Ischemic Heart Disease and ACS

Question 1

_____ angina: discomfort which is new in onset, increased in duration, frequency, or intensity with less exertion or at rest

Answer 1

Unstable

Question 2

_____ angina: present when there is increased demand for myocardial oxygen in a reproducible fashion

Answer 2

Stable

Question 3

_____ plaque: cause angina and claudication (exertional ischemia) if obstructive (>70%)

Answer 3

Stable

Question 4

_____ plaque: cause MI and stroke

Answer 4

Unstable

Question 5

_____ plaque: less biologically active

Answer 5

Stable

Question 6

_____ plaque: less fibrous tissue, less calcified, more lipid content, more inflammation, more apoptosis

Answer 6

Unstable

Question 7

_____ plaque: less likely to cause thrombotic or embolic events

Answer 7

Stable

Question 8

_____ plaque: more biologically active

Answer 8

Unstable

Question 9

_____ plaque: more likely to cause damage via thrombotic or embolic mechanisms

Answer 9

Unstable

Question 10

_____ plaque: rich in fibrous tissue, calcified, less lipid content, less inflammation, less apoptosis

Answer 10

Stable

Question 11

______ artery is most susceptible to atheroembolism from a carotid bifurcation lesion.

Answer 11

Ophthalmic

Question 12

BNP is good at ruling __ (in/out) ACS.

Answer 12

out

Question 13

Cardiac peptide released in response to increased stretch or ventricular volume

Answer 13

BNP

Question 14

Complications of aneurysm (2)

Answer 14

Thromboembolism, Dissection

Question 15

Determinants of Myocardial Oxygen Demand (3)

Answer 15

Heart Rate, Wall Tension, Inotropic state

Question 16

Determinants of Myocardial Oxygen Supply (4)

Answer 16

Perfusion Pressure, Perfusion Time, Vascular Resistance, Oxygen Content of Blood

Question 17

EKG changes in NSTEMI

Answer 17

ST depression; possible T wave inversion

Question 18

EKG changes in STEMI

Answer 18

ST elevation

Question 19

EKG changes in UA

Answer 19

May have ST depression

Question 20

Heart Disease Drugs: Anti-anginal agents

Answer 20

Nitrates, Beta-Blockers, Ca-Channel Blockers

Question 21

Heart Disease Drugs: lipid-lowering medications

Answer 21

statins

Question 22

Heart Disease Drugs: LV dysfunction

Answer 22

ACEIs or ARBs

Question 23

Ischemic Response manifestation on ECG

Answer 23

ST depression

Question 24

MI tissue changes: 1 day

Answer 24

Gross: Pallor, Micro: Neutrophils

Question 25

MI tissue changes: 1 week

Answer 25

Gross: Pallor, Micro: Macrophages

Question 26

MI tissue changes: 10 days

Answer 26

Gross: yellow, soft, sunken, Micro: Granulation tissue

Question 27

MI tissue changes: 2 months

Answer 27

Gross: firm gray scar, Micro: fibrosis

Question 28

MI tissue changes: 4 hours

Answer 28

Gross: N/A, Micro: coagulation necrosis

Question 29

Most important serum biomarkers in MI

Answer 29

TnI and TnT

Question 30

Time when rupture of ventricular wall is most likely following AMI

Answer 30

Within 2 weeks

Question 31

Treatment of NSTEMI and UA (other than cath lab)

Answer 31

Anticoagulation (Heparin, etc.), Anti-platelet (aspirin, P2Y12 Inhibitor), Oral Beta-blockers or Nitrates (Reduce myocardial oxygen demand)

Question 32

What pathology? ______ myocardial infarction (______MI): partial coronary vessel occlusion with myocardial necrosis

Answer 32

Non-ST Elevation; NSTEMI

Question 33

What pathology? ________ myocardial infarction (_____MI): complete coronary vessel occlusion

Answer 33

ST Elevation; STEMI

Question 34

What pathology? calcification of muscular arteries

Answer 34

Monckeberg's medial calcific sclerosis

Question 35

What pathology? claudication and acute limb ischemia

Answer 35

Peripheral Arterial Disease

Question 36

What pathology? partial coronary vessel occlusion, escalating symptoms, no myocardial necrosis

Answer 36

Unstable Angina

Question 37

What pathology? vasospasm causing chest pain at rest (sleep)

Answer 37

Prinzmetal's (Variant) Angina