Lecture 8 Chronic Ischemia Heart Disease

Question 1

Family history is a risk factor for CAD but only in a ____ ____ relative

Answer 1

first degree

Question 2

modifiable risk factors of CAD

Answer 2

diabetes, HTN, hyperlipidemia, smoking

Question 3

A ____ HDL or a ______ triglyceride count increases the risk of CAD

Answer 3

low, high

Question 4

The most common manifestation of CAD is what

Answer 4

chronic stable angina

Question 5

In diabetics and the elderly, CAD often presents as ____

Answer 5

silent ischemia

Question 6

what heart sound is often seen during periods of ischemia with CAD

Answer 6

S4

Question 7

In classic angina pectoris, the pain is ____ and _____ and is often accompanied by _____, _____, nausea, and light headedness

Answer 7

diffuse, subternal;

dyspnea, diaphoresis

Question 8

Angina pectoris is provoked by ____, ____, or working in ____ temperatures

Answer 8

exercise, stress, cold

Question 9

What releives angina pectoris?

Answer 9

rest or nitroglycerin

Question 10

Classic distribution of angina

Answer 10

substernal chest, radiating down left arm and possible to the jaw

Question 11

_____ angina or postprandial angina may indicate critical disease because it is occurring during periods of low metabolic demand

Answer 11

nocturnal

Question 12

pain from pericarditis is described as _____ duration, sharp, positional, and worse with _____

Answer 12

variable; inspiration

Question 13

pain from aortic dissection is described as excruciating, _____, and radiating to the _____. Make sure to check what?

Answer 13

ripping, back;

pulses in both arms

Question 14

ischemia occurs when there is an increase in _____ and a decrease in _____

Answer 14

demand, supply

Question 15

most common finding on resting ECG of a patient with angina?

what suggests previous infarction?

Answer 15

non-specific ST changes;

abnormal Q waves

Question 16

likelihood of CAD is a function of ____ and ____

Answer 16

age, symptoms

Question 17

stress tests such be used in patients with a pretest probability of _____

Answer 17

50% (ie, not too low or too high, or results aren’t useful)

Question 18

what 2 pharmaceuticals can be used as a substitute for exercise in a stress test?

Answer 18

dobutamine, vasodilators

Question 19

Patients only develop ischemia at greater than ____ Stenosis due to _____ ____

Answer 19

60%; reactive hyperemia

Question 20

Duration of ischemia and symptoms (from early signs to late):
____ dysfunction, _____ dysfunction, decreased _____, _____, _____

Answer 20

diastolic, systolic, filling, ST depression, angina

Question 21

stress ECG’s have a high false _____ in ____ and are unreliable with an ____ _____ ECG. they also have a high false ____ if goal HR is not achieved

Answer 21

positive, females;
abnormal resting;

negative

Question 22

What is the target heart rate in exercise stress testing?

Answer 22

85% of predicted max (220-age)

Question 23

_____ ____ on ECG is diagnostic for ischemia.

Answer 23

ST depression

more is worse

Question 24

Stress ECG is more sensitive in patients with ____ _____ involved

Answer 24

more arteries

ie 3 coronary vessels involved = more sensitive

Question 25

less than ____ mets is considered poor functional cpaacity –> increased risk of MI

Answer 25

6

Question 26

3 indications for stress imaging:

Answer 26

unable to exercise, abnormal baseline ECG, known CAD

Question 27

dobutamine causes an increase in ____ and _____

Answer 27

HR, contractility

Question 28

regadenoson/adenosine/dipyridamole cause coronary ____ in normal segments. diseased segments are unable to _____ –> relative _____

Answer 28

vasodilation;

dilate, hypoperfusion

Question 29

Normally, coronary blood vessels _____ in response to exercise or stress

Answer 29

vasodilate

Question 30

____ imaging should be used in obese patients rather than Echo

Answer 30

nuclear

Question 31

PCI is indicated only in patients with greater than ____ ischemia

Answer 31

20%;

else, can cause an increase in mortality