Cardiovascular Disease - Coronary Artery Disease

Question 1

most common underlying cause of myocardial ischemia and injury

Answer 1

obstruction of coronary arteries by artherosclerosis

Question 2

most common cause of anterior chest musculoskeletal pain

Answer 2

costochondral and chondrosternal syndromes

Question 3

myocardial perfusion occurs during this time

Answer 3

diastole

Question 4

remains the major cause of death and premature disability in developed societies

Answer 4

atherosclerosis

Question 5

site with higher predilection for developing atherosclerotic disease

Answer 5

proximal left anterior descending coronary artery

Question 6

initial lesion of atherosclerosis

Answer 6

fatty streak

Question 7

age when lipid screening should start (based on current ATP III guidelines)

Answer 7

20 y/o (fasting lipid profile; total cholesterol; triglycerides; LDL, and HDL), repeated every five years

Question 8

initial management of dyslipidemia

Answer 8

therapeutic lifestyle changes (TLC)

Question 9

ultimately causes the gravest complications of atherosclerosis

Answer 9

thrombosis

Question 10

key feature of metabolic syndrome

Answer 10

central adiposity

Question 11

most accepted and unifying hypothesis to describe pathophysiology of metabolic syndrome

Answer 11

insulin resistance

Question 12

driving force behind the metabolic syndrome

Answer 12

obesity

Question 13

primary approach to metabolic syndrome

Answer 13

weight reduction ( caloric restriction: most important component)

Question 14

in LDL cholesterol - generally the first choice for medication intervention

Answer 14

HMG-CoA Reductase inhibitors (statins)

Question 15

drug of choice to lower fasting TG and typically achieve a 35-50% reduction

Answer 15

fibrates

Question 16

only currently available drug with predictable HDL cholesterol raising properties

Answer 16

nicotinic acid

Question 17

most common cause of myocardial ischemia

Answer 17

atherosclerotic disease of epicardial coronary artery

Question 18

major site of atherosclerotic disease

Answer 18

epicardial arteries (most common: left anterior descending artery)

Question 19

predilection for atherosclerotic plaques to develop at sites of increased turbulence

Answer 19

branch points in the epicardial arteries

Question 20

reversible damage in myocardium

Answer 20

less then or equal to 20 minutes for total occlusion in the absence of collaterals

Question 21

typical patient with angina

Answer 21

man >50 years or a woman >60years of age who complains of chest discomfort (heaviness, pressure, squeezing, smothering or choking) and only rarely as frank pain

Question 22

most commonly used test for both the diagnosis of IHD and estimating the prognosis

Answer 22

electrocardiographic stress testing

Question 23

route providing most rapid and complete absorption of nitrates

Answer 23

mucous membranes

Question 24

most common route in administration of nitroglycerin

Answer 24

sublingually

Question 25

most common pathophysiologic cause of unstable angina

Answer 25

plaque rapture or erosion with superimposed non-occlusive thrombus

Question 26

clinical hallmark of ACS, typically located in the substernal region or sometimes in the epigastrum, that radiate to the neck, left shoulder, and left arm

Answer 26

chest pain

Question 27

only absolute contraindications to nitrate use

Answer 27

hypotension | use of sildenafil or similar drugs in previous 24-48 hours

Question 28

most important adverse effect of all antithrombotic agents

Answer 28

excessive bleeding

Question 29

most common artery involved in focal spasms of Prinzmetal angina

Answer 29

right coronary artery

Question 30

main agents for acute episodes of prinzmetal angina and to abolish recurrent episodes

Answer 30

nitrates and calcium channel blockers

Question 31

type of necrosis seen in M.I.

Answer 31

coagulation necrosis (preserved architecture, faded details)

Question 32

initial occurrence of gross changes in M.I.

Answer 32

12 hours after onset of symptoms

Question 33

color changes in M.I.

Answer 33

mottling: 4 hours bright yellow: 1 week surrounding red granulation tissue: 2 weeks gray-white scar: 2 months

Question 34

full-thickness/transmural; ECG: ST-Elevation, Q waves; associated with increased early mortality rate

Answer 34

Q-wave infarction (clinically equivalent to STEMI)

Question 35

Partial-thickness/subendocardial; involves inner third of myocardium; ECG: ST depression; increased risk of infarction and sudden cardiac death post-M.I.

Answer 35

Non-Q-wave infarction (Clinically equivalent to NSTEMI)

Question 36

Fibrous pericarditis (bread & butter pericarditis) associated with M.I.

Answer 36

Dressler's syndrome (Dressler's Triad: fever, pleuritic pain, pericardial effusion)

Question 37

Myocardial rupture post-M.I.

Answer 37

Usually in 1st time M.I. patients (cardiac scar that forms in those with previous M.I. prevents rupture)

Question 38

most common presenting complaint in STEMI

Answer 38

chest pain

Question 39

pivotal diagnostic and triage tool because it is at the center of the decision pathway for screening and management in STEMI

Answer 39

12-lead ECG

Question 40

preferred biochemical markers for MI

Answer 40

cardiac-specific troponin T & cardiac-specific troponin I

Question 41

most out-of-hospital deaths from STEMI

Answer 41

ventricular fibrillation

Question 42

primary cause of in-hospital deaths from STEMI

Answer 42

pump failure

Question 43

greatest delay usually occurs between

Answer 43

onset of pain and the patient's decision to call for help

Question 44

principal goal of fibrinolysis

Answer 44

prompt restoration of full coronary arterial patency

Question 45

door-to-needle time

Answer 45

less than or equal to 30 min

Question 46

most frequent and potentially the most serious complication of fibrinolysis

Answer 46

hemorrhage (hemorrhagic stroke: most serious complication)

Question 47

standard antiplatelet agent for STEMI

Answer 47

aspirin

Question 48

standard anticoagulant agent used in clinical practice (IN STEMI)

Answer 48

unfractionated heparin

Question 49

most common clinical signs of pump failure

Answer 49

pulmonary rales; s3 and s4 gallop sounds

Question 50

extent of LV involvement that usually results in cardiogenic shock

Answer 50

infarction >40%

Question 51

usual duration of hospitalization for an uncomplicated STEMI

Answer 51

5 days

Question 52

most common complication of angioplasty

Answer 52

restenosis, or re-narrowing of the dilated coronary stenosis

Question 53

most common thrombi found in NSTEMI

Answer 53

white thrombi (composed mainly of platelets)

Question 54

most common thrombi found in STEMI

Answer 54

red thrombi (composed of cells and fibrins)