Unrein Flashcards
Various etiologies of IHD
o Atherosclerosis: western diets and lack of exercise
o Hyperthyroidism
o Anemia: decreased oxygen carry capacity
o Emotional stress: catecholamines and increased HR
o Variant angina: Prinzmetal’s - vasospasm in etiology, associated with other vasospastic phenomena, usually more common in females
RFs for IHD.
Which is the best to stop to improve overall health?
What is the most powerful modifiable risk factor for IHD?
- Increasing age
- Male
- Smoking ** best thing to stop to improve health
- Hypertension
- Diabetes
- High cholesterol/Dyslipidemia ***the most powerful modifiable risk factor for iIHD
- Family history
- Male
What is hsCRP useful for? What risk score does it influence?
Useful in assessing patients with intermediate Framingham risk scores, reclassifies up to 30% into either low or high risk
Reynolds Risk Score 2 → Sex specific tool that accounts for family history and high sensitivity C-reactive protein → he recommends this one
What is tako-tsubo CM caused by? Is it reversible?
Depression, anxiety, anger
Is reversible
What is the CIRT trial
a trial that started about a year ago to see whether the common anti-inflammatory drug low-dose methotrexate (LDM, target dose of 15 to 20 mg po weekly) will reduce rates of recurrent myocardial infarction, stroke, or cardiovascular death among patients with established coronary artery disease and either type 2 diabetes or metabolic syndrome
• Determine whether LDM will reduce the rate of new onset type 2 diabetes among those with metabolic syndrome at study entry
***not sure if this is important, but he said RVU is participating…
Serum markers for IHD. Which is “too” sensitive?
o CPK – MM, MB, BB
o Troponin → can leak with angina, but will not have CPK MB fraction, troponin might be too sensitive
o LDH (1-5)
3 kinds of stress tests? When do you do each?
- Exercise stress test → Patients need to be stable as these are provocative tests.
- Pharmacological → Induce stress on heart via drugs. Do this if a patient just cannot do normal
- Imaging augmentation w/ nuclear and/or echo (do this when EKG is un-interpretable)
Gold standard for Dx’ing IHD?
• Angiography → gold standard → low dose radiation, squirt into left main and into right coronary
How is a CT determined coronary artery Ca score useful?
Maybe useful for patient with an intermediate risk for CAD, calcium helps if you see it to test more things, but does not give functional data and is not that useful.
Stable vs Unstable Angina vs MI
Unstable Angina –> Non-ST-elevation
- New onset
- At rest
- Crescendo
MI – ST-elevation MI
Stratified based upon ECG and serum biomarkers (troponin and creatine kinase – CPK)
Come back to this ???
Typical Features of CP. What does this determine?
o Central substernal pain/discomfort – usually retrosternal +/- radiation to shoulder, arms, jaw or back. May be Visceral, which is assx w/ nausea, vomiting, diaphoresis and/or shortness of breath
o Exertional – Brought on or increased with activity/emotional stress
o Relieved by nitrates or rest
What is Baye’s Theorem? What do you do for the different risk classes?
A chart that tells you based on # of typical Sxs vs age & genger, how high their risk is, and how much of a workup you need to do
- Low probability – no further work up
- Intermediate + Normal EKG – stress test
- Intermediate + Abnormal EKG – stress test w/ possible imaging augmentation, treatment based upon findings
- High probability – medical therapy and coronary angiography, treatment based upon findings
When might you see atypical (silent) IHD (does not present with any of the classic clinical features)?
Woman, diabetics, elderly
atypical Sxs = Shortness of breath, palpitations, dizziness, and syncope
TIMI trial risk scores
Similar idea - it’s for risk stratification - but he calls these “narrow”
What are some mimickers of acute coronary syndromes? What are some key findings for each?
Recent med use may mimik
Aortic dissection - Widened mediastinum on CXR
PE - New onset of Atrial fibrillation
CHF – SOB, orthopnea
