CV 2

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Questions and Answers

Which of the following is the most common cause of impaired coronary blood flow resulting in angina pectoris?

  • Cigarette smoking
  • Diabetes mellitus
  • Hypertension
  • Hypercholesterolemia (correct)

Which of the following is the first manifestation of ischemic heart disease?

  • Angina pectoris
  • Myocardial infarction (correct)
  • Sudden death
  • Cardiac dysrhythmias

What is the most important risk factor for ischemic heart disease?

  • Obesity
  • Increasing age
  • Genetic factors
  • Male gender (correct)

What is the definition of unstable angina?

<p>All of the above (D)</p> Signup and view all the answers

What is the equation for coronary perfusion pressure (CPP)?

<p>CPP = Aortic diastolic pressure - LVEDP (B)</p> Signup and view all the answers

What is the most dangerous anatomic lesion associated with an unfavorable prognosis in ischemic heart disease?

<p>Left main coronary artery disease (B)</p> Signup and view all the answers

What is the most common cause of myocardial ischemia?

<p>Atherosclerotic plaque (C)</p> Signup and view all the answers

Which of the following agents should NOT be administered as part of the next management steps for a patient with chest pain and ST depression on the electrocardiogram (ECG)?

<p>Procainamide (B)</p> Signup and view all the answers

What is the formula for cardiac output?

<p>CO = HR x SV (D)</p> Signup and view all the answers

What is the special consideration for a 32-year-old female with mitral stenosis undergoing a large abdominal surgery?

<p>Avoid hypervolemia (A)</p> Signup and view all the answers

Which reflex is usually seen in brain injury and is characterized by Cushing's triad (hypertension, bradycardia, and irregular breathing)?

<p>Cushing reflex (A)</p> Signup and view all the answers

What are the compatible vital signs for a patient with severe traumatic brain injury and epidural hematoma being taken to the operating room for decompressive craniotomy?

<p>HR: 50, BP: 180/99, RR: 14 (on MV), Saturation: 100% (B)</p> Signup and view all the answers

Which reflex is responsible for maintaining circulatory homeostasis by responding to changes in blood pressure and heart rate?

<p>Baroreceptor reflex (B)</p> Signup and view all the answers

What is the formula for stroke volume?

<p>SV = ESK-EDV (C)</p> Signup and view all the answers

Which of the following is the most common cause of acute myocardial infarction (MI)?

<p>Rupture of a plaque that had produced less than 50% stenosis of a coronary artery (C)</p> Signup and view all the answers

Which of the following is NOT a treatment option for chronic stable angina?

<p>Revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) (B)</p> Signup and view all the answers

Which of the following is a recommended lifestyle modification for reducing the risk of coronary artery disease?

<p>All of the above (D)</p> Signup and view all the answers

Which class of drugs is associated with a substantial decrease in the risk of death due to cardiac events?

<p>Antiplatelet drugs (C)</p> Signup and view all the answers

Which of the following is a contraindication for the use of nitrates?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is a common side effect of nitrate treatment?

<p>Headache (B)</p> Signup and view all the answers

Which class of drugs is associated with a decrease in heart rate and myocardial contractility?

<p>Beta blockers (B)</p> Signup and view all the answers

Which class of medications is recommended for the medical management of Angina Pectoris?

<p>Calcium channel blockers (C)</p> Signup and view all the answers

What is the mechanism of action of calcium channel blockers?

<p>All of the above (D)</p> Signup and view all the answers

What are the common side effects of calcium channel blockers?

<p>All of the above (D)</p> Signup and view all the answers

What are the contraindications to the use of calcium channel blockers?

<p>Both A and B (C)</p> Signup and view all the answers

Which class of medications is recommended for the medical management of Angina Pectoris in patients with coronary artery disease and hypertension?

<p>ACE inhibitors (D)</p> Signup and view all the answers

What are the contraindications to the use of ACE inhibitors?

<p>All of the above (D)</p> Signup and view all the answers

When is revascularization indicated for the treatment of Angina Pectoris?

<p>All of the above (D)</p> Signup and view all the answers

In patients with ST-segment elevation myocardial infarction (STEMI), when is percutaneous coronary intervention (PCI) preferred over thrombolytic therapy?

<p>All of the above (D)</p> Signup and view all the answers

What is the recommended timeframe for performing angioplasty in patients with STEMI?

<p>Both A and B (C)</p> Signup and view all the answers

Which of the following is a common symptom of ischemic heart disease?

<p>Chest pain (A)</p> Signup and view all the answers

Which of the following is a common treatment for valvular heart disease?

<p>Valve replacement surgery (C)</p> Signup and view all the answers

Which of the following is a risk factor for congenital heart disease?

