ISCHEMIC HEART DISEASE

Question 1

The major determinants of myocardial oxygen demand (MVO2)

Answer 1

heart rate, myocardial contractility, and myocardial wall tension (stress).

Question 2

the major site of atherosclerotic disease

Answer 2

Epicardial coronary arteries

Question 3

The condition in which patients with IHD also can present with cardiomegaly and heart failure secondary to ischemic damage of the LV myocardium that may have caused no symptoms before the development of heart failure

Answer 3

ischemic cardiomyopathy

Question 4

Which of the following is true regarding CSAP?

A. Crescendo-decrescendo in nature typically lasts 2–5 min, and can radiate to either shoulder and to both arms
B. Rarely localized below the umbilicus or above the mandible
C. Typical patient with angina is a man >50 years or a woman >60 years of age who complains of episodes of chest discomfort
D. Chest pain is described as heaviness, pressure, squeezing, smothering, or choking and only rarely as frank pain.

Answer 4

All are true

• Aortic stenosis, aortic regurgitation, pulmonary hypertension, and hypertrophic cardiomyopathy must be excluded, since these disorders may cause angina in the absence of coronary atherosclerosis.
• ischemia can cause transient LV failure with the appearance of a third and/or fourth heart sound, a dyskinetic cardiac apex, mitral regurgitation, and even pulmonary edema.

Question 5

It is an independent risk factor for IHD and may be useful in therapeutic decision-making about the initiation of hypolipidemic treatment

Answer 5

High sensitivity CRP

*An elevated level of high-sensitivity C-reactive protein (CRP) (specifically, between 1 and 3 mg/L)
* Major benefit of high-sensitivity CRP is in reclassifying the risk of IHD in patients in the “intermediate” risk

Question 6

TRUE OR FALSE: Presence of LVH is a significant indication of increased risk of adverse outcomes from IHD

Answer 6

True

Question 7

The most widely used test for both the diagnosis of IHD and the estimation of risk and prognosis

Answer 7

STRESS TESTING
* involves recording of the 12-lead ECG before, during, and after exercise, usually on a treadmill

Question 8

Indications in discontinuing treadmill stress test

Answer 8

• Evidence of chest discomfort
• Severe shortness of breath
• Dizziness
• Severe fatigue
• ST-segment depression >0.2 mV (2 mm)
• A fall in systolic blood pressure >10 mmHg
• Development of a ventricular tachyarrhythmia

Question 9

ischemic ST-segment response in stress testing is generally defined as

Answer 9

flat or downsloping depression of the ST segment >0.1 mV below baseline (i.e., the PR segment) and lasting longer than 0.08 secs

Question 10

Contraindications to exercise stress testing include

Answer 10

• Rest angina within 48 hours
• Unstable rhythm
• Severe aortic stenosis
• Acute myocarditis
• Uncontrolled heart failure
• Severe pulmonary hypertension
• Active infective endocarditis

Question 11

What is the ISCHEMIA trial?

Answer 11

The ISCHEMIA trial informs decision-making about referral for coronary arteriography (with intent to perform revascularization) in patients with stable IHD and an ejection fraction >35% even in the presence of moderate-severe ischemia on noninvasive functional testing

Question 12

What are the principal prognostic indicators in patients known to have IHD

Answer 12

• Age
• Functional state of the left ventricle
• Location(s) and severity of coronary artery narrowing
• Severity or activity of myocardial ischemia

Question 13

specific sinus node inhibiting agent that may be helpful for preventing cardiovascular events in patients with IHD who have a resting heart rate ≥70 beats/ min (alone or in combination with a beta blocker) and LV systolic dysfunction.

Answer 13

Ivabradine

Question 14

TRUE OR FALSE:
Aspirin should be administered indefinitely and a P2Y12 antagonist daily (dual antiplatelet therapy [DAPT]) for at least 1 year after implantation of a drug-eluting stent

Answer 14

TRUE