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Cardiology: Exam > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

(59 cards)

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1
Q

What is the leading cause of death for both men and women?

A

Coronary Artery Disease

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2
Q

How many people have Coronary Artery Disease in the United States?

A

17 million

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3
Q

What is the cost of caring for patients with Coronary Artery Disease per year?

A

$150 billion

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4
Q

What are the two majors roles for endothelia cells lining the coronary arteries?

A

Regulate Vascular Tone
Prevent Intravascular Thrombosis

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5
Q

What is the order of Atherosclerotic Plaque Formation?

A
  1. Disruption of Endothelial Cell Integrity
  2. Macrophages coalesce to form fatty streak
  3. Fibrous Cap
  4. Fibrous Cap Rupture
  5. Thrombus Formation
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6
Q

When do most Acute Coronary Syndromes occur?

A

When the Fibrous Cap Ruptures

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7
Q

What determines a plaques vulnerability to rupture?

A

Plaque Characteristics
(not size)

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8
Q

Reproducible angina symptoms such as chest pain or pressure that are precipitated by exertion or emotional stress and relieved by rest or nitroglycerin.

A

Stable Angina

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9
Q

What is the fundamental problem in Stable Angina?

A

Imbalance between myocardial oxygen supply and demand.

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10
Q

What are the strongest risk factors for developing Coronary Artery Disease

A

65+
Male
Postmenopausal Females
Hyperlipidemia
Smoking
Diabetes
Obesity
Family History

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11
Q

Why are the two independent risk factors for Coronary Artery Disease?

A

65+
Diabetes

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12
Q

Chest pain that typically occurs during physical exertion and gradually resolves with exercise cessation.

A

Stable Angina

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13
Q

What symptoms can occur that increase oxygen demand and can cause Angina?

A

Anemia
Fever
Sepsis
Thyrotoxicosis

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14
Q

What patients may present with atypical symptoms of Coronary Artery Disease?

A

Women
Diabetics
Elderly

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15
Q

Can patients with stable angina still have normal EKGs?

A

Yes
(50% do)

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16
Q

What does a pathologic Q Wave represent?

A

Old MI

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17
Q

What three findings on a EKG increase the likelihood of having Coronary Artery Disease?

A

Pathologic Q
LBBB
L. Anterior Fascicular Block

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18
Q

Stress tests are most useful for diagnosing Coronary Artery Disease in what types of patients?

A

Intermediate Pretest Probability

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19
Q

What are the two types of Stress Tests?

A

Exercise
Pharmacologic

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20
Q

What medications are used during a pharmacologic stress test?

A

Dobutamine
Adenosine Agonist

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21
Q

What are the two options for Imaging?

A

Nuclear Isotope
Echocardiography

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22
Q

What nuclear isotopes are used for Nuclear Imaging?

A

Thallium-201
Technetium-99m

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23
Q

A noninvasive and quantitate assessment of coronary artery calcification?

A

Calcium Score Screen CT

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24
Q

What is a higher Coronary Artery Calcium Score associated with?

25
Can a Calcium Score Screening CT detect hard or soft plaques?
Hard Plaques
26
What is the most accurate noninvasive modality in ruling out Coronary Artery Disease with a very high negative predictive value? (Screening)
Coronary CT Angiography
27
What does a Coronary CT Angiography allow for?
Direct Coronary Artery visualization of a beating heart with little motion artifact.
28
What is considered the Gold Standard for Diagnosing CAD?
Cardiac Angiography
29
What is the First-Line Therapy for Stable Angina? (Anti-Anginal)
Beta Blockers Nitrates
30
What is the Second-Line Therapy for Stable Angina? (Anti-Anginal)
Calcium Channel Blockers
31
What are the medications to treat Stable Angina? (Anti-Thrombosis)
Aspirin Clopidogrel
32
How is hypertension in Chronic CAD?
Beta Blockers (unti HR = 55 - 60) Calcium Channel Blockers ACE-I
33
What is the goal BP in the treatment of hypertension of a patient with Chronic CAD?
< 130/80
34
What is the major indication for revascularization in chronic CAD?
Relief of Angina in patients on optimal medical management
35
Does revascularization reduce the risk of death or myocardial infarction?
No
36
What are the two components of Revascularization?
1. Percutaneous Transluminal Coronary Angioplasty (Balloon) 2. Stent Deployment
37
What is recommended for patients with extensive CAD in the LCA or 3 vessels?
CABG (Coronary Artery Bypass Grafting)
38
What pathologies fall under: Acute Coronary Syndrome
Unstable Angina NSTEMI STEMI
39
- Angina at Rest - New onset exertional angina - Preexisting angina that has increased in frequency or duration or that is now brought on with less exertion than before - Post MI angina
Unstable Angina
40
Similar to Unstable Angina but has evidence of myocardial necrosis as seen with elevated Troponin.
NSTEMI
41
ST-Segment + Elevated Cardiac Enzymes
STEMI
42
How much of the vessel is occluded with a STEMI?
100%
43
Criteria for STEMI on EKG
Greater than 1mm Limb Leads (2 or more contiguous) Rather than 2mm Precordial Leads (2 or more contiguous)
44
What type of clots are seen with STEMI?
Red Clot (Red is Dead)
45
When does Acute Coronary Syndrome occur?
1. Vulnerable Plaque Ruptures 2. Platelet activation + aggregation 3. Intracoronary Thrombus Forms
46
What test has the highest sensitivity and specificity for detecting Myocardial Infarction?
Troponin T and I (measurable within 4 hours)
47
One of the earliest enzymes released during a MI (2 - 3 hours)
Myoglobin
48
Cardiac enzyme first measurable in the bloodstream at 6 - 10 hours and peaks at 24 hours.
Creatine Phosphokinase Myocardial Band (CPK-MB)
49
Findings of abrupt, severe, and tearing chest pain that radiates to the back or abdomen. Unequal pulses and BP in the upper extremities.
Aortic Dissection
50
Findings include chest pain that may be pleuritic or is relieved by sitting up. Pericardial friction rub may be present.
Acute Pericarditis
51
Sudden onset chest pain and dyspnea. S Wave in Lead I Q Wave in Lead III T Wave Inversion Lead III S1Q3T3
Pulmonary Embolism
52
What are the Anti-Anginal medications given during: Unstable Angina + NSTEMI
Nitrates Beta Blockers Morphine
53
What are the Anti-Clot medications given during: Unstable Angina + NSTEMI
Anti-Platelets Anti-Coagulants Statins ACE-I or ARB if EF < 40% PCI
54
Do you give Thrombolytics for: Unstable Angina + NSTEMI?
NO!
55
Anti-Anginal meds for STEMI
Nitrates Beta-Blockers Morphine
56
Anti-Clot meds for STEMI
Anti-Platelets + Anti-Coagulants Statins ACE-I or ARBs if EF < 40% Thrombolytics or Revascularization
57
What is the preferred method of treating STEMI
PCI Goal = within 90 minutes Within 2 hours at the most
58
When should Thrombolytic Therapy be given for STEMI?
Within first 6 hours Can be given up to 12 hours after onset
59
Absolute contraindications of Thrombolytics for STEMI
- History of Intracranial Bleeds - Cerebral Vascular Lesion - Intracranial Malignancy - Ischemic Stroke within 3 months - Closed head or facial trauma in 3 months - Aortic Dissection - Active bleeding

Cardiology: Exam (5 decks)

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