Ischemic Heart Disease

Question 1

Which of the following is not a clinical mainfestation f ischemic heart disease? 
A. Chest discomfort
B. Heart failure
C. Bradycardia
D. Abnormal EKG/stress test

Answer 1

C. Arrhythmia –> sometimes syncope –> sudden death

Question 2

T/F: Acute MI are often responsible for triggering arrhythmia causing Sudden Cardiac Death episode.

Answer 2

False. Old remote myocardial infarction and coronary atherosclerosis

Question 3

Most sudden cardiac deaths are due to ____

Answer 3

ventricular fibrillation

Question 4

Which of the following is NOT a direct determinant of myocardial oxygen demand?
A. Intraventricular diastolic pressure
B. Ventricular cavity radius
C. Heart rate
D. Contractility of muscle

Answer 4

A. Intraventricular systolic pressure

Question 5

2 determinants of O2 supply

Answer 5

Coronary artery blood flow

O2 delivery: hematocrit, O2 saturation

Question 6

____ = coronary blood flow x oxygen blood flow across coronary bed

Answer 6

Myocardial O2 demand

Question 7

Increase in O2 delivery must be met almost exclusive by _____

Answer 7

increase in coronary blood flow

Question 8

Which of the following is NOT a determinant of myocardial blood flow?
A. Perfusing pressure
B. Resistance to flow in coronary arteries
C. Left atrial pressure

Answer 8

C. Right atrial pressure. Pressure in coronary sinus.

Question 9

Etiology of Ischemic Heart Disease:

Name 2 diseases of increased O2 demand

Answer 9

Aortic valve disease: aortic stenosis, aortic insufficiency

Idiopathic hypertrophic cardiomyopathy

Question 10

Etiology of Ischemic Heart Disease:

Name 2 diseases of coronary arteries

Answer 10

Atherosclerosis

Coronary artery spasm

Question 11

T/F: Clinical diagnosis of stable, classical angina pectoris is heavily dependent on lab testing, including the treadmill stress test and biomarkers.

Answer 11

False. History from pt

Question 12

List the 3 characteristics of typical angina

Answer 12

1. Substernal chest discomfort
2. Provoked by exertion or emotional stress
3. Relieved by rest/nitroglycerin

Question 13

T/F: Physical exam is often confirmatory of stable, classical angina pectoris.

Answer 13

False. Often unrevealing

Question 14

T/F: Graded Multistage Treadmill Exercise test is relatively diagnostic in unstable angina but is NOT particulary useful in screening asymptomatic people for presence of coronary disease.

Answer 14

False. DO NOT use for unstable angina. Use for stable angina.

Rest of the statement is true.

Question 15

Coronary artery’s lumen must be compromised by at least ___% before significant interference flow in artery under demand for maximal flow.

Answer 15

50%

Question 16

Diagnosis of angina pectoris is a ____ dignosis

Answer 16

pathophysiologic or functional

Question 17

Which of the following is NOT a PE finding of MI?
A. Fever 
B. S2 gallop 
C. Apical systolic murmur
D. Pericardial friction rub

Answer 17

B: S4 gallop in majority/all

A. onset ~6 hours, resolves 4-5 days after MI began
C. Due to papillary mm dysfunction
D. > 24 hours after onset of pain

Question 18

T/F: Diagnosis of MI can not be based entirely on historical data.

Answer 18

True.

EKG: pathological Q waves, ST-T changes = diagnostic

Abnormal cardiac troponin

Question 19

Complications of MI:

____ is maor cause of death from acute MI

Answer 19

Ventricular fibrillation

Question 20

T/F: Atrial arrhythmias are most important + occur w/ greatest frequency during 1st few hours after infarction.

Answer 20

False. Ventricular arrhythmias

Question 21

T/F: ST Elevation Myocardial Infarctions (STEMI) most form Q wave on EKG.

Answer 21

True

Question 22

T/F: NonST Elevation Myocardial Infarctions most form Q wave on EKG.

Answer 22

False. Most do NOT form Q on EKG.

Question 23

Which of the following is not a feature of unstable angina?
A. New onset angina
B. Increasing frequency, precipitation by progressively more degrees of exertion
C. Angina at rest/during sleep
D. Prolonged angina of >20-30 minutes duration

Answer 23

B. progressively LESSER degree

Question 24

Basic pathophysiologic mechanism for all acute coronary syndrome is _____.

Answer 24

unstable, ruptured atherosclertic plaque