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ischemic heart disease Flashcards | StudBud
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ischemic heart disease
ischemic heart disease
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Answers
1
abrupt withdrawal assoicated with increased severity & # of pain epidoes & MI are seen in which drug class?
calcium channel blockers
nitrates
beta blockers
ACei
2
which of the following is a characteristic that would differentitate
unstable
from
stable angina
chest pain relieved by rest in 5 minutes
reproducible pain brought on by stress
chest pain lasting >20 mins
poorly localized chest or arm discomfort
3
which is a contraindication of ranolazine?
prior stroke or active bleed
hepatic failure / impairment
preexisting QT interval prolongation
renal failure
4
this medication can mask common symptoms of hypoglycemia except sweating, what is the drug class?
beta blockers
Non-DHP CCB
CCB
ACEi
5
pt recieved BARE METAL STENTs (PCI) for a non-ACS indication how long should pt be on dual antiplatelet therapy
plavix for 1 year + aspirin indefintely
plavix for 1 month + aspirin indefintely
only need 325mg aspirin?
lovenox weekly for 6 months + asprin PRN
6
how should prinzmetal angina be treated?
nitrates for acute attacks
aspirin indefinitely
CCB for 6-12 months after initial attack
beta blockers for one year after
7
afterload, preload, HR and contractility all are part of what?
determinants of myocardial oxygen demand or consumption MVO2
what causes infarctions
8
first line for SIHD includes sublingual nitro + beta blocker
False
True
9
which class is 1st line in chronic angina that requires daily maintenance therapy?
calcium channel blockers
beta blockers
nitrates
statins
10
if angina is not controlled in SIHD with beta blocker + nitro what is next step?
increase beta blocker dose
add or sub calcium channel blocker , long acting nitrate or ranolazine
ranolazine alone
change to acei + arb + lovenox
11
which of the following determines myocardial oxygen demand
pulmonary function
blood pressure
heart rate
weight
12
vasospasm is associated with which form of angina?
chronic stable angina
unstable angina (ACS)
variant angina
13
what are some risk factors for angina that can increase mortality
prior heart attack
diabetes
COPD
smoking
14
which medication can we give to CABG patient if theyre allergic to aspirin, how long is therapy?
indefinetly
6 months
lovenox
plavix
15
IHD = CHD = CAD
False
True
16
should aspirin and P2Y12 receptor antagonists be used in combination?
yes
no
17
this medication reduces Ca2+ overload in ishcemic myocytes through selective inhibition of late Na+ current
amlodipine
nitroglycerin
ranolazine (ranexa)
verapimil
18
which medication carries the risk of QT prolongation?
metformin
ranexa (ranolazine)
atorvastain
amlodipine
19
calcium channel blockers play what role in stable exertional angina pectoris?
improve coronary blood flow through coronary artery vasodilation.
decreases MVO2
increases MVO2
you dont use CCB here
20
when should revascularization be considered for stable angina pectoris?
CABG and PCI are always considered an option for this
first line / first attack
2-3 antiangina agents should be considered a failure
up to the pateint
21
pt presents with variant angina, started on nitro for chest pain, what med should be given to prevent future events
ivabradine
ranolazine
metoprolol
nifedipine
22
many ischemia episodes are SILENT meaning no symptoms
False
True
23
stable vs unstable angina, which is true of UNSTABLE agina
pain awakens pt from sleep, more severe or prolonged or more frequent
occurs at rest or minimal exertion, typically lasts >10 or >20 min
deep poorly localized,arm discomfort, reproducibl, relived in 5-10 min rest
severe and described as frank pain
24
what are some aggravating factors of variant angina pectoris
cocaine
cigarette smoking
nitroglycerin
alcohol
25
which of the following is not a precipitating factor of variant angina pectoris
walking after a meal
cold temperature
hyperventilation
exercise
26
chronic stable angina is assoicated with ?
MI
vasospasm
thrombus
fixed stenosis
27
HR, contractility, intramyocardial wall tension are all determinants of what?
determinants of TIA
determinants of stroke
determinants of hepatic oxygen demand or consumption
determinants of myocardial oxygen demand or consumption MVO2
28
severe stenosis >70% can cause what
symptoms at rest
ischemia
nada
increase in heart contractility
29
when will Calcium channel blocker be used for SIHD symptom relief?
