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M3 > Cardio - IHD > Flashcards

Cardio - IHD Flashcards

1
Q

condition in which there is an inadequate

supply of blood and oxygen to a portion of the myocardium

A

Ischemic heart disease

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2
Q

Most common cause of ACS

a. atherosclerotic disease of an endocardial artery
b. atherosclerotic disease of myocardial artery
c. atherosclerotic disease of epicardial artery
d. NOTA

A

C

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3
Q

The major determinants of myocardial oxygen demand

MVO2) are (3

A

(1) heart rate
(2) myocardial contractility
(3) myocardial wall tension (stress).

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4
Q

2 requirements for adequate supplt of oxygen to the myocardium

A
  1. satisfactory level of oxygen-carrying capacity of the blood
  2. adequate level of coronary blood flow
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5
Q

3 things that determine level of oxygen carrying capacity of blood

A
  1. inspired level of oxygen
  2. pulmonary function
  3. hemoglobin (concentration and function)
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6
Q

75% of the total coronary resistance to flow occurs across three sets
of arteries:

A
  1. large epicardial arteries
  2. prearteriolar areteries (R2)
  3. arteriolar and intramyocardial capillary vessels (R3)
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7
Q

True about coronary circulation

a. large epicardial arteries are R2
b. prearteriolar arteries are R3 arteries
c. major determinant of coronary resistance is found in R1 and R2
d. normal circulatory circulation is dominated by the brain’s demand for oxygen

A

a. they are R1
b. R2 and R3 are the major determinant of coronary resistance
d. it is dominated by the heart’s requirements for oxygen

answer: C

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8
Q

The changing oxygen needs of the heart with exercise and
emotional stress affect coronary vascular resistance and in this manner
regulate the supply of oxygen and substrate to the myocardium. This is an example of what kind of regulation?

A

metabolic regulation

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9
Q

The coronary resistance vessels also adapt to
physiologic alterations in blood pressure to maintain coronary blood
flow at levels appropriate to myocardial needs. This is an example of what kind of regulation?

A

autoregulation

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10
Q

Reduction of lumen of coronary arteries due to atherosclerosis causes

a. decrease in perfusion when demand for flow is augmented
b. increase in perfusion during exercise
c. both
d. neither

A

A

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11
Q

The following statements are true EXCEPT

a. coronary embolism rarely cause myocardial ischemia
b. coronary blood flow can be limited by spasm as in Prinzmetal angina
c. Myocardial ischemia can occur in LVH
d. NOTA

A

D

for letter C, there can be increase myocardial oxygen demand

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12
Q

Abnormal constriction or failure of normal dilation of the coronary resistance vessels also can cause ischemia. When it causes angina, this condition
is referred to as

A

microvascular angina

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13
Q

major site of coronary atherosclerotic disease

a. epicardial coronary arteries
b. endocardial coronary arteries
c. myocardial arteries

A

A

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14
Q

Major risk factors for atherosclerosis

A
  1. high levels of
    plasma low-density lipoprotein [LDL]
  2. low plasma high-density lipoprotein [HDL]
  3. cigarette smoking
  4. hypertension
  5. diabetes
    mellitus
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15
Q

Atherosclerosis is a problem of

a. vulnerable vessel
b. vulnerable blood
c. both
d. neither

A

C

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16
Q

Predilection for atherosclerotic plaques

a. turbulence in coronary flow
b. branch points in epicardial arteries
c. both
d. neither

A

C

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17
Q

limitation of ability to increase flow to meet increased myocardial demand is observed when there’s __% reduction in the diameter of an epicardial artery

A

50%

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18
Q

when there’s __% reduction in the diameter of an epicardial artery, blood flow at rest may be reduced

A

80%

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19
Q

The severity and duration of
the imbalance between myocardial oxygen supply and demand determine
whether the damage is reversible if duration of total occlusion is

A

<=20min

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20
Q

The severity and duration of
the imbalance between myocardial oxygen supply and demand determine
whether the damage is permanent if duration of total occlusion is

A

> 20min

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21
Q

Transient T wave inversion

a. non-transmural, intramyocardial ischmia
b. patchy subendocardial ischemia
c. severe transmural ischemia

A

A

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22
Q

Transient ST-segment depression

a. non-transmural, intramyocardial ischmia
b. patchy subendocardial ischemia
c. severe transmural ischemia

A

B

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23
Q

ST-segment elevation

a. non-transmural, intramyocardial ischmia
b. patchy subendocardial ischemia
c. severe transmural ischemia

24
Q

The following can be found in myocardial ischemia EXCEPT

a. T wave inversion
b. isolated ventricular premature beats
c. ventricular tachycardia
d. ventricular arhythmia
e. NOTA

