Coronaries

Question 1

Most common congenital coronary artery anomaly?

Answer 1

Myocardial bridge

Question 2

Surgical options for anomalous coronary from opposite sinus

Answer 2

Bypass, surgical unroofing or re-implantation of coronaries

Question 3

Most common origin and drainage of coronary fistula

Answer 3

RCA
Usu drain into RV, or RA
(can also drain into PA or coronary sinus)

Question 4

Name of syndrome with anomalous origin of coronary from PA

Answer 4

“Bland-Garland-White” (ALCAPA)

• result in vascular steal with blood flowing from coronary into lower pressure PA
• present in infancy with heart failure
• intercoronary collaterals

Question 5

Most common cause and site of coronary artery aneurysm

Answer 5

Right side, atherosclerosis

Worldwide- kawasaki, usu on left

Question 6

Stunned versus hibernating myocardium

Answer 6

Stunned - dysfunctional myocardium even after adequate reperfusion therapy, acute setting, usually resolves within weeks
- maintained or nearly maintained perfusion in the setting of wall motion abnormality

Hibernating - contractile dysfunction as a result of ongoing ischemic damage, chronic process
- “perfusion metabolism mismatch” - reduced perfusion, normal to increased metabolism on FDG-PET (also have redistribution on thallium) - distinguishes this from infarct!

Question 7

In what patient population should coronary calcium score be performed in?

Answer 7

Those who are “intermediate risk” for CAD as per Framingham (10-20%)