12.2 A

Question 1

How is angina pectoris best described?

Answer 1

as discomfort in the chest or related areas

Question 2

Angina pectoris is typically located where?

Answer 2

retrosternal but it may radiate to jaw, neck, shoulders, back, or arms

Question 3

Angina pectoris is typically relieved with what?

Answer 3

rest or nitroglycerine

Question 4

What is stable angina pectoris?

Answer 4

there has been no change in frequency, duration, precipitating factors, etc. in the past 60 days

Question 5

More than half of those with CAD have experienced what other two issues?

Answer 5

angina pectoris and/or MI

Question 6

The mainstay of treatment for CAD is what?

Answer 6

lipid lowering therapy

Question 7

The best lipid lowering therapy for CAD is what?

Answer 7

a statin

Question 8

What are PCSK9 inhibitors?

Answer 8

a monoclonal antibody that inhbits LDL receptor degradation, thus increasing LDL extraction from the blood and lowering blood cholesterol

Question 9

What is alirocumab?

Answer 9

a PCSK9 inhibitor that reduces cholesterol

Question 10

How effective are PCSK9 inhibitors?

Answer 10

shown to significantly reduce LDL levels in one year but outcome studies are still underway

Question 11

Statins have what benefit over PCSK9 inhibitors?

Answer 11

in addition to lowering LDL, they lower triglycerides and raise HDL levels to a modest degree

Question 12

What are the effects of niacin on lipid levels?

Answer 12

lowers LDL and cholesterol while raising HDL

Question 13

What are fibrates, bile acid resins, and absorption inhibitors?

Answer 13

lipid lowering agents to be used as supplements to another lipid lowering treatment

Question 14

What are the side effects of statins?

Answer 14

• myalgia/muscle complaints most common
• potentially serious myopathy
• elevated liver function tests and the potential for hepatotoxicity

Question 15

PCSK9 inhibitors have what side effects?

Answer 15

nasopharyngitis, injection site reactions, joint pain

Question 16

Fibrates have what side effects?

Answer 16

myopathy

Question 17

Niacin has what side effects?

Answer 17

flushing and heptatoxicity

Question 18

What are the four statin benefit groups?

Answer 18

• known ASCVD
• elevated LDL
• diabetics
• adults with risk of ASCVD

Question 19

The Framingham Heart Study demonstrated what?

Answer 19

linked obesity to increased risk of heart failure

Question 20

What are the three common acute coronary syndromes?

Answer 20

unstable angina

• non-ST segment elevation MI (NSTEMI)
• ST segment elevation MI (STEMI)

Question 21

What are some possible medical therapies for CAD other than statins?

Answer 21

• aspirin
• beta blockers
• ACE inhibitors
• angiotensin receptor blockers
• thienopyridines

Question 22

How can one modify their risk of CAD?

Answer 22

• smoking cessation
• dietary modification
• exercise
• cardiac rehab
• BP control
• diabetic control

Question 23

Beta blockers are contraindicated by what?

Answer 23

asthma, severe COPD, bradycardia, advanced heart block

Question 24

Beta blockers most often have what side effect?

Answer 24

fatigue

Question 25

Clopidogrel, prasugrel, and ticagrelor are what?

Answer 25

alternatives for patients allergic to aspirin

Question 26

ACE inhibitors are particularly beneficial for what class of post-MI patients?

Answer 26

those with LV systolic dysfunction (a limited ejection fraction)

Question 27

How are ACE inhibitors disease modifying?

Answer 27

they prevent adverse cardiac remodeling

Question 28

What are the side effects of ACE inhibitors?

Answer 28

cough and more rarely, angioedema

Question 29

What is the benefit of giving nitrates? The drawback?

Answer 29

they reduce angina but are not disease modifying

Question 30

STEMIs can be treated in what two ways?

Answer 30

PCI or fibrinolysis

Question 31

NSTEMIs can be treated in what two ways?

