Ischemic Heart Disease II

Question 1

How do you diagnose stable coronary artery disease?

Answer 1

• Get a hx (angina, dyspnea, risk factors)
• Physical exam
• ECG
• Non-invasive imaging (echo, nuclear medicine, CT)
• Coronary angiography

Question 2

What do you on an ECG with stable coronary artery disease?

Answer 2

• ST segment ∆s (usually depression
• T wave inversion
• Q-waves

Question 3

What do you on an exercise ECG with stable coronary artery disease?

Answer 3

Dynamic ST segment ∆s

• Displacements of ST segment
• See ‘how much excursion does it take for you to see evidence of ischemia?’
• Perfusion imaging is coupled with these stress tests (remember the colorful donut imaging from PPT)

Question 4

What is the tx of stable angina?

Answer 4

• Anti-anginal agents (nitrates, BBs)
• control BP w/ anti-HTNs
• Lower lipids (statin)
• Anti-platelets (aspirin)

If symptoms not relieved => need coronary angiogram (used for diagnosis of obstruction)

Question 5

Describe coronary angiography

Answer 5

• Gets in picture of vessel lumen (doesn’t tell about vessel wall or how much atherosclerosis)
• Can diagnose coronary obstruction — NOT good for predicting future events
• Guides therapeutic intervention (angioplasty, bypass)

Question 6

What must the ratio of distal coronary pressures:aortic pressure to indicated significant stenosis?

Answer 6

<0.75

Question 7

Describe the acute tx of unstable angina

Answer 7

• Hospitalization
• IV nitroglycerin
• BBs
• Aspirin (other anti-platelets)
• Anticoag (heparin)
• usualy early catheterization and coronary intervention

Question 8

What are the effects of balloon angioplasty on the vessel wall?

Answer 8

a

Question 9

What are the problems associated with balloon angioplasty?

Answer 9

• Acute occlusion
• Restenosis

Can fix w/ stents, anti-platelets

Question 10

What are stents?

Answer 10

• Meshed tube thingys
• Put in vessel lumen after the balloon angioplasty
• They reduce risk of restenosis and vessel occlusion

Question 11

Describe the tx of acute MI w/ ST elevation

Answer 11

• Immediate aspirin, nitroglycerin, maybe BBs
• Reperfusion therapy ASAP (coronary angioplasty <= if unavailable thrombolytic therapy)

Tx initiated in the field (?)

Question 12

Describe coronary artery bypass grafting

Answer 12

• shown to reduce mortality in selected pts compared to medical therapy
• May be better than angioplasty when there are multiple blockages

Question 13

What are the principal graft types used in bypass surgery?

Answer 13

• Internal mammary artery (almost always pristine!)
• Saphenous vein
• Prosthetic material NOT as sucussful as coronary grafts