Coronary Artery Disease

Question 1

What is the most common cause of heart disease in the US and Canada?

Answer 1

Atherosclerosis

Question 2

In women, at what age does the risk of CAD tend to increase?

Answer 2

55

Question 3

In men, at what age does the risk of CAD tend to increase?

Answer 3

45

Question 4

What are 4 clues to look for to suspect a right ventricular wall MI in a 12-lead ECG?

Answer 4

• ST elevation in V1 and ST depression in V2
• isoelectric ST segment in V1 and major ST depression in V2
• inferior wall MI also can be found
• ST elevation in III will be more pronounced than ST elevation in II

Question 5

Why is streptokinase not used in treating UA/

NSTEMI?

Answer 5

With UA/NSTEMI, the coronary artery is open to some extent, so there is no need to break open a plaque, therefore streptokinase (aka a thrombolytic) is useless.
Also, thrombolytics increase risk of bleeding, so it’s not really worth the risk if it’s not doing much good.

Question 6

An MI in which location can lead to the most types of arrhythmias, including vFib?

Answer 6

anterior wall MI can trigger the sympathetic nervous system, which can lead to vFib, among other types of arrhythmias

Question 7

How can you use an ECG to tell unstable angina apart from a non-ST elevation MI?

Answer 7

You can’t, the only way to tell a NSTEMI apart from unstable angina is to do multiple ECGs over a period of time, blood tests, get patient’s medical history, and/or check cardiac enzymes.

Question 8

Which structures of the heart is the left anterior descending artery responsible for (excluding role in collateral circulation)?

Answer 8

Interventricular septum
Lateral LV
Anterior LV
right bundle branch
left bundle branch

Question 9

Which structures of the heart is the left anterior descending artery responsible for (excluding role in collateral circulation)?

Answer 9

• interventricular septum
• right bundle branch
• left bundle branch
• anterior LV
• lateral LV

Question 10

Which coronary artery is responsible for the following structures of the heart:

• SA node (in 40-50% of people)
• left atrium
• AV node (only 10-15% of people)
• posterior third of the septum (only 10% of people)
• inferior myocardium
• anterior LV
• posterior of the ventricles
• lateral LV

Answer 10

left circumflex artery

Question 11

Generally, how much of a coronary artery’s lumen has to get blocked before the pt shows symptoms?

Answer 11

75%, aka a grade 4 blockage

Question 12

Which one of the twelve leads in a 12-lead ECG doesn’t correspond to a coronary artery?

Answer 12

aVR

Question 13

What types of actions/movements exacerbate the pain caused by the complication that’s commonly found 1-3 days after a MI?

Answer 13

1-3 days after the original infarct, fibrinous pericarditis can develop. The pain associated with this type of pericarditis is exacerbated by leaning back and breathing deeply.

Question 14

What type of complication is most likely within the first 24 hours on a MI?

Answer 14

cardiogenic shock

Question 15

What ECG changes will Prinzmetal’s angina episodes produce?

Answer 15

You will see ST elevation (as opposed to episodes of other angina types, which shows ST depression).

Question 16

Which sex is more prone to Prinzmetal’s angina?

Answer 16

Women are more likely than men to suffer this condition.

Question 17

What brings on the pain of Prinzmetal’s angina, and when is it most likely to occur?

Answer 17

Nothing, it often happens during rest from midnight to 8:00 am.

Question 18

What is the physiological cause of Prinzmetal’s angina?

Answer 18

Prinzmetal’s angina is caused by vasospasm of a coronary artery.