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Cardiology > 31.7.2014 > Flashcards

31.7.2014 Flashcards

0
Q

Anginal symptoms result when fixed occlusion is more than

A

70%

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1
Q

Coronary artery disease

A

More than 50% occlusion of epicardial coronary arteries

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2
Q

Role of hormone replacement in CAD prevention

A

No role

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3
Q

Typical angina

A
  • sub sternal chest discomfort or heaviness with characteristic quality and duration
  • precipitated by stress
  • relieved by rest or nitroglycerine

Atypical chest pain meets only two of the criteria
Non cardiac chest pain meets one or none of the criteria

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4
Q

Grading system for angina

A

Canadian cardiovascular society classification

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5
Q

Associated symptoms of angina

A 
Dyspnea
Diaphoresis
Nausea
Vomiting
Dizziness
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6
Q

Minimal or atypical symptoms of angina are seen in

A

Women
Diabetes
CKD

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7
Q

Angina equivalents

A

Dyspnea
Nausea
Epigastric pain

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8
Q

Cardiovascular causes of chest pain

A 
Aortic stenosis
Syphilitic AR- nocturnal angina due to coronary osteal stenosis
HOCM
Prinzmetal angina
Syndrome X
Pericarditis
Aortic dissection
Cocaine use
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9
Q

Non-cardiac chest pain responsive to nitrates

A

Esophageal spasm

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10
Q

Tsetse syndrome

A

Costochondritis

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11
Q

Non cardiac causes of chest pain

A 
Anemia 
Thyrotoxicosis 
Biliary colic
Pneumonia
Costochondritis
Esophageal disease
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12
Q

Indications for cardiovascular stress testing

A

Without known CAD
Stress testing as screening in asymptomatic patients is not recommended
Pts with anginal symptoms
Asymptomatic intermediate risk patients with high risk occupations or planning intensive exercise regimen
Asymptomatic high risk patients with risk factors like diabetes or peripheral vascular disease
With known CAD
Post MI risk stratification
Preoperative risk assessment
Recurrent angina after medical therapy or revascularisation

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13
Q

Test of choice for assessing intermediate risk for CAD pts

A

Exercise stress testing

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14
Q

Protocol used in exercise stress testing

A

Bruce protocol

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15
Q

Bruce protocol

A

3 min stages of increasing treadmill speed and incline

HR,BP and ECG are monitored

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16
Q

Target Heart rate to be reached in exercise stress testing

A

85% of maximum predicted for age

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17
Q

Exercise stress testing is considered positive if

A

New ST segment depressions of more than 1mm in multiple leads
Hypotensive response to exercise
Sustained ventricular arrythmias precipitated by exercise

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18
Q

Duke treadmill score

A

Minutes exercised- 5maximum ST deviation- 4anginal score

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19
Q

Management based on duke treadmill score

A

More than 5 - medical therapy
-10 to 4 : further testing based on risk factors
Less than -10 : coronary angiography

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20
Q

Indications for stress testing with imaging

A 
Pre excitation
LVH
LBBB or paced rhythm
Intra ventricular conduction delay
Digoxin effects 
Resting ST-T wave changes
21
Q

Substances used in myocardial perfusion imaging

A

Thallium 201

Technitium 99m

22
Q

Substance used in magnetic resonance perfusion imaging

A

Adenosine

23
Q

Contraindications to stress testing

A

Acute MI in past 2 days
UA not previously stabilised by medical therapy
Cardiac arrythmias causing symptoms or hemodynamic compromise
Symptomatic severe aortic stenosis
Symptomatic heart failure
Acute pulmonary embolus,myocarditis,pericarditis,aortic dissection

24
Q

Gold standard test for evaluating coronary anatomy

A

Coronary angiography

25
Q

Limitations of coronary CT angiography

A

Radiation exposure
Requirement of HR less than 70 bpm
Presence of coronary calcification or stents

26
Q

Role of dual therapy,Aspirin+clopidogrel

A

Pts with prior MI

27
Q

Dosage of beta blockers is adjusted according to

A

Until a heart rate of 50-60 is reached

28
Q

CCB contraindicated in angina

A

Short acting dihydropyridines(nifedipine)

29
Q

Contraindications to beta blocker therapy

A

Active bronchospasm
Significant AV block
Marked resting bradycardia
Poorly compensated HF

30
Q

When should an angina patient on nitrate therapy seek prompt medical help

A

Rest pain

Pain not relieved by third dose of nitrates

31
Q

Drugs used in treatment of chronic stable angina

A 
Aspirin and clopidogrel
Beta blockers
CCB
nitrates
Ranolazine
ACE inhibitors
Intensive statin therapy
32
Q

Failure of medical therapy in angina

A

Atleast two or preferably 3 anti anginal drugs have been used

33
Q

Indications of coronary revascularisation procedures in angina patients

A

Angina refractory to medical therapy
Angina and reduced LV function
Severe activity limiting angina(class 3 and 4)
Angina in the presence of left main or triple vessel disease

34
Q

CABG in angina is preferred in

A

Diabetics with multivessel disease and LV dysfunction

35
Q

Trial that compared PCA versus CABG in untreated left main stem or triple vessel disease

A

Syntax(CABG is superior)

36
Q

Steele rule of thirds

A
  • canal of atlas is about 3 cm in its AP diameter
    - spinal cord, odontoid process, and free space for cord are each about 1 cm in diameter
    - anterior displacement of the atlas that exceeds one centimeter may jeopardize the adjacent segment of the spinal cord
37
Q

Erbs spastic paraplegia is seen in

A

Syphilis

38
Q

Graft patency in CABG

A

90% for 10 years if internal mammary artery is used

40-50% for Saphenous vein grafts

39
Q

Novel therapies for treatment of chronic stable angina

A

Transmyocardial LASER revascularisation

Therapeutic angiogenesis with VEGF or FGF

40
Q

Non selective beta blockers

A

Propranolol
Nadolol
Timolol
Pindolol

41
Q

Onset and duration of action of sublingual nitroglycerin

A

Onset: 2-5 min
Duration: 10-30 min

42
Q

Onset and duration of action of oral isosorbide dinitrate

A

Onset: 30-60 min
Duration: 4-6 hr

43
Q

Peripheral opioid receptor antagonists

A

Alvimopen

Methylnaltrexone

44
Q

Use of peripheral opioid antagonists

A

Postoperative illeus and constipation caused by opioids

45
Q

ECG criteria for STEMI

A

ST elevation of more than 0.1mV in two or more contiguous leads
New LBBB

46
Q

Diff btw STEMI and UA

A

Cardiac bio markers are elevated in NSTEMI

47
Q

ECG findings in NSTEMI

A

ST segment depression
T wave inversions
Transient ST elevation(rarely)

48
Q

Most common ACS

A

UA

49
Q

Which is common STEMI or NSTEMI?

A

NSTEMI 2/3

STEMI 1/3

50
Q

NSTEMI due to increased myocardial oxygen demand

A

Severe Anemia

Hypertensive crisis

51
Q

Atherosclerotic plaques that are prone to rupture are called

A

Vulnerable plaques(difficult to detect angiographically as they don’t cause mechanical obstruction)

Cardiology (16 decks)

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