Term
| What is the worst risk factor for developing athersclerosis? |
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Definition
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Term
| What is the most common risk factor for development of stable angina? |
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Definition
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Term
| What is Metabolic Syndrome X? |
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Definition
| Any combination of HLD, hypertriglyceridemia, impaired glucose tolerance, diabetes, hyperuricemia, HTN |
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Term
| What is the key underlying factor in Metabolic Syndrome X? |
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Definition
| insulin resistance due to obesity |
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Term
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Definition
| Exertional angina with normal coronary arteriogram: Pts present with chest pain after exertion but have no coronary stenoses at cardiac catherization |
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Term
| What is used to diagnose Syndrome X? |
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Definition
| Exercise testing and nuclear imaging show evidence of myocardial Ischemia. Prognosis is excellent |
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Term
| When is a STRESS TEST useful? |
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Definition
| useful for pts with an INTERMEDIATE PRETEST PROBABILITY of CAD |
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Term
| What is the indication for CABG? |
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Definition
| indicated if a cath shows LEFT MAIN DISEASE or THREE VESSEL DISEASE |
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Term
| By what factor does quitting smoking reduce CHD? |
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Definition
| reduces the risk of CHD by half after by 1 year after quitting |
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Term
| What are the only drugs that lower mortality in stable angina? |
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Definition
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Term
| Which BP medication is avoided in CAD and why? |
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Definition
non-dihydro CCB can increase mortality,
because they can initially increase HR thereby increasing demand ischemia. |
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Term
| What did the COURAGE TRIAL show? |
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Definition
| showed no difference in all cause mortality and nonfatal MIs between pts with stable angina treated with maximal medical therapy alone vs medical therapy with PCI. |
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Term
| What are the two methods of REVASCULARIZATION? |
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Definition
PCI(aka angioplasty)
CABG |
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Term
| Does revascularization reduce the incidence of MI? |
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Definition
| NO! revascularization does NOT reduce the incidence of MI, but does result in significant reduction of symptoms. |
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Term
| What is considered MILD DISEASE in a pt with CHD? |
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Definition
normal EF
mild angina
SINGLE-vessel disease |
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Term
| What is the management of pts with MILD CHD? |
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Definition
nitrates (for symptoms and prophylaxis)
B-blocker
(consider CCB if symptoms continue despite nitrates and B-blockers |
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Term
| What is considered MODERATE DISEASE in pts with CHD? |
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Definition
normal EF
moderate angina
TWO-vessel disease |
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Term
| What is the management of MODERATE CHD? |
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Definition
same medical therapy as MILD disease
However, consider angiography to assess suitability for REVASCULARIZATION |
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Term
| What is cosidered SEVERE DISEASE in pts with CHD? |
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Definition
decreased EF
severe angina
THREE-VESSEL disease/LEFT main or LAD disease |
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Term
| What ist he treatment for SEVERE CHD? |
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Definition
| Coronary angiography and consider for CABG |
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Term
| What is a common problem in pts who undergo PCI? |
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Definition
| Restenosis - usually occurs before six months after the procedure. If restenosis does not occur by then, it probably won't happen |
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Term
| What is the role of Heparin in treating acute MI? |
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Definition
| decreases thrombus formation |
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Term
| What is better to use LMWH or IV Heparin? |
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Definition
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Term
| What is the better method of revascularization in someone with a DELAYED presentation for MI? |
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Definition
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Term
| Dual antiplatelet treatment with ASA and CLOPIDOGREL should continue for at least 30 days in pts who receive a _________ |
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Definition
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Term
| How long should dual therapy with ASA and CLODPIDOGREL conitnue in a pt with a DRUG ELUTING STENT? |
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Definition
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Term
| What should all pts who have had an MI receive before leaving the hospital? |
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Definition
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Term
| What does an inpatient STRESS TEST after an MI determine before leaving the hospital? |
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Definition
| the need for ANGIOGRAHPY (which in turn determines the need for ANGIOPLASTY or CABG) |
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Term
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Definition
| PHYSICIAN-SUPERVISED regimen of EXERCISE and RISK FACTOR REDUCTION after MI |
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Term
| Pts who suffer an acute MI have a HIGH RISK for ________ within the next ________ ? |
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Definition
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Term
| What do recent MI pts have a higher risk of stroke? |
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Definition
| There is a LOWER EF and the OLDER the pt, the higher the risk of stroke |
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Term
| What did the PAMI TRIAL show? |
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Definition
| that PTCA reduces mortality more than t-PA |
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Term
| What heart sound is hard to hear, but the MOST SPECIFIC for CHF? |
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Definition
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Term
| Where is S3 best auscultated? |
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Definition
| heard best at the APEX with the BELL of the stethoscope |
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Term
| What is the "sound" that is often used to describe S3? |
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Definition
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Term
| What is the physical reasoning for S3? |
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Definition
| rapid filling phase "into" a noncompliant left ventricular chamber |
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Term
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Definition
| sound of atrial systole as blood is EJECTED into a noncompliant, or stiff left ventricle |
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Term
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Definition
| left sternal border with bell of stethoscope |
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Term
| What is used to describe the sound of S4? |
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Definition
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Term
| What is "nuclear ventriculography"? |
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Definition
RBCs tagged with radioisotope are imaged during exercise and during rest.
-aka "Radionuclide ventriculography" |
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Term
| When is nucelar ventriculography useful? |
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Definition
Can be useful when an echocardiogram is technically suboptimal (eg SEVERE PULMONARY DISEASE), or when more precise assessment of left ventricular function is desired.
-Considered the most accurate test (but not ordered in most cases) |
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Term
| If noninvasive test are equivocal in determing the cause of CHF, what can be ordered next? |
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Definition
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Term
| What 4 objectives is stress testing usef for? |
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Definition
1. Identifies ischemia and/or infarction
2. Qauntitates level of conditioning
3. Can differentiate cardiac versus pulomnary etiology of dypsnea
4. Assesses dynamic responses of HR, heart rhythm, and BP |
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Term
| At what levels of BNP does it strongly correlate with CHF? |
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Definition
| BNP> 150 pg/mL (unit of measurement varies) |
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Term
| BNP is useful in differentiating between dypsnea caused by . . . . |
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Definition
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Term
| What is N-terminal pro-BNP? |
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Definition
| new assay with similar predictive value as BNP, except the normal range for this value depends on age |
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Term
| What level of NT-proBNP excludes CHF? |
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Definition
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Term
| What did the RALES TRIAL show? |
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Definition
| showed that spironolactone redcues morbiditiy and mortality in pts with CLASS III and CLASS IV heart failure |
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Term
| What is an important contraindication to use of spironolactone? |
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Definition
| contraindicated in RENAL FAILURE |
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Term
| When is spironolactone considered effective in treating HF? |
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Definition
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Term
| What is the standard treatment for CHF? |
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Definition
| loop, beta blocker, and ACE-inhibitor |
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Term
| When is an ACE-inhibitor used? |
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Definition
| Left ventricular systolic dysfunction |
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Term
| What is the initial tx for symptomatic CHF pts? |
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Definition
| ACE-inhibitor and diuretic |
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Term
| What study showed ACE-inh reduce mortality in pts with CHF? |
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Definition
| CONSENSUS and SOLVD trials |
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