Chapter 21, 22, 23

Question 1

Condition that is associated with prominent y descent
A cardiac tamponade
B. ventricular ischemia
C. tricuspid stenosis
D. constrictive pericarditis

Answer 1

D

Conditions that blunt the right atrial y descent include cardiac tamponade, ventricular ischemia, and tricuspid stenosis. Conversely, constrictive pericarditis is associated with the prominence of the y descent because the very earliest phase of diastolic ventricular filling is unimpeded in this condition.

Question 2

Which of the following statements is true?
A. a wave represents atrial systole and occurs after the P wave on the ECG
B. The height of the v wave refIects atrial compliance.
C. In the left atrium, as opposed to the RA, the v wave is generally more prominent than the a wave.
D. The x descent represents the relaxation of the atrium and downward tugging of the tricuspid annulus by right ventricular contraction.
E. All of the above

Answer 2

E

Question 3

What are the contraindications to CA?

Answer 3

no absolute contraindications to coronary angiography

Question 4

What are the class I indications in stable CAD for Coronary angiogram?

Answer 4

1. Patients with SIHD who have survived sudden cardiac death or potentially life-threatening ventricular arrhythmia.
2. Patients with SIHD who develop symptoms and signs of HF.
3. Patients with high likelihood of severe IHD and in whom the benefits are deemed to exceed risk.
4. Patients with presumed SIHD who have unacceptable ischemic symptoms despite optimal medical therapy and who are amenable to, and candidates for, coronary revascularization.

Question 5

What are the class I indications in NSTEMI acute coronary syndrome for Coronary angiogram?

Answer 5

1. Urgent/immediate invasive strategy in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability.
2. Early invasive strategy in initially stabilized patients with NSTE-ACS who have elevated risk for clinical events. (within 24 hours)

Question 6

What are the class I indications in STEMI acute coronary syndrome for Coronary angiogram?

Answer 6

1. Immediate angiography and PCI when indicated should be performed in resuscitated out-of-hospital cardiac arrest patients whose initial ECG shows STEMI.
2. Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration.
3. Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact.
4. Primary PCI should be performed in patients with STEMI and cardiogenic shock or acute severe HF, irrespective of time delay from MI onset.

Question 7

Risk Factors That Support Early Invasive Evaluation of Patients Presenting with ACS

Answer 7

Significant troponin increase
Diagnostic ST or T wave changes
GRACE score >140
Diabetes mellitus
Reduced LV function (ejection fraction <40%)
Early postinfarction angina
Recent PCI
Prior CABG
Intermediate to high GRACE risk score

Question 8

Complications of Coronary Angiography

Answer 8

Complication Risk (%)
Mortality 0.11
Myocardial infarction 0.05
Cerebrovascular accident 0.07
Arrhythmias 0.38
Vascular complications 0.43
Contrast agent reaction 0.37
Hemodynamic complications 0.26
Perforation of heart chamber 0.03
Other complications 0.28
Total of major complications 1.70

Question 9

Deep cannulation of the RCA and injection of contrast media directly into the conus branch?

Answer 9

ventricular fibrillation

Question 10

Contrast-induced acute kidney injury (CI-AKI) definition:

Answer 10

Increase in creatinine of 0.5 mg/dL or more or 25% or greater compared with baseline

24 to 72 hours after contrast injection

Question 11

Mechanism of AKI in CA

Answer 11

Blood redistribution:
Blood flow increases in the cortex and decreases in the medulla

Medulla is vulnerable to ischemic injury for the basal hypoxic condition (P o 2 = 20 mm Hg) because of high metabolic activity

Question 12

Who are high risk for developing AKI?

Answer 12

eGFR value below 60 mL/min are at high risk of CI-AKI

CIN-develops 24 to 72 hours
IOCM, iso-osmolar contrast media

compared to the renal chapter:

Question 13

What are the complications of coronary angiogram?

Answer 13

Complications: 2%
Serious complications (cerebrovascular accident (CVA), or stroke, or myocardial infarction (MI)) <1%
Mortality rate is lower than 0.1%
Complication Risk (%)
Mortality 0.11
Myocardial infarction 0.05
Cerebrovascular accident 0.07
Arrhythmias 0.38
Vascular complications 0.43
Contrast agent reaction 0.37
Hemodynamic complications 0.26
Perforation of heart chamber 0.03
Other complications 0.28
Total of major complications 1.70

Question 14

most common location of radiation-induced lesions?

