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CVM Exam 2 COPY > Lecture 8: Coronary Artery Disease: Angina - Stable/Unstable > Flashcards

Lecture 8: Coronary Artery Disease: Angina - Stable/Unstable Flashcards

1
Q

Which leads can you best see an anterior wall infarction (LAD) in?

A

V1-V7

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2
Q

An inferior wall infarction is associated with what artery and which leads will show you this best?

A
  • RCA
  • Leads II, III, and aVF
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3
Q

Which artery is involved in RV infarction and which leads will show this best?

A
  • RCA
  • V3R-V6R
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4
Q

Which artery is involved in lateral wall infarction and which leads will this be seen in best?

A
  • Circumflex artery
  • Leads I, aVL + V5-V6
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5
Q

Which artery is involved in posterior wall infarction and will be best seen in which leads?

A
  • Posterior descending artery
  • V1-V3
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6
Q

LVH due to AS, anemia, emotion, stress, fever, and thyrotoxicosis can all contribute to what type of angina (supply/demand)?

A

Demand Angina

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7
Q

What are 3 biochemial consequences of ischemia?

A
  • Fatty acids can’t be oxidized
  • ↑ lactate production
  • Reduced pH w/ metabolic acidosis
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8
Q

What are some of the ECG abnormalities seen with ischemia; what is ischemia is subendocardial or subepicardial?

A
  • Inversion of T wave
  • Transient displacement of ST segment
  • Depression = subendocardial
  • Elevation = subepicardial
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9
Q

Pt presenting with chest pain that seems like an MI has an S3 gallop, what is the S3?

A

May be “impending” LV dysfunction leading to HF

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10
Q

Why might you hear a murmur representing MR in a patient who presents to the ED with what seems to be an MI?

A

Dysfunction of the papillary m. during the chest pain led to MR

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11
Q

List 5 CV causes of Chest Pain

A
  • Ischemic HD (angina, UA, ACS, MI)
  • Valvular HD
  • Pericarditis
  • Myocarditis
  • Cardiomyopathies
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12
Q

List some of the non-cardiac causes of chest pain?

A
  • Pleuritis/Pneumonia/PE/Pulmonary infarction/Pneumothorax
  • GI —> GERD, PUD, gallstones, esophageal motility disorders
  • Chest wall syndromes
  • Lung cancer
  • Aortic aneursym
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13
Q

List some of the non chest pain sx’s of chronic ischemic heart disease?

A
  • Dyspnea
  • Mid-epigastric or abdominal pain
  • Diaphoresis
  • Excessive fatigue and weakness
  • Dizziness and syncope
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14
Q

Systolic murmur or MR due to papillary muscle dysfunction is associated with ischemia in which location and due to what artery?

A
  • Inferior or inferior-posterior ischemia
  • Due to RCA
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15
Q

List 5 cardiac dysfunctions which can all mimic angina in the absence of CAD

A
  • Aortic stenosis
  • Aortic insufficiency
  • Pulmonary HTN
  • Hypertrophic Cardiomyopathy
  • Heart Failure
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16
Q

Chest pain with elevation of cardiac enzymes (troponin I or CK-MB) and without ST elevation is known as?

A

NSTEMI

17
Q

In unstable angina/NSTE ACS the magnitude of what correlates with prognosis?

A

ST segment depression

18
Q

Stress cardiomyopathy (Takotsubo syndrome) will have what ECG change and have a similar presentation to what?

A
  • Deeply inverted T wave
  • Similar presentation to NSTE ACS
19
Q

Increase in which labratory marker is associated with an increased mortality in NSTE ACS?

A

BNP

20
Q

During stress testing for atherosclerotic CAD what are 5 signs associated with a high risk for coronary event?

A
  1. Positive stress test at low work load
  2. ST depression >5 mins after completing test
  3. Decrease in BP - syst. fall >10 mmHg during exercise
  4. Ventricular tachycardia during exercise
  5. Reduced EF during exercise (stress echo)
21
Q

Which type of stress test is preferred if patient is suspected to have angina and is also very safe?

A

Exercise electrocardiography

22
Q

If patient is unable to exercise/abnormal LBBB on ECG or LVH; what stress test should be used?

A

Pharmacologic Stress Test

23
Q

What is used in the pharmacologic stress test?

A
  • Adenosine /regadenosine
  • Vasodilators –> ↑ HR
  • Dobutamine –> ↑ HR
24
Q

In which 3 conditions is using nuclear myocardial perfusion imaging (SPECT) during a stress test most useful?

A
  • LBBB
  • LVH
  • Digitalis effect
25
Q

Using a stress echocardiogram is particularly useful in detecting which abnormalities?

A

Detect wall motion abnormality and ejection fraction (EF)

26
Q

Why may the ability to quantify lesion severity be limited using cardiac computer tomographic angiography (CCTA)?

A

Coronary calcification

27
Q

What is the gold standard for anatomic definition of CAD?

A

Coronary Angiography (Cardiac Catherization)

28
Q

Which type of revascularization procedure is recommended in patient with left main disease or 3 vessel disease w/ LVEF <50%?

A

Coronary Artery Bypass Grafting (CABG)

29
Q

What are 3 contraindication for giving a beta-blocker for treatment of angina?

A
  • Decompensated HF
  • Hypotension
  • Advanced AV block
30
Q

Which pharmacologic tx for angina is very useful in diabetics (renal protection) and pt’s with LV systolic dysfunction?

A

ACEI

31
Q

Which 2 classes of drugs are shown to decrease CV mortality if given for tx of angina?

A
  • ACE-I
  • Beta-blockers
32
Q

Which procedure can be done on pt who cannot undergo CABG or only has 1-2 vessel disease?

A

Percutaneous Coronary Intervention (PCI) = stents

33
Q

What is the drug of choice for variant (prinzmetal) angina?

A

Dihydropyridine CCB (amlodipine)

CVM Exam 2 COPY (15 decks)

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