Nov23 M2-Ischemic Heart Disease

Question 1

IHD def and most common cause

Answer 1

imbalance of O2 + nutrients supply and demand to myocardium.

often bc CAD

Question 2

3 presentations of IHD

Answer 2

angina pectors (stable, unstable, variant), silent ischemia, MI

Question 3

stable angina def

Answer 3

symptoms at specific exercise level, relieved at rest

Question 4

stable angina cause

Answer 4

stable plaque, dev over yrs, 70% + narrowing

Question 5

unstable angina def

Answer 5

increase in tempo and duration of episodes + with less exertion

Question 6

unstable angina cause

Answer 6

plaque rupture, plt aggreg, thrombus. still ischemia only

Question 7

variant angina cause + differences with stable unstable

Answer 7

coronary vasospasm. diff: this one has coronary elevation + can have infarction

Question 8

silent ischemia: who

Answer 8

diabetic patients (nociceptors damaged), women, elderly

Question 9

acute MI def + cause

Answer 9

region of myocardial necrosis. bc of acute thrombosis

Question 10

Levine sign

Answer 10

grab chest

Question 11

quality of angina: what it is and what it’s not

Answer 11

is: discomfort

is not: stabbing, sharp, pleuritic, worsened by palpation or mvmt

Question 12

angina accompanying symptoms

Answer 12

dyspnea mainly, also tac, sweat, nausea

Question 13

angina phys exam

Answer 13

earlobe crease, carotid or femoral bruits

Question 14

angina diagnostic studies

Answer 14

ECG, stress test (EST)

Question 15

ischemia on ECG (stable, unstable angina, subendocardial ischemia)

Answer 15

ST depression, T wave inversion

Question 16

transmural ischemia on ECG

Answer 16

ST elevation

Question 17

stress test def

Answer 17

record ECG and BP during exercise

Question 18

EST 2 results

Answer 18

can be clinically positive (reproduces symptoms) and electrically positive (see ECG)

Question 19

acute coronary syndrome def

Answer 19

plaque rupture

Question 20

goals of IHD treatment

Answer 20

prevent ACS, less anginal attacks, address risk factors, prolong survival

Question 21

medication in IHD

Answer 21

nitrates, beta blockers, calcium channel blockers

Question 22

tachyphylaxis of nitrates def

Answer 22

means need a drug free period otherwise (continuous admin) effectiveness drops

Question 23

nitrates effect on mortality

Answer 23

none

Question 24

beta blockers in angina why

Answer 24

reduce HR and contractility so reduce myocardium O2 demand

Question 25

beta blocker effect on disease in IHD

Answer 25

reduce rate of reccurent infarction and reduce mortality after acute MI

Question 26

calcium channel blockers in IHD what type and action

Answer 26

dihydropyridines (end in dipine) vasodilators, reduce preload so reduce wall stress, coronary dilation: increases their blood supply

Question 27

CCBs: non DHP use

Answer 27

reduce HR: reduce myocardial O2 demand

Question 28

what to prevent acute cardiac events (ACS)

Answer 28

ASA (continuously): reduce risk of ACS. or clopidogrel if allergic

Question 29

statins when to use and effect on disease

Answer 29

if had CAD. lower MI rates and mortality

Question 30

ACE inhibitors when and effect on disease

Answer 30

reduce mortality, MI, and CVA (stroke) rates

Question 31

revascularization when

Answer 31

no response of angina to treatment, side effects too bad, or when could improve survival

Question 32

revasc 2 methods

Answer 32

PCI + stent (also PTCA), CABG

Question 33

stents effect on disease

Answer 33

reduce restenosis rates

Question 34

drug-eluting stents diff with usual stent

Answer 34

has anti prolif medication. decrease restenosis rate by 50%

Question 35

CABG: arterial vs venous graft

Answer 35

saphenous vein in leg or internal mammary

Question 36

which CABG better and why

Answer 36

mammary artery graft, more resistant to ats

Question 37

most important angina meds

Answer 37

statin, beta blocker, ACEi, ASA