Ischemic Heart Disease II Flashcards Preview

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Flashcards in Ischemic Heart Disease II Deck (11)
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1
Q

Techniques used to dx CAD

A
  • history
  • physical examination
  • ECG
  • non-invasive imaging
  • coronary angiography
2
Q

History of CAD

A
  • chest pain
  • dyspnea
  • risk factors
3
Q

Types of non-invasive imaging

A
  • echocardiography
  • nuclear medicine (perfusion imaging)
  • ultrafast CT
4
Q

Dx of CAD from ECG

A
  • resting ECG: ST segment changes, T wave inversion, Q-waves
  • exercise ECG (stress testing): dynamic ST segment changes
  • sensitivity of ECG is low
  • sensitivity/specificity in stress-testing is improved w/concurrent imaging of myocardial perfusion or echocardiography
5
Q

Dx of CAD via CT or direct angiography

A

-Picture of the vessel lumen – but does not tell us about the vessel wall.
-Good for diagnosis of coronary obstruction
causing anginal symptoms; not as good for
predicting future events.
-Guides therapeutic intervention (angioplasty,
bypass surgery)

6
Q

Use of fractional flow reserve to estimate severity of coronary lesion

A

-if ration of distal coronary/aortic pressure stenosis is significant

7
Q

Major types of treatment of CAD

A
Risk factor modification (for prevention AND
treatment of overt disease)
– Diet, exercise, smoking cessation
• Drugs to treat angina, blood pressure, lipids,
platelets
• Revascularization
– Coronary angioplasty
– Coronary artery bypass surgery
8
Q

Classes of drugs useful in treatment of coronary heart disease

A
• Lipid-modifying: Statins
• Anti-platelet: Aspirin, clopidogrel
• Anti-anginal: Nitrates, beta blockers,
calcium channel blockers
• LV dysfunction: ACE inhibitors or
angiotensin receptor blocker
9
Q

Acute tx of unstable angina

A
• Hospitalization
• Intravenous nitroglycerin
• Beta blockers
• Aspirin and other anti-platelet agents
• Anticoagulation (heparin)
• Usually early catheterization and coronary
intervention
10
Q

Major problems with balloon angioplasty

A
  • acute occlusion

- restenosis

11
Q

Tx of acute MI w/ST elevation

A

• Treatment may be initiated in the field
• Immediate aspirin, nitroglycerin, ± beta blocker
• Reperfusion therapy ASAP: Usually coronary
angioplasty, if unavailable thrombolytic therapy.