ischemic heart dz

Question 1

2 general causes of angina

Answer 1

• demand is increased but theres inadequate flow d/t fixed obstruction (exertional angina, emotional upset angina)
• demand is normal but supply decreased bc of a primary event

Question 2

insufficient oxygen to supply the cardiac muscle

Answer 2

ischemia

Question 3

pain/pressure caused by ischemia

Answer 3

angina

Question 4

squeezing, grip like, suffocating heavy chest pain but NOT sharp or related to breathing; levine sign

Answer 4

typican angina

Question 5

fist to chest d/t pain is what

Answer 5

levine sign

Question 6

fist to chest d/t pain is what

Answer 6

levine sign

Question 7

which group is more likely to feel atypical angina and what is that?

Answer 7

• women more likely
• no pain but nausea, burning, atypical location

Question 8

things that may intensify ischemia

Answer 8

• anemia
• fever & infection
• tachyarrhythmiaas
• emotional stress
• hypoxemia

Question 9

sx of acute myocardial ischemia secondary to acute plaque rupture & carrying degrees of coronary artery thrombosis (occlusion)

Answer 9

ACS

Question 10

two ACS conditions of subtotal occlusion with ST depression &/or T wave inversions

Answer 10

UA, NSTEMI

Question 11

positive cardiac enzymes is seen in which ACS conditions?

Answer 11

NSTEMI and STEMI

Question 12

condition of total occlusion with ST elevation

Answer 12

STEMI

Question 13

most common cause of MI

Answer 13

atherosclerosis

Question 14

chest pain at rest with ACS indicates what level of occlusion

Answer 14

> 90%

Question 15

how does ECG progress with STEMI

Answer 15

1. hyperacute T waves
2. ST elevations
3. pathologic Q wave

Question 16

4 populations that troponin may be FALSELY elevated in

Answer 16

• renal failure
• advanced heart failure
• acute PE
• CVA

Question 17

what is OANM

Answer 17

• oxygen
• aspirin 325mg chewed
• Nitroglycerin sublinual
• Morphine IV NTG

Question 18

what test can be done to differntiate btwn UA and NSTEMI if you see ST depression &/or T wave inversion on ECG

Answer 18

cardiac enzymes
* will be + in NSTEMI and - in UA

Question 19

medication for cocaine related ACS

Answer 19

BZD for sx
standard therapies (aspirin, nitro)

Question 20

which class of med should be avoided in cocaine related ACS

Answer 20

beta blocker

Question 21

new onset severe chest pain < 2 month that is frequent (> 3x/day) should make you think of

Answer 21

unstable angina

Question 22

ischemic sx of ACS, negative cardiac markers +/- ECG ischemic changes

Answer 22

unstable angina

Question 23

most common cause of unstable angina

Answer 23

plaque rupture causing incomplete coronary artery stenosis

Question 24

angina is unstable if it has any of these 3 things

Answer 24

• rest angina lasting more than 20-30 mins
• new onset angina
• change in angina pattern

Question 25

# what type of MI: type 1 or 2 spontaneous MI * plaque rupture/erosion w/ occlusive or non-occlusive thrombus

Answer 25

type 1 MI

Question 26

# what type of MI: type 1 or 2 something else triggers the problem (pneumonia, emotional upset, etc) * atherosclerosis & oxygen supply/demand imbalance * vasospasm or corooary microvascular dysfunction * non-atherosclerotic coronary dissection * o2 supply/demand imbalance alone

Answer 26

Type 2

Question 27

* reduces events for pt w/ stabile angina * reduces short & long term odds of MI in Unstable angina

Answer 27

antiplatelet therapy

Question 28

what medication can be used if pt is intolerant to ASA but antiplatelet therapy is indicated

Answer 28

clopidogrel

Question 29

beta blockers are good as first line for control of ____ angina

Answer 29

exertional | CCB of equal efficacy too

Question 30

CCBs are mainstay therapy for ____ angina

Answer 30

vasospastic/Prinzmetal

Question 31

____ is effective in reducing exertional angina but can cause reflex tachycardia; works well with BB

Answer 31

nitrates

Question 32

unstable angina tx for admitted patients (3)

