Cardiovascular Risk Factors and Diagnosis

IHD Risk Factors

• Age: > 45 years for males, > 55 years for females
• Family history: premature IHD in males < 55 years, females < 65 years
• Hypertension: BP > 130/80 or on anti-hypertensive therapy
• Smoking
• Hyperlipidemia: HDL < 40 mg/dL (subtract one risk factor if > 60 mg/dL)
• Diabetes
• Obesity: BMI > 30 kg/m2
• Sedentary lifestyle
• CVD (cardiovascular disease)
• PAD (peripheral arterial disease)

IHD Symptoms

• Typical pain: pressure, heaviness, or squeezing in the anterior chest area
• May radiate to the neck, jaw, shoulder, back, or arm
• May be accompanied by dyspnea, nausea, vomiting, or diaphoresis
• Sharp pain is not a typical symptom of IHD
• Symptoms of stable angina are often provoked by exertion, emotional stress, exposure to cold temperatures, and heavy meals
• Symptoms of stable angina are relieved within minutes by rest or sublingual nitroglycerin
• Symptoms of ACS: pain occurs at rest (without provocation) and is prolonged and unrelieved by sublingual nitroglycerin

Diagnosis and Evaluation

• A thorough medical history, physical exam, and laboratory analysis are necessary to ascertain cardiovascular risk factors
• Laboratory analyses should assess for glycemic control, fasting lipids, hemoglobin, and organ function
• Electrocardiogram (ECG): a 12-lead ECG recorded during rest is often normal in patients with chronic stable angina
• Cardiac troponins T and I are the preferred markers for myocardial injury
• Serum troponin levels increase within 3-12 hours from the onset of chest pain, peak at 24-48 hours, and return to baseline over 5-14 days
• CK-MB levels increase within 3-12 hours of onset of chest pain, reach peak values within 24 hours, and return to baseline after 48-72 hours

Angina Types

• Stable Angina (also known as "effort angina")
• Unstable Angina
• Prinzmetal's (Variant) Angina
• Chronic Stable Angina (CSA): also known as "effort angina", refers to the classic type of angina related to myocardial ischemia
• Symptoms of CSA typically decline several minutes after activity and happen again when activity resumes
• Other recognized precipitants of stable angina include cold weather, heavy meals, and emotional stress

This quiz assesses knowledge on cardiovascular risk factors, symptoms, and diagnosis of heart conditions such as angina and myocardial infarction. It covers character of pain, response to relievers, and laboratory analysis.