PANCE Cardiology

Question 1

Name 3 risk factors for stable angina.

Answer 1

• Hyperhomocysteinemia has been correlated with the occurrence of blood clots, heart attacks and strokes,
• high LDL
• low HDL

Question 2

Name 2 prognostic indicators for CAD

Answer 2

1) LVEF <50%

2) which vessels involved-Left Main or 2-3 vessel CAD

Question 3

Name clinical features of stable angina

Answer 3

substernal chest pain lasting <10-15 minutes
chest discomfort described as heaviness, pressure, squeezing.
brought on by exertion, relieved by rest or Nitro

Question 4

What is syndrome X

Answer 4

Exertional angina with normal coronary angiography so no coronary stenosis.
Exercise testing and nuclear imaging show cardiac ischemia. Good prognosis.

Question 5

Exercise induces ischemia results in …… ischemia, producing ……. on the ECG

Answer 5

subendocardial, ST depression

Question 6

What is the best test to detect coronary heart dz?

Answer 6

Coronary Angiography can detect ischemia, assess LV size and function, and diagnose valvular dz.

Question 7

How much does a coronary artery need to be stenosed to cause angina?

Answer 7

> 70%

Question 8

Name 2 agents for pharmacologic stress test?

Answer 8

IV adenosine, dobutamine

Question 9

Name the only medication indicated to decrease morbidity and reduce risk of developing MI from stable angina?

Answer 9

Aspirin

Question 10

Risk facotr modifications and aspirin are indicated in all pts. But when do you initiate meds?
Define Mild dz

Answer 10

normal EF, mild angina, single-vessel dz.

start nitrites and beta blockers, CA+ blockers if those dont work

Question 11

Define Moderate Heart Dz

Answer 11

normal EF, moderate angina, 2 vessel dz.
start the nitrites , BBlockers, CA+ blockers and consider coronary angiography to assess suitability for revascularization.

Question 12

Define severe Heart Dz

Answer 12

decreased EF, severe angina, 3 vessel/left main or left anterior descending dz
start coronary agiography and consider CABG.

Question 13

Define acute coronary syndrome

Answer 13

unstable angina or acute MI

Question 14

What is the difference between unstable angina and stable angina

Answer 14

unstable angina oxygen demand is unchanged. Supply is decreased secondary to reduced resting coronary flow. Stable angina is due to increased demand (oxygen demand exceeds available blood supply)

Question 15

Whats the difference between unstable angina and non ST-segment elevation MI?

Answer 15

They have very similar presentations. Get cardiac enzymes

Question 16

Treatment for unstable angina? After MONA

Answer 16

Beta blockers, LMWH (enoxaparin)Glyoprotein inhibitors (antiplatellets)

Question 17

Folic acid can help treat what cardiac risk factor?

Answer 17

hyperhomocystinemia

Question 18

What is the presentation of Variant Angina
What is definitive test.
Tx

Answer 18

ST segment elevation.
coronary angiography.
Vaso-dialators nitrates, Ca+ blockers

Question 19

What is classic presentation of acute MI?

Answer 19

substernal chest pain >30 minutes

diaphoresis

Question 20

What is classic presentation of right ventricular infarct.

5 things.

Answer 20

Inferior ECG changes.
hypotension.
elevated jugular venous pressure. 
hepatomegaly.
CLEAR LUNGS........

Question 21

MI can be asymptomatic in…

Answer 21

Elderly, Diabtic pts, post operative pts, women

Question 22

Other sx’s of MI

Answer 22

Dyspnea.
weakness, fatigue
nausea/vomiting
syncope

Question 23

Sudden cardiac death usually due to…

Answer 23

VFib

Question 24

Name the markers for ishemia

5 things

Answer 24

Peaked T-waves=occur early
S-T segment elevation=acute infarct, transmural
Q-waves=evidence of necrosis, later finding
T-wave inversion=
S-T segment depression=subendocardial injruy

Question 25

When to intitiate thrombolytic therapy. And what meds? Contra to these meds What procedure is of choice if thrombolytics are contra?

Answer 25

``` As soon as possible up to 24 hrs of onset of chest pain, Outcome is best if given within first 6 hrs. t-PA, streptokinase. Contra; HTN >180/110 head trauma. PUD. previous stroke. recent surgery dissecting aortic aneurysm (PTCA) percutaneous transluminal coronary angioplasty which is 1st line in some centers for tx of a MI ```

Question 26

When and how often should you get cardiac enzymes

Answer 26

1x on admission, then every 8hrs, until 3 samples obtained

Question 27

What does non-ST segment elevation mean

Answer 27

subendocardial infarct, tend to be small, tend to be similar to unstable angina.

Question 28

Cardiac enzymes CK-MB Troponin:

Answer 28

CK-MB=Increase within 4-8hrs, returns to normal 48-72hrs, reaches peak in 24hrs. Troponin (most important) increases in 3-5hrs, returns to normal in 5-14 days, peak is 24-48hrs. Greater specificty

Question 29

Which 3 drugs prove to reduce mortality with MI

Answer 29

aspirin, beta blockers(metroprolol, atenolol), ACE inhibitors.

Question 30

Which cardiac enzyme is elevated 1st?

Answer 30

Myoglobin

Question 31

What does Aortic stenosis sound like, Where do you hear it loudest, can it radiate? What does it increase as far as preload, afterload

Answer 31

Harsh crescendo-decrescendo at the 2nd intercostal on the right side radiating to the carotids. It increases afterload.

Question 32

Clinical presentation of Aortic stenosis? plus 2 findings on auscultation. Sx's begin when.....

Answer 32

DOE, Angina pectoris, PND, orthopnea, syncope paradoxical splitting of S2, ejection early click. Once peak echo gradient is >64mmHg

Question 33

Best test to dx Aortic stenosis | What is Gallaverdin phenomenon?

Answer 33

Echocardiography/Doppler are diagnostic. BNP to check for cooresponding LVH. Gallaverdin phenomenon is when the aortic stenosis is heard at the apex and sounds like MR.

Question 34

What does Mitral Regurge sound like? Where do you hear it loudest? Test that help diagnose? What does it increase?

Answer 34

Holosystolic blowing/pansystolic murmur at the apex radiating to the axilla. And a S3 heart sound Echocardiography/Doppler. Increases preload and reduces afterload=INCREASED EJECTION FRACTION.

Question 35

What ia an associated symptoms of blood backed up into the LA? Clinical findings with chronic MR? MR can predipose you to what?

Answer 35

Acute mitral regurge can lead to pulmonary edema. DOE, fatigue over time. Predispose you to infective endocarditis or Afib

Question 36

What does Mitral Prolpase sound like? Test that help co-morbidity?

Answer 36

Mid-systolic click, late systolic/crescendo murmur at apex. Echocardiography Some pts have collagen abnormalities(Marfans, Ehlers Danlos Syn)

Question 37

Clinical findings of .... | Dynamic aucultation?

Answer 37

Most pts are female, chest pain, palpitations in young adult with pectus excavatum or scoliosis These maneuvers can move the click=valsalva, squatting,