocardial ischemia.

Question 4

Stable angina treatment

Answer 4

Anti-anginal agents (nitrates, beta blockers), Control of blood pressure with anti-hypertensives, Lipid-lowering medication (statin), Anti-platelet therapy (aspirin), angiography if not relieved

Question 5

Explain the use of fractional flow reserve in CAD

Answer 5

Measure pressure distal to the plaque with a solid state catheter, then compare to aortic pressure. If ratio of distal coronary artery pressure/ aortic pressure <0.75, stenosis is significant

Question 6

What findings do you see in CT scan of coronary atherosclerosis

Answer 6

coronary calcium

Question 7

Coronary artery disease treatment

Answer 7

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

Question 8

How long does it take for risk of coronary events to return to the level of “never smoked”

Answer 8

10 years after quitting smoking

Question 9

Drugs used to treat coronary heart disease

Answer 9

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

Question 10

Treatment of unstable angina

Answer 10

IV nitroglycerin, Beta blockers, Aspirin and other anti-platelet agents, Anticoagulation (heparin), Usually early catheterization and coronary intervention

Question 11

Problems with balloon angioplasty

Answer 11

Acute occlusions (use stents and antiplatelet drugs), restenosis (use stents)

Question 12

Treatment of acute MI

Answer 12

Immediate aspirin, nitroglycerin +/- Beta blocker. Reperfusion therapy ASAP: Usually coronary angioplasty, if unavailable thrombolytic therapy. May require bypass surgery

Question 13

Types of grafts used in coronary artery bypass surgery

Answer 13

Internal mammary artery, Saphenous vein

Prosthetic materials have not proven successful as coronary grafts