Answer 32

* dual antiplatelets-- Aspirin + P2Y12 receptor antagonist (Clopidrogrel) * anticoagulant-- heparin * BB scheduled & nitrates PRN

Question 33

name the worst risk factor and also the most important modifiable risk factor for angina pectoris/stable angina

Answer 33

* DM-- worst risk factor * smoking-- most modifiable risk factor

Question 34

substernal/retrosternal chest pain/discomfort that is poorly localized, exertional, short in duration; worse w/ activity and relieved with rest or nitroglycerin

Answer 34

angina pectoris/stable angina

Question 35

3 tests used in diagnosing stable angina

Answer 35

* ECG * stress testing * coronary angiography

Question 36

most important noninvasive testing used in diagnosing stable angina

Answer 36

stress testing

Question 37

definitive diagnostic test for stable angina that defines location and extent of CAD

Answer 37

coronary angiography

Question 38

4 drugs used in secondary prevention tx regimen

Answer 38

* aspirin + BB * sublingual nitroglycerin PRN * daily statin | should also reduce risk factors like HTN, DM, smoking, diet/exercise

Question 39

definitive management of stable angina (2)

Answer 39

* percutaneous transluminal coronary angioplasty (PCTA) * coronary artery bypass graft | both are "revascularization"

Question 40

# angina pectoris which revascularization procedure is used with 1 or 2 vessel dz in non-DM not invoving left main coronary artery & w/ normal ejection fraction

Answer 40

PTCA

Question 41

which revascularization is used with left main coronary artery stenosis, 3 vessel dz or w/ 2 for DM, ejection fraction < 40%

Answer 41

coronary artery bypass graft

Question 42

when can you give morphine IV in patient w/ MI

Answer 42

when pain isnt responding to nitro

Question 43

pt w/ MI but w/o shock, pulmonary congestion or bradycardia should get what adjuctive tx?

Answer 43

IV BB

Question 44

pt w/ MI + bradycardia complications involving AV and sinus node should get what ?

Answer 44

atropine

Question 45

early complications of MI (5)

Answer 45

* v. fib * ventricular aneurysm * cardiogenic shock * heart failure * LV wall rupture

Question 46

____ reduces angina but does not reduce mortality in stable patients compared to medical manage; does not lower long term risk for subsequent MI

Answer 46

PCI (PTCA)

Question 47

**best **w/in 3hrs of sx onset & superior to thrombolytics in tx of STEMI

Answer 47

PCI (PCTA)

Question 48

reperfusion via PCI or thrombolytics is best done w/in ____ of sx onset or if ongoing chest pain

Answer 48

12 hrs

Question 49

used when theres > 120 min delay from FMC to primary PCI or if PCI is not an option

Answer 49

fibrinolytic therapy

Question 50

what is the difference between antithrombotics and thrombolytics (fibrinolytics)

Answer 50

* antithrombotics prevent new clots, the other dissolves them

Question 51

Spontaneous episodes of angina accompanied by transient ECG ischemic ST changes d/t epicardial coronary artery vasospasm, leading to transient myocardial ischemia

Answer 51

vasospastic/prinzmetals angina

Question 52

**coronary artery vasospasm** causing ST segment elevation & transmural ischemia; **endothelial dysfunction **

Answer 52

pathophys of vasospastic angina

Question 53

name 3 triggers of vasospastic angina

Answer 53

* cold weather * alpha-agonists * hyperventilation

Question 54

Chest pain mainly at rest usually not triggered by exertion nor relieved with rest in younger patient w/ few or no CV risk factors; episodes last 5-15mins

Answer 54

vasospastic angina

Question 55

# likely condition? * ECG shows **Transient ST elevations** in pattern of affected artery that resolve w/ sx resolution * Angiography r/o CAD & has **no evidence of high grade stenosis**

Answer 55

vasospastic angina

Question 56

# this is used to treat what? * no smoking * CCB * SL nitroglycerin PRN

Answer 56

vasospastic angina