Coronary Artery Disease Flashcards
1
Q
The only nicotine replacement Rx that delays smoking cessation-weight gain is …
A
the nicotine gum.
2
Q
Bupropion should be started 1-2 weeks before quitting smoking and continued for … weeks.
A
8-12
3
Q
… is second only to smoking as a leading cause of preventable death in the US (CV dz plus CA endometrium, breast, prostate, colon and rectum).
A
Obesity
4
Q
Waist more than … inches in men and … inches in women is considered high risk.
A
40 AND 35
5
Q
A patient with chest pain with intermediate risk and abnormal ECG or incapacity to exercise maximally, should undergo …
A
Exercise echo or radionuclide imaging
6
Q
A patient with chest pain with intermediate risk and normal ECG, should undergo …
A
Exercise treadmill test
7
Q
Serum… is a routine test in patients with high LDL or total cholesterol.
A
TSH
8
Q
The main 3 drugs for hypertriglyceridemia are…
A
fibrates, niacin and omega-3 fatty acids.
9
Q
… combination for dyslipidemia, should be used with close clinical monitoring only in patients at high risk for CHD, due to increased risk for myositis and fatal rhabdomyolysis.
A
A statin and a fenofibrate
10
Q
The therapeutic target in dyslipidemias is recommended by National Cholesterol Education Program to be… (cholesterol fraction).
A
non-HDL Cholesterol
11
Q
The non-HDL Cholesterol target level is… in DM or CAD equivalent patients.
A
<130
12
Q
The non-HDL Cholesterol target level is… in patients with 0-1 cardiac risk factors.
A
<190
13
Q
The point at which myocardial oxygen consumption is impaired strictly by low red cell mass is hemoglobin of around…
A
7.
14
Q
One year post-STEMI mortality is …
A
7-8%
15
Q
In a patient with endothelial dysfunction, acetylcholine or methergine cause…
A
vasoconstriction.
16
Q
Transplant vasculopathy leads to flow-limiting lesions within … years after Sx, but increases exponentially afterwards.
A
5
17
Q
Patients post-CABG with recurrent… is class IIa indication for coronary angiography.
A
angina inadequately controlled by medical means
18
Q
Patients with high or intermediate risk for adverse outcome in unstable angina refractory to initial adequate medical therapy or recurrent symptoms after initial stabilization is class I indication for coronary angiography and… is recommended.
A
emergent catheterization
19
Q
Patients with postrevascularization recurrent angina or high-risk criteria on noninvasive evaluation within… mo of percutaneous revascularization is class I indication for coronary angiography.
A
9
20
Q
Patients post-CABG with noninvasive evidence of high-risk criteria occurring… is class IIa indication for coronary angiography.
A
any time postoperatively
21
Q
Patients with CCS class I or II stable angina with intolerance or failure to… is class IIa indication for coronary angiography.
A
respond to medical therapy
22
Q
Patients with known or suspected CAD and asymptomatic or with stable angina resuscitated from sudden cardiac death or with… (2 arrhythmias) is class I indication for coronary angiography.
A
sustained monomorphic VT or nonsustained polymorphic VT
23
Q
Evidence of high risk on… in patients with asymptomatic or stable angina and with known or suspected CAD is class I indication for coronary angiography.
A
noninvasing testing
24
Q
In patients during the initial Rx of AMI, coronary angiography with the intent to perform primary PTCA is class I indication as an alternative to thrombolytic Rx when performed in a timely fashion by individuals skilled in the procedure in an appropriate
A
ischemic symptoms persist
25
Patients with known or suspected CAD and asymptomatic or with stable angina and serial noninvasive testing showing... is class IIa indication for coronary angiography.
progressive abnormalities
26
Patients with asymptomatic or stable angina and whose occupation involves... is class IIa indication for coronary angiography.
safety of others (e.g., pilots, bus drivers)
27
Patients with nonspecific CP and high-risk findings on.... is class I indication for coronary angiography.
noninvasive testing
28
Patients suspected of… angina is class I indication for coronary angiography.
