week 1 required learning objectives

Question 1

What causes coronary artery disease (CAD)?

Answer 1

Endothelial damage leading to inflammation and lipid deposition, resulting in vessel narrowing.

Question 2

What happens when coronary artery narrowing exceeds 70%?

Answer 2

It can cause ischemic pain, especially during increased oxygen demand (angina).

Question 3

How does acute myocardial infarction (MI) occur in acute coronary syndrome (ACS)?

Answer 3

Due to plaque rupture or endothelial erosion.

Question 4

Why are new plaques with thinner caps more prone to rupture?

Answer 4

They are more prone to rupture, often causing acute events in less stenotic arteries (<50% narrowing).

Question 5

What are the two types of clots formed in ACS and their characteristics?

Answer 5

Platelet-rich (white clots) or fibrin-rich (red clots), leading to partial or complete occlusion, respectively.

Question 6

List three risk factors for coronary artery disease.

Answer 6

Diabetes Mellitus (DM), Hypercholesterolemia, Hypertension (HTN).

Question 7

What are other risk factors for coronary artery disease?

Answer 7

Tobacco use, Family history, Increased age, Male sex, Peripheral arterial disease (PAD), Renal insufficiency.

Question 8

What is the goal timing for an Electrocardiogram (EKG) in a patient with chest pain?

Answer 8

<10 minutes from presentation.

Question 9

What should be included in blood work for chest pain?

Answer 9

CBC, BMP, Magnesium and Phosphorus levels, Coagulation studies (aPTT, PT/INR), Cardiac biomarkers (preferably cardiac troponin).

Question 10

What imaging studies are recommended for a patient with chest pain?

Answer 10

Chest X-ray, and other tests as needed (e.g., urinalysis, urine drug screen, pregnancy test).

Question 11

What subjective characteristics suggest ACS?

Answer 11

Left-sided or retrosternal chest pain, shortness of breath, nausea, or syncope.

Question 12

What physical exam signs may indicate acute MI?

Answer 12

S4, paradoxical splitting of S2, or new murmurs.

Question 13

What EKG findings suggest ischemia?

Answer 13

ST-elevation, new ST-segment depression, T-wave inversion.

Question 14

What laboratory finding indicates myocardial injury?

Answer 14

Elevated cardiac troponin levels.

Question 15

How is a STEMI identified on EKG?

Answer 15

New ST-elevation at the J-point in two contiguous leads, with elevation of ≥1 mm/box (other than V2-V3).

Question 16

What are hyperacute T-waves on EKG?

Answer 16

Prominent, symmetrical T-waves in at least two contiguous leads.

Question 17

How does ST elevation change over time?

Answer 17

It becomes concave over time.

Question 18

What is reciprocal ST depression?

Answer 18

Seen in 70% of inferior and 30% of anterior infarctions.

Question 19

When do Q-waves appear on EKG?

Answer 19

Hours to days after MI, can be transient.

Question 20

How does T-wave inversion indicate ischemia?

Answer 20

Symmetric inversion suggests ischemia, while asymmetric inversion is less concerning.

Question 21

What medications are used in the treatment of NSTEMI/UA?

Answer 21

Antiplatelet therapy, anticoagulation, beta-blockers, statins, and possibly revascularization.

Question 22

What are some contraindications for these treatments?

Answer 22

Bleeding risks and existing comorbidities.

Question 23

What is the ideal timing for reperfusion therapy in STEMI?

Answer 23

Within 90 minutes of first medical contact.

Question 24

What are some contraindications for reperfusion therapy?

Answer 24

Active bleeding, history of hemorrhagic stroke, or recent major surgery.

Question 25

List cardiac causes mistaken for ACS.

Answer 25

Aortic dissection, Pericarditis, Myocarditis, Aortic stenosis, Pulmonary hypertension, Hypertrophic cardiomyopathy.

Question 26

List non-cardiac causes mistaken for ACS.

Answer 26

Pulmonary (e.g., pulmonary embolism, pneumothorax), Gastrointestinal (e.g., gastritis, GERD), Musculoskeletal (e.g., costochondritis), Psychogenic (e.g., anxiety disorders).

Question 27

What are the three main causes of CHF?

Answer 27

Coronary artery disease, Hypertension, Valvular heart disease.

Question 28

What are three exotic causes of CHF?

Answer 28

Infiltrative diseases (e.g., amyloidosis), Metabolic disorders (e.g., glycogen storage disease), Neuromuscular disease.

Question 29

What physical exam findings indicate CHF exacerbation?

Answer 29

Displaced PMI, presence of S3, JVD, lung crackles, and wheezing.

Question 30

What lab work is helpful for diagnosing CHF exacerbation?

Answer 30

Elevated BNP.

Question 31

What imaging studies are used to diagnose CHF exacerbation?

Answer 31

Chest X-ray (alveolar and interstitial pulmonary edema, cardiothoracic ratio > 0.50) and Echocardiogram.

Question 32

What factors in history might lead to CHF exacerbation?

Answer 32

Recent infections, medication noncompliance, increased salt intake, use of NSAIDs.

Question 33

What echocardiogram findings indicate CHF?

Answer 33

EF < 50%, reversed E/A ratio, valvular abnormalities (aortic stenosis/regurgitation, mitral stenosis/regurgitation).

Question 34

What is Heart Failure with Reduced Ejection Fraction (HFrEF)?

Answer 34

EF < 40%.

Question 35

What is Heart Failure with Preserved Ejection Fraction (HFpEF)?

Answer 35

EF ≥ 50%.

Question 36

What is Mid-range Ejection Fraction?

Answer 36

EF 40-49%.

Question 37

What is the acute treatment for pulmonary edema in CHF?

Answer 37

Oxygen therapy, diuretics, vasodilators, positioning (elevate head of bed).

Question 38

What are some long-term treatments for CHF?

Answer 38

ACE inhibitors or ARBs, beta-blockers, diuretics, aldosterone antagonists, lifestyle modifications.

Question 39

How does acute onset/exacerbation CHF differ from chronic CHF?

Answer 39

Acute onset has rapid symptoms; medications include IV diuretics and vasodilators. Chronic CHF has gradual onset; medications include oral diuretics, ACE inhibitors, beta-blockers.

Question 40

What lifestyle changes can help decrease CHF exacerbations?

Answer 40

Low-sodium diet, regular physical activity, smoking cessation, limiting alcohol intake, monitoring weight daily.