CAD, Angina - Johnston

Question 1

Most common cause of CAD/MI

Answer 1

Atherosclerosis

Question 2

Function of LDL in atherosclerosis

Answer 2

Helps macrophage foam cells produce cytokines that cause vessel wall inflammation

Question 3

Main way to lower LDL in hyperlipidemia/atherosclerosis

Answer 3

Statin

Question 4

A patient has MI w/o major chest pain…think what?

Answer 4

Diabetes mellitus

Question 5

Physical activity amount to recommend?

Answer 5

10-60 min. medium intensity 4-7 days per week

Question 6

2 components of angina/cardiac blood supply

Answer 6

Supply - oxygen/blood getting to heart tissue

Demand - cardiac workload, stress, emotion, LVH, etc.

Question 7

Mechanical consequences of myocardial ischemia (3)

Answer 7

• Heart failure
• Angina/M.I.
• Segmental akinesis/dyskinesis

Question 8

Biochemical consequences of myocardial ischemia (3)

Answer 8

• FA’s can’t be oxidized
• Lactate production
• Decreased pH w/ metabolic acidosis

Question 9

Electrical consequences of myocardial ischemia (2)

Answer 9

• ST segment displacement (depression or elevation)

- Arrhythmias/electrical instability (tachy, fib)

Question 10

A posterior wall infarction (transmural) will produce what change on EKG?

Answer 10

Reciprocal ST DEPRESSION in V1-V2

- No leads to directly measure posterior wall

Question 11

Non-STEMI on EKG

Answer 11

Inverted T waves WITHOUT ST elevation

Question 12

An S3 heard w/ angina or MI signifies what?

Answer 12

Impending heart failure

Question 13

During an MI/angina, a systolic murmur over the apex would most likely be what?

Answer 13

INFERIOR M.I. –> Ischemic papillary muscle –> mitral regurg.

Question 14

What are the NON-chest pain symptoms of chronic ischemic heart disease?

Answer 14

SoB, diaphoresis, fatigue, dizziness, syncope

Question 15

GI-seeming symptoms that can be suspicious for MI

Answer 15

Heart burn, indigestion, gas

Question 16

Levine’s sign

Answer 16

Clinched fist on sternum

Question 17

Anginal equivalent

Answer 17

Elderly, diabetics, women –> ischemia –> elevated LV filling –> pulmonary edema –> dyspnea, fatigue, belching, etc.

Question 18

Skin risk factors for angina/ischemic heart disease

Answer 18

• Xanthelasma (soft yellow spots on eyelids)
• Xanthomas
• Diabetic skin lesions
• Nicotine stains (tar-stained fingers)
• Pale

Question 19

4 things that can mimic angina w/o CAD

Answer 19

• Aortic stenosis
• Aortic insufficiency
• Pulmonary hypertension
• Hypertrophic cardiomyopathy

Question 20

New or worsening chest pain
More severe, prolonged, frequent
Longer than 20 minutes each time
No myocyte necrosis or cardiac enzymes

Answer 20

Unstable angina

Question 21

Chest pain
Elevated cardiac enzymes
No ST elevation

Answer 21

NSTEMI

Question 22

Inverted T waves + severe chest pain

Answer 22

M.I.

Question 23

A stable angina attack can show what on EKG?

Answer 23

ST depression (subendocardial ischemia)

Question 24

How does EKG relate to unstable angina/M.I.?

Answer 24

Lower (more) ST depression = worse prognosis

Question 25

5 signs of HIGH RISK for coronary event during stress test

Answer 25

- Positive at low work load - ST depression greater than 5 minutes after test - Hypotension during test - V. tach during test - Reduced EF during test

Question 26

Contraindications to stress testing

Answer 26

Any major cardiac issue

Question 27

Useful test for LBBB, LVH, or digitalis

Answer 27

Nuclear myocardial perfusion imaging

Question 28

Useful test for detecting wall motion abnormality and EF

Answer 28

Stress echo

Question 29

Useful test for detecting coronary calcification

Answer 29

Cardiac computer tomographic angiography

Question 30

Useful test for detecting cardiomegaly, VHD, cardiomyopathy, pericardial effusion

Answer 30

Chest X-ray

Question 31

GOLD STANDARD test for coronary artery disease

Answer 31

Coronary angiography

Question 32

A patient being considered for ___ should have coronary angiography done first

Answer 32

CABG (bypass graft)

Question 33

6 drug types found useful in preventing or reducing MIs and death after MI

Answer 33

- Aspirin - Beta blocker - ACE inhibitor - Statin - Nitrates - CCB

Question 34

When NOT to give a beta blocker?

Answer 34

- Decompensated heart failure - Hypotension - Advanced AV block

Question 35

When TO give a beta blocker?

Answer 35

- Post-MI - Ischemia - Compensated heart failure - Arrhythmia (not a block)

Question 36

When TO give an ACE inhibitor?

Answer 36

- Diabetics (renal protection) | - LV systolic dysfunction (prevent volume overload)

Question 37

When TO give nitrates?

Answer 37

Acute ischemia and angina due to vasoconstriction (Prinzmetal)

Question 38

When do you consider CABG?

Answer 38

- L main vessel disease

Question 39

When do you consider PCI? (percutaneous coronary intervention)

Answer 39

1 or 2 vessel disease

Question 40

In Prinzmetal, what are the 2 things to treat with?

Answer 40

Nitrates | Amlodipine (DHP CCB)

Question 41

Goals for hyperlipidemia treatment

Answer 41

LDL-C 60 | TG

Question 42

2 dietary things that are protective against atherosclerosis

Answer 42

- 2-4 g sodium per day max | - Reduce alcohol