Lecture 8 Chronic Ischemia Heart Disease Flashcards
Family history is a risk factor for CAD but only in a ____ ____ relative
first degree
modifiable risk factors of CAD
diabetes, HTN, hyperlipidemia, smoking
A ____ HDL or a ______ triglyceride count increases the risk of CAD
low, high
The most common manifestation of CAD is what
chronic stable angina
In diabetics and the elderly, CAD often presents as ____
silent ischemia
what heart sound is often seen during periods of ischemia with CAD
S4
In classic angina pectoris, the pain is ____ and _____ and is often accompanied by _____, _____, nausea, and light headedness
diffuse, subternal;
dyspnea, diaphoresis
Angina pectoris is provoked by ____, ____, or working in ____ temperatures
exercise, stress, cold
What releives angina pectoris?
rest or nitroglycerin
Classic distribution of angina
substernal chest, radiating down left arm and possible to the jaw
_____ angina or postprandial angina may indicate critical disease because it is occurring during periods of low metabolic demand
nocturnal
pain from pericarditis is described as _____ duration, sharp, positional, and worse with _____
variable; inspiration
pain from aortic dissection is described as excruciating, _____, and radiating to the _____. Make sure to check what?
ripping, back;
pulses in both arms
ischemia occurs when there is an increase in _____ and a decrease in _____
demand, supply
most common finding on resting ECG of a patient with angina?
what suggests previous infarction?
non-specific ST changes;
abnormal Q waves
likelihood of CAD is a function of ____ and ____
age, symptoms
stress tests such be used in patients with a pretest probability of _____
50% (ie, not too low or too high, or results aren’t useful)
what 2 pharmaceuticals can be used as a substitute for exercise in a stress test?
dobutamine, vasodilators
Patients only develop ischemia at greater than ____ Stenosis due to _____ ____
60%; reactive hyperemia
Duration of ischemia and symptoms (from early signs to late):
____ dysfunction, _____ dysfunction, decreased _____, _____, _____
diastolic, systolic, filling, ST depression, angina
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
positive, females;
abnormal resting;
negative
What is the target heart rate in exercise stress testing?
85% of predicted max (220-age)
_____ ____ on ECG is diagnostic for ischemia.
ST depression
more is worse
Stress ECG is more sensitive in patients with ____ _____ involved
more arteries
ie 3 coronary vessels involved = more sensitive
less than ____ mets is considered poor functional cpaacity –> increased risk of MI
6
3 indications for stress imaging:
unable to exercise, abnormal baseline ECG, known CAD
dobutamine causes an increase in ____ and _____
HR, contractility
regadenoson/adenosine/dipyridamole cause coronary ____ in normal segments. diseased segments are unable to _____ –> relative _____
vasodilation;
dilate, hypoperfusion
Normally, coronary blood vessels _____ in response to exercise or stress
vasodilate
____ imaging should be used in obese patients rather than Echo
nuclear
PCI is indicated only in patients with greater than ____ ischemia
20%;
else, can cause an increase in mortality