Answer 14

skin of the back

common patterns include erythema, telangiectasia, and plaques

Question 15

Where to puncture when preparing for femoral access?

Answer 15

the common femoral artery (CFA) is punctured with a base-metal needle approximately 1 cm below the inguinal line with a 45- to 60-degree angulation

Question 16

What is the ideal puncture site for radial access?

Answer 16

1 to 2 cm proximal to the radial styloid with the wrist slightly hyperextended

Question 17

Preferred access site for CA?

Answer 17

Radial artery

> fewer periprocedural events
>to prevent thromboembolic events and radial artery occlusion, weight-adjusted unfractionated heparin (UFH), 40 to 70 U/kg up to 5000 U, is administered either intravenously or intra-arterially
>nitroglycerin (100 to 200 μg) or verapamil (2.5 mg) diluted into 10 mL of saline to prevent vasospasm

Question 18

What diagnostic catherter automatically engages the ostium of the left coronary artery (LCA)?

Answer 18

preformed left Judkins (JL)

> when using a femoral access, the JL4 is the most adaptable catheter for the LCA, whereas for the radial access, the JL3.5 catheter may be more suitable
JR, once positioned in the right coronary sinus, requires a clockwise rotation to engage the ostium of the RCA from any vascular approach

Question 19

At what view is RCA is cannulated?

Answer 19

left anterior oblique (LAO)

Right Coronary Artery
LAO 45 Vessel engagement projection
Ostium and RCA along AV sulcus
LAO10-30, CRAN 30 PDA, PL branches, and RCA after crux
RAO 30 PDA ostium, PDA septal branches, right ventricular branches, acute margin branches

Question 20

Saphenous Vein Grafts origin and attachment:
1. aorta to the distal RCA or posterior descending artery (PDA)
2. SVG to LAD-
3. SVG to OM-

A. left anterolateral aspect of the aorta 9 to 10 cm superior to the sinotubular ridge
B.anterior portion of the aorta approximately 7 cm superior to the sinotubular ridge
C.anterolateral aspect of the aorta 5 cm (2 inches) superior to the sinotubular ridge

Answer 20

1. SVG to the aorta to the distal RCA or posterior descending artery (PDA)- anterolateral aspect of the aorta 5 cm (2 inches) superior to the sinotubular ridge
2. SVGs to the LAD artery -originate from the anterior portion of the aorta approximately 7 cm superior to the sinotubular ridge
3. SVGs to the obtuse marginal branches arise from the left anterolateral aspect of the aorta 9 to 10 cm superior to the sinotubular ridge

LAO projection

Question 21

View used in cannulating LIMA

Answer 21

right anterior oblique (RAO) or anteroposterior (AP) projections can be used to visualize the IMA

Question 22

Classification of MR by Sellers:
Moderate opacification of the left atrium with each cycle, clearing with the subsequent beats

A. trivial
B. Mild
C. Moderate
D. Severe

Answer 22

Answer: B
Trivial (+1): A minimal jet with a brief and incomplete atrial opacification during systole, rapidly clearing during each cycle without atrial enlargement.
Mild (+2): A moderate opacification of the left atrium with each cycle, clearing with the subsequent beats. The atrium is less opacified than the left ventricle, usually with preserved dimensions.
Moderate (+3): A complete opacification of the left atrium, equal intensity to ventricular opacification. There is delayed atrial clearing over several cycles and a significant enlargement of the left atrium.
Severe (+4): A complete and immediate opacification of the left atrium, even denser than the ventricle. The left atrium is typically severely enlarged and opacification of pulmonary veins may be visible.

Question 23

Classification of AR by Sellers:
regurgitation jet causing complete ventricular opacification within two cycles, as dense as in the ascending aorta and with delayed clearing from the ventricle over several cycles, often associated with dilated left ventricle
A. Grade I
B. Grade II
C. Grade III
D. Grade IV

Answer 23

Trivial or grade 1 (1+): minimal regurgitation jet with a brief and incomplete left ventricle opacification during diastole and fast clearance of the contrast agent.
Mild or grade 2 (+2): regurgitation jet causing a moderate ventricular opacification, which less dense than in the ascending aorta and is cleared within one to two cardiac cycles.
Moderate or grade 3 (+3): regurgitation jet causing complete ventricular opacification within two cycles, as dense as in the ascending aorta and with delayed clearing from the ventricle over several cycles, often associated with dilated left ventricle.
Severe or grade 4 (+4): complete and immediate opacification of the left ventricle, denser than observed in the ascending aorta.

