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Questions and Answers
What structure does the left main coronary artery primarily divide into?
What structure does the left main coronary artery primarily divide into?
Which artery primarily supplies the right atrium and right ventricle?
Which artery primarily supplies the right atrium and right ventricle?
In most individuals, which artery supplies the posterior descending artery?
In most individuals, which artery supplies the posterior descending artery?
What structure is predominantly supplied by the right coronary artery in approximately 60% of individuals?
What structure is predominantly supplied by the right coronary artery in approximately 60% of individuals?
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What does the venous system of the coronary circulation primarily do?
What does the venous system of the coronary circulation primarily do?
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What is the primary cause of coronary artery disease (CAD)?
What is the primary cause of coronary artery disease (CAD)?
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Which term is synonymous with coronary artery disease (CAD)?
Which term is synonymous with coronary artery disease (CAD)?
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What characterizes the stable form of coronary artery disease?
What characterizes the stable form of coronary artery disease?
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Which of the following statements best describes myocardial ischemia?
Which of the following statements best describes myocardial ischemia?
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What type of angina is categorized under acute coronary syndromes (ACSs)?
What type of angina is categorized under acute coronary syndromes (ACSs)?
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Which artery is a branch of the left coronary artery (LCA)?
Which artery is a branch of the left coronary artery (LCA)?
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What is the function of the sinoatrial node in the heart?
What is the function of the sinoatrial node in the heart?
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Which of the following is NOT a classification of coronary artery disease?
Which of the following is NOT a classification of coronary artery disease?
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Which symptom is typically associated with angina?
Which symptom is typically associated with angina?
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What is a common precipitating factor for angina?
What is a common precipitating factor for angina?
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What is the classic position patients assume when describing chest pain associated with angina?
What is the classic position patients assume when describing chest pain associated with angina?
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During an anginal episode, which change is commonly observed in an ECG?
During an anginal episode, which change is commonly observed in an ECG?
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What factor can relieve angina symptoms?
What factor can relieve angina symptoms?
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What condition can lead to angina equivalents such as dyspnea or fatigue?
What condition can lead to angina equivalents such as dyspnea or fatigue?
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What finding might you expect during provocative testing for angina?
What finding might you expect during provocative testing for angina?
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What is a common characteristic of the pain associated with angina?
What is a common characteristic of the pain associated with angina?
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What is the primary purpose of coronary angiography?
What is the primary purpose of coronary angiography?
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Which of the following therapies is NOT part of the treatment goals for stable angina?
Which of the following therapies is NOT part of the treatment goals for stable angina?
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Which patient condition is most likely to warrant the use of coronary angiography?
Which patient condition is most likely to warrant the use of coronary angiography?
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What role does myocardial perfusion CMR mainly play in assessing cardiac conditions?
What role does myocardial perfusion CMR mainly play in assessing cardiac conditions?
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Which of the following is NOT a recommended control measure for stable angina management?
Which of the following is NOT a recommended control measure for stable angina management?
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What does cardiac radio nucleotide imaging with thallium 201 assess during exercise?
What does cardiac radio nucleotide imaging with thallium 201 assess during exercise?
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Which test directly assesses ventricular dysfunction affecting management decisions?
Which test directly assesses ventricular dysfunction affecting management decisions?
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What is the primary goal of a stress echocardiography test?
What is the primary goal of a stress echocardiography test?
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Which imaging technique is considered the most reliable noninvasive method for assessing coronary artery disease?
Which imaging technique is considered the most reliable noninvasive method for assessing coronary artery disease?
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What is the purpose of using intravenous pharmacologic challenge during PET exams?
What is the purpose of using intravenous pharmacologic challenge during PET exams?
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What does a transient perfusion defect during a radionuclide scan indicate?
What does a transient perfusion defect during a radionuclide scan indicate?
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Which method is NOT mentioned as an alternative for assessing myocardial ischemia?
Which method is NOT mentioned as an alternative for assessing myocardial ischemia?
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What kind of abnormalities can an echocardiogram reveal that indicate possible ischemia?
What kind of abnormalities can an echocardiogram reveal that indicate possible ischemia?
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Study Notes
Coronary Circulation
- The left main coronary artery and the right coronary artery branch from the aorta, just after the aortic valve.
- The left main coronary artery divides into:
- The left anterior descending artery: supplies the front of the left ventricle, the apex, and the front of the septum.
