Stable Angina Pectoris

Question 1

Major site of atherosclerotic disease

Answer 1

Epicardial coronary arteries

Question 2

Episodic clinical syndrome that is due to transient myocardial ischemia

Answer 2

Stable angina pectoris

Question 3

CCS I

Answer 3

Ordinary physical activity, such as walking and climbing stairs does not cause angina. Angina present with strenuous or rapid or prolonged exertion at work or recreation

Question 4

CCS II

Answer 4

Slight limitation of ordinary activity.
Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold or when under emotional stress or only during the few hours after awakening.
Walking more than two blocks on the level and climbing more than one flight or stairs at a normal pace and in normal condition

Question 5

CCS III

Answer 5

Marked limitation of ordinary physical activity.
Walking one to two blocks on the level and climbing more than one flight of stairs in normal conditions

Question 6

CCS IV

Answer 6

Inability to carry on any physical activity without discomfort.
Anginal syndrome may be present at rest

Question 7

NYHA I

Answer 7

Patients have cardiac disease but without the resulting limitations of physical activity.
Ordinary activity does not cause undue fatige, palpitation, dyspnea or anginal pain

Question 8

NYHA II

Answer 8

Patients have cardiac disease resulting in slight limitation of physical activity.
They are comfortable at rest.
Ordinary physical activity results in fatigue, palpitation, dyspnea or anginal pain.

Question 9

NYHA III

Answer 9

Patients have cardiac disease resulting in marked limitation of physical activity.
They are comfortable at rest.
Less than ordinary physical activity causes fatigue, palpitation, dyspnea or anginal pain.

Question 10

NYHA IV

Answer 10

Patients have cardiac disease resulting in inability to carry on any physical activity without discomfort.
Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.

Question 11

Possible indications for stress testing of patient

Answer 11

1. Dx of IHD uncertain
2. Assess functional capacity of patient
3. Assess adequacy of treatment program for IHD
4. Markedly abnormal calcium score on EBCT

Question 12

Principal prognostic indicators in patients known to have IHD

Answer 12

1. Age
2. Functional state of the left ventricle
3. The location and severity of coronary artery narrowing
4. Severity or activity of myocardial ischemia

Question 13

Signs and symptoms associated with increased risk of adverse coronary events

Answer 13

1. Inability to exercise for 6 min (i.e. stage II Bruce protocol) of the exercise test
2. A strongly positive exercise test showing onset of myocardial ischemia at low workloads 3. Development of large or multiple perfusion defects or increased lung uptake during stress radioisotope perfusion imaging
3. Decrease in LV ejection fraction during exercise on radionuclide ventriculography or during stress echocardiography

Question 14

Signs that indicate very low risk for future coronary events

Answer 14

1. Patients who can complete stage III of the Bruce exercise protocol
2. Normal stress perfusion scan
3. Negative stress echocardiographic evaluation

Question 15

Nonpharmacologic management of IHD

Answer 15

1. Explanation and reassurance
2. Identification and treatment of aggravating conditions
3. Recommendations for the adaptation of activity as needed.

Question 16

Management of patient with IHD

Answer 16

Question 17

Most common clinical Indication for PCI

Answer 17

Symptom limiting angina pectoris despite medical therapy, accompanied by evidence of ischemia during a stress test

Question 18

Ideal candidate for CABG

Answer 18

Male
<80 years old
No other complicating disease
Troublesome or disabling angina that is not adequately controlled by medical therapy or does not tolerate medical therapy

Question 19

CABG vs PCI indication

Answer 19

PCI
-single or two vessel lesions with normal LV function and anatomically suitable lesions

CABG
-three vessel disease (or two-vessel disease that includes the proximal left descending coronary artery)
-impaired global LV function (EF <50%)
- DM
- Left main CAD or other lesions unsuitable for catheter-based procedures

Question 20

Prognosis of silent ischemia

Answer 20

Increased likelihood of adverse coronary events (death and myocardial infarction)