Question 24

Views for Left Ventriculography (2)

Answer 24

Question 25

Views for Right Ventriculography (2)

Answer 25

AP cranial or AP lateral projections

Question 26

What is the classification of allergic reaction to contrast associated with chest pain?

Answer 26

moderate

Question 27

When to give prophylactic therapy for allergic reaction to contrast?

Answer 27

history of allergic adverse events especially anaphylactic reaction ## Footnote >>prednisone, 50 mg by mouth (PO), or hydrocortisone, 200 mg intravenous (IV) at 13 hours, 7 hours, and 1 hour before ICA injection, plus diphenhydramine, 50 mg IV, intramuscularly (IM), or PO, 1 hour before ICA administration >>Methylprednisolone, 32 mg PO, 12 hours and 2 hours before ICA injection, plus an antihistamine can also be used

Question 28

Where is LAD visible in LAO views?

Answer 28

in LAO views, the LAD is visible on the right side of the spinal column ## Footnote >In RAO projections, the LAD is on the left side of the spinal column. >Caudal views are mostly used for the proximal segment of the LCA. >cranial views avoid foreshortening and allow for the evaluation of the mid- and distal portion of the vessel and its bifurcations. >Left Coronary Artery Anteroposterior, CAUD 10 LMCA engagement projection LAO 20-45, CAUD 30-45 “Spider projection”: LMCA and proximal segment of LAD, Cx, and ramus (if present) LAO 20-45, CRAN 30-60 Mid- and distal LAD and its branches, Cx PDA, and Cx PL branches if present RAO 15-30, CAUD 10-30 All LAD and branches, Cx and OM branches RAO 15-30, CRAN 10-30 Mid- and distal LAD and branches, mid-Cx and branches

Question 29

Codominance of coronary vessel

Answer 29

10% PDA arising from the RCA and the PL branches arising from the Cx

Question 30

What course of an anomalous LCA is associated with SCD during or shortly after exercise in young individuals

Answer 30

interarterial coming from the right sinus ## Footnote origin of the RCA from the left aortic sinus with an interarterial course is associated with myocardial ischemia and SCD Treatment: CABG

Question 31

Anomalous origin of the LCA from PA (ALCAPA)

Answer 31

Bland-White-Garland syndrome

Question 32

Most common Anomalous pulmonary origin of coronary arteries (APOCA)?

Answer 32

ALCAPA (Bland-White-Garland syndrome) ## Footnote Almost 90% of patients with this CAA die during the first year of life

Question 33

The most common form of congenital coronary absence

Answer 33

Lack of an LMCA ## Footnote benign

Question 34

Diagnosis of hypoplasia of a coronary artery

Answer 34

luminal diameter of less than 1.5 mm in a major epicardial vessel, with no nearby compensatory branches ## Footnote prognosis of single-vessel hypoplasia of the Cx or RCA is relatively good

Question 35

Most common draining of coronary artery fistula?

Answer 35

Right ventricle ## Footnote >low-pressure structures, such as the right ventricle (40%), right atrium (26%), PA (17%), coronary sinus (7%), and superior vena cava (1%) >most origin:RCA in 33% to 55%, the LAD in 35% to 49%, and the Cx in 17% to 18% >common symptoms: dyspnea, fatigue, palpitation, and chest pain

Question 36

Gold standard for the diagnosis of CAFs?

Answer 36

Coronary angiography

Question 37

Coronary Anomalies that would present with typical ischemia? (3)

Answer 37

Anomalous Left coronary artery from the pulmonary artery (ALCAPA); coronary ostial atresia or severe stenosis ## Footnote Absence of ischemia: Most anomalies (split RCA, ectopic RCA from right cusp; ectopic RCA from left cusp) Episodic ischemia: Anomalous origin of a coronary artery from the opposite sinus (ACAOS); coronary artery fistulas; myocardial bridge

Question 38

Treatment for myocardial bridging?

Answer 38

BBs may be considered

Question 39

Dynamic reversible focal restriction or occlusion of a coronary artery caused by the constriction of the smooth muscle cells in the vessel wall?

Answer 39

Coronary artery spasm ## Footnote Treatment:nitrates and calcium channel blockers Cigarette smoking, cocaine use, alcohol, intracoronary irradiation, and administration of catecholamines can promote coronary artery spasm

Question 40

Provocative tests for coronary artery spasm?