<p>Advanced maternal age (B)</p> Signup and view all the answers

Which of the following agents should NOT be administered as part of the next management steps for a patient with chest pain and ST depression on the electrocardiogram (ECG)?

<p>Procainamide (A)</p> Signup and view all the answers

Which of the following reflexes is usually seen in brain injury and is characterized by Cushing's triad (hypertension, bradycardia, and irregular breathing)?

<p>Cushing reflex (C)</p> Signup and view all the answers

Which of the following reflexes is responsible for maintaining circulatory homeostasis by responding to changes in blood pressure and heart rate?

<p>Baroreceptor reflex (D)</p> Signup and view all the answers

Which class of drugs is associated with a decrease in heart rate and myocardial contractility?

<p>Beta blockers (A)</p> Signup and view all the answers

Which of the following is the most common cause of impaired coronary blood flow resulting in angina pectoris?

<p>Hypercholesterolemia (B)</p> Signup and view all the answers

Which of the following is the most dangerous anatomic lesion associated with an unfavorable prognosis in ischemic heart disease?

<p>Left main coronary artery disease (A)</p> Signup and view all the answers

Which of the following is the first manifestation of ischemic heart disease?

<p>Myocardial infarction (MI) (C)</p> Signup and view all the answers

Which of the following is the most important risk factor for ischemic heart disease?

<p>Male gender (C)</p> Signup and view all the answers

Which of the following is NOT a diagnostic modality for angina pectoris?

<p>Adenosine SPECT (A)</p> Signup and view all the answers

Which of the following is a characteristic feature of stable angina?

<p>Chest pain that changes appreciably in frequency or severity over 2 months or longer (B)</p> Signup and view all the answers

Which of the following is a symptom of unstable angina?

<p>Angina at rest or of new onset (C)</p> Signup and view all the answers

Which of the following is a lifestyle modification recommended for reducing the risk of coronary artery disease?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is the most common side effect of nitrate treatment?

<p>Headache (C)</p> Signup and view all the answers

Which class of drugs is associated with a decrease in heart rate and myocardial contractility?

<p>Beta-blockers (A)</p> Signup and view all the answers

Which of the following is a contraindication for the use of nitrates?

<p>All of the above (D)</p> Signup and view all the answers

Which of the following is the most common cause of impaired coronary blood flow resulting in angina pectoris?

<p>Rupture of a plaque with less than 50% stenosis of a coronary artery (C)</p> Signup and view all the answers

Which of the following is a class of drugs associated with a substantial decrease in the risk of death due to cardiac events?

<p>Antiplatelet drugs (D)</p> Signup and view all the answers

Which of the following is the most correct statement about the therapeutic value of organic nitrates?

<p>The therapeutic value of organic nitrates is compromised by the development of tolerance (D)</p> Signup and view all the answers

Which class of medications is contraindicated in patients with severe congestive heart failure or severe aortic stenosis?

<p>Long acting calcium channel blockers (B)</p> Signup and view all the answers

What are the common side effects of calcium channel blockers?

<p>Hypotension, peripheral edema, and headache (B)</p> Signup and view all the answers

Which class of medications is recommended for patients with coronary artery disease, especially those with hypertension, left ventricular dysfunction, or diabetes?

<p>ACE inhibitors (C)</p> Signup and view all the answers

What is the preferred treatment choice in patients with a contraindication to thrombolytic therapy and those with severe heart failure and/or pulmonary edema?

<p>Percutaneus Coronary Intervention (PCI) (B)</p> Signup and view all the answers

When is revascularization indicated for the treatment of Angina Pectoris?

<p>All of the above (D)</p> Signup and view all the answers

What is the recommended timeframe for performing angioplasty in patients with STEMI?

<p>Within 90 minutes of arrival at the health care facility and within 12 hours of symptom onset (A)</p> Signup and view all the answers

Which of the following is a contraindication for the use of nitrates?

<p>Both A and B (C)</p> Signup and view all the answers

What is the equation for coronary perfusion pressure (CPP)?

<p>CPP = (2 * SBP) + DBP (C)</p> Signup and view all the answers

Which of the following is a recommended lifestyle modification for reducing the risk of coronary artery disease?

<p>Smoking cessation (B)</p> Signup and view all the answers

Which medication should be started at least one week before surgery?

<p>Statins (C)</p> Signup and view all the answers

What is the most effective method for monitoring myocardial ischemia during surgery?

<p>Computerized ST-segment analysis (D)</p> Signup and view all the answers

Which medication is an appropriate choice when myocardial ischemia is associated with a normal or modestly elevated blood pressure?

<p>Nitroglycerin (B)</p> Signup and view all the answers

What is the goal heart rate during surgery to control tachycardia?

<p>Around 80 bpm (B)</p> Signup and view all the answers

Which induction agent is preferred for cardiac transplantation due to its minimal effect on hemodynamics?

