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CC Sept 2017 Stable Ischemic Heart disease

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echoecho's version from 2017-12-10 17:37

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Question Answer
Define ischemic heart disease?Refers to atherosclerotic Coronary artery disease that reduces normal blood flow in one or more coronary arteries
What is ischemic heart disease due to?1) fixed or dynamic stenosis of coronary arteries 2) microvascular dysfunction and/or. 3) focal or diffuse coronary artery spasm
What produces chest pain (angina pectoris)?During exercise the resulting mismatch between myocardial oxygen supply and myocardial oxygen demand produces chest pain (angina pectoris)
List the 3 categories that patients who present with chest pain are placed in?1) typical chest pain (angina) characterized by substernal chest discomfort ("pressure", "tightness", "pain", "squeezing") lasting for several minutes with pain being either localized to the arm, epigastrium, shoulder, neck or jaw . Pain is provoked by exercise or emotional stress and relieved by rest and NTG 2) atypical chest pain characterized by chest discomfort characterized by 2 of the 3 components of typical angina 3) non-angina chest pain characterized by chest discomfort that meets 0 or 1 of the components of typical angina
memorize
*** Patients seen in primary care practices with chest pain can be evaluated using a well-validated prediction rule composed of 5 components (each worth 1 point). This rule can be used to r/o CAD as a cause of chest pain with a specificity of 81% (<2 points), and a sensitivity of 87% (3-5 points). List these points? : 1) male > 55 y.o. , female > 65 years 2) known vascular disease 3) patient assumes pain is of cardiac origin 4) pain is worse during exercise 5) pain is not reproducible by palpating
Question Answer
What should be obtained on all patients with chest pain, even if not currently experiencing symptoms?EKG
Initial evaluation also includes identification of risk factors, list these?1) ischemic heart disease 2) HTN 3) dyslipidemia 4) DM 5) tobacco use 6)_ obesity 7) sedentary lifestyle 8) family hx of ischemic heart disease 9) previous episodes of atherosclerotic cardiovascular disease (known CAD, MI, CVA, PVD or heart failure)
For those being seen in the ER, what is the initial diagnostic tests done?1) high-sensitivity troponin to r/o myocardial necrosis 2) hgb 3) blood sugar (HgbA1c for DM patients also), 4) renal function tests 5) fasting lipid levels 6) BNP if heart failure is suspected
List the major steps for determining a diagnostic and treatment strategy after the initial evaluation?1) clinical assessment of the risk of ischemic heart disease ("protest probability") 2) selection of appropriate noninvasive testing 3) optimization of medical therapy and determination of appropriate invasive testing andor revascularization procedures
Regarding step 1, pretest probabilities are determined by what?identifying the probabilty of CAD
Regarding step 1, if pretest probability is < ____%, no further testing is recommended?15%
Regarding step 1, if pretest probability is ___% to ___% should have an exercise stress test if possible?15%; 65%
Regarding step 1, if pretest probability is ___% to ___%, a noninvAsive imaging functional stress test should e done?66%; 85%
Regarding step 1, if pretest probability is > ______%, this may be assumed patient has ischemic heart disease and risk stratification should be done?85%
List the clinical assessment of risk of ischemic heart disease (pretest probabilities) as to TYPICAL angina and age and gender groups?(30-39 y.o = men 59%; women 28%) (40-49 y.o. = men 69%; women 37%) (50-59 y.o. = men 77%; women 47%) (60-69 y.o. = men 84%; women 58%) ( 70-79 y.o. = men 89%; women 68%) (> 80 y.o. = men 93%; women 76%)
List the clinical assessment of risk of ischemic heart disease (pretest probabilities) as to ATYPICAL angina and age and gender groups?(30-39 y.o. = men 29%; women 10%) (40-49 y.o. = men 28%; women 14%) (50-59 y.o. = men 49%; women 20%) (60-69 y.o. = men 59%; women 28%) (70-79 y.o. = men 69%; women 37%) (>80 y.o. = men 78%; women 47%)
List the clinical assessment of risk of ischemic heart disease (pretest probabilities)n as to NON-ANGINAL chest pain and age and gender groups?(30-39 y.o. = men 18%; women 5%) (40-49 y.o. = men 25%; women 8%) (50-59 y.o. = men 34%; women 12%) (60-69 y.o. = men 44%; women 17%) (70-79 y.o. Men = 54%; women 24%) (> 80 y.o. = men 65%; women 32%)
memorize