CCB + long acting nitrates should be used when initial treatment BB fail
we dont use CCB in SIHD
when beta blockers are contraindicated or cause unacceptable side effects
these should be prescribed as first line for relief of symptoms
30
describe prinzmetal angina (SATA)
associatd with ST-segment elevation
manifests as deep, poorly localized chest or arm discomfort, reproducible
usually younger patients, commonly resolves without progression to MI
aka: variant angina pectoris = vasospasm
31
CABG patients can receive 81-325 mg of aspirin indefinitely, while PCI pt can only take 81mg indefinitely
False
True
32
which is true of clincial presentation of angina
less severe
symptoms at rest suggests STABLE angina
patients often have reproducible pattern, pain other symptoms
decreases in frequency
33
what is a cause of variant angina pectoris?
plaque formation that leads to reduced O2 supply to heart muscle
imbalance between endothelium produced vasodilator and vasoconstrictiors
imbalance of autonomic control characterized by parasympathetic dom inflamm
adrenoreceptr polymorph may predispose pt to develop vasospasm
34
which of the following is NOT a determinant of ischemia?
resistance in vessels delivering blood to myocardium.
exercising too much
MVO2 which is determinants of myocardial oxygen demand or consumption
35
ECG / EKG is abnormal with elevated ST wave in 1/2 patients with angina not experincing an acute attack
False
True
36
what is the gold standard for evaluating coronary anatomy that quantifies presence of atherosclerotic lesions
PCI
EKG
exercsise tolerance testing (stress test)
Cath (coronary angiography)
37
what are some
unalterable
risk factors for STABLE ischemic heart disease (SIHD)
diabetes (remember, once you get DM, you will always be classified as DM)
smoking, HTN
glycemic control in Diabetes
gender, age
38
what side effects of nitrates do we worry about?
postural hypotension
reflex tachy
diarrhea
headaches
39
which medications should be avoided in CABG patients?
effient (prasugrel)
aspirin
plavix
lovenox (enoxaprin )
40
which of the following is NOT a Contraindication of Cath (coronary angiography)
pre exisiting heart conditions
acute renal failure
digitalis intoxication
chronic renal failure secondary to diabetes
41
where does ranexa fall into treatment for stable exertional angina pectoris?
first line with beta blockers
pt who have not achieved adequate response with other antianginal agents
used first line if beta blockers are contrindicated
42
are beta blockers used in treatment for variant angina pectoris?
CCB used first line, dose titration is needed
yep used first line
nope, have little or no role
nitrates used for acute attacks
43
IDH is atherosclerotic plaque formation that leads to reduced O2 supply to heart muscle
False
True
44
can nitrates be used for long term prophylaxis for stable exertional angina pectoris (which is basically SIHD -_-)
no, only ranexa should be used
no, only beta blockers can be used
yes, can be used alone
yes but usually in combo with beta blockers or calcium channel blockers
45
which medication has
NO
affect on HR, inotropic state, hemodynamic state or increase coronary blood flow
ranexa (ranolazine)
calcium channel blockers
46
clincial presentation of Angina include:
visceral pain lasting 0.5 to 30 mins, gets relief with rest and nitro
pressure / burning over or near sternum, can radiate to shoulder, arm, jaw
heart burn that keeps you awake at night
precipitating factors: exercise, cold environement, walking after eat,
47
which of the following is considered gold standard for evaluating whether the cornary arteries have atherosclerosis
echo
ECG
exercise stress test
coronary angiography (Cath)
48
pt recieved drug eluting sten for SIHD, how long does pt have to be on dual antiplatelet therapy? (non- ACS)
12 months
1 month
6 months
3 months
49
____ terminate acute anginal attacks
beta blockers
nitrates
calcium channel blockers
aspirin
50
is it worse to have CAD in left or right artery? think about what each side of heart does and where it supplies blood
right artery
left artery
betz said this is called the widow maker fun fact :)
