Coronary Artery Disease

Question 1

What are symptoms of carotid stenosis?

Answer 1

Focal neurological dysfunction, including TIA, ischemic stroke, etc.

Question 1

The vast majority of strokes (80-90%) are

Answer 1

Ischemic

Question 2

The risk of ischemic stroke is highest among individuals with CAS greater than

Answer 2

80%

Question 3

Ischemic stroke involves neurological deficits that persist longer than

Answer 3

24 hours; if <24 hours - TIA

Question 4

What is the 1st line diagnostic for CAD?

Answer 4

Duplex ultrasound

Question 5

What is the most accurate diagnostic test for CAD?

Answer 5

Catheter-based angiography

Question 6

What are 2 diagnostic tests that could be used in adjunct to US?

Answer 6

MRA and CTA

Question 7

What labs should be ordered when suspecting CAD?

Answer 7

CBC (H/H), BMP or CMP (magnesium), lipid panel, coagulation studies, TSH, CRP, BNP

Question 8

Name 5 differential diagnoses for CAD

Answer 8

Carotid artery dissection, valvular heart disease (especially aortic valve stenosis), intracranial arterial stenosis, lacunar stroke, fibromuscular dysplasia

Question 9

All patients who present with amaurosis fugax, TIA, or stroke symptoms should undergo which diagnostic test?

Answer 9

Non-invasive imaging

Question 10

Non-invasive imaging is indicated for patients who present with amaurosis fugax, TIA, or stroke.. but also for patients who present with

Answer 10

Carotid bruit, or other non-specific symptoms such as dizziness

Question 11

What medical management is used in CAD?

Answer 11

Aspirin, statins, and management of HTN

Question 12

Medical management of CAD can be combined with

Answer 12

Carotid revascularization (carotid endarterectomy, CEA), carotid angioplasty, or stenting

Question 13

What is the primary cause of death for both men and women in the U.S.?

Answer 13

CHD

Question 14

Microvascular angina is also known as

Answer 14

Syndrome X

Question 15

What should be considered a working diagnosis while evaluating patients for treatable underlying causes of CAD?

Answer 15

Suspected myocardial infarction with non-obstructed coronary arteries (MINOCA)

Question 16

What diagnostic tests can be used to evaluate patients for underlying causes of CAD?

Answer 16

MRI, provocative testing, and evaluation for thrombophilia

Question 17

Rather than actual chest pressure, myocardial ischemia can also be experienced as

Answer 17

Dyspnea, indigestion, nausea, numbness in the upper extremities, and fatigue

Question 18

Microvascular angina is chest pain that is often

Answer 18

Unpredictable and occurring with rest, routine physical activity, or stressful events

Question 19

Vasospastic angina can be present with a history of

Answer 19

Spontaneous or unprovoked episodes of typical angina

Question 20

What 4 things are considered in unstable angina and non-STEMI?

Answer 20

Nature of symptoms, prior history of CAD, age >65, and number of risk factors present for CAD

Question 21

Consider the timeline of serial cardiac troponin levels

Answer 21

Rises 3-12 hours post injury, peaks at 3-4 hours, and normalizes after 14 days

Question 22

What are 2 differential diagnoses for CAD that cover integumentary and chest wall discomfort?

Answer 22

Herpes zoster and costochondritis

Question 23

What are differential diagnoses of CAD that cover pulmonary?

Answer 23

Pneumonia, pneumothorax, pulmonary embolus, pulmonary hypertension

Question 24

What are differential diagnoses of CAD that cover cardiac?

Answer 24

Aortic stenosis, aortic dissection, mitral valve prolapse, pericarditis, Takotsubo cardiomyopathy

Question 25

What are differential diagnoses of CAD that cover GI?

Answer 25

Reflux, acute cholecystitis

Question 26

What medications are used in the management of CAD?

Answer 26

Aspirin, BBs, nitrates, CCBs, ACEIs, and anticoagulants

Question 27

What medications are used for lipid management in CAD?

Answer 27

Statins and PCSK9 inhibitors

Question 28

Which gender presents more often with GI symptoms than classic chest pain in CAD?

Answer 28

Women

Question 29

Which patients should be referred to cardiology for management of CAD?

Answer 29

Patients with comorbidities

Question 30

When are angina symptoms often present?

Answer 30

Days to weeks before the onset of an acute MI

Question 31

If BBs are contraindicated for symptom relief of chronic, stable angina, what is another option?

Answer 31

CCBs

Question 32

ACEIs or ARBs should be used for patients with

Answer 32

<40% LVEF and those with DM, HTN, or CKD