Ischemic Heart Disease II

Question 1

resting ECG findings for CAD?

Answer 1

1. ST segment changes (usu. depression)
2. T wave inversion
3. Q waves (prior infarct)

Question 2

DX?

1. ST segment changes (usu. depression)
2. T wave inversion
3. Q waves (prior infarct)

Answer 2

CAD (resting ECG findings)

Question 3

exercise ECG (stress test) findings for CAD?

Answer 3

dynamic ST changes (depression)

Question 4

DX?

ST depression

Answer 4

subendocardial ischemia

Question 5

DX and TX for below case?
• 80 year old man, hypertensive, slightly elevated LDL and low HDL cholesterol, non-smoker, not diabetic
• Chest tightness and shortness of breath walking up a
grade, relieved by rest
• No symptoms at rest; stable pattern of symptoms for 6
months
• Physical exam: BP 155/95, P 85, 4th heart sound, carotid artery bruit
• Diagnostic testing: resting ECG, stress ECG with
perfusion imaging

Answer 5

Stable angina
• Anti-anginal agents (nitrates, beta blockers)
• Control of blood pressure with anti-hypertensives
• Lipid-lowering medication (statin)
• Anti-platelet therapy (aspirin)
• If symptoms not relieved, he may need further invasive diagnosis/treatment with coronary angiography

Question 6

If ratio of distal coronary/aortic pressure is _____, the stenosis is significant.

Answer 6

<0.75

Question 7

If ratio of distal coronary/aortic pressure <0.75, _____.

Answer 7

the stenosis is significant

Question 8

General tx plan for CAD?

Answer 8

1. modify risk factors
2. drugs for angina, BP, lipids, platelets
3. revascularization

Question 9

What are the lipid modifying agents?

Answer 9

statins

Question 10

Name 2 anti-platelet meds.

Answer 10

1. aspirin

2. clopidogrel

Question 11

Name 3 anti-angina drugs.

Answer 11

1. nitrates
2. beta-blockers
3. Ca++ channel blockers

Question 12

DX and TX?
• 63 year old rancher; physically active
• 2 week history of chest discomfort, occurring with
minimal activity, accompanied by shortness of breath
• 2 nights ago he awoke from sleep with chest discomfort; and on day of admission he had episodes of chest pain that occurred at rest on and off, and was finally relieved by nitroglycerin in the emergency room
• History of hypertension, smoker, elevated cholesterol
• Exam: Comfortable and and pain-free after nitroglycerin;
BP 160/93, pulse 95, premature beats, crackles over lung
bases, 4th heart sound
• Diagnostic testing: resting ECG, coronary angiography

Answer 12

unstable angina;

• Intravenous nitroglycerin
• Beta blockers
• Aspirin and other anti-platelet agents
• Anticoagulation (heparin)
• Usually early catheterization and coronary intervention

Question 13

Dx and Tx for case below?
• 59 year old man, long-standing diabetes, difficult to control HTN, mild hypercholesterolemia; no prior history of CAD
• Abrupt onset of crushing substernal chest pain, diaphoresis, dyspnea, nausea and vomiting
• Exam: clutching chest, diaphoretic, elevated neck veins, rales
• Diagnostic tests: resting ECG, coronary angio

Answer 13

Acute MI

• Immediate aspirin, nitroglycerin, ± beta blocker
• Reperfusion therapy ASAP: Usually coronary
angioplasty, if unavailable thrombolytic therapy.

Question 14

Where do the coronary artery grafts come from?

Answer 14

– Internal mammary artery

– Saphenous vein