CAD

Question 1

ischemic heart disease is a

Answer 1

consequence of atherosclerosis of the coronary arteries

Question 2

major factors that predispose to coronary heart disease

Answer 2

1. elevated blood cholesterol
2. HTN
3. Cigarette smoking

Question 3

non-modifiable risk factors for CAD

Answer 3

1. age
2. sex
3. genetics

Question 4

what do we see in pathology in CAD

Answer 4

dimished coronary perfusion due to fixed atherosclerotic narrowing of epicardial arteries

Question 5

pathogenesis in CAD (5)

Answer 5

1. chronic coronary obstruction
2. acute plaque change
3. coronary thrombosis
4. vasoconstriction
5. inflammation

Question 6

coronary obstructions usually occur

Answer 6

within the first 2 cm of the left anterior descending and the left circumflex arteries and the entire length of the right coronary artery

Question 7

hallmark of CAD

Answer 7

coronary atherosclerotic plaque rupture or disruption

Question 8

types of MI

Answer 8

1. transmural
2. subendocardial
3. multifocal microinfarction

Question 9

transmural infarction:

1. extends from
2. 3 arteries involvement

Answer 9

1. extends from endocardium to the epicardium- LV

2. LAD, RCA or LXC

Question 10

subendocardial infarction:

1. affects the
2. due to

Answer 10

1. affects the inner one third to one half of the LV, usually circumferential, not necessary in the distribution of any one coronary artery
2. due to hypoperfusion states

Question 11

multifocal microinfarction

Answer 11

involves small intramural vessels in the setting of microemboli, vasculitis or vasospasm

Question 12

MI in first 12-24 hr.

Answer 12

pallor, red blue hue (dark mottling)
wavy fibers
contraction band necrosis
deeply eosinophili

Question 13

in an MI the first changes occur in the

Answer 13

subendocardial zone, more through the myocardium wall in the form of a wavefront

Question 14

MI in 2-4 days

Answer 14

1. mottling with yellow- tan infarct center
2. PMNs
3. interstitial hemorrhage and edema
4. myocytes are clearly necrotic

Question 15

M 5-10 days

Answer 15

1. sahrply outlined border (hyperemic)
2. central pale, yellowish necrotic region
3. lymphocytes
4. fibroblast proliferation with collagen deposition

Question 16

risk for free wall rupture in MI is highest

Answer 16

5 days of onset

Question 17

MI 10 days- 2 weeks

Answer 17

• depressed, soft, gelatinous area

- granulation tissue

Question 18

risk for ventricular aneurysm formation in MI

Answer 18

2-8 weeks post MI

Question 19

MI 2-8 weeks

Answer 19

• gray white scar

Question 20

MI complications (6)

Answer 20

1. contractile dysfunction-cardiogenic shock
2. arrhythmias
3. muocardial rupture
4. aneurysms
5. mural thrombosis and embolism
6. pericarditis

Question 21

occurs in 10-15% of patients after an acute MI, usually indicates a large infarct causing L ventricular failure, hypotension, pul. vascular congestion and transudation

Answer 21

contractile dysfunction cardiogenic shock

Question 22

prognosis of MI

Answer 22

overall mortality is 30% for first year and survivors have a 3-4% with each passing year

Question 23

MI therapy (3)

Answer 23

1. thrombolytic enzymes
   2, Percutaneous transluminal coronary angioplasty
2. coronary artery bypass grafting

Question 24

reperfusion injury

Answer 24

new cellular damage to tissues that cells are already lethally injured

Question 25

Chronic ischemic Heart disease: 1. who is affected? 2. what do we see

Answer 25

1. elderly pt. with CHF, previous hx of angina and MI and post-infarct cardiac decompensation 2. myocardial atrophy with inerstitial fibrosis

Question 26

What are the two most common causes of death in the US?

Answer 26

Heart disease and cancer

Question 27

What is the most common cause of heart disease?

Answer 27

Coronary artery disease

Question 28

What is the pathological hallmark in acute coronary syndromes?

Answer 28

Coronary atherosclerotic plaque rupture or disruption

Question 29

What type of infarction extends from the endocardium to the epicardium and conforms to the distribution of one of the three major coronary arteries?

Answer 29

A transmural infarction

Question 30

A myocardial infarction that is 5-10 days old shows which gross macroscopic features?

Answer 30

A sharply outlined hyperemic border with central pale, yellowish, necrotic region

Question 31

A myocardial infarction that is 2-4 days old will show which microscopic features?

Answer 31

PMN’s , necrotic myocytes, interstitial edema, and hemorrhage.

