Ischaemic Heart Dx

Question 1

What is the primary cause of ischemic heart disease (IHD)?

Answer 1

Atherosclerosis, which leads to narrowing or obstruction of coronary arteries.

Question 2

What are the four main clinical manifestations of IHD?

Answer 2

Stable angina, unstable angina, NSTEMI, and STEMI.

Question 3

Which cardiac biomarkers are most specific for myocardial infarction (MI)?

Answer 3

Troponin T and Troponin I.

Question 4

What are the classic symptoms of angina?

Answer 4

Retrosternal chest pain, radiating to the left arm, jaw, or neck, typically triggered by exertion and relieved by rest or nitrates.

Question 5

What ECG changes indicate STEMI?

Answer 5

ST-segment elevation in two or more contiguous leads, new left bundle branch block (LBBB).

Question 6

What is the difference between STEMI and NSTEMI?

Answer 6

STEMI shows ST-segment elevation and full-thickness myocardial infarction, while NSTEMI has ST depression/T-wave inversion and subendocardial infarction.

Question 7

What are the risk factors for IHD?

Answer 7

Hypertension, diabetes, smoking, hyperlipidemia, obesity, sedentary lifestyle, family history, and male gender.

Question 8

What is the mechanism of atherosclerosis?

Answer 8

Endothelial injury leads to lipid accumulation, inflammation, plaque formation, and potential rupture causing thrombosis.

Question 9

What is the first-line treatment for STEMI?

Answer 9

Primary percutaneous coronary intervention (PCI) within 90 minutes, or fibrinolysis if PCI is unavailable.

Question 10

What is the mechanism of action of aspirin in IHD?

Answer 10

It inhibits platelet aggregation by irreversibly inhibiting COX-1, reducing thrombus formation.

Question 11

What is the role of beta-blockers in IHD?

Answer 11

They reduce myocardial oxygen demand by lowering heart rate and contractility.

Question 12

Which cholesterol-lowering drugs are used in IHD management?

Answer 12

Statins (e.g., atorvastatin, rosuvastatin) to lower LDL and reduce plaque progression.

Question 13

What is the primary goal of treating unstable angina?

Answer 13

Prevent progression to myocardial infarction with antiplatelets, anticoagulants, and risk stratification for PCI.

Question 14

What are the contraindications for thrombolytic therapy in STEMI?

Answer 14

Active bleeding, recent stroke, severe hypertension, prior intracranial hemorrhage, and suspected aortic dissection.

Question 15

What is the best imaging modality for assessing coronary artery disease?

Answer 15

Coronary angiography (invasive) or CT coronary angiography (non-invasive).

Question 16

What is the pathophysiology of Prinzmetal’s angina?

Answer 16

Coronary artery spasm leading to transient ischemia, often occurring at rest.

Question 17

What is the most common cause of sudden cardiac death in MI?

Answer 17

Ventricular fibrillation.

Question 18

What is the function of P2Y12 inhibitors in IHD?

Answer 18

They inhibit platelet aggregation, preventing thrombus formation (e.g., clopidogrel, ticagrelor).

Question 19

Which lifestyle modifications can reduce IHD risk?

Answer 19

Smoking cessation, regular exercise, healthy diet, weight control, and blood pressure management.

Question 20

What ECG changes suggest a prior myocardial infarction?

Answer 20

Pathological Q waves in multiple leads.

Question 21

What is Takotsubo cardiomyopathy?

Answer 21

A stress-induced cardiomyopathy mimicking MI but with normal coronary arteries.

Question 22

What is the recommended dual antiplatelet therapy (DAPT) duration after PCI?

Answer 22

12 months with aspirin and a P2Y12 inhibitor.

Question 23

What is the role of ACE inhibitors in post-MI patients?

Answer 23

They prevent ventricular remodeling and reduce mortality.

Question 24

Which condition presents with ST elevation but normal coronary arteries?

Answer 24

Pericarditis or Takotsubo cardiomyopathy.

Question 25

What is the most sensitive marker for early MI?

Answer 25

High-sensitivity troponin.

Question 26

What is the treatment of choice for a patient with a large anterior STEMI?

Answer 26

Urgent PCI or fibrinolysis if PCI is unavailable.

Question 27

What are the signs of cardiogenic shock post-MI?

Answer 27

Hypotension, cold extremities, oliguria, altered mental status, pulmonary congestion.

Question 28

Which condition mimics MI but has normal coronary arteries?

Answer 28

Takotsubo cardiomyopathy.

Question 29

What is the role of calcium channel blockers in IHD?

Answer 29

They reduce coronary spasm in Prinzmetal’s angina and can be used when beta-blockers are contraindicated.

Question 30

What are the components of the Killip classification for MI severity?

Answer 30

Class I: No HF, Class II: Pulmonary congestion, Class III: Pulmonary edema, Class IV: Cardiogenic shock.

Question 31

Which non-cardiac conditions can cause ST elevation on ECG?

Answer 31

Pericarditis, early repolarization, myocarditis, Brugada syndrome.

Question 32

What is the primary goal of secondary prevention in IHD?

Answer 32

Prevent recurrent events through lifestyle changes and medications (aspirin, statins, beta-blockers, ACE inhibitors).

Question 33

What is the mechanism of nitrates in angina?

Answer 33

They cause vasodilation, reducing myocardial oxygen demand.

Question 34

Which antihypertensive medications are preferred in post-MI patients?

Answer 34

Beta-blockers and ACE inhibitors.

Question 35

What is the significance of left ventricular ejection fraction (LVEF) post-MI?

Answer 35

LVEF <40% indicates increased risk of heart failure and mortality.

Question 36

Which arrhythmias are most common after MI?

Answer 36

Ventricular fibrillation, ventricular tachycardia, atrial fibrillation.

Question 37

What is the recommended LDL target for high-risk IHD patients?

Answer 37

LDL-C <55 mg/dL (<1.4 mmol/L).

Question 38

Which antiplatelet drugs are used for long-term IHD management?

Answer 38

Aspirin and P2Y12 inhibitors (clopidogrel, ticagrelor, prasugrel).

Question 39

What is the role of PCI in acute coronary syndrome?

Answer 39

Restores coronary blood flow by opening occluded arteries.

Question 40

What is the most specific symptom of myocardial infarction?

Answer 40

Severe, persistent chest pain lasting >30 minutes.

Question 41

Which imaging modality is most useful for detecting myocardial ischemia?

Answer 41

Stress echocardiography or nuclear perfusion imaging.

Question 42

What is the best initial test for suspected MI?

Answer 42

ECG within 10 minutes of arrival.

Question 43

What is the primary treatment for NSTEMI?

Answer 43

Antiplatelet therapy, anticoagulation, and risk stratification for PCI.

Question 44

What is the most effective way to prevent IHD?

Answer 44

Lifestyle modifications and risk factor control.