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Questions and Answers
Which of the following is an unalterable risk factor for ischemic heart disease?
What is the primary goal of short-term treatment for effort-induced angina?
Which of the following alterable risk factors can increase the likelihood of ischemic heart disease?
What is the long-term goal of treatment for effort-induced angina?
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Which of the following is a secondary intervention for ischemic heart disease?
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How do β-adrenergic blockers help in the treatment of effort-induced angina?
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What is the relationship between myocardial blood flow and arteriolar resistance?
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What is the significance of atherosclerotic lesions occluding R1?
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What is the clinical presentation of ischemic episodes?
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What is the relationship between the severity of stenosis and clinical events such as MI?
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What are some precipitating factors for ischemic episodes?
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What is the role of R2 in maintaining coronary blood flow?
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What is the primary determinant in the occurrence of ischemia in ischemic heart disease?
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What does the double product (DP) serve as in the context of ischemic heart disease?
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Which of the following is NOT a major determinant of myocardial oxygen demand?
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Which of the following is NOT a presentation of ischemic heart disease?
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Which of the following best describes the relationship between large epicardial vessels and intramyocardial arteries and arterioles in normal circumstances?
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Which of the following is NOT a potential intervention to alleviate ischemia in ischemic heart disease?
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Study Notes
Risk Factors for Coronary Heart Disease (CHD)
- Ask patients about personal risk factors for CHD, including smoking, hypertension, and diabetes mellitus
- Obtain family history, including premature CHD, hypertension, lipid disorders, and diabetes mellitus
Goals of Treatment
- Short-term goals: reduce or prevent anginal symptoms that limit exercise capability and impair quality of life
- Long-term goals: prevent CHD events such as myocardial infarction (MI), arrhythmias, and heart failure (HF), and extend the patient's life
Nonpharmacologic Therapy
- Primary prevention: modify risk factors to reduce prevalence of IHD
- Secondary intervention: reduce subsequent morbidity and mortality
- Risk factors for IHD are additive and can be classified as alterable or unalterable
Alterable and Unalterable Risk Factors
- Alterable risk factors: smoking, hypertension, hyperlipidemia, obesity, sedentary lifestyle, hyperuricemia, psychosocial factors, and use of detrimental drugs
- Unalterable risk factors: gender, age, family history or genetic composition, environmental influences, and diabetes mellitus
Pharmacologic Therapy
- β-Adrenergic blockers: decrease heart rate, contractility, and blood pressure, reducing MVo2 and oxygen demand in patients with effort-induced angina
- Myocardial blood flow is inversely related to arteriolar resistance and directly related to coronary driving pressure
Clinical Presentation
- Many ischemic episodes are asymptomatic (silent ischemia)
- Symptoms may include pressure or burning over the sternum, radiating to the left jaw, shoulder, and arm, and can be precipitated by exercise, cold environment, emotional upset, and other factors
- Symptoms usually last from 30 seconds to 30 minutes
Ischemic Heart Disease (IHD)
- Defined as lack of oxygen and decreased or no blood flow to the myocardium resulting from coronary artery narrowing or obstruction
- Can present as acute coronary syndrome (ACS), chronic stable exertional angina, ischemia without symptoms, or ischemia due to coronary artery vasospasm (variant or Prinzmetal angina)
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Description
Learn about Ischemic Heart Disease (IHD) and its various presentations, including acute coronary syndrome and chronic stable exertional angina. Understand the definition, causes, and symptoms associated with IHD.
