What are the "Big 6" in regards to risk factors for CAD? - ANSWER
*FSH DAD*
F - Family Hx of premature CAD/MI (M < 45; F < 55)
S - Smoking (Cigarettes)
H - HTN, Homocysteine levels elevated
D - DM/Metabolic syndrome
A - Age (M: > 45; F: > 55)
D - Dyslipidaemia - Elevated LDL; Low HDL
What is the normal ejection fraction? What is the ejection fraction value that corresponds to
increased mortality? - ANSWER Normal = > 50%
<50% is associated w/ mortality
What vessel corresponds to a poor prognosis in regards to CAD? - ANSWER LAD - b/c it
covers 2/3 of the heart
What type of CAD is being described: CP that lasts < 10/15 min that is described as
heaviness/pressure that is brought on by exertion, and relieved by rest or NTG?
A. Unstable Angina
B. Stable Angina
C. Prinzmetal's Angina - ANSWER B. Stable Angina
1
,What diagnostic procedures can be used as a screening tool for CAD? - ANSWER Exercise
stress ECHO/EKG
What is the *GOLD STANDARD* diagnostic procedure for CAD? - ANSWER Coronary
Angiography
The coronary cath looks at what? Coronary angiography looks at what? - ANSWER Cath --
> determining a cardiac diagnosis
Angiography --> presence and severity of CAD; looks at delineating coronary anatomy
What procedures can be used with "reversible" ischemia? - ANSWER CABG and PTCA
If a patient is unable to exercise, what procedure can you use as a screening test for CAD? -
ANSWER Pharmacological Stress Test w/ IV adenosine, dipyramidole, dobutamine
What device can be used to detect silent ischemia and silent arrhythmias not assable by an
in office EKG? - ANSWER Holter Monitor
What are the components of metabolic syndrome? - ANSWER hypercholesterolemia
hypertriglyceridemia
impaired glucose tolerance
diabetes
hyperuricemia
HTN
What is a nonpharmacological treatment that can be used for the tx of CAD? - ANSWER
TLC - EXERCISE is crucial and DIET modification (decrease fat, cholesterol)
2
,What pharmacological therapies are first line for all CAD patients? - ANSWER TLC,
Aspirin, BB, Nitrates
(2nd line: add CCB)
What is the TOC is severe CAD? - ANSWER CABG
The pathophysiology of stable vs unstable angina? - ANSWER Stable: due to increased
demand
Unstable: reduced resting coronary flow
What three patient profiles can be diagnosed with unstable angina (USA)? - ANSWER 1)
Pts with chronic angina with increasing freq, duration, and intensity of CP
2) Pts with new-onset angina that is severe or worsening
3) Patients w/ *ANGINA AT REST*
What diagnostic procedures should be utilitzed for USA? - ANSWER Higher risk for AE w/
Stress test sooo....
1) Stablize w/ medical management before stress test
or
2) undergo cardiac cath initially
What management should be taken with USA? - ANSWER Admit w/ IV access and O2
3
, Medical Management: *"HANG"*
Heparin (LMWH)
Aspirin
NTG - FIRST LINE THERAPY
Glycoprotein IIb/IIa
+
BB - FIRST LINE THERAPY
+
Cardiac Cath
After acute event, what tx are used for USA? - ANSWER Aspirin, BB, nitrates
What form of angina is characterized by *"transient coronary vasospasm"*, the episodes
occur at rest, and ass w/ ventricular dysfunction?
