Cardiovascular Risk Factors and Diagnosis

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Questions and Answers

Which of the following is NOT a typical symptom of IHD?

Sharp pain in the back

Which of the following is a major risk factor for IHD?

Hypertension with BP > 130/80 mmHg

Which type of angina is characterized by pain that occurs at rest and is prolonged and unrelieved by sublingual nitroglycerin?

Acute Coronary Syndrome (ACS)

What is the primary strategy for delaying IHD progression and preventing IHD-related events?

Early detection and aggressive modification of risk factors Signup and view all the answers

Which of the following is a symptom of stable angina?

Pain provoked by exertion Signup and view all the answers

What is the typical duration of symptom relief for stable angina after rest or sublingual nitroglycerin?

Minutes Signup and view all the answers

What is a characteristic of stable angina?

Responds to GTN Signup and view all the answers

Which of the following is NOT a risk factor for IHD?

Body temperature Signup and view all the answers

What is the preferred marker for myocardial injury?

Cardiac troponins T and I Signup and view all the answers

What is the significance of elevated cardiac troponins?

High risk of death from ACS Signup and view all the answers

What is the time frame for peak levels of cardiac troponins?

Within 24-48 hours Signup and view all the answers

What is the purpose of an electrocardiogram (ECG) in diagnosis?

To rule out active ischemia Signup and view all the answers

What is the significance of a normal ECG?

Is often seen in patients with chronic stable angina Signup and view all the answers

What is the purpose of CK-MB in diagnosis?

To diagnose myocardial infarction Signup and view all the answers

What is the primary cause of coronary artery narrowing and reductions in coronary blood flow in chronic stable angina?

Atherosclerotic plaques Signup and view all the answers

Which type of angina is also known as 'effort angina'?

Chronic Stable Angina Signup and view all the answers

What is the typical presentation of stable angina?

Chest discomfort and associated symptoms precipitated by some activity Signup and view all the answers

What is the underlying pathology of chronic stable angina?

Atherosclerosis Signup and view all the answers

What is the effect of rest on symptoms of stable angina?

Symptoms decline with rest Signup and view all the answers

What is the characteristic of chronic stable angina?

Occasional periods of anginal symptoms, which are usually predictable and related to the amount of heart work Signup and view all the answers

What is the primary difference between chronic stable angina and unstable angina?

Chronic stable angina is predictable and unstable angina is unpredictable Signup and view all the answers

What is the characteristic of anginal episodes in chronic stable angina?

Anginal episodes are predictable and occasional Signup and view all the answers

Study Notes

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