Ischemic Heart Dz

Question 1

What results in typical chest pain of angina pectoris?

Answer 1

thalamic & cortisol stimulation

Question 2

How is angina relieved?

Answer 2

rest or nitro

Question 3

What indicates myocardial ischemia with an exercise ecg?

Answer 3

at least 1mm of horizontal or downsloping ST-segment depression during or within 4 min after exercise

Question 4

Has greater sensitivity for detection of ischemic heart disease

Answer 4

nuclear stress test

Question 5

Provides the best information about the condition of the coronary arteries

Answer 5

coronary angiography

Question 6

The most dangerous anatomic lesion

Answer 6

Left main

Question 7

Aspirin inhibits what enzyme? this is irreversible for the duration of the platelets lifespan, ___ days

Answer 7

cyclooxyrgenase (COX)-1. 7 days

Question 8

all pt with ischemic heart dz should be on what drug?

Answer 8

aspirin

Question 9

best drug to give someone with myocardial ischemia

Answer 9

b-blocker

Question 10

When should you recheck troponin?

Answer 10

within 3 hrs

Question 11

When should thrombolytic therapy be given for MI

Answer 11

within 30-60 min of hospital arrival and within 12 hrs of symptom onset

Question 12

all pts with a larger anterior wall MI, clinical evidence of left ventricular failure, and EF < 40%, or diabetes should be treated with?

Answer 12

ACE inhibitors or ARBs

Question 13

_______ should not be administered routinely but should be reserved for pts with persistent myocardial ischemia despite optimal use of aspirin, blockers, nitrates, and heparin

Answer 13

CCBs

Question 14

Most significant independent predictor of stent thrombosis

Answer 14

P2Y12 inhibitor discontinuation

Question 15

How long do you want the pt off of plavix?

Answer 15

7 days

Question 16

How does exercise stress test detect myocardial ischemia?

Answer 16

ST-segment changes

Question 17

When would you use a stress (pharmacologic) test over exercise?

Answer 17

pts undergoing non cardiac surgery who cannot perform enough exercise to detect stress induced myocardial ischemia

Question 18

What do beta blockers do?

Answer 18

reduce myocardial O2 consumption, improve coronary blood flow by prolonging diastole, improve the supply demand ratio, stabilize cellular membranes, improve oxygen dissociation from Hgb, & inhibit platelet aggregation

Question 19

Suppress perioperative tachycardia & appear most efficacious in preventing perioperative myocardial ischemia

Answer 19

beta blockers

Question 20

Based on the ACC/AHA guidelines, ______ for prevention of cardiac events are NOT recommended in pts undergoing non cardiac sx

Answer 20

a2 agonists (Clonidine)

Question 21

The simplest, most cost-effective method for detecting perioperative myocardial ischemia

Answer 21

standard ECG

Question 22

When should tx of myocardial ischemia be instituted?

Answer 22

when there are 1-mm ST-segment changes on ECG

Question 23

______ ,______, _____ have similar effects in normal & denervated hearts (transplanted)

Answer 23

Epinephrine, isoproterenol, & dobutamine

Question 24

indirect-acting sympathomimetics such as _____ have a blunted effect in denervated hearts (transplanted)

Answer 24

ephedrine

Question 25

Vagolytic drugs such as ______ do not increase the HR in transplanted heart

Answer 25

atropine

Question 26

Which drugs do not work on denervated hearts?

Answer 26

Ephedrine, Atropine, & Pancuronium

Question 27

______ do not slow the HR of denervated hearts

Answer 27

neostigmine & other anticholinesterases

Question 28

intravascular volume must be maintained in heart transplant recipients bc these pts are _______

Answer 28

preload dependent

Question 29

Anesthetic management of heart transplant recipients must include what?

Answer 29

avoidance of significant vasodilation & acute reductions in preload