Answer 40

IV ergonovine maleate, IV acetylcholine, and hyperventilation

Question 41

Residual SYNTAX score that was an independent predictor of 5-year mortality

Answer 41

>8 ## Footnote in patients with LM or multivessel disease, current guidelines recommend SYNTAX score to assess the anatomical complexity of CAD, as well as the long-term risk of mortality and morbidity after PCI

Question 42

Based on AHA/ACC Lesion Classification, what are the characteristics of lesions with procedural success rate of 92% and a low complication rate?

Answer 42

Type A lesions: Length <10 mm * Discrete * Concentric readily accessible * <45-degree angle * Smooth contour

Question 43

What are the characteristics of coronary artery lesions that have a 72% success rate with a 10% rate of complications?

Answer 43

Type B lesion: * Length 10-20 mm * Eccentric * Moderate tortuosity of proximal segment * 45- to 90-degree angle * Irregular contour * Presence of any thrombus grade

Question 44

What is the success and compication rates of type C coronary artery lesion?

Answer 44

61%- success rate 21%- complications ## Footnote Type A lesions have a procedural success rate of 92% and a low complication rate Type B lesions have a 72% success rate with a 10% rate of complications Type C lesions have only a 61% success rate and a 21% rate of complications

Question 45

Characteristics of Type C lesion?

Answer 45

* Length >20 mm * Diffuse * Excessive tortuosity of proximal segment * >90-degree angle * Total occlusion >3 months old and/or bridging collaterals inability to protect major side branches * Degenerated vein graft with friable lesions

Question 46

Normal values of TIMI flow count on: LAD Cx RCA

Answer 46

TFCs are 36 ± 3 (or 21 ± 2 if corrected) for the LAD, 22 ± 4 for the Cx, and 20 ± 3 for the RCA.

Question 47

TRUE/FALSE The myocardial blush grade is superior to TIMI flow grade for predicting postprocedural cardiac death and major adverse cardiovascular event (MACE).

Answer 47

TRUE ## Footnote Grade 0 No myocardial blush or contrast density Grade 1 Minimal myocardial blush or contrast density Grade 2 Moderate myocardial blush but less than that obtained from the ipsilateral non–infarct-related coronary artery Grade 3 Normal myocardial blush or contrast density comparable to that obtained during angiography of a contralateral or ipsilateral non–infarct-related artery

Question 48

Rentrop Classification Grade 0-3 >no retrograde visualization of the epicardial vessels with minor filling of the collaterals

Answer 48

Grade 0- No filling of collateral circulation Grade 1- Minor filling of collateral vessels with no retrograde visualization of the epicardial vessel Grade 2- Partial retrograde opacification by the collateral vessels of the epicardial artery Grade 3- Complete retrograde opacification by the collateral vessels of the epicardial vessel

Question 49

TIMI classification 0-3

Answer 49

TIMI 0 Flow No penetration of contrast beyond the stenosis (100% stenosis, occlusion) TIMI 1 Flow Penetration of contrast beyond the stenosis but no perfusion of the distal vessel (99% stenosis, subtotal occlusion) TIMI 2 Flow Contrast reaches the distal vessel but at reduced rate of filling or clearing compared with other coronary arteries (partial perfusion) TIMI 3 Flow Contrast reached the distal vessel and clear at the same rate as the other coronary arteries

Question 50

What scoring system was develop to predict the probability of successful guidewire CTO crossing within 30 minutes?

Answer 50

J-CTO ## Footnote independent predictors were previously failed lesion, blunt stump type, vessel bending, presence of calcification, and occlusion length of 20 mm or more

Question 51

What is the gold standard for the evaluation of calcific lesions?

Answer 51

CTCA ## Footnote can detect plaque burden at a very early stage

Question 52

Agatson Calcium score? Moderate calcium is detected in the coronary arteries. There is a moderate risk of having a cardiovascular event within 10 years.

Answer 52

Score (Agaston) Plaque Burden Description/Probability of Coronary Artery Disease 0 Nonidentified- Negative test: very low risk of having a cardiovascular event in the next 10 years (<5%). 1-10 Minimal- Minimal atherosclerosis is present. Findings are consistent with a low risk of having a cardiovascular event in the next 10 years (<10%). 11-100 Mild- Mild coronary atherosclerosis is present. Mild or minimal coronary stenosis is likely. 101-400 Moderate- Moderate calcium is detected in the coronary arteries. There is a moderate risk of having a cardiovascular event within 10 years. >400 Extensive High risk of having at least one significant coronary stenosis (>90%). Significant risk of having a cardiovascular event within the next 10 years.

Question 53

Thrombus score?