<p>Etomidate (C)</p> Signup and view all the answers

What is the preferred technique for maintenance of anesthesia during cardiac transplantation?

<p>Total intravenous anesthesia (C)</p> Signup and view all the answers

Which anesthetic drug should be avoided in patients undergoing cardiac transplantation due to the presence of significant pulmonary hypertension?

<p>Nitrous oxide (D)</p> Signup and view all the answers

Which mechanism is responsible for the increase in stroke volume in response to an increase in preload in patients with transplanted hearts?

<p>Frank-Starling mechanism (D)</p> Signup and view all the answers

Which of the following is a significant association with increased troponin levels in surgical patients?

<p>Cardiac death (A)</p> Signup and view all the answers

What is the recommended action if there is an increase in troponin level postoperatively, even in the absence of clear cardiovascular signs and symptoms?

<p>Immediate referral to a cardiologist (A)</p> Signup and view all the answers

Which of the following is a specialized preoperative testing for perioperative assessment in ischemic heart disease?

<p>Thallium Scintigraphy scan (A)</p> Signup and view all the answers

What is the purpose of evaluating clinical risk factors in the perioperative assessment of ischemic heart disease?

<p>To evaluate severity, progression, and functional limitations (C)</p> Signup and view all the answers

Which of the following is a major clinical predictor of increased perioperative cardiovascular risk?

<p>Uncontrolled systemic hypertension (A)</p> Signup and view all the answers

Which of the following is a moderate clinical risk factor for perioperative cardiac complications?

<p>Abdominal aortic aneurysm (A)</p> Signup and view all the answers

Which of the following is a minor clinical risk factor for coronary artery disease?

<p>History of stroke (C)</p> Signup and view all the answers

What is the fundamental reason for risk stratification in patients with ischemic heart disease?

<p>To identify patients at increased risk for perioperative cardiac events (A)</p> Signup and view all the answers

Which patients are traditionally thought to be contraindicated for β-blockers?

<p>All of the above (D)</p> Signup and view all the answers

What is the primary goal in the management of STEMI?

<p>Reestablishment of blood flow in the obstructed coronary artery (D)</p> Signup and view all the answers

What is the association between thrombolytic therapy and hemorrhagic stroke?

<p>Hemorrhagic stroke occurs in 0.3% to 1% of patients receiving thrombolytic therapy (D)</p> Signup and view all the answers

What is the recommended duration of delaying elective noncardiac surgery after PCI with drug-eluting stent placement?

<p>12 months (C)</p> Signup and view all the answers

Which of the following is the most common symptom of valvular heart disease?

<p>Shortness of breath (B)</p> Signup and view all the answers

Which of the following is NOT a diagnostic modality used in the perioperative evaluation of valvular heart disease?

<p>Cardiac catheterization (B)</p> Signup and view all the answers

Which of the following is the most appropriate management strategy for patients with valvular heart disease who require anticoagulation therapy?

<p>Continue anticoagulation therapy during minor surgery (D)</p> Signup and view all the answers

Which of the following is the most common complication associated with prosthetic heart valves?

<p>Valve thrombosis (A)</p> Signup and view all the answers

Which of the following is the most common cause of mitral stenosis?

<p>Rheumatic heart disease (B)</p> Signup and view all the answers

What is the normal mitral valve area?

<p>4-6 cm2 (B)</p> Signup and view all the answers

Which of the following symptoms is commonly associated with mitral stenosis?

<p>Dyspnea (C)</p> Signup and view all the answers

What is the gold standard for diagnosing mitral stenosis?

<p>Echocardiogram (ECHO) (A)</p> Signup and view all the answers

Which of the following is the recommended treatment for mitral stenosis?

<p>Percutaneous repair or replacement (A)</p> Signup and view all the answers

What events should be prevented or treated during anesthesia for patients with mitral stenosis?

<p>All of the above (D)</p> Signup and view all the answers

Which chamber of the heart is best heard at the cardiac apex?

<p>Left ventricle (C)</p> Signup and view all the answers

Which heart sound is produced by the closure of the tricuspid and mitral valves?

<p>S1 (D)</p> Signup and view all the answers

Which heart sound is produced by the closure of the pulmonic and aortic valves?

<p>S2 (A)</p> Signup and view all the answers

Which valve lesion requires a slow heart rate to improve left ventricular filling and coronary blood flow?

<p>Mitral stenosis (B)</p> Signup and view all the answers

Which induction agent is preferred for cardiac transplantation because it has little effect on hemodynamics?

<p>Etomidate (B)</p> Signup and view all the answers

Which of the following is rarely used during cardiac transplantation due to the presence of significant pulmonary hypertension?

<p>Nitrous oxide (A)</p> Signup and view all the answers

Which mechanism is responsible for the increase in stroke volume in response to an increase in preload in patients with transplanted hearts?