Prinzmetal variant
29
Patients with postrevascularization ischemia with suspected… is class I indication for coronary angiography.
abrupt closure or subacute stent thrombosis after percutaneous revascularization
30
The preferred strategy in elderly patients with AMI is...
primary angioplasty.
31
In this type of AMI..., preload-reducing drugs should be avoided (diuretics, nitrates and even morphine).
right ventricle
32
All ACS patients should have their... checked during hospitalization, ideally in the first 24 hours.
lipid profile
33
... is the drug of choice to maintain adequate blood pressure and increase cardiac output in right ventricle AMI, after adequate hydration is given (up to 1l).
Dobutamine
34
Patients under age 70 and with EF>... can be operated on early after AMI with little increase in early mortality.
30%
35
Right ventricle AMI patients who remain hypotensive after hydration and dobutamine should undergo... (procedure).
Swan-Ganz placement (there is though high risk of perforation due to thin infracted wall).
36
... Study (HPS) showed that lipid-decreasing therapy should be started in all patients with atherosclerotic CV disease and also all ACS patients unless a contraindication exists.
Heart Protection
37
For smoking cessation, medical therapy with... was associated with significantly higher cessation rates than placebo.
Bupropion
38
In a patient with AMI who has hypotension, elevated JVP, +/- Kussmaul sign, no rales and clear lung fields, diagnosis is...
right ventricle AMI.
39
... (AMI complication) is most likely to occur in elderly patients with HTN.
Septal rupture
40
Volume infusion alone is not effective in right ventricular infarction, so therapy with... is required.
dobutamine or dopamine
41
The results of CAPRIE trial showed... is an effective substitute for ASA in intolerant patients with CAD, with similar benefit.
clopidogrel
42
Transient or persisting STD with or without T-wave inversion in association with CP is a reliable indicator of... and almost always associated with severe coronary lesions.
ACS
43
Cardiac rehab should be used in AMI patients during the days... of hospitalization.
two and five
44
The essential feature needed before managing a postinfarction VSD is...
coronary angiography.
45
The ACEI therapy is indicated post-ACS only in patients with CHF or EF... %.
<40
46
The 4S trial showed a 5-year follow-up led to a 25% reduction in total cholesterol and 35% in LDL, 37% reduction in revascularization and 28% reduction in stroke incidence in patients started on... therapy.
simvastatin.
47
The one year mortality risk in patients post-AMI with LVEF<30% is... %.
45
48
During the hospitalization for AMI, this class of drugs... is a must because they prevent increased intra-thoracic pressure causing adverse cardiac effects by Valsalva maneuver.
stool softeners
49
The anterolateral papillary muscle receives blood supply from the...
LAD and LCX.
50
A true ventricular aneurysm (all three layers outpouching) is rarely associated with...
rupture.
51
The best long-term mortality reduction from beta-blockers use post-AMI was obtained in the Norwegian Multicenter Study Group where... was used: 39% (RR) at 33 months follow-up.
Timolol
52
Magnesium during AMI can be used only for...
polymorphic VT.
53
... is usually advised in postinfarction pseudoaneurysm due to the high risk of free wall rupture.
Surgical resection
54
The therapy of choice in postinfarction VSD is...
early surgical intervention.
55
In patients where beta blockers are contraindicated,... can be used to prevent reinfarction and angina when there are no signs of heart failure.
nondihydropyridines calcium blockers (verapamil and diltiazem)
56
After day one of AMI when patients are CP free, this class of non-CV drugs... helps prevent increased adrenergic release.
anxiolytics (benzodiazepines)
57
In the cases of... AMI, reciprocal Q waves may appear as increased R waves in V1-3.
posterior
58
Troponin release with normal CK-MB in patients with long-lasting myocardial ischemia is of... prognosis.
ominous
59
Nitrates can be used in AMI for marginal survival benefit and pain control but can be discontinued after... h.