Answer 53

Grade 3 ## Footnote Grade 0, no cineangiographic characteristics of thrombus present; Grade 1, images suggestive but not diagnostic for thrombus: reduced contrast density, haziness, and irregular lesion contour; Grade 2, small thrombus present that is one-half or less the vessel diameter; Grade 3, moderate-size thrombus present with greatest linear dimension more than one-half the vessel diameter but less than two vessel diameters Grade 4, large thrombus present with a dimension that is two vessel diameters or greater; Grade 5, recent total occlusion, which can involve some collateralization but usually does not involve extensive collateralization and tends to have a “beak” shape and a hazy edge or appearance of distinct thrombus; and Grade 6, CTO, which usually involves extensive collateralization, tends to have a distinct, blunt cutoff or edge and will generally clot to the nearest proximal side branch.

Question 54

Thrombus grade?

Answer 54

Grade 4

Question 55

Classification for bifurcating lesions?

Answer 55

Medina classification ## Footnote 0 if no significant CAD 1 if with significant stenosis

Question 56

What are the types of dissection that are usually considered benign and might not require intervention?

Answer 56

Type A and B ## Footnote types C - F are often major dissections associated with morbidity and mortality Management: whenever necessary, stent deployment

Question 57

Classification of Coronary Dissections: (A-F) Spiral (“barbershop pole”) luminal filling defects frequently with excessive contrast staining in the dissected false lumen

Answer 57

Type D ## Footnote Type A Minor radiolucent areas within the coronary lumen during contrast injection with no persistence of the contrast after dye has cleared from the lumen Type B Dissections are parallel tract or double lumen separated by a radiolucent area during contrast injection with minimal or no persistence after dye clearance Type C Presence of contrast outside the coronary lumen (“extraluminal cap”) with persistence of contrast after dye has cleared from the lumen Type D Spiral (“barbershop pole”) luminal filling defects frequently with excessive contrast staining in the dissected false lumen Type E Dissection appears as new, persistent filling defects within the coronary lumen Type F Dissection that leads to total occlusion of the coronary lumen without distal antegrade flow

Question 58

True of Spontaneous coronary artery dissections (SCADs): A. common in pregnancy B. more common in young women age 40 to 50 C. probably due to FMD D. B and C

Answer 58

D ## Footnote more common within 2 weeks postpartum- associated with steroid hormones presence of undetected fibromuscular dysplasia (FMD)

Question 59

Superficial signal rich, low penetration, signal-free shadowing on OCT?

Answer 59

Red thrombus

Question 60

Trials using IVUS-guided with angiography-guided PCI: (3)

Answer 60

ULTIMATE- IVUS-guided DES implantation was associated with reduction in target vessel failure (0.530 [0.312 to 0.901]; P = 0.019) EXCEL- PROSPECT- nonculprit lesion–related MACE (composite of all-cause death, cardiac arrest, MI, or rehospitalization due to unstable or progressive angina) was associated with plaque burden of 70% or more, minimum lumen area of 4 mm 2 or less, and thin-cap fibroatheroma less than 65 μ

Question 61

When is the increased incidence of reinfarction after noncardiac surgery if the previous MI had occurred?

Answer 61

within 6 months of the operation

Question 62

When is the highest-risk after MI? during which time plaque and myocardial healing occur

Answer 62

within 30 days of MI

Question 63

Hypertensive crises in the post-operative period is defined as:

Answer 63

DBP >120 mmHg and clinical evidence of impending or actual end-organ damage ## Footnote >poses a definite risk for MI and stroke >iatrogenic precipitants of hypertensive crises: abrupt withdrawal of clonidine, BB; chronic use of MOAi; and inadvertent discontinuation of anti-HPN drugs >little evidenc of the benefit of delaying surgery if DBP>110 mmHg in the absence of hypertensive urgency or emergency >

Question 64

Risk associated with intraoperative hypotension: (2)

Answer 64

Mortality type II MI ## Footnote >withholding ACEI to avoid intra-operative hypotension >vasopressin for intractable hypotension >restart ASAP post-op

Question 65

TRUE/FALSE HOCM is regarded as low risk in relation to general anesthesia and major noncardiac surgery

Answer 65

TRUE ## Footnote >>spinal anesthesia was a relative contraindication compared to HF- significant risk for adverse events post-op

Question 66

TRUE/FALSE Critical stenosis is associated with the highest risk for cardiac decompensation in patients undergoing elective noncardiac surgery.

