Ischemic heart disease

Question 1

What is the resting coronary blood flow?

Answer 1

225 mL/min

4-5% total CO

Question 2

The ____ coronary artery system is dominant in 80% to 90% of people and supplies the ______ (60%), _____ (85%), and _______. 84% of the cases it terminates as the ______.

Answer 2

Right
Sinoatrial node
Atrioventricular node
Right ventricle
Posterior descending artery (PDA)

Question 3

The left main coronary artery gives rise to the ______ and _____________.

Answer 3

Circumflex artery

Left anterior descending (LAD) artery

Question 4

Myocardial oxygen demand is determined by 2 factors?

Answer 4

Wall tension

Contractility

Question 5

Wall tension (T) is the product of 3 components?

Answer 5

Intraventricular pressure
Radius
Wall thickness

Question 6

Mi occuring > 7 days but < 30 days prior to surgery

Answer 6

Recent MI

Question 7

Prior MI is defined as?

Answer 7

MI >30 days before surgery

Question 8

1 MET equals ___ ml/kg/min oxygen uptake at rest

Answer 8

3.6

Question 9

Is the gold standard for defining the coronary anatomy

Answer 9

Coronary angiography

Question 10

Consistent with the ACC/AHA 2004 Guideline Update for coronary artery bypass graft surgery, the following patients need coronary revascularization (either coronary artery bypass grafting or percutaneous coronary intervention) before noncardiac surgery: (5)

Answer 10

1) Stable angina with L main coronary artery stenosis.
2) Stable angina with 3-vessel disease.
3) Stable angina with 2-vessel disease with significant proximal LAD stenosis and EF < 50% or ischemia on noninvasive testing.
4) High-risk unstable angina or non–STEMI
5) Acute STEMI

Question 11

Ischemic changes in leads ___, ____, ____, suggest right coronary artery disease

Answer 11

II, III, and aVF

Question 12

Ischemic changes in leads ___, ___, ____, _____, monitor the circumflex artery distribution

Answer 12

I, aVL, V5 and V6

Question 13

Ischemic changes in leads ____ to ___ look at the distribution of the left anterior descending artery.

Answer 13

V1 to V4

Question 14

How long should a patient with a recent myocardial infarction wait before undergoing elective noncardiac surgery?

Answer 14

Suggested that elective surgery is associated with prohibitive risk only during the initial 4 to 6 weeks

The patient’s functional status following rehabilitation froman MI is probably more important than the absolute time interval

Question 15

Is the most sensitive single ECG lead for detecting ischemia and should be monitored routinely in patients at risk for IHD

Answer 15

V5

Question 16

Detect ischemia of the right coronary artery distribution and is the most useful lead for monitoring P waves and cardiac rhythm.

Answer 16

II

Question 17

Transesophageal echocardiography (TEE) can provide continuous intraoperative monitoring of ______ function.

Answer 17

Left ventricular

Question 18

In high-risk patients detection of regional wall motion abnormalities with this technique is the most sensitive monitor for myocardial ischemia.

Answer 18

Transesophageal echocardiography (TEE)