Carotid Stenosis
Does the presence of a carotid bruit confirm that a patient has significant stenosis?
No. A bruit does not reliably indicate stenosis severity. Absence doesn't exclude stenosis; presence doesn't confirm it.
Name the three classic features of stable angina.
Substernal pressure/heaviness, exertional trigger, and relief by rest or nitroglycerin within minutes.
This lipid pattern, high LDL-C with low HDL-C, contributes to endothelial injury and atherosclerosis.
Hyperlipidemia
Name the four first-line medication classes for treating stable angina.
Aspirin, beta-blocker (or CCB), statin, and ACE inhibitor/ARB, plus nitroglycerin PRN.
What ejection fraction (EF) cutoff differentiates HFrEF (systolic heart failure) from HFpEF diastolic heart failure)? .
HFrEF (systolic HF) is EF less than 40%; HFpEF (diastolic HF) is EF greater than 50%.
What are Hollenhorst plaques and why are they clinically important?
Cholesterol crystals from carotid plaques that have traveled to retinal vessels. They indicate major stroke risk.
This is the term for chest pain that is precipitated by exertion and relieved by rest, caused by a fixed atherosclerotic coronary stenosis.
Stable Angina
Ischemia begins within 10 seconds of coronary occlusion, and cardiac cells remain viable for about 20 minutes. This many minutes is the reperfusion window for improving survival.
90 minutes
In STEMI, caused by complete coronary occlusion, this is the preferred reperfusion strategy, performed at a chest pain center with an interventional cardiac program. Fibrinolysis is the alternative when it is not available.
What is immediate PCI (percutaneous coronary intervention)?
Describe the typical patient profile for HFpEF (diastolic heart failure).
Older female with hypertension, obesity, and/or diabetes.
What is the LDL goal for a symptomatic carotid stenosis patient who has had a prior stroke?
Less than 70 mg/dL (using high-intensity statin like atorvastatin 80mg daily).
What medication class is contraindicated in vasospastic angina because it can trigger coronary spasm?
Nonselective beta-blockers.
What medication class should be avoided in patients with HFrEF because it reduces contractility?
Calcium channel blockers (especially non-dihydropyridines like verapamil and diltiazem).
In a patient with CAD who also has asthma or COPD, this type of beta-blocker is preferred because it has mainly B-1 receptor affinity. It should be used with caution.
What is a cardioselective (B-1 selective) beta-blocker, such as metoprolol?
This drug class should be avoided in heart failure.
What is calcium channel blockers.
When should CEA (carotid endarterectomy) be performed after a patient has a TIA?
Within 14 days of symptom onset but wait at least 48 hours after the acute event for neurologic stabilization.
This drug class is the first-line treatment for vasospastic (Prinzmetal) angina, and nonselective beta-blockers should be avoided in this condition.
Calcium channel blockers
Diabetic patients and older adults are at particular risk for this form of ischemia, which is objective evidence of ischemia without symptoms and is often found on ambulatory ECG monitoring.
Silent MI
ST elevation in leads II, III, and aVF on the ECG indicates this type of MI
What is an inferior MI? The inferior wall of the heart is viewed by leads II, III, and aVF. When these leads show ST elevation, the injury is in the inferior wall.
This type of heart failure has an ejection fraction above 50% and a stiff, noncompliant left ventricle. It is typically seen in older women with long-standing hypertension and LVH.
What is HFpEF (diastolic heart failure)?
What is the stroke risk when a patient presents with Hollenhorst plaque PLUS amaurosis fugax (transient vision loss)?
Stroke risk comparable to TIA. This is a medical emergency requiring urgent imaging and possible CEA.
This type of angina causes rest pain, often at night, with transient ST elevation during episodes. It results from coronary artery spasm rather than a fixed stenosis
Vasospastic angina (Prinzmetal, Variant Angina, Coronary Artery Spasm).
Name three possible causes of MINOCA (Myocardial Infarction with Nonobstructive Coronary Arteries).
Any three of: vasospasm, SCAD (spontaneous coronary artery dissection), microvascular dysfunction, embolism, plaque erosion, or supply-demand mismatch.
What is the door-to-balloon time goal for STEMI intervention?
Less than 90 minutes. Time is myocardium!
This blood test, along with an ECG and chest x-ray, is part of the initial workup for suspected heart failure.
BNP