CAD/MI

Question 1

Describes chest pain that radiates to the trapezius?

Answer 1

Pericarditis

Question 2

Sign where the patient uses a clenched fist to indicate squeezing central substernal discomfort in CSAP

Answer 2

Levine’s sign

Question 3

Crescendo decrescendo, lasts for 2-5mins, rarely below the umbilicus or above the mandible

Answer 3

Stable angina pectoris

Question 4

Canadian Cardiovascular Society functional classification: walking more than 2 blocks, climbing more than 1 flight of stairs at a normal pace, slight limitation of activities

Answer 4

Functional class II

Question 5

Canadian Cardiovascular Society functional classification: ordinary physical activity does not cause angina, angina with strenuous or rapid or prolonged exertion at work or recreation

Answer 5

Functional class I

Question 6

Canadian Cardiovascular Society functional classification: angina after walking 1-2 blocks on the level and climbing more than 1 flight of stairs in normal conditions?

Answer 6

Functional class III

Question 7

Canadian Cardiovascular Society functional classification: angina at rest, unable to carry out any physical activity without discomfort

Answer 7

Functional class IV

Question 8

Positive stress test:

Answer 8

Flat or down sloping depression of the ST segment >0.1mV below baseline (PR segment) lasting >0.08sec

Question 9

Negative stress test defined as target heart rate of __ is not achieved

Answer 9

85% of maximal predicted heart rate for age and sex

Question 10

Most widely used test for both the diagnosis of IHD and the estimation of risk and prognosis?

Answer 10

TMST

Question 11

Contraindications for TMST

Answer 11

Angina within the last 48 hours
Unstable rhythm
Severe AS
Acute myocarditis
CHF uncontrolled
Severe pulmonary HTN
Active IE

Question 12

Suspected IHD, can exercise adequately but with confounding features present on resting ECG, next step?

Answer 12

Imaging study should be done: 2D Echo, Cardiac MRI, Cardiac PET scan, Sestamibi scan

Question 13

Indications for coronary arteriography:

Answer 13

1. Severely symptomatic CSAP despite meds, considered for PCI, CABG
2. Diagnostic difficulties, with need to rule out IHD
3. Post cardiac arrest with angina
4. Angina + evidence of ischemia on labs and non invasive tests
5. High risk for coronary events

Question 14

Other indications of performing coronary arteriography

Answer 14

1. Suggestive angina, negative stress test
2. Admitted repeatedly in the hospital for suspected ACS
3. Careers that involve safety of others
4. HCM, AS with chest pain
5. Male >45, Female >55 pre op for valve replacement or repair
6. Post MI
7. Angina + Poor exercise capacity
8. Coronary spasm

Question 15

Typical chest pain in NSTE ACS?

Answer 15

Crescendo pattern, more severe, more frequent than previous episodes
Occurs at rest lasting for >10 mins
Onset relatively recent <2 weeks