25
Most common cuase of death in patients with IHD
ventricular tacharrhythmias
26
Patients with IHD also can present with cardiomegaly and heart failure secondary to ischemic damage of the left ventricular myocardium that may have caused no symptoms before the development of heart failure; this condition is referred to as
Ischemic cardiomyopathy
27
The following may happen in patient who enters the symptomatic phase a. progressive course b. revert to asymptomatic stage c. die suddenly d. A and C e. A, B, C
E
28
The following statements are true of stable angina pectoris a. Males constitute 75% of all patients with angina pectoris b. males constitute a greater portion of those having stable angina pectoris in px younger than 50yrs c. neither d. both
B
29
Typical presentation of patient with angina where he/she places a hand over the sternum, sometimes with a clenched fist, to indicate a squeezing, central, substernal discomfort.
Levine's sign
30
True of stable angina pectors a. typical patient is man >60years, woman >50 yrs b. episodes of chest discomfort usually described as heaviness, pressure, squeezing, smothering, choking and frank pain c. both d. neither
D man >50 years woman >60 years rarely as frank pain
31
True of Angina a. usually cresendo-decrescendo b. typically lasts 2-5 minutes and radiate to either shoulder, or bot arms c. both d. neither
C
32
Other sites of radiation of angina pain a. interscapular region, root of neck, jaw, teeth and epigastrium b. rarely below umbilucs or above the mandible c. neither d. both
D
33
angina can be caused by a. exertion b. emotion c. both d. neither
C
34
Angina that occurs when patient is recumbent
angina decubitus
35
Angina can be a. relieved by rest b. occur at rest c. both d. neither
C
36
due to episodic tachycardia, diminished oxygenation as the respiratory pattern changes during sleep, or expansion of the intrathoracic blood volume that occurs with recumbency
Nocturnal angina
37
Many patients report a fixed threshold for angina, which occurs predictably at a certain level of activity, such as climbing two flights of stairs at a normal pace. In these patients, coronary stenosis and myocardial oxygen supply are fixed, and ischemia is precipitated by an increase in myocardial oxygen demand. These patients have
Stable exertional angina
38
Exertional angina is relieved in 1-5 min by a. rest b. sublinguual nitroglycerin c. slowing down of activities d. AOTA e. NOTA
D
39
``` NYHA classification Patients have cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain. ```
II
40
``` NYHA classiication Patients have cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased ```
IV
41
Sharp, fleeting chest pain or a prolonged, dull ache localized to the left submammary area is rarely due to myocardial ischemia a. true b. false
A
42
example of patients that present with atypical angina a. women b. diabetic patients c. elderly d. AOTA e. NOTA
C
43
symptoms of myocardial ischemia other than angina
anginal equivalents
44
Examples of anginal equivalents (4)
1. dyspnea 2. nausea 3. fatigue 4. faintness
45
Significant family history for IHD ____ for men ____ for women
<55 years | <65 years
46
The following statement/s is/are true a. The history of typical angina pectoris is not enough to establish the diagnosis of IHD b. advanced age, female sex, the postmenopausal state, and risk factors for atherosclerosis increase the likelihood of hemodynamically significant coronary disease. c. a murmur is often heard in patients with stable angina even if they are asymptomatic d. treatment of microvascular coronary disease should focus on efforts to improve endothelial function
D murmur is heard if previous MI impaired papillary muscle function
47
Palpation may reveal cardiac enlargement and abnormal contrac tion of the cardiac impulse
left ventricular dyskenesia
48
PE when suspecting ischemic heart disease include the ff EXCEPT a. ABI b. arterial bruits c. search for xanthelasmas d. third and fourth heart sounds e. NOTA
E
49
``` Examination during an anginal attack is useful since ischemia can cause: a. S3and/S4 b. dyskinetic cardiac apex c. mitral regurgitation d. pulmonary edema E. AOTA ```
E
50
The following characteristics make myocardial ischemia likely a. Tenderness of the chest wall, localization of the discomfort with a single fingertip on the chest b. reproduction of the pain with palpation of the chest c. boh d. neither
D
51
Significance of a protuberant abdomen in the PE of myocardial ischemia
may indicate that patient has metabolic syndrome and is at increased risk for atherosclerosis
52
What do you look for when you examine urine in patient suspected with IHD?
urine should be examined | for evidence of diabetes mellitus and renal disease (esp. microalbuminuria)
53
what is the significance of renal disease and DM in IHD?
accelerate atherosclerosis
54
Which of the ff blood tests should be done only if indicated based on PE? a. lipids b. glucose c. creatinine d. hct e. thyroid function
E
55
What 2 things will you look for in cxr of patient with suspected IHD?
cardiac enlargement ventricular aneurysm signs of heart failure
56
True of CRP EXCEPT a. elevated CRP is an independent risk factor for IHD b. CRP between 0 and 3 mg/dL is signifcant risk factor c. elevated CRP is useful in diagnosis of the disease d. NOTA
C; it is useful in therapeutic decision making about the inititation of hypolipidemic treatment

M3 (66 decks)

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