Answer 31

conservatively with medical management or with PCI of the culprit vessel and medical management

Question 32

Fibrinolytics is indicated for what?

Answer 32

STEMIs and acute ischemic stroke

Question 33

Alteplase, reteplase, and tenecteplase are examples of what?

Answer 33

fibrinolytics

Question 34

How do fibrinolytics work?

Answer 34

by converting proenzyme plasminogen to plasmin and relieving clots

Question 35

What is the major risk of fibrinolytics?

Answer 35

intracranial bleeding

Question 36

What is the primary anticoagulant used to treat acute coronary syndromes?

Answer 36

heparin

Question 37

When is heparin given for ACS?

Answer 37

- those with high risk of embolization after STEMI | - thrombus propagation prevention with NSTEMI

Question 38

What must be done when treating someone with heparin?

Answer 38

monitor their platelet counts daily

Question 39

What is a distal protection PCI?

Answer 39

used to prevent embolic material from going downstream

Question 40

What is intracoronary thrombectomy PCI?

Answer 40

use of a catheter to suck out the thrombus

Question 41

What are some surgical options for those with CAD?

Answer 41

- coronary artery bypass grafting (CABG) | - valve repair/replacement

Question 42

CABG patches are always used to treat unstable angina or NSTEMI when what is true?

Answer 42

they have left main disease

Question 43

For multivessel CAD, the best treatment is what?

Answer 43

CABG patch

Question 44

The most common causes of heart failure are what?

Answer 44

- CAD/ischemic heart disease - hypertension - valve dysfunction

Question 45

What are the available disease modifying agents for heart failure?

Answer 45

- beta blockers - ACE inhibitors/ARBs - aldosterone antagonists - hydralazine/isosorbide dinitrate combo

Question 46

What are some symptomatic treatments available for heart failure?

Answer 46

- vasodilators - loop diuretics - nitrates - digoxin

Question 47

What is furosemide?

Answer 47

a loop diuretic used for symptomatic relief of heart failure

Question 48

What is enalapril?

Answer 48

an ACE inhibitor used to treat heart failure

Question 49

What is captopril?

Answer 49

an ACE inhibitor used to treat heart failure

Question 50

What are valsartan and candesartan?

Answer 50

angiotensin receptor blcokers

Question 51

Aldosterone blockades for heart failure are contraindicated for what?

Answer 51

those with renal disease or elevated sodium potassium because they elevate potassium

Question 52

What are loop diuretics?

Answer 52

- improve renal performance to remove excess salt and water retention - symptomatic relief of heart failure

Question 53

Bradydysrhythmias are treated with what?

Answer 53

a pacemaker

Question 54

What is a dual chamber pacemaker?

Answer 54

a pacemaker with leads in both the right atrium and ventricle

Question 55

What is cardiac resynchronization therapy?

Answer 55

- aka biventricular pacing | - intended to restore synchronous right and left ventricular conduction

Question 56

Cardiac resynchronization therapy is indicated for what patients?

Answer 56

- significant heart failure symptoms despite optimal medical therapy - ejection fraction <35% - delayed intraventricular conduction, particularly a left bundle branch block

Question 57

Where does the lead go for the left ventricle in cardiac resynchronization therapy?

Answer 57

in the coronary vein because it would pose a clotting risk if it were in the left ventricle

Question 58

ACE inhibitors affect what determinant of ventricular function?

Answer 58

afterload

Question 59

Diuretics and nitrates affect what determinant of ventricular function?

Answer 59

preload

Question 60

What are ICDs?

Answer 60

implantable cardioverter defibrillators

Question 61

What are the primary prevention indications for ICDs?

Answer 61

- persistently low ejection fraction despite medical therapy | - hypertrophic cardiomyopathy with high risk of sudden cardiac death

Question 62

ICDs are indicated for what secondary prevention following what?

Answer 62

- resuscitated sudden cardiac arrest not associated with acute MI - hemodynamically significant sustained vtach or vfib