48
60
The CURE trial showed a 20% improvement in CV death, AMI or stroke incidence in UA patients treated with...
clopidogrel.
61
A male who reports erectile dysfunction should trigger aggressive assessment of...
CAD risk status.
62
In stable angina patients, SAPAT trial showed that daily use of... was associated with a 34% reduction in the incidence of sudden death and AMI.
ASA
63
CABG is indicated in chronic angina patients with 3-vessel disease and...
low EF or DM.
64
... is defined as rest angina associated with transient STE, both of which resolve spontaneously or after nitrate administration.
Variant angina pectoris
65
The CP in variant angina pectoris occurs most often at... (time of the day).
night and early morning.
66
The most sensitive and specific test for coronary spasm is the...
ergonovine test.
67
Therapy with a... is the most effective way in suppressing asymptomatic ischemia (particularly the morning surge of ischemic activity).
beta blocker
68
A completely normal ECG recorded during an episode of significant CP should turn attention to a...
non-cardiac cause.
69
Patients with chronic stable angina and known or suspected CHD (who can exercise and who cannot) should have… as the initial test for diagnosis or for risk assessment.
adenosine or dipyridamole MPI (class I indication, 2002 ACC/AHA Task Force)
70
... represents postischemic dysfunction that persists despite restoration of normal blood flow but can improve with time.
Myocardial stunning
71
Partial and complete papillary muscle rupture is a...
surgical emergency.
72
... has impaired function at rest due to severely reduced coronary blood flow and can improve with revascularization.
Hibernating myocardium
73
In AMI, this complication... is likely to develop in elderly and patients with prior AMI, PVD, CVA, and anterior location.
shock
74
Partial and complete papillary muscle rupture can be temporized by...
IABP and afterload reduction.
75
The therapy in suspected cardiac syndrome X consists of a trial of... (2 classes)
a calcium blocker or a nitrate.
76
In patients during the first 36 hr of initial diagnosis of AMI, who develop cardiogenic shock, are younger than 75 years, and in whom revascularization can be performed within... hr of the onset of the shock, coronary angiography with the intent to perfor
18
77
Type II diabetes confers an increased risk for CAD of... fold.
2-4
78
A DM patient needs... when having at least two other risk factors and positive evidence of peripheral vascular disease.
cardiac testing
79
After... years in menopause, women have a similar CAD risk as men the same age.
10
80
Blood levels of homocysteine can be decreased by an increase in... intake.
the folic acid and vitamin B6
81
Type I diabetes confers an increased risk for CAD of... fold.
10
82
A positive FH of premature CAD increases the risk of an offspring to develop premature CAD... times.
1.3-1.6
83
One systematic review has found that for prolonged use, aspirin 75–150 mg daily is as effective as higher doses for... (primary/secondary/tertiary) prevention.
secondary
84
One large RCT in people with recent myocardial infarction complicated by LV dysfunction and clinical CHF already on medical treatment (which could include ACEIs, ARBs, diuretics, ß blockers, or coronary reperfusion therapy) found that adding... (an aldost
eplerenone (Effesus trial)
85
Decreasing the homocysteine levels has... on the risk of major vascular events after invasive coronary procedures.
a positive effect
86
HDL cholesterol less then... is a positive CAD risk factor.
40 (New ATP III guideline, was 35)
87
HDL cholesterol more then... is a negative CAD risk factor.
60
88
An “average” CAD risk is present when the cholesterol/HDL ratio is less then...
4.5.
89
The familial hyperlipidemia is an overproduction of... leading to an overproduction of LDL.
VLDL
90
The HERS trial showed that women with a prior AMI had more serious CAD-related events during the first year of... treatment when compared to placebo.
estrogen
91
All patients with this disease... should be screened for diabetes.
CAD
92
... is, together with the ankle-brachial index (ABI), a widely accepted marker of subclinical atherosclerosis.
Carotid intimal median wall thickness
93
The LDL particles shift to a more dense type (type B particle) in... (disease).
DM.
94
The persistence of STE after AMI, occurring more often in the anterior AMI, signals failure to reperfusion with an extreme manifestation of...
aneurysm formation.
95
The finding of Q waves and ST segment changes in leads ... is helpful in diagnosing a true posterior MI.
V7 to V9
96
A wall motion score of 2 on echo represents...
hypokinesis.
97
A wall motion score of 4 on echo represents...
dyskinesis.
98
A wall motion score of 1 on echo represents...
normal motion.
99
Duke High-risk score is ...
<-11 (11/1/2008)
100
Echocardiography can be used to track recovery of function in patients with myocardial stunning or hibernation, and ... is an excellent means of predicting viability.
dobutamine stress echocardiography
101
The regional wall motion score is directly related to the size of the myocardial infarction; however, because of the ... phenomenon, wall motion abnormalities overestimate the true anatomical extent.
tethering
102
An alternative to dobutamine echocardiography is... , which relies on provocation of ischemia by differential vasodilation in normal and diseased arteries.
dipyridamole infusion
103
... is defined as the progressive dilation of the infarct zone without recurrent myocardial necrosis.
Infarct expansion
104
An additional complication of right ventricular infarction is ... with subsequent right-to-left shunting.
the opening of a patent foramen ovale
105
Echocardiographically, an ... is defined as a noncontracting area of myocardium with abnormal geometry in both diastole and systole.
aneurysm
106
Because only ... % of the myocardium needs to be involved in the ischemic or infarction process for the entire wall to become dysfunctional, nontransmural (non-Q-wave myocardial infarction) results in a wall motion abnormality that is indistinguishable fr
20
107
After 5 years post CABG, ... % of the patients will need redo or PCI.
5
108
Using high-frequency transducers, it is possible to directly visualize the proximal portions of the left main and right coronary arteries and detect proximal coronary artery aneurysms in ... (dz).
children with Kawasaki disease
109
In most clinical trials of ACE inhibitors, serum creatinine levels as high as... have been tolerated, and few patients have needed discontinuation of the drug because of clinically significant renal dysfunction.
3.0
110
Use of... (HTN drugs) is contraindicated during pregnancy.
ACE inhibitors and angiotensin receptor blockers
111
In patients with type II hypercholesterolemia (Hypercholesterolemic xanthomatosis or Familial hypercholesterolemia), a... (food) reduced plasma cholesterol by 25%.
textured soy preparation (soy meat, or soya meat is a meat analogue or meat substitute made from defatted soy flour, a by-product of making soybean oil)
112
The most recent AHA guidelines do not recommend... (lifestyle change) as a cardioprotective strategy.
alcohol use
113
In the FACET trial, DM II patients treated with... had a significantly lower risk of major vascular events compared with patients on amlodipine.
fosinopril (Monopril®)
114
It is estimated that the conversion from a sedentary lifestyle to an active lifestyle could eliminate... of coronary artery disease risk.
33%
115
In relation to meals, niacin has to be taken...
with a large glass of water at meals, while avoiding hot beverages to prevent flushing.
116
In relation to meals, fenofibrate (Tricor) has to be taken...
with meals.
117
In addition to lowering cholesterol levels... (diet) is associated with reduced BP, increased insulin sensitivity, decreased factor VIIc and enhanced weight control.
high soluble (preferred) fiber intake
118
In the presence of high levels of... (food), lovastatin and simvastatin blood level may rise 20-fold. (lipitor to a lower extent)
grapefruit juice
119
The primary indication of bile-acid sequestrants (cholestyramine, colestipol, and colesevelam) is for use in combination with statin therapy to...
reduce LDL levels.
120
It is estimated that 12% of the total mortality in the US (250.000/year) is attributable to... (lifestyle choice).
physical inactivity
121
The HDL target in DM patients recommended by ADA are... in men and… in women.
>45 and >55
122
A group of patients in which niacin should be avoided is...
the pre-diabetes patients because it can make them frankly diabetic.
123
In the GISSI-3 study, the addition of an... to beta-blocker reduced the rates of mortality or poor EF from 12.6% to 5.5% in DM patients only on beta-blockers.
ACEI (lisinopril)
124
Exertion-related AMI is more common in patients who...
smoke and have hypercholesterolemia.
125
For every 1% decrease in the total cholesterol there is a... decrease in CHD risk.
2%
126
The Diet and Reinfarction Trial (DART) demonstrated a ...% reduction in overall mortality among men with CVD who ate fatty fish twice a week.
29
127
In relation to meals, gemfibrozil has to be taken...
30 minutes before the morning and evening meal.
128
A reduction in the dose of warfarin as much as 30% is needed in patients starting... (class lipid lowering agent) due to their action of displacing warfarin from albumin-binding sites.
a fenofibrate
129
... (drug class) are clearly indicated in patients with type V hyperlipoproteinemia and TG levels>1000 to prevent acute pancreatitis.
Fibrates
130
Patients with CHD with LDL>200 despite maximal lifestyle and drug therapy may be considered for...
plasmapheresis.
131
... is a lipid-lowering agent approved by FDA for therapy in children.
Pravastatin
132
Most patients undergoing organ transplant will develop... (metabolic disturbance) due to immunosuppressive drugs.
hyperlipidemia
133
One systematic review has found that... (antiplatelet) reduces the risk of death, myocardial infarction, and stroke compared with placebo in people with unstable angina.
aspirin
134
The therapy of choice for elevated BP in a patient with scleroderma crisis is an...
ACEI.
135
Subgroup analysis of one RCT found... difference in mortality after 21 days between thrombolysis and no thrombolysis in people with cardiogenic shock.
no significant
136
... exposure is associated with increased risk for coronary artery disease, childhood middle ear infections and respiratory illnesses, impaired lung function, and sudden infant death syndrome.
Passive smoke
137
The evidence suggests no added cardiovascular benefit in people with unstable angina, and possible added harm, from doses of aspirin over... mg daily.
325
138
Two RCTs have found that... (2 antiplatelet drugs) reduce mortality and myocardial infarction compared with placebo or conventional treatment alone in people with unstable angina.
clopidogrel or ticlopidine
139
One systematic review found that intravenous glycoprotein IIb/IIIa inhibitors compared with placebo in people with unstable angina...
significantly reduced the combined outcome of death and myocardial infarction at 30 days and 6 months.
140
Systematic reviews have found that... is associated with at least 2% of smokers quitting smoking and not relapsing for 1 year.
simple, one office advice from a physician during a routine consultation.
141
Monotherapy with bile acid sequestrants may significantly increase... in patients with already elevated levels.
triglycerides
142
Piolgitazone (Actos), an insulin sensitizer, has an important side effect...
weight gain.
143
Initial perioperative prep for pheochromocytomas includes fluids administration together with...
alpha-blockade (phenoxybenzamine).
144
Pregnant patients younger than 25, with normal weight, no FH of DM or pertaining to an ethnic group with high DM prevalence, no history of abnormal glucose tolerance or poor fetal outcome, need...
no testing for glucose tolerance.
145
... is the leading cause of death in patients with RA.
CAD
146
Prolonged steroid use can lead to... (cardiovascular disease).
CAD
147
... is indicated in patients with SLE for CAD prophylaxis.
ASA 80 mg/day
148
Non-selective beta-blockers are useful in... variceal bleeding.
preventing (not treating)
149
Chromogranin A levels are elevated in patients with... 83% of the time.
pheochromocytoma
150
The BP control in pheochromocytoma prior to surgery should be done with an alpha-blocker like... for a target BP<160/90.
phenoxybenzamine (marketed under the trade name Dibenzyline)
151
The efficacy of low-dose... in post-MI patients with NSVT was demonstrated by significantly lower yearly rate of arrhythmic death or resuscitated ventricular fibrillation in the treated patients.
amiodarone (Canadian Myocardial Infarction Amiodarone Trial (CAMIAT))
152
ADA recommends cardiac testing in DM pts older then...
35
