CAD

Question 1

Left anterior descending artery

Answer 1

supplies anterior wall of both ventricles and ant 2/3 septum & ant papillary muscle

Question 2

diagonal branches

Answer 2

supply ant surface LV

Question 3

left circumflex artery

Answer 3

supplies left atrium, posterior and lateral lv ventricle

Question 4

RCA

Answer 4

supplies right atrium and right ventricle , SA and AV nodes and posterior interventricular septum

Question 5

right marginal artery

Answer 5

supplies RV

Question 6

posterior descending artery

Answer 6

supplies inferior and post walls of ventricle and post 1/3 septum including posterior papillary muscle

Question 7

dysfunctional endothelium

Answer 7

decrease in NO and prostacyclin ( relaxation doesnt occur) and contraction occurs via 5-HT and TXA2 and less inhibition of the coagulation bc of decrease in NO and prostacyclin

Question 8

metabolic syndrome

Answer 8

any of the 3: 
abdominal obesity ( men >40 in / women >35in) 
TG > 150 mg/dl
BP >= 130/85
fasting glucose >110 mg/dl 
HDL cholesterol : men < 50 mg/dl

Question 9

biomarkers of increased risk of CAD

Answer 9

elevated lipoprotein (a)
elevated homocysteine levels
elevated high sensitivity C -reactive protein

Question 10

ischemia VS angina

Answer 10

I->inadequate supply of blood and oxygen to myocardium

A-> clinical presentation of what is happening at the myocardial level - chest pain from ischemia

Question 11

critical narrowing

Answer 11

70% you have symptoms with exercise or emotional distress

90% symptoms at rest

Question 12

Stable angina

Answer 12

chronic pattern of transient angina precipitated by physical activity or emotional upset and relieved by rest within a few mins. no permanent myocardial damage

Question 13

silent ischemia

Answer 13

asymptomatic myocaradial ischemia ; detected by EKG or lab tests

Question 14

variant angina

Answer 14

typical anginal pain by occurs at rest due to coronary artery spasm- not do to plaques

Question 15

unstable angina

Answer 15

increasing frequency or duration of anginal episodes with less exertion or at rest

Question 16

MI

Answer 16

myocardial necrosis from prolonged blood loss - permanent

Question 17

EKG

Answer 17

look for signs of previous MI - Q waves

• ST- segment depression during angina
• inverted T waves during angina
• absence of EKG changes during pain suggests non-ischemia etiology

Question 18

NonTransmural (subendocardial) ischemia -ekg

Answer 18

ST segments are transiently depressed and may show T wave inversion

Question 19

transmural ischemia -ekg

Answer 19

st segments are transiently elevated ( early acute mi)

- after transmural MI -> q waves are present and permanent

Question 20

what to look for changes in - RCA, LAD, Circumflex

Answer 20

RCA-> II, III and aVF - ST depression
LAD -> V1-V4
circumflex -> V5, V6 I and aVL

Question 21

acute coronary syndromes

Answer 21

unstable angina
non- st- segment elevation ( NSTEMI) - subendocardial
St-segment elevation ( STEMI)- transmural

Question 22

stable angina

Answer 22

• > = 70% luminal narrowing of one or more coronary arteries
• EKG : baseline often normal ; ST segment depression or T wave inversion with angina
• exercise stress test
• modify risk factors, drugs - decrease MVO2
• nitrates - decrease preload , beta blockers - decrease MVO2 by decreasing contractility - calcium channel blockers - vasodilation

Question 23

prinzmetal’s or variant angina

Answer 23

pattern: angina at rest
abnormality: coronary artery spasm
EKG: transient ST -segment elevation with pain, may have AV block or vent arrhy
diagnosis: cardiac cath -> acetylcholine-> provoke acetylcholine
treatment; calcium channel blockers/ nitrates

Question 24

partially occluded thrombus

Answer 24

unstable angina or NSTEMI

Question 25

completely obstructing thrombus

Answer 25

stemi

Question 26

Unstable angina

Answer 26

- occurs at rest >10 minutes -severe of new onset ( 4-6 weeks) -crescendo pattern -unpredictable abnormality: plaque rupture with thrombus causing worsening coronary blockage EKG: same as stable - may go onto NSTEMI or STEMI unless treated

Question 27

unstable angina - diagnosis

Answer 27

crescendo ST depression and/or T wave inversion on EKG no serum biomarkers

Question 28

NSTEMI - daignosis

Answer 28

prolonged chest pain - ST depression and/or T wave inversion on EKG - positive serum markers

Question 29

STEMI- diagnosis

Answer 29

prolonged chest pain - ST elevation ( with Q waves later) - positive serum biomarkers

Question 30

cardiac biomarkers

Answer 30

``` cardiac specific troponins - reg proteins involved in actin and myosin - TnC, TnI , TNT - cardiac forms of troponin I and T -3-4 hrs after MI -peak 18-36 hours declines after 10-14 days ``` creatine kinase - myocardial specific isoenzyme - 3-8 hours after onset - peak 24 hrs - returns to normal by 48 hrs - not as sens or spec as cardiac troponins - used to detect early reinfarction

Question 31

Treatment

Answer 31

Same for all 3 : 1. rapid response time critical to limit damage. 2. correct intracoronary thrombus 3. restore balance of myocardial oxygen supply with demand different: STEMI pt need immediate reperfusion therapies die to complete occlusion of vessel - NSTEMI and UA dont anti-ischaemic, control pain ( morphine), O2, antithrombotic , adjunctive treatment ( statins, ace inhibitors)

Question 32

anti-ischemic therapy

Answer 32

b blockers, nitrates, calcium channel blockers

Question 33

antithrombotic therapy

Answer 33

antiplatelet: aspirin, clopidogrel , glycoprotein IIb. IIA inhibitors anticoagulants : low molecular weight heparin, unfractionated IV heparin, other

Question 34

STEMI ONLY TREATMENT

Answer 34

within 90 mins -> percutaneous coronary intervention | after 90 mins 0> fibrinolytic therapy ( tPA)

Question 35

STEMI and UA treatment only

Answer 35

``` risk assessment thrombolysis in MI score ( TIMI) -7 variables to predict risk) if low - conservative approach -if high -> invasive approach NO FIBRINOLYTICS ```

Question 36

complications of MI

Answer 36

``` LV dysfunction - 25% loss -> CHF 40% cardiogenic shock - recurrent ischemia - 20-30% -arrhythmias -mechanical problems: pump failure, pap muscle rupture( posterior is more vulnerable) , ventricular free wall rupture , vent septal rupture, vent aneurysm ```

Question 37

dressler syndrome

Answer 37

uncommon form of pericarditis that occurs weeks after MI - due to immune process directed at damaged myocardial tissue - fever malaise, sharp pleuritic chest pain - pericardial effusion seen - treat with aspirin or NSAIDS