ischemic heart disease, angina, MI

Question 1

ischemic heart disease

Answer 1

coronary blood demand exceeds coronary blood flow

myocardial metabolism is aerobic

Question 2

etiologies of IHD

Answer 2

atherosclerosis
hyperthyroidism
anemia
emotional stress
variant angina

Question 3

ischemic equivalents/associated symptoms

Answer 3

SOB
diaphoresis
nausea/vomiting
dizziness
weakness

Question 4

framingham

Answer 4

1948
5000+ M and F, 30-62
return every 2 years
second generation in 1971
third gneration in 2002
omni chohorts in 1994

Question 5

low risk

Answer 5

<10% 10-year framingham risk

monitor

Question 6

intermediate risk

Answer 6

10-20% 10 yr framingham risk

further evaluation- EKG, stress test

Question 7

high risk

Answer 7

> 20% 10 yr framingham risk

aggressive risk modification

Question 8

metabolic syndrome

Answer 8

insulin resistance
hyperglycemia
HTN
elevated triglycerides
low HDL
obesity
doubles risk for CV disease

Question 9

conditional risk factors

Answer 9

homocystein
Lp(a)
hsCRP
LDL particle size

Question 10

conditional preventions

Answer 10

antioxidant therapies

omege-3-FAs

Question 11

Lp(a)

Answer 11

resembles LDL w/added glycoprotein
few pharmacological agents lower Lp(a)
no research has demonstrated efficacy in CV risk reduction by lowering Lp(a)

Question 12

hsCRP

Answer 12

high sensitivity C-reactive protein

useful in assessing patients w/intermediate framingham risk scores, reclassifies up to 30% into either low or high risk

Question 13

reduction of risk

Answer 13

aspirn
reduction of BP
reduction of hyperlipemia
smoking cessation
regular exercise
weight reduction and reduction of BMI (<25)
reduction of psychological stresses

Question 14

HRmax

Answer 14

220-age

Question 15

pharmacological stress tests

Answer 15

dobutamine- increase cardiac stress and O2 demand

adenosine/dipyridmole- vasodilate

Question 16

TIMI trial risk indicators

Answer 16

age >= 65
>= 3 traditional cadiac rsik factors
documented CAD w/ >=50% stenosis
ST segment abnormalities
>=2 anginal episodes in last 24hrs
used aspirin in last week
elevated cardiac enzymes

Question 17

TIMI trial risk 0-1

Answer 17

low risk- medical therapy and stress test to evaluate therapy, if stress test abnormal - angiography

Question 18

TIMI trial risk 3-4

Answer 18

intermediate risk- medical therapy and early angiography

Question 19

TIMI trial risk 5-7

Answer 19

high risk

medical therapy and immediate angiography

Question 20

aortic dissection

Answer 20

widened mediastinum on chest x-ray

Question 21

PE

Answer 21

new onset of A fib

Question 22

CHF

Answer 22

orthopnea

SOB

Question 23

timing of thrombolytic therapy

Answer 23

less then 90min

most significant determining factor

Question 24

absolute contraindications to thrombolytic therapy

Answer 24

intracranial hemorrhage
ischemic CVA in last 3 months
facial trauma in last 3 months
bleeding diathesis

Question 25

relative contraindications to thrombolytic therapy

Answer 25

``` after 12 hours chronic, sever, poorly-controlled HTN severe uncontrolled HTN on presentation ischemic CVA>3 months, known intracranial pahtology dementia internal bleeding w/in last 4 weeks pregnancy peptic ulcer disease current anticoagulant use ```

Question 26

higher death risk w/thrombolytics

Answer 26

``` new LBBB Anterior wall mi cardiogenic shock ventricular arrhythmias advanced age >75 ```

Question 27

early complications of IWMI

Answer 27

bradycardia and AV block- AV nodal perfusion by RCA right ventricular infarction hypotension for volume depletion

Question 28

early complications of AWMI

Answer 28

pump failure and CHF in large area infarcts, cardiogenic shcok

Question 29

late complications of MI

Answer 29

``` 24-28hrs cardiogenic shock VSD papillary m rupture and MR free wall rupture left ventricular thrombus ```

Question 30

cardiogenic shock

Answer 30

due to pump failure and inflammation

Question 31

VSD

Answer 31

new systolic murmur and thrill on LSB

Question 32

Papillary m rupture and MR

Answer 32

new systolic murmur, pulmonary edema, thrill, cardiogenic shock

Question 33

free wall rupture

Answer 33

electromechanical dissociation | first infarction, ant infarction, females, elderly

Question 34

left ventricular thrombus

Answer 34

blood stasis, endocardial injury and possible inflammation leading to hypercoagulable state most often located in left ventricular apex

Question 35

indications for angiography before discharge

Answer 35

EF <40% Clinically significant ischemia on non-invasive testing arrhythmias during hospital stay recurrent chest pain during hospital stay significant heart failure during stay

Question 36

mortality intervention

Answer 36

``` beta blockers aspirin ACE inhibitors HMG-CoA reductase inhibitors intense management of hyperglycemia ```

Question 37

coronary revascularization

Answer 37

``` percutaneous intervention (PCI) coronary artery bypass grafting (CABG) ```

Question 38

PCI

Answer 38

shown not to have improvement overall in survival or recurrent acute events, except those w/silent ischemia by non invasive stress testing primarily reserved for those w/positive stress stess, failure of medical therapy, or poor surgical risk

Question 39

CABG

Answer 39

in stable CAD is only indicated in patients w/left main disease, left main equivalent, 3 vessel disease, two vessels involving proximal LAD and EF<50%

Question 40

Left main equivalent

Answer 40

high grade stenosis >70% proximal LAD and Circ

Question 41

coronary angiography

Answer 41

gold standard successfully resuscitated for cardiac arrest life limiting angina despite medical therapy unclear diagnositc evaluation ST segment elevation MI

Question 42

coronary a calcium CT or MRI

Answer 42

highly effective in negative predictive value, also used to evaluate patients w/intermeidate framingham scores