Ischemic Heart Dz

Question 1

Plaque rupture =?

Answer 1

Unstable angina and acute blockage downstream.

Question 2

Stable angina

Answer 2

presence of a plaque but it has yet to rupture causing fleeting s/s with increased o2 demand.

Question 3

Angina Hx MUST contain these 5 things…

Answer 3

What makes it better worse... (P)
Characteristics of discomfort (Q)
Location and duration (R)
Duration (of episode and when it started) (T)
Effects of Nitro....

Question 4

FIrst-line therapy for stable angina?

Answer 4

Beta Blockers (Metoprolol)

• Decrease BP
• Decrease myocardial O2 consumption

Question 5

Ranolazine (Ranexa)

Answer 5

Used as add-on to standard therapy for refractory angina.
Does not affect BP or HR
Can lengthen QT (monitor this)
Cleared through liver

Question 6

Vasospastic Angina

Answer 6

AKA Prinzmetals, Variant.
CP w/o usual precipitating factors
ST elevation during episodes
Often young women
Awakens patients from sleep in early morning hours
Associated w/ arrhythmias and conduction defects
Cyclical pain pattern over months

Question 7

What will EKG show in vasospastic angina?

Answer 7

ST elevation, ischemia
Normal exercise tolerance
Normal coronary angiogram

Question 8

What triggers vasospasm?

Answer 8

Cold exposure
Emotional stress
Vasoconstricting meds
Cocaine, tobacco
Beta Blockers
Angiography catheter

Question 9

Associated disorders to coronary vasospasm

Answer 9

CAD
Migraine HA’s
Raynaud’s phenominon

Question 10

Which Meds can be used for vasospasm prevention?

Answer 10

Calcium channel blockers and long-acting nitrates

SL Nitro

Question 11

Are beta blockers first-line for coronary vasospasm?

Answer 11

NO. They will leave alpha one receptors unopposed aka “Alpha One Receptors Gone Wild” Leading to worsening vasospasm.

Question 12

Acute coronary syndrome

Answer 12

NSTEMI
Unstable Angina
STEMI

Question 13

Definition of MI?

Answer 13

Elevated CK-MB and/or Troponin
PLUS one of the following:
- Symptoms of ischemia
- EKG changed that indicate new ischemia
- New Q waves
- Imagine of new wall motion abnormality

Question 14

Medical therapy for unstable angina

Answer 14

Oxygen
Nitro
Morphine
Beta Blockers
Anti-platelet therapy
Anticoagulation

Question 15

NSTEMI Nitro dosage

Answer 15

1 tab or spray Q 3-5 minutes until relief of CP or 3rd dose.

IV drip if persistent pain after 3 tablets/spray

Question 16

NSTEMI Morphine Dosage

Answer 16

2 - 4 mg for CP or anxiety
repeat Q 5-15 mins
can be given with nitro

Question 17

NSTEMI Beta blockers dosage

Answer 17

Metoprolol IV if ongoing CP, HTN, tachy

Question 18

NSTEMI Aspirin dosage

Answer 18

Aspirin 325 mg chewed

Question 19

Which statin is suggested for discharge of patients with NSTEMI

Answer 19

Lipitor (Atorvastatin) 80 mg daily

Question 20

Cocaine Associated MI

Answer 20

Manage similarly to acute coronary spasm patients
Give benzodiazepimes early
DO NOT use Beta Blockers.

Question 21

FIrst line therapy for STEMI

Answer 21

Primary percutaneous coronary intervention (PCI) unless not available within 90 - 120 mins (then use fibrinolytics “drip and ship”.

Question 22

Preferred anticoagulant therapy for STEMI?

Answer 22

Unfractionated heparin or LMWH with Loading dose IV or Bivalrudin PLUS GP IIb/IIIa inhibitor

Question 23

Fibrinolytics convert _____ to ________.

Answer 23

Plasminogen to Plasmin and break down clots.