(Nisha) Cardiology p 55-63

Question 1

CAD is also known as

Answer 1

atherosclerotic heart disease or ischemic heart disease

Question 2

Chest pain can be of two etiologies

Answer 2

Cardiac or GI

Question 3

Protective effect of menstruation and estrogen wears off at what age?

Answer 3

After 55-60

Question 4

Do more women or men die of heart disease ?

Answer 4

Women

Question 5

Name some risk factors for CAD

Answer 5

DM, Tobacco smoking, HTN, hyperlipidemia, family history of premature CAD, age above 45 in men and 55 in women

Question 6

What is the worst risk factor for CAD?

Answer 6

DM

Question 7

What is the most common risk factor for CAD?

Answer 7

HTN

Question 8

Premature coronary artery disease is defined as being in a family member who is men age < _____ and women age < _____

Answer 8

55,65

Question 9

What portion of a lipid profile is most dangerous risk factor for CAD ?
Elevated TG, elevated total cholesterol, decreased HDL, elevated LDL, obesity

Answer 9

Elevated LDL

Question 10

Tako Tsubo cardiomyopathy is acute myocardial damage that occurs in _______ women after an overwhelming, emotionally stressful event.

Answer 10

Postmenopausal. Examples of stressful events - divorce, financial issues, earthquake lightning strike, and hypoglycemia

Question 11

Ballooning and left ventricular dyskinesis ?

Answer 11

Tako Tsubo Cardiomyopathy

Question 12

How do you treat Tako Tsubo cardiomyopathy ?

Answer 12

Beta blockers, ACE inhibitors

Question 13

Correcting which of the following risk factors for CAD will result in the most immediate benefit for the patient?

a. DM
b. Tobacco smoking
c. HTN
d. Hyperlipidemia
e. Weight loss

Answer 13

Tobacco smoking. Within a year after stopping smoking, risk of CAD decreases by 50%. Within 2 years, risk is reduced by 90%

Question 14

Describe ischemic pain

Answer 14

Dull or sore, Squeezing or pressure like

Question 15

Ischemic pain is not tender, positional and pleuritic (respiration). True or false?

Answer 15

True. If pain is described using these 3, do not answer ischemia or CAD

Question 16

Most common cause of chest pain that is not ischemic in nature is ?

Answer 16

GI disorders

Question 17

Ischemic pain duration? Stable angina vs ACS?

Answer 17

Stable angina - 2-10 min

ACS - 10-30 min

Question 18

Provoking factors of ischemic pain?

Answer 18

Physical activity, cold, emotional stress

Question 19

Symptoms associated with ischemic pain?

Answer 19

SOB, nausea, diaphoresis, dizziness, lightheadedness, fatigue

Question 20

Quality of ischemic pain?

Answer 20

Squeezing, tightness, heaviness, pressure, burning, aching.

NEVER - sharp, pins, stabbing, knifelike

Question 21

Location of ischemic pain?

Answer 21

Substernal

Question 22

Alleviating factors for Ischemic pain ?

Answer 22

Rest

Question 23

Radiation for Ischemic pain?

Answer 23

Neck, lower jaw and teeth, arms and shoulders

Question 24

Chest wall tenderness ? DX and test?

Answer 24

Costochondritis, PE

Question 25

Radiation to back, Unequal pressure between arms ? DX and test?

Answer 25

Aortic dissection, Chest x-ray with widened mediastinum, chest CT, MRI, or TEE confirms the diagnosis

Question 26

Pain worse with lying, flat, better when sitting up, young ? DX and test ?

Answer 26

Pericarditis. ECG with ST elevation everywhere, PR depression

Question 27

Epigastric discomfort, pain better when eating ? DX and test ?

Answer 27

Duodenal ulcer disease, Endoscopy

Question 28

Bad taste, cough, hoarseness ? DX and test ?

Answer 28

GERD, Response to PPI

Question 29

Cough, sputum, hemoptysis ? Dx and test ?

Answer 29

Pneumonia, Chest x-ray, CTA

Question 30

Sudden onset SOB, tachycardia, hypoxia ? Dx and test?

Answer 30

Pulmonary embolism, Spirat CT, V/Q scan

Question 31

Sharp, pleuritic pain, tracheal deviation ? Dx and test ?

Answer 31

Pneumothorax, Chest X-ray

Question 32

best initial test for chest pain?

Answer 32

ECG

Question 33

In an emergency setting, what do you order after ECG?

Answer 33

Cardiac enzymes (CK-MB, troponin)

Question 34

If etiology is not clear and EKG is not diagnostic, what test should you order?

Answer 34

Exercise tolerance testing, based on 2 factors - you can read the EKG and the patient can exercise

Question 35

How do you calculate the maximum heart rate?

Answer 35

220 - (age of patient)

Question 36

How do you detect ischemia on EKG?

Answer 36

ST segment depression

Question 37

How can you detect ischemia without the use of EKG?

Answer 37

Nuclear isotope uptake (thallium or sestamibi)

Echocardioagraphic detection of wall motion abnormalities

Question 38

How can you detect abnormalities with thallium uptake?

Answer 38

Decreased thallium uptake in abnormalities

Question 39

How can you differentiate between ischemia and infarction with thallium uptake?

Answer 39

In ischemia, you have decreased thallium uptake and decreased wall motion that will return to normal after a period of rest

Question 40

What if the patient cannot exercise ?

Answer 40

Persantine (dipyridomole) or adenosine in combination with nuclear isotopes such as thallium and sestamibi

Dobutamine + echo

Question 41

Dypridamole side effect?

Answer 41

Bronchospasm. avoid in asthmatics

coronary steal syndrome