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</p> Signup and view all the answers

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

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

    What is the most common cause of myocardial ischemia?

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

    What is the formula for cardiac output?

    <p>CO = HR x SV</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</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</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%</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</p> Signup and view all the answers

    What is the formula for stroke volume?

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

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

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

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

    <p>Headache</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</p> Signup and view all the answers

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

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

    What is the mechanism of action of calcium channel blockers?

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

    What are the common side effects of calcium channel blockers?

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

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

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

    What are the contraindications to the use of ACE inhibitors?

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

    When is revascularization indicated for the treatment of Angina Pectoris?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    <p>Headache</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</p> Signup and view all the answers

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

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

    What are the common side effects of calcium channel blockers?

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

    When is revascularization indicated for the treatment of Angina Pectoris?

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

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

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

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

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

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

    <p>Statins</p> Signup and view all the answers

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

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

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

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

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

    <p>Etomidate</p> Signup and view all the answers

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

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

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

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

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

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

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

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

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

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

    What is the normal mitral valve area?

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

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

    <p>Dyspnea</p> Signup and view all the answers

    What is the gold standard for diagnosing mitral stenosis?

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

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

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

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

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

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

    <p>S1</p> Signup and view all the answers

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

    <p>S2</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</p> Signup and view all the answers

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

    <p>Etomidate</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</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</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</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</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</p> Signup and view all the answers

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

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

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

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

    What is the normal mitral valve area?

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

    Which of the following symptoms is characteristic of mitral stenosis?

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

    What is the gold standard for diagnosing mitral stenosis?

    <p>ECHO</p> Signup and view all the answers

    What is the recommended treatment for mitral stenosis?

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

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

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

    What is the normal mitral valve area?

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

    Which gender is most commonly affected by mitral stenosis?

    <p>Females</p> Signup and view all the answers

    What is the most common symptom of mitral stenosis?

    <p>Dyspnea</p> Signup and view all the answers

    What is the gold standard for diagnosing mitral stenosis?

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

    What is the treatment of choice for mitral stenosis?

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

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

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

    What is the most common complication after mitral stenosis surgery?

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

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