- The circumflex artery: supplies the back of the left ventricle and the lower surface.
- The right coronary artery: supplies the right atrium, the right ventricle, and the inferior posterior part of the left ventricle.
- In most people, the right coronary artery supplies the posterior descending artery.
- In some people, the left circumflex artery supplies the posterior descending artery.
- The sinoatrial node is supplied by the right coronary artery in about 60% of people, and the atrioventricular node in 90%.
- The venous system mainly follows the coronary arteries and drains into the coronary sinus, which then empties into the right atrium.
Coronary Artery Disease (CAD)
- CAD is also known as ischemic heart disease (IHD) and is usually caused by atherosclerosis of a coronary artery.
- IHD describes a group of syndromes where there is an imbalance between myocardial blood supply and demand.
Stable CAD (Chronic Coronary Syndrome)
- Characterized by stable angina pectoris.
- It is characterized by chest pain that:
- Builds up quickly (within 30 seconds) and disappears gradually (within 5 to 15 minutes).
- Feels like tightness, squeezing, or constriction.
- Can feel like an ache, discomfort, indigestion, or burning pain.
- Is usually located behind the breastbone (retrosternal).
- Radiates to the left shoulder, arm, back, neck, jaw, teeth, or epigastrium.
- Is caused by exertion, emotions, or sexual activity.
- Is relieved by rest and sublingual nitroglycerin.
- Other characteristics:
- Nocturnal angina: chest pain that occurs during sleep.
- Postprandial angina: chest pain that develops after meals.
- Angina equivalents: chest pain may not be present, instead experiencing shortness of breath, dizziness, fatigue, or faintness, especially common in diabetics.
Diagnosing Stable CAD
- Physical examination may be normal, but may reveal signs of risk factors.
- Electrocardiogram (ECG):
- May be normal in 50% of cases.
- During episodes of angina: ST segment depression, T wave inversion, and ventricular tachyarrhythmias may be observed.
- Continuous ECG monitoring:
- Helps detect silent ischemia.
- Provocative testing: Used to confirm the presence of ischemia if resting ECG is normal.
- Stress ECG (treadmill test): Records the 12-lead ECG before, during, and after exercise.
- Discontinued if the patient experiences chest discomfort, severe dyspnea, dizziness, fatigue, fall in systolic blood pressure > 10 mmHg, ST segment depression > 0.2 mV, or ventricular tachyarrhythmias.
- Cardiac radionuclide imaging: Utilizes thallium 201 to show areas of absent perfusion during exercise.
- Echocardiogram: Assesses ventricular function.
- Reduced left ventricular ejection fraction (LVEF) may indicate reduced heart function.
- Regional wall motion abnormalities may suggest ischemia or old infarction.
- Stress echocardiography: After intravenous dobutamine (pharmacological challenge) or exercise, it shows areas of regional wall motion abnormality (akinesia) in the left ventricle due to persistent ischemia or myocardial infarction.
- Multislice CT coronary angiography: Emerging as the most reliable noninvasive method for assessing coronary artery disease.
- Detects and defines coronary anatomy, identifying flow-limiting atherosclerotic lesions, coronary plaques, and significant obstructive coronary lesions.
- Can confirm or exclude the diagnosis of ischemia.
- Used for patients who are still experiencing ischemia despite medical treatment.
- Positron emission tomography (PET): Used for assessing myocardial perfusion.
- Intravenous pharmacologic challenge is used for patients who cannot exercise.
- Aims to create a "steal" by temporarily increasing flow in non-diseased coronary segments, at the expense of diseased segments.
- Uses dipyridamole or adenosine to identify myocardial ischemia.
- Transient perfusion defects with radionuclides like thallium or 99mTc can help detect myocardial ischemia.
- Cardiac magnetic resonance (CMR) stress testing: Evolving as an alternative to radionuclide, PET, or echocardiographic stress imaging.
- Performed with dobutamine infusion.
- Helps assess wall motion abnormalities associated with ischemia.
- Multislice MR imaging and myocardial perfusion CMR: Provide a more comprehensive ventricular evaluation.
- Coronary angiography: Invasive diagnostic method that shows narrowing of the coronary artery lumen.
- Helps assess the severity of obstruction in the coronary arteries.
- Can confirm or exclude the diagnosis of ischemia.
- Used for patients experiