Non- Invasive CAD Eval

Question 1

Name the three components of typical chest pain.

Answer 1

Sub-sternal chest pain
Provoked by exertion
Relived with rest or NTG

Question 2

What’s the formula for reaching max heart rate, and what do you need to achieve on Bruce protocol.

Answer 2

220-age

>85%

Question 3

On nuclear medicine testing, what are the causes of false positive anterior and posterior perfusion defects?

Answer 3

Anterior=breast

Posterior=diaphragm

Question 4

Name the high risk results of different stressing modalities that would cause you to move to cath.

Answer 4

EKG: ST depression >1mm in stage 1 or >5 leads or >5min after rest; or >2mm any time. VT or ST elevation seen.

Physiologic: decreased blood pressure, exercise < 4METs, angina during exercise, Duke score <35%.

Radionucleotide: 1 large or 2 moderate reversible defects, transient cavity dilatation, increased lung uptake.

Question 5

Name the tests that can be used for myocardial viability in order of greatest to least sensitivity.

Answer 5

MRI, PET, rest- redistribution thallium, dobutamine stress echo.

Question 6

When is it Optional to use the coronary calcium score?

Answer 6

For risk stratification of intermediate Framingham Risk score.

Question 7

What are high-risk test results for exercise EKG?

Answer 7

ST depression > 2 mm or >1 mm in stage one.
ST depression in > five leads, Or >five minutes in recovery.
ST elevation
VT
Decreasing blood pressure during exercise
Exercise 1 large or >2 moderate reversible defects, transient cavity dilation, increased lung uptake.

Question 8

List major indications for coronary angiography.

Answer 8

CCS class 3 to 4 angina despite medical remedies.
High-risk stress test.
Uncertain diagnosis after noninvasive testing.
Systolic dysfunction with unexplained cause.
Survivor of sudden cardiac death, polymorphic VT, sustained monomorphic VT.
Suspected spasm or non-atherosclerotic cause of ischemia. (Anomalous coronary artery)

Question 9

Name important items on the pre cath checklist.

Answer 9

Document peripheral arterial exam(femoral pulses distal dorsal pedal and posterior tibial pulse; Femoral bruits).
Check CBC, PT, and creatinine; IV fluids to avoid contrast induced nephropathy. Type and cross.
NPO >6 hours
Aspirin 325 mg, clopidogrel 300 to 600 mg 2 to 6 hours prior to cath.

Question 10

When is CABG preferred over PCI?

Answer 10

1. Three vessel disease
2. Left main disease
3. Two vessel disease with critical proximal LAD.
4. systolic heart failure with evidence of viable myocardium.

Question 11

When is PCI comparable to CABG?

Answer 11

In patients with out three vessel disease, without diabetes mellitus, and normal ejection fraction.

Question 12

When is optimal medical management preferred for angina?

Answer 12

Stable coronary artery disease without critical anatomy and without decreased EF.

Question 13

When is PCI preferred over CABG?

Answer 13

1. limited number of discrete lesions
2. Normal ejection fraction.
3. No diabetes mellitus.
4. Poor operative candidate.

Question 14

When is CABG preferred over PCI?

Answer 14

1. Extensive or diffuse disease.
2. Decreased ejection fraction
3. diabetes mellitus
4. concomitant valvular heart disease.