<p>Frank-Starling mechanism (B)</p> Signup and view all the answers

Which of the following is a noninvasive imaging test used to assess myocardial perfusion in patients with suspected ischemic heart disease?

<p>Radionuclide imaging (C)</p> Signup and view all the answers

Which of the following is a significant association with increased troponin levels in surgical patients?

<p>Increased risk of congestive heart failure (C)</p> Signup and view all the answers

What is the recommended action when an increase in troponin level is detected postoperatively, even in the absence of cardiovascular signs and symptoms?

<p>Immediate referral to a cardiologist (A)</p> Signup and view all the answers

Which specialized preoperative testing is recommended for perioperative assessment in ischemic heart disease?

<p>Exercise ECG (D)</p> Signup and view all the answers

What is the purpose of perioperative assessment in ischemic heart disease?

<p>Evaluate severity, progression, and functional limitations (D)</p> Signup and view all the answers

Which of the following is a contraindication for the use of β-blockers?

<p>All of the above (D)</p> Signup and view all the answers

Which type of plaque is most prone to rupture?

<p>Plaques with rich lipid cores and thin fibrous caps (B)</p> Signup and view all the answers

What is the primary goal in the management of STEMI?

<p>Reestablish blood flow in the obstructed coronary artery (A)</p> Signup and view all the answers

What is the recommended duration of dual antiplatelet therapy after a PCI with drug-eluting stent placement?

<p>12 months (A)</p> Signup and view all the answers

Which of the following is a major clinical risk factor for perioperative cardiovascular risk?

<p>Uncontrolled systemic hypertension (B)</p> Signup and view all the answers

Which of the following is an intermediate clinical risk factor for perioperative cardiovascular risk?

<p>Previous MI based on history or Q waves on ECG (D)</p> Signup and view all the answers

Which of the following is a minor clinical risk factor for coronary artery disease?

<p>Rhythm other than sinus arrhythmias (A)</p> Signup and view all the answers

Which of the following is a goal in the preoperative management of patients with ischemic heart disease?

<p>All of the above (D)</p> Signup and view all the answers

Which medication should be used to treat myocardial ischemia associated with a normal or modestly elevated blood pressure?

<p>Nitroglycerin (B)</p> Signup and view all the answers

Which medication can be used to treat a persistent increase in heart rate in the setting of normal or high blood pressure?

<p>Esmolol (B)</p> Signup and view all the answers

What is the most effective method for monitoring myocardial ischemia during surgery?

<p>Monitoring three leads (II, V4, and V5) (D)</p> Signup and view all the answers

When should treatment of myocardial ischemia be instituted?

<p>When there are 1-mm ST-segment changes on the ECG (B)</p> Signup and view all the answers

Which of the following is the most common cause of mitral stenosis?

<p>Rheumatic heart disease (A)</p> Signup and view all the answers

What is the normal mitral valve area?

<p>4-6 cm2 (C)</p> Signup and view all the answers

Which of the following symptoms is characteristic of mitral stenosis?

<p>Progressive dyspnea (B)</p> Signup and view all the answers

What is the gold standard for diagnosing mitral stenosis?

<p>ECHO (B)</p> Signup and view all the answers

What is the recommended treatment for mitral stenosis?

<p>Percutaneous balloon valvuloplasty (B)</p> Signup and view all the answers

Which of the following events can impact mitral stenosis during anesthesia?

<p>Marked increase in central blood volume (C)</p> Signup and view all the answers

Which of the following is the most common cause of mitral stenosis?

<p>Rheumatic heart disease (C)</p> Signup and view all the answers

What is the normal mitral valve area?

<p>4-6 cm2 (A)</p> Signup and view all the answers

Which gender is most commonly affected by mitral stenosis?

<p>Females (B)</p> Signup and view all the answers

What is the most common symptom of mitral stenosis?

<p>Dyspnea (B)</p> Signup and view all the answers

What is the gold standard for diagnosing mitral stenosis?

<p>Echocardiography (ECHO) (B)</p> Signup and view all the answers

What is the treatment of choice for mitral stenosis?

<p>Percutaneous repair or replacement (A)</p> Signup and view all the answers

What is the most important factor to monitor during anesthesia for patients with mitral stenosis?

<p>Pulmonary artery pressure (C)</p> Signup and view all the answers

What is the risk associated with overtransfusion or head-down positioning in patients with mitral stenosis?

<p>Pulmonary edema (B)</p> Signup and view all the answers

What is the recommended technique for induction of anesthesia in patients with mitral stenosis?

<p>Intravenous induction (C)</p> Signup and view all the answers

What is the most common complication after mitral stenosis surgery?

<p>Pulmonary edema (A)</p> Signup and view all the answers

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