Term
| What is another name for ischemic heart disease? |
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Definition
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Term
| What things fall under ischemic heart disease? |
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Definition
acute coronary syndrome
non-ST-segment elevation MI
ST-segment-elevation MI
MI with biomarkers only
unstable angina
variant or Prinzmetal's angina |
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Term
| What are 4 manifestations of atherosclerosis other than ischemic heart disease? |
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Definition
heart failure
arrhythmias
cerebrovascular disease
peripheral vascular disease |
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Term
| What do foam cells indicate? |
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Definition
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Term
| What are unstable plaques? |
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Definition
| plaques that do no affect the lumen but are future areas for culprit lesions; may rupture |
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Term
| What are culprit lesions? |
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Definition
lesions where plaque has formed over and narrows the lumen.
Less dangerous than unstable plaques to suddenly cause ischemia |
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Term
T/F
Angiograms may show the arteries as healthy when the patient is in fact at risk. |
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Definition
| True - unstable plaques can exist and not be seen and these are more dangerous than the culprit lesions that can be seen. |
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Term
T/F
Coronary Artery Bypass Grafting (CABG) may be more adventageous than percutaneous coronary intervention in patients with multivessel disease. |
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Definition
| True - future lesions are bypassed and plaque vulnerability is no longer an issue |
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Term
T/F
Ischemic heart disease can be an isolated condition. |
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Definition
| False - often seen with diabetes and other conditions |
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Term
T/F
Diabetics have a decrease in blood flow to the heart after a meal. |
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Definition
| True - normal patients have an increase. |
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Term
T/F
Dyslipidemia is directly related to the rate at which coronary heart disease events occur. |
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Definition
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Term
T/F
Lowering LDL levels decreases the risk of a coronary artery disease event ever occurring. |
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Definition
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Term
T/F
Patients presenting to PCP with chest pain are less likely to be having a heart attack than those presenting to ER. |
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Definition
| True - patients tend to know how serious it is |
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Term
| What is the most common anginal syndrome? |
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Definition
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Term
| Describe chronic stable angina. |
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Definition
discomfort, pressure, or squeezing sensation (sometimes burning, sticking or sharp)
substernal area, precardium, or epigastrum with radiation to L arm, jaw or neck
Precipitated by exercise, emotion, exposure to cold, eating, or smoking
relieved by rest, removal of provoking factors, or sublingual nitrates
few minutes - 20-30 min |
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Term
| Describe how unstable angina pectoris presents. |
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Definition
1. recent onset that is provoked by minimal exertion
2. chronic stable angina that crescendos over time
3. prolonged chest pain at rest, clinically indistinguishable from acute MI |
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Term
| What is prinzmetal's angina (variant angina)? |
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Definition
| Myocardial ischemia caused by coronary artery spasm |
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Term
T/F
Prinzmetal's angina can occur in patients with or without coronary atherosclerosis. |
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Definition
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Term
| What change does variant angina cause on an EKG? |
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Definition
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Term
| When does pain occur in variant angina? |
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Definition
at rest, unprovoked
may follow circadian manner and occur in the early morning hours |
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Term
| What lifestyle modifications do you recommend to a patient with angina? |
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Definition
stop smoking
modify diet - low fat, eat fish, eat 1800 calories or less
lose weight
increase physical activity |
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Term
| What is the pharmacological treatment for stable angina pectoris? |
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Definition
1. Aspirin therapy
2. Beta blockers for previous MI
3. ACE-I (especially for DM and LVH)
4. Lipid therapy for LDL >/= 100
5. Regular exercise
6. stop smoking
7. avoid cocaine - causes vasoconstriction |
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Term
T/F
Aspirin therapy for stable angina is less effective in diabetes patients. |
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Definition
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Term
| What is the first line therapy for terminating infrequent acute episodes of angina? |
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Definition
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Term
| How is nitroglycerin administered? |
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Definition
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Term
| How is nitorglycerin dosed? |
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Definition
0.4 mg
one tab every 5 minutes, up to 3 tabs as needed for chest pain |
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Term
T/F
Nitro should be stored in the refrigerator, but can last 3 months in pocket. |
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Definition
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Term
| What is the advantage to spray nitroglycerin? |
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Definition
| shelf life of 1 year without refrigeration |
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Term
| How is nitroglycerin taken prophylactically? |
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Definition
| 5-10 minutes before activity |
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Term
| What are the side effects of nitroglycerin? |
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Definition
| headache, dizziness, orthostatic hypotension, and reflex tachycardia |
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Term
| What 2 things make orthastatic hypotension resulting from Nitro use worse? |
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Definition
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Term
| Name 2 counterindications for Nitro use. |
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Definition
1. use of PDE-5 inhibitor - 24 hours after sildenafil and vardenafil, 48 hours after tadalafil
2. intracranial pressure |
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Term
| When do you dose long acting nitrate? |
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Definition
| QAM so that nitrate free interval begins in the evening |
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Term
| Name 3 long-acting nitrates. |
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Definition
| isosorbide dinitrate, isosorbide mononitrate, nitroglycerin transdermal patches |
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Term
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Definition
the development of tolerance to nitrates in smooth muscle
this is why it is important to remove transdermal patches at night |
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Term
| What is coronary steal syndrome? |
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Definition
| a condition that is suggested if the nitrate does not reieve the pain. The vasodilatory effects of nitro may open other vessels and the atherosclerotic artery may still be bypassed. |
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Term
| What is first line treatment for chronic angina? |
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Definition
beta blocker
reduces episodes of silent ischemia and reduces early morning peak ischemia |
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Term
T/F
Beta blockers used to treat chronic angina improve mortality after MI |
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Definition
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Term
| Why are beta blockers generally discontinued? |
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Definition
| fatigue, depression, malaise, or sexual dysfunction |
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Term
| When are CCBs preferred over Beta blockers to treat angina? |
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Definition
| in patients with severe peripheral vascular disease symptoms at rest |
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Term
| Name 4 CCBs used to treat angina. |
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Definition
| amlodipine, diltiazem, verapamil, and nifedipine |
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Term
T/F
Amlodipine reduces the symptoms of angina and is okay to use with long-acting nitrates |
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Definition
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Term
| What drug should be avoided in a patient with variant (Prinzmetal's) angina? |
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Definition
beta blockers
potential to worsen vasospasm |
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Term
T/F
Short acting CCBs are used to treat the patient with variant angina. |
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Definition
| False - only long-acting formulations. Short-acting increase cardiac events. |
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Term
T/F
Patients with variant angina should have immediate release nitro for acute attacks. |
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Definition
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Term
| What can be done for multiple daily acute angina attacks? |
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Definition
| long-acting nitrate treatment |
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Term
| What drugs are best to treat acute coronary syndrome post MI? |
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Definition
Beta blocker and ACE-I
ARBS are used only if ACE-I intolerant |
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Term
| What is the first line therapy for patients with high coronary disease risk? What drug is added on in acute coronary syndromes (unstable angina, NSTEMI)? |
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Definition
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Term
| What over the counter medication is an important part of acute coronary syndrome treatment? |
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Definition
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Term
| How does statin therapy help treat acute coronary syndrome? |
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Definition
| reduces CRP and stabilizes plaques |
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Term
| Which patients are most susceptible to the effects of beta blockers and CCB inotropic and chronotropic effects? |
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Definition
| elderly - start low and go slow |
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Term
T/F
Asymptomatic bradycardia may be acceptable in elderly patients being treated with a beta blocker and a CCB. |
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Definition
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