Answer 66

TRUE ## Footnote >angina, syncope, and HF in a patient with aortic stenosis should prompt further evaluation >>Emergency surgery type and symptomatic aortic stenosis increased both MACE and mortality >>asymptomatic aortic stenosis did not experience a higher rate of major adverse cardiovascular events (MACE) or mortality in elective surgery

Question 67

Practices in anticoagulation relating to warfarin and peri-operative surgery?

Answer 67

>cessation of warfarin 3 days before surgery >oral anticoagulants can then be resumed on postoperative day 1 >low-molecular-weight heparin (LMWH) as a preoperative bridge to warfarin anticoagulation in which warfarin was withheld for 5 days and LMWH was given 3 days preoperatively and at least 4 days postoperatively

Question 68

High risk for valve thrombosis:

Answer 68

is defined by the presence of a mechanical mitral or tricuspid valve or a mechanical aortic valve in the presence of certain risk factors, including AF, previous thromboembolism, hypercoagulable condition, older-generation mechanical valves, an ejection fraction lower than 30%, or more than one mechanical valve. ## Footnote Heparin is reserved for high risk for valve thrombosis

Question 69

When to do stress test in a non-emergent surgery according to AHA/ACC? A. in ACS patients B. elevated risk for MACE C. Mets <4 D. all of the above

Answer 69

B and C ## Footnote class IIa for pharmacologic stress test

Question 70

High risk surgery (reported cardiac risk often >5%)

Answer 70

Aortic and other major vascular surgery Peripheral vascular surgery

Question 71

Intermediate risk surgery (reported cardiac risk often 1-5%)

Answer 71

Intraperitoneal and intrathoracic surgery Carotid endarterectomy Head and neck surgery Orthopedic surgery Prostate surgery

Question 72

Components of RCRI: (6)

Answer 72

high-risk type of surgery, history of ischemic heart disease, history of congestive HF, history of cerebrovascular disease, preoperative treatment with insulin, and preoperative serum creatinine concentration >2.0 mg/dL ## Footnote 1- low 2- intrmediate 3-high >predict long-term outcome and quality of life

Question 73

AUB-HAS2 predictors: (6)

Answer 73

1. history of H eart disease, 2. H eart symptoms of angina or dyspnea, 3. A ge ≥75 years, 4. A nemia with hemoglobin less than 12 mg/dL, 5. vascular S urgery, and 6. emergency S urgery ## Footnote >AUB-HAS2 index was superior to that of the RCRI in all surgical subgroups, needs further evaluation >superior discriminatory power compared with the RCRI >ACS-NSQIP risk calculator is the best option

Question 74

“cardiac anesthesia” and were advocated for use in all high-risk patients, including those undergoing noncardiac surgery.

Answer 74

Narcotic-based anesthetics ## Footnote >offer the advantages of hemodynamic stability and lack of myocardial depression. >requirement for postoperative ventilation >remifentanil- ultra short-acting narcotic >propofol- aid in early extubation in CABG, profound hypotension because of reduced arterial tone and no change in HR

Question 75

Strongest predictor of perioperative ischemia

Answer 75

Tachycardia

Question 76

Name the study: HR control reduced the incidence of perioperative MI, with the greatest benefit achieved if HR was controlled to less than 70 beats/min

Answer 76

DECREASE

Question 77

TRUE/FALSE: In the absence of tachycardia, hypotension is not associated with myocardial ischemia

Answer 77

TRUE

Question 78

TRUE/FALSE Tachycardia is the primary mechanism of MI in the perioperative stage.

Answer 78

FALSE plaque disruption and thrombosis Fatal perioperative MI occurs predominantly in patients with multivessel coronary disease, especially left main and three-vessel disease.

Question 79

Effect of epidural anesthesia in platelet:

Answer 79

decrease platelet aggregability ## Footnote Postoperative analgesia may also reduce the hypercoagulable state

Question 80

Which of the following is true? A. Post-operative MI peaks at 2nd-3rd post-op day B. Do not cause ST elevation C. usually silent D. All of the above

Answer 80

D

Question 81

Class I indication for BB use in the peri-operative period.

Answer 81

Continue beta blockers in patients who are receiving beta blockers chronically.

Question 82

How long to delay non-cardiac surgery post PCI?

Answer 82

30 days- BMS 6 months- DES ideally >180 days after DES

Question 83

Name the study: restrictive policy of transfusion may be the most beneficial for patients undergoing noncardiac surgery

Answer 83

FOCUS (Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair) ## Footnote restrictive transfusion strategy (symptoms of anemia or at physician’s discretion for hemoglobin level <8 g/dL)