Diagnosis of Myocardial Ischemia

Question 1

What artery branches come off the LAD?

Answer 1

Diagonal branches and Septal arteries.

Question 2

What branches come off the Left circumflex?

Answer 2

Large marginal branch and posteriolateral branches.

Question 3

Which two arteries are apart of the heart being right or left dominant?

Answer 3

Posterior descending artery and the posterolateral branch

Question 4

What are therecommended Nyquist limit for color flow Doppler of the left and right coronary artieres?

Answer 4

50 cm/s for left

20 cm/s for right

Question 5

What velocities in left main coronary and LAD and LCX under doppler is significant for relevant stenosis?

Answer 5

L main > 140 cm/s

LAD > 90 cm/s

LCX > 110 cm/s

Question 6

Do segmental wall motion abnormalities or EKG findings present first with ischemia?

Answer 6

SWMA

Question 7

What is hibernation of myocardium?

Answer 7

chronic ischemic condition where reductions in systolic wall motion and/or thickening persist in viable myocardium with marginal resting blood flow.

Question 8

Grading for hypokinesis?

Answer 8

Question 9

Newer guidelines on Systolic wall motion grading?

Answer 9

Grade 1 - Normal - > 30% thickening

Grade 2 - Hypokinesis < 30 %

Grade 3 - Akinesis - no thickening.

Grade 4 - Dyskinesis

LV Dyssyncrhony - delay in timing of contraction in different myocardial segments of LV