A. Stable Angina
B. Unstable Angina
C. Prinzmetal's Angina - ANSWER C. Prinzmetal's Angina
What is the *HALLMARK* of prinzmetal's angina? - ANSWER transient *S-T ELEVATION*
on ECG during chest pain, which respresents transmural ischemia
What is the *DEFINITVE TEST* for prinzmetal's angina? - ANSWER CORONARY
ANGIOGRAPHY - displays coronary vasopasm when the pt is given "IV ERGONOVINE"
What management can be used for prinzmetal's angina? - ANSWER Nitrates, CCB
What is the *MOST COMMON CAUSE* of a MI? - ANSWER Acute Coronary Thrombosis
4
*FSH DAD*
F - Family Hx of premature CAD/MI (M < 45; F < 55)
S - Smoking (Cigarettes)
H - HTN, Homocysteine levels elevated
D - DM/Metabolic syndrome
A - Age (M: > 45; F: > 55)
D - Dyslipidaemia - Elevated LDL; Low HDL
What is the normal ejection fraction? What is the ejection fraction value that corresponds to
increased mortality? - ANSWER Normal = > 50%
<50% is associated w/ mortality
What vessel corresponds to a poor prognosis in regards to CAD? - ANSWER LAD - b/c it
covers 2/3 of the heart
What type of CAD is being described: CP that lasts < 10/15 min that is described as
heaviness/pressure that is brought on by exertion, and relieved by rest or NTG?
A. Unstable Angina
B. Stable Angina
C. Prinzmetal's Angina - ANSWER B. Stable Angina
1
,What diagnostic procedures can be used as a screening tool for CAD? - ANSWER Exercise
stress ECHO/EKG
What is the *GOLD STANDARD* diagnostic procedure for CAD? - ANSWER Coronary
Angiography
The coronary cath looks at what? Coronary angiography looks at what? - ANSWER Cath --
> determining a cardiac diagnosis
Angiography --> presence and severity of CAD; looks at delineating coronary anatomy
What procedures can be used with "reversible" ischemia? - ANSWER CABG and PTCA
If a patient is unable to exercise, what procedure can you use as a screening test for CAD? -
ANSWER Pharmacological Stress Test w/ IV adenosine, dipyramidole, dobutamine
What device can be used to detect silent ischemia and silent arrhythmias not assable by an
in office EKG? - ANSWER Holter Monitor
What are the components of metabolic syndrome? - ANSWER hypercholesterolemia
hypertriglyceridemia
impaired glucose tolerance
diabetes
hyperuricemia
HTN
What is a nonpharmacological treatment that can be used for the tx of CAD? - ANSWER
TLC - EXERCISE is crucial and DIET modification (decrease fat, cholesterol)
2
,What pharmacological therapies are first line for all CAD patients? - ANSWER TLC,
Aspirin, BB, Nitrates
(2nd line: add CCB)
What is the TOC is severe CAD? - ANSWER CABG
The pathophysiology of stable vs unstable angina? - ANSWER Stable: due to increased
demand
Unstable: reduced resting coronary flow
What three patient profiles can be diagnosed with unstable angina (USA)? - ANSWER 1)
Pts with chronic angina with increasing freq, duration, and intensity of CP
2) Pts with new-onset angina that is severe or worsening
3) Patients w/ *ANGINA AT REST*
What diagnostic procedures should be utilitzed for USA? - ANSWER Higher risk for AE w/
Stress test sooo....
1) Stablize w/ medical management before stress test
or
2) undergo cardiac cath initially
What management should be taken with USA? - ANSWER Admit w/ IV access and O2
3
, Medical Management: *"HANG"*
Heparin (LMWH)
Aspirin
NTG - FIRST LINE THERAPY
Glycoprotein IIb/IIa
+
BB - FIRST LINE THERAPY
+
Cardiac Cath
After acute event, what tx are used for USA? - ANSWER Aspirin, BB, nitrates
What form of angina is characterized by *"transient coronary vasospasm"*, the episodes
occur at rest, and ass w/ ventricular dysfunction?
A. Stable Angina
B. Unstable Angina
C. Prinzmetal's Angina - ANSWER C. Prinzmetal's Angina
What is the *HALLMARK* of prinzmetal's angina? - ANSWER transient *S-T ELEVATION*
on ECG during chest pain, which respresents transmural ischemia
What is the *DEFINITVE TEST* for prinzmetal's angina? - ANSWER CORONARY
ANGIOGRAPHY - displays coronary vasopasm when the pt is given "IV ERGONOVINE"
What management can be used for prinzmetal's angina? - ANSWER Nitrates, CCB
What is the *MOST COMMON CAUSE* of a MI? - ANSWER Acute Coronary Thrombosis
4
