Exam (elaborations)
ISCHEMIC HEART DISEASE /MI EXAM QUESTIONS AND ANSWERS
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ISCHEMIC HEART DISEASE /MI EXAM QUESTIONS AND ANSWERS...
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ISCHEMIC HEART DISEASE /MI EXAMQUESTIONS AND ANSWERS
Coronary artery disease - ANSWER may be clinically silent.
is associated with symptoms: myocardial infarction, angina pectoris, sudden
death
Angina Pectoris - ANSWER Chest discomfort associated with myocardial
ischemia that occurs when myocardial oxygen demand exceeds supply.
Diagnosis of Angina - ANSWER Typically described as retrosternal pain,
discomfort, heaviness, or pressure radiating to neck, jaw, shoulders or arms
lasting 2-5 minutes - differential.
Usually precipitated by exertion and relieved by rest.
Associated symptoms of Angina - ANSWER dyspnea, diaphoresis, nausea,
vomiting, and occasionally lightheadedness & palpitations
In men and older women with Angina - ANSWER a hx in the presence of
other risk factors is good evidence of ischemic heart disease 90% probability
Non-Invasive Dx of Angina - ANSWER Resting EKG may demonstrate:
- significant Q waves consistent with prior MI - resting ST segment depression
or elevation and/or - T-wave inversion suggestive of myocardial ischemia.
EKG may be normal.
Non-Invasive Dx of IHD - ANSWER Exercise Stress Test
Exercise Stress Test (EST) - ANSWER useful in establishing diagnosis (Dx)
of CAD & helps risk stratification of patients with angina.
Requires exercise sufficient to increase heart rate to 85% of the maximum
predicted for age in order to be optimally sensitive.
Equivocal Exercise Stress Test - ANSWER perfusion defects may occur that
are so strange that one cannot tell if they are
artifactual or real. should undergo cardiac cath
, Positive Exercise Stress Test - ANSWER S.T. segment depression early after
the start of exercise- >2mm of new S.T. segment depression in multiple leads.
New ST segment elevation.
Decreased systolic BP with exercise.
Inability to exercise for > 2 min.
Development of heart failure with exercise.
Prolonged interval after exercise before ischemic ST changes return to baseline.
EST with patients who have CAD - ANSWER ability to complete 7 minutes of
standard Bruce Protocol EST without significant ST changes is associated with
an excellent 4 year survival rate
Exercise Thallium Imaging & Radionuclide Ventriculography - ANSWER
Improve the sensitivity of EST's
Especially useful in patients on digoxin & those with pre-existing EKG changes
such as:
LVH
LBBB
ST-T changes
Stress 2-D ECHO - ANSWER Especially useful in Dx of CAD in patients with
murmur.
Sensitivity is similar to exercise thallium.
Pharmacologic Stress Testing - ANSWER Dipyridamole thallium stress testing
- used for suspected CAD in patients that cannot exercise.
2-D echo has also been used along with IV dipyidamole, adenosine, or high-
dose dobutamine to induce detectable ischemia
Resting 2-D ECHO or Radionuclide Ventriculography - ANSWER Should be
done in patients with suspected CAD when the clinical picture suggests left
ventricular dysfunction.
Patients with significant CAD & EF's < 50% have a better prognosis with
CABG as opposed to medical therapy - definite cath to determine extent of
CAD.
Coronary Angiography - ANSWER In patients with left ventricular
dysfunction - this is the definitive test for a diagnosis of CAD.
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