Question 32

Which complication can occur two to eight weeks post infarction?

Answer 32

Ventricular wall aneurysm

Question 33

Insufficient oxygen delivery relative to demand causes _______that can manifest as “angina”

Answer 33

myocardial ischemia

Question 34

decreased oxygen delivery due to (4)

Answer 34

1. decreased perfusion pressure 2. increased coronary artery resistance to blood flow 3. increased microvascular resistance to blood flow 4. decreased blood oxygen

Question 35

increased oxygen demand due to (4)

Answer 35

1. tachycardia 2. increased contractility 3. increased LV wall stress 4. ventricular hypertrophy

Question 36

flow limiting disease

Answer 36

1. stable occlusive atheroma/ acute thrombus | 2. vasospasm

Question 37

clinical manifestation of stable CAD

Answer 37

1. chest pain 2. SOB 3. syncope

Question 38

Stress Myocardial perfusion imaging

Answer 38

identifies flow-limiting or obstructive CAD

Question 39

gold standard for dx. CAD

Answer 39

coronary angiography

Question 40

NSTEMI

Answer 40

no st elevation but there might be depression | - troponin elevation

Question 41

STEMI

Answer 41

- troponin elevation | - ST segment elevation

Question 42

Typically LAD occlusion ST Elevation: I and aVL V2-V5 Substantial amount of myocardium may be in jeopardy particularly for proximal LAD disease May significantly reduce LV systolic function causing pump/heart failure

Answer 42

anterior stemi

Question 43

Typically RCA occlusion but may alternatively be LCx Associated GI symptoms common (e.g. burping) ST Elevation: II, III, aVF Nitroglycerin induced hypotension Bradycardia from vagal influences AV node block if AV node ischemic Proximal RCA occlusion can cause RV infarction

Answer 43

inferior stemi

Question 44

NSTEMI may be caused by a

Answer 44

demand ischemia as opposed to a new plaque rupture

Question 45

``` Coronary artery thrombosis Can be STEMI or NSTEMI No obvious change in myocardial oxygen demand Typical symptoms of MI Elevated troponin ```

Answer 45

MI type I

Question 46

Atherosclerotic blockage usually present but without coronary artery thrombosis Transient increased myocardial oxygen demand Tachycardia: sepsis Elevated BP: stop meds May not be associated with chest pain or typical symptoms Elevated troponin

Answer 46

MI type II

Question 47

Restoring blood flow in infarct related artery less than 6 hours from symptom onset provides survival advantage.

Answer 47

true

Question 48

After 6-hours revascularization may improve survival while also reducing symptoms, heart failure and potentially arrhythmia.

Answer 48

true

Question 49

acute MI interventions (3)

Answer 49

1. PCI 2. thrombolytic therapy 3. surgical therapy such as a CABG

Question 50

time is

Answer 50

muscle

Question 51

which medications can lessen remodeling following infarction

Answer 51

ACEi and BB

Question 52

Acute MI complications (4)

Answer 52

1. Pump failure and shock 2. ventricular arrhythmia 3. mechanical complications 4. VSD

Question 53

Progressive CAD leading to another MI: 1. Medical therapy for ASCVD: (2) 2. Revascularization: (2)

Answer 53

Progressive CAD leading to another MI: 1. Medical therapy for ASCVD: Statin, ASA 2. Revascularization: PCI or CABG

Question 54

Systolic Dysfunction leading to CHF: 1. Medical therapy: (3 2. Revascularization

Answer 54

Systolic Dysfunction leading to CHF: 1. Medical therapy: ACEi, beta-blocker, Aldosterone receptor blocker 2. Revascularization

Question 55

Scar and Systolic Dysfunction leading to VT/VF: treatment

Answer 55

Defibrillator

Question 56

major cause of cardiac death

Answer 56

ischemic heart disease

Question 57

Pressure is lost owing to viscous friction along the entrance and throat of the narrowed section

Answer 57

Poiseuille's law

Question 58

The pressure gradient across a stenosis is determined by

Answer 58

the sum of viscous and separation losses

Question 59

Resistance to blood flow is directly proportional to __________and inversely proportional to the _______ to the fourth power

Answer 59

Resistance to blood flow is directly proportional to length of stenotic segment and inversely proportional to the radius of the minimum diameter to the fourth power

Question 60

Insufficient oxygen delivery relative to demand causes myocardial ischemia that can manifest as

Answer 60

“angina”

Question 61

Provides assessment of the amount of myocardium at risk, which is proportional to outcome

Answer 61

myocardial perfusion imaging test