Heart Disease Investigations and CAD Overview

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Questions and Answers

Which diagnostic tool is considered the 'gold standard' for imaging the anatomy of coronary arteries?

Cardiac isoenzymes and troponins

Resting electrocardiography

Coronary angiography (correct)

Echocardiography

What is the minimum percentage of stenosis considered severe in coronary angiography?

60%

80%

70% (correct)

50%

Which type of graft is most commonly used during CABG surgery?

Long saphenous vein (correct)

Radial artery

Reversed saphenous vein

Left internal mammary artery

Which condition indicates an urgent need for surgical intervention in ischemic heart disease?

Triple-vessel disease Signup and view all the answers

What are the primary disadvantages of mechanical prosthetic valve replacements?

Need for lifelong anticoagulation Signup and view all the answers

What role do troponins play in diagnosing ischemic heart disease?

They are markers of myocardial damage. Signup and view all the answers

What is a common indication for the surgical treatment of valvular heart disease?

Severe aortic stenosis Signup and view all the answers

Which of the following best describes the function of echocardiography in cardiac assessments?

Valuable for evaluating ventricular function and wall motion. Signup and view all the answers

What is the primary cause of ischemic heart disease?

Atherothrombotic disease Signup and view all the answers

Which of the following risk factors is not typically associated with coronary artery disease?

Gluten intolerance Signup and view all the answers

Which clinical manifestation is most commonly associated with ischemic heart disease?

Chest pain or angina Signup and view all the answers

What is the primary role of surgical intervention in coronary artery disease?

To restore adequate blood flow Signup and view all the answers

Which type of angina is characterized by chest pain due to plaque rupture and thrombosis?

Unstable angina Signup and view all the answers

Which diagnostic technique is most commonly used to assess coronary artery disease?

CT angiography Signup and view all the answers

Which of the following describes a significant risk factor for ischemic heart disease related to lifestyle?

Reduced physical activity Signup and view all the answers

Which of the following statements correctly defines atherosclerosis?

Blockage caused by cholesterol accumulation in arteries Signup and view all the answers

What is a common complication associated with biological valves?

Thromboembolism Signup and view all the answers

Which type of valve is more prone to structural valve failure?

Biological valves Signup and view all the answers

What is the best initial diagnostic test for a hemodynamically stable patient suspected of having an aortic dissection?

CT scan Signup and view all the answers

What is the standard treatment for a Type A aortic dissection?

Surgical repair with prosthetic graft Signup and view all the answers

Which of the following is NOT a risk factor for developing an aortic aneurysm?

Age 30 years or younger Signup and view all the answers

What is a key feature of prosthetic valve endocarditis (PVE)?

Has an incidence of 2-4% Signup and view all the answers

Which of the following describes the etiologies of aortic aneurysm?

Atherosclerosis and inflammation among others Signup and view all the answers

What is the primary advantage of biological valves over mechanical valves?

Less risk of clot formation Signup and view all the answers

Study Notes

Investigations for Heart Disease

Resting electrocardiography (ECG) is useful for acute clinical settings.
Troponin T and I are markers of myocardial damage, and can be used to diagnose and assess the prognosis of heart disease.
Echocardiography assesses ventricular function, regional wall motion abnormalities, and valvular lesions.
Coronary angiography is a gold-standard method for evaluating coronary artery anatomy and determining location, severity, and extent of stenoses.

Coronary Artery Disease

Coronary artery disease (CAD) results from progressive blockage of coronary arteries by atherothrombotic disease, decreasing myocardial perfusion.
Risk factors include hypertension, dyslipidemia (high LDL, low HDL, elevated Lp (a) or apoB, or triglycerides), diabetes mellitus, obesity, cigarette smoking, and family history of premature CAD.
Metabolic syndrome refers to the combination of several of these risk factors.
Progressive compromise in luminal diameter usually leads to chronic stable angina (stable ischemic heart disease).
Acute coronary syndromes (ACS), including unstable angina, non-ST-elevation myocardial infarction (non-STEMI), and ST-elevation infarction (STEMI), are often caused by plaque rupture with superimposed thrombosis.

Ischemic Heart Disease (IHD)

IHD is usually caused by atherosclerosis of the coronary arteries.

Atherosclerosis

Atherosclerosis is a process characterized by focal intimal elevation and blockage in large and medium-sized arteries, caused by accumulations of cholesterol and proliferation of connective tissue in the subintimal space.

Risk Factors for IHD

Advancing Age
Male gender
Hyperlipidemia
Diabetes mellitus
Hypertension
Smoking
Family history of IHD
Obesity
Reduced physical activity

Clinical Manifestations of IHD

Chest pain or angina
Breathlessness
Fatigue
Palpitations
Syncope

Coronary Artery Bypass Graft (CABG)

Indications for CABG include:
- Stenosis of the left main stem greater than 50%
- Stenosis of the proximal left anterior interventricular artery greater than 70%
- Triple-vessel disease
- Poor ventricular function associated with coronary artery disease

Conduits for CABG

Venous grafts: The long saphenous vein is commonly used as a conduit.
Arterial grafts: The left internal mammary (thoracic) artery (LIMA) or radial artery are preferred.

Valvular Heart Disease

Surgical Treatment: Repair or replacement of the diseased valve.

Types of Prosthetic Valves

** Mechanical Valves:**
- Advantages: Durability, lasts a lifetime.
- Disadvantages: Requires lifelong anticoagulation and is susceptible to infection.
** Biological Valves:**
- Advantages: Less risk of clot formation, lifelong anticoagulation is usually not necessary.
- Disadvantages: Less durable than mechanical valves.

Postoperative Management of Valvular Heart Disease:

Antibiotics to prevent endocarditis.
Anti-thrombotic therapy.

Complications of Valvular Heart Disease:

Structural Valve Failure: More common in biological valves due to degenerative changes.
Thromboembolism: Risk is greater with mitral valve replacements.
Prosthetic Valve Endocarditis: Incidence is 2-4%.

Aortic Aneurysm

Dilatation at least 1.5 times normal.
Etiologies: Degeneration (atherosclerosis, fibromuscular dysplasia), infection (syphilis), trauma, inflammation (Takayasu), connective tissue diseases (Marfans, Ehlers-Danlos syndrome), and congenital (Turner syndrome).
Risk factors include hypertension, high cholesterol, other vascular disease, family history, smoking, gender (males > females), and age (≥ 65 yrs).
Complications: Rupture, thrombosis, embolism, fistula, and mass effect.

Ruptured Aortic Aneurysm

Presents with hypotension, severe tearing abdominal pain radiating to the back, iliac fossae, or groin, syncope, and a pulsatile abdominal mass.

Aortic Dissection

Involves the separation of the layers of the aortic wall.
Presentation: Sudden, severe, tearing chest pain that may radiate to the back.
Diagnosis:
- Transthoracic echocardiography (TTE) is the preferred initial test for a hemodynamically stable patient.
- Transesophageal echocardiography (TEE) is the preferred initial test for a patient with hemodynamic instability or in impending rupture, especially if the dissection involves the ascending aorta.

Surgical Treatment for Aortic Dissection:

Type A: Surgical repair with a prosthetic graft.
Type B: Endovascular repair is preferred over open surgical repair.

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Description

This quiz delves into the diagnostic methods and risk factors associated with heart disease, focusing on resting ECG, troponin markers, echocardiography, and coronary angiography. It also explores coronary artery disease (CAD), its causes, risks, and the concept of metabolic syndrome. Test your knowledge on these crucial cardiovascular topics.