Screening for CAD, Hyperlipidemia

Question 1

stress testing w/ adjunctive imaging is needed when

Answer 1

suspected CAD who have baseline ECG abnormalities (ST depression >.5 mm, LBBB, V paced, pre-excitation digitalis effect

Question 2

when to order coronary artery calcium scoring

Answer 2

asymptomatic pts >40 yrs with intermediate ASCVD 10 yr risk (7.5-19.9%)

Question 3

when does coronary artery calcium scoring fail?

Answer 3

used as a primary preventative screening than a true diagnostic testing as will not differentiate between obstructive CAD vs stable

Question 4

for a patient who has mild hypertriglyceridemia and suboptimal total cholesterol, LDL, HDL, what do you order?

Answer 4

if they have possible hypothyroid levels, order a TSH.

Question 5

Common cause of dysplipidemia

Answer 5

hypothyroidism.

Question 6

for newly diagnosed with hyperlipidemia or dyslipidemia what test should you order?

Answer 6

TSH Also should be ordered prior to starting a statin therapy in case there is a risk for statin induced myopathy dysplipidemia from hypothyroidism improves with levothyroxine

Question 7

How does exercise EKG testing work to screen for CAD?

Answer 7

relies on increased HR and BP and works best for pts who are able to reach tHR (85% of 220-age)

Question 8

who is exercise EKG testing not for?

Answer 8

pts with: LBBB, pacemaker, or anyone unable to reach tHR

Question 9

pharmacological stress testing with adenosine or dipyridamole testing mechanism of action to see if there’s true ischemia is by: ?

Answer 9

• dilates coronary arteries without increased HR or BP

adenosine or dipyridamole chemical stress

Question 10

Who is pharmacological stress testing with adenosine and dipyridamole best for?

Answer 10

pts who have LBBB, pace maker, pts who are unable to reach tHR

Question 11

who should not get pharmacological stress testing with adenosine or dipyridamole?

Answer 11

reactive airway dx, pts on dipyridamole or theophylline

Question 12

how does dobutamine stress echocardiography work for screening for CAD?

Answer 12

it is a B1 agonist and increases your heart rate and blood pressure

Question 13

who is dobutamine echocardiography stress testing best for?

Answer 13

pts who have reactive airway disease and people who are not able to reach their total HR

Question 14

who should NOT get dobutamine echocardiography stress testing ?

Answer 14

people with tachyarrhythmias

Question 15

typical angina or classic angina is defined with

Answer 15

substernal chest pain or discomfort with exertion or stress, that is relieved with rest or nitroglycerin

Question 16

probable or atypical angina definition

Answer 16

chest pain with 2 out of 3 features (chest pain, worse with exertion or stress and relieved by rest or nitroglycerin)

Question 17

non-anginal chest pain definition

Answer 17

chest pain with one or more above features

Question 18

why do we not like paced ventricular rhythm pt doing a exercise radionucleotide imaging.

Answer 18

produced s a false positive perfusion defects on exercise radionucleoide myocardial perfusion scan

Question 19

why do we not like paced ventricular rhythm pt doing a exercise echocardiogram?

Answer 19

a paced ventricular rhythm resting echocardiogram can show a paradoxical septal motion due to early activation of the right ventricle and so these findings can be worse with exercise and cause a false positive abnormality.

Question 20

Chart showing low pretest probability for true angina

Answer 20

Question 21

Chart comparing stress test probablities

Answer 21

Question 22

Exercise EKG stress testing: findings seen with poor outcomes AKA if you see this on exercise EKG, they have CAD and need PCI or will have poor outcome!

chart

Answer 22

Question 23

how can radionucleotide myocardial perfusion imaging after a EKG stress test have a FALSE negative?

Answer 23

through balanced ischemia.

Radionucleotide scan looks at differences in uptake to make a determination of ishcemia.

Balanced ischemia means that there is coronary flow that is equally or near equally impaired. If there’s blockages diffiusely but appears that all areas had equal uptake it can create a homogenous cardiac image and create a false negative.

Question 24

what to do if EKG stress test shows ST depression in multiple leads during peak stress but NO EVIDENCE OF ISCHEMIA on radionucleotide myocardial perfusion imaging?

Answer 24

proceed with a left heart catherization to look for diffuse triple vessel disease.

The no ischemia on the radionucleotide myocardial perfusion scan have false negatives if there’s balanced ischemia or diffuse triple vessel dx.

Question 25

downfall of radionuclide myocardial perfusion scans

Answer 25

balanced ischemia that can cause false negative. Always look at the corresponding exercise stress test EKG to see if there’s sinister signs of ischemia that radionucleotide myocardial scan may have missed.

Question 26

What is the Reynold Risk Score for CAD

Answer 26

calculates the future risk for cardiovascuar events by system

looks at

Gender,

age,

blood pressure,

cholesterol, levels,

HLD cholesterol level,

family history

smoking status

CRP

parential history of MI before age 60