PANCE PREP PEARLS UPDATED EXAMS SCRIPT ALL
QUESTIONS AND ANSWERS SURE A+
✔✔what are the 3 phases of formation of atherosclerotic plaque - ✔✔fatty streak: lipid
deposits in WBC
early plaque: LDL is oxidized attracting macrophages/smooth muscle cells to ingest
harmful LDL
fibrous plaque: narrowing of arterial lumen and calcification
✔✔define myocardial ischemia - ✔✔narrowing of arterial lumen reduce cardiac blood
flow in conditions of increased demand
usually >70% of lumen reduction
✔✔define angina and the classes - ✔✔substernal chest pain brought on by exertion that
is poorly localized and relieved with rest/nitro
I: angina w/ only unusually strenuous activity
II: angina w/ more prolonged activity
III: angina w/ daily activity
IV: angina at rest
,✔✔what is Levine's sign - ✔✔present in angina
✔✔what are the percutaneous transluminal coronary angiography indications - ✔✔1 or
2 vessels NOT involving main left coronary artery
near/normal left ventricular function
(definitive tx for angina)
✔✔coronary artery bypass graft (CABG) indications - ✔✔left main coronary artery
disease
symptomatic 3 vessel disease
left ventricular ejection fraction < 40%
(definitive tx for angina)
✔✔nitroglycerin MOA and contraindications - ✔✔MOA: increase myocardial blood
supply and decrease in demand
CI: PDE5 inhibitors, R ventricular MI, SBP<90mmHg
✔✔1st line drug for chronic management of stable angina - ✔✔beta blockers (increase
myocardial blood supply and decrease in demand)
note: reduces mortality
✔✔____ play a major role in preventing/terminating ischemia induce by coronary
vasospasm (Prinzmetal's angina) - ✔✔calcium channel blockers (increase myocardial
blood supply and decrease in demand)
✔✔aspirin: MOA - ✔✔prevents platelet activation/aggregation
(by inhibiting cyclooxygenase)
reduced risk of thrombosis
prevents progression of from chronic stable angina to ACS
✔✔what is classic outpatient regimen for angina - ✔✔aspirin, sublingual nitro, daily B-
blocker and statin
✔✔who is at risk for a silent MI - ✔✔women, elderly, diabetics, obese
, ✔✔what defines chronic stable angina? - ✔✔caused by fixed stenosis (coronary
plaque)
relieved by rest/NTG
✔✔chronic stable angina Tx - ✔✔aspirin
beta blocker
statin
PRN sublingual NTG
✔✔what makes it unstable angina? - ✔✔fixed stenosis
negative cardiac enzymes
NOT relieved by rest/NTG
new onset angina
note: > 90% occlusion can cause anginal Sx at rest aka pian at rest indicates 90%
blockage!
✔✔what defines NSTEMI? - ✔✔positive cardiac enzymes
no ST elevations on EKG
✔✔what defines STEMI - ✔✔ST elevations >1mm in >2 contd leads + reciprocal leads
new LBBB
✔✔most common cause of MI - ✔✔atherosclerosis
✔✔most common causes of coronary artery vasospasm - ✔✔cocaine
prinzmetal's variant angina
✔✔troponin vs CK/CK-MB - ✔✔troponin
-most sensitive and specific for cardiac ischemia
-appears 4-6 h
-peaks 12-24 h
-returns to baseline 7-10 d
CK/CK-MB
-appears 4-6 h
-peaks 12-24 h
-returns to baseline 3-4 d
✔✔what is anti-thrombotic tx in UN/NSTEMI - ✔✔1. aspirin
2. unfractionated heparin
3. enoxaparin (Lovenox)
4. clopidogrel (Plavix)
5. GP IIb/IIIa inhibitors (eptifibatide, tirofiban, abciximab)
QUESTIONS AND ANSWERS SURE A+
✔✔what are the 3 phases of formation of atherosclerotic plaque - ✔✔fatty streak: lipid
deposits in WBC
early plaque: LDL is oxidized attracting macrophages/smooth muscle cells to ingest
harmful LDL
fibrous plaque: narrowing of arterial lumen and calcification
✔✔define myocardial ischemia - ✔✔narrowing of arterial lumen reduce cardiac blood
flow in conditions of increased demand
usually >70% of lumen reduction
✔✔define angina and the classes - ✔✔substernal chest pain brought on by exertion that
is poorly localized and relieved with rest/nitro
I: angina w/ only unusually strenuous activity
II: angina w/ more prolonged activity
III: angina w/ daily activity
IV: angina at rest
,✔✔what is Levine's sign - ✔✔present in angina
✔✔what are the percutaneous transluminal coronary angiography indications - ✔✔1 or
2 vessels NOT involving main left coronary artery
near/normal left ventricular function
(definitive tx for angina)
✔✔coronary artery bypass graft (CABG) indications - ✔✔left main coronary artery
disease
symptomatic 3 vessel disease
left ventricular ejection fraction < 40%
(definitive tx for angina)
✔✔nitroglycerin MOA and contraindications - ✔✔MOA: increase myocardial blood
supply and decrease in demand
CI: PDE5 inhibitors, R ventricular MI, SBP<90mmHg
✔✔1st line drug for chronic management of stable angina - ✔✔beta blockers (increase
myocardial blood supply and decrease in demand)
note: reduces mortality
✔✔____ play a major role in preventing/terminating ischemia induce by coronary
vasospasm (Prinzmetal's angina) - ✔✔calcium channel blockers (increase myocardial
blood supply and decrease in demand)
✔✔aspirin: MOA - ✔✔prevents platelet activation/aggregation
(by inhibiting cyclooxygenase)
reduced risk of thrombosis
prevents progression of from chronic stable angina to ACS
✔✔what is classic outpatient regimen for angina - ✔✔aspirin, sublingual nitro, daily B-
blocker and statin
✔✔who is at risk for a silent MI - ✔✔women, elderly, diabetics, obese
, ✔✔what defines chronic stable angina? - ✔✔caused by fixed stenosis (coronary
plaque)
relieved by rest/NTG
✔✔chronic stable angina Tx - ✔✔aspirin
beta blocker
statin
PRN sublingual NTG
✔✔what makes it unstable angina? - ✔✔fixed stenosis
negative cardiac enzymes
NOT relieved by rest/NTG
new onset angina
note: > 90% occlusion can cause anginal Sx at rest aka pian at rest indicates 90%
blockage!
✔✔what defines NSTEMI? - ✔✔positive cardiac enzymes
no ST elevations on EKG
✔✔what defines STEMI - ✔✔ST elevations >1mm in >2 contd leads + reciprocal leads
new LBBB
✔✔most common cause of MI - ✔✔atherosclerosis
✔✔most common causes of coronary artery vasospasm - ✔✔cocaine
prinzmetal's variant angina
✔✔troponin vs CK/CK-MB - ✔✔troponin
-most sensitive and specific for cardiac ischemia
-appears 4-6 h
-peaks 12-24 h
-returns to baseline 7-10 d
CK/CK-MB
-appears 4-6 h
-peaks 12-24 h
-returns to baseline 3-4 d
✔✔what is anti-thrombotic tx in UN/NSTEMI - ✔✔1. aspirin
2. unfractionated heparin
3. enoxaparin (Lovenox)
4. clopidogrel (Plavix)
5. GP IIb/IIIa inhibitors (eptifibatide, tirofiban, abciximab)
