Ischemic HD (Test 2)

Question 1

Two most important risk factors for the development of atherosclerosis involving the coronary arteries are what?

Answer 1

male gender & increasing age.

Question 2

___________ is the most common cause of impaired coronary blood flow resulting in angina pectoris.

Answer 2

Atherosclerosis

Question 3

Imbalance between coronary blood flow (supply) and myocardial oxygen consumption (demand)
can precipitate __________, which frequently manifests as chest pain.

Answer 3

ischemia

Question 4

Ischemia leads to release of ________ & ___________. These substances slow _______ ________ & decrease cardiac contractility.

Answer 4

adenosine & bradykinin

AV conduction

Question 5

What 3 things can induce angina?

Answer 5

Physical exertion, emotional tension, & cold weather may induce angina

Question 6

Which statement best describes chronic stable angina? What does it indicate usually?

Answer 6

Ongoing, does NOT change in frequency or severity in 2-month period
Indicates >70% blockage

Question 7

Which statement best describes chronic UNSTABLE angina? What does it indicate usually?

Answer 7

-Increases in frequency and/or severity without increase in cardiac biomarkers
-Lasts >10 min
-Unrelieved by NTG

-Indicates >90% blockage

Question 8

Troponin levels usually bumped within how many hours? And remain elevated for up to 2 weeks.

Answer 8

3-4 hours

up to 2 weeks

Question 9

ST-segment depressionis a characteristic of ____________ ischemia

Answer 9

subendocardial.

Question 10

The greater the degree of ST-segment depression, the greater the likelihood of significant __________ __________ __________.

Answer 10

Coronary artery disease

Question 11

Which test has a greater sensitivity than exercise testing for detection of ischemic heart disease?

Answer 11

Nuclear stress imaging

Question 12

Which substances contribute to thrombogenesis? (4)

Answer 12

Collagen, ADP, epinephrine, serotonin
Thromboxane A2
Glycoprotein IIb/IIIa receptors
Fibrin deposit

Question 13

What diagnostic data is indicative of a myocardial infarction select 2

Answer 13

• Detection of rise &/or fall o cardiac biomarkers (trop) with at least one value above the 99th percentile of he upper reference limit AND evidence of MI indicated by at least one of the following:

1. sx of ischemia
2. ECG changes indicative of ischemia
3. Pathologic Q waves developed
4. Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
5. Identification of an intracoronary thrombus by angiography or autopsy

Question 14

The primary goal in management of STEMI is to do what?

Answer 14

reestablish blood flow in the obstructed coronary artery as soon as possible.

Question 15

The two principal issues related to PCI with stent placement now are ____________ and __________________ due to dual antiplatelet therapy.

Answer 15

Thrombosis

Increased risk of bleeding

Question 16

If a pt is on clopidegrol or prasugrel , how long before surgery do we want them to pause them?

Answer 16

5 days - clopidogrel (Plavix)
7 days – prasugrel (Effient)

Question 17

How long should we wait for elective surgery after a balloon angioplasty?

Answer 17

2-3 weeks

Question 18

How long should we wait for elective surgery after a bare-metal stent placement?

Answer 18

12 weeks

Question 19

How long should we wait for elective surgery after drug-eluting stent?

Answer 19

a full 1 year or longer

Question 20

_______ _________ discontinuation is the most significant independent predictor of stent thrombosis.

Answer 20

P2Y12inhibitor

Continue ASA if possible during surgery

Question 21

What are active cardiac conditions that require additional investigation?

Answer 21

1. Unstable coronary syndromes ( > 60 days since MI is ideal)
2. Unstable or severe angina
3. Decompensated HF
4. Severe valvular heart disease (severe aortic or mitral stenois)
5. Significant dysrhythmias
6. Advanced age

Question 22

Why might volatile anesthetics be beneficial in patients with ischmic heart disease?

Answer 22

because they decrease myocardial oxygen requirements & may precondition the myocardium to tolerate ischemic events,

OR

they may be detrimental because they lead to a decrease in BP & asx reduction in coronary perfusion pressure.

Question 23

What is the preferred method of anesthesia for patietns with severely impaired LV function?

Answer 23

• Opioids
• Regional is okay
• Epidural is preferred over spinal, however hypotension must be controlled promptly.

Question 24

Why is glycopyrollate preferred over atropine in patients with ischemic heart disease?

Answer 24

Glycopyrrolate has a much LESS chronotropic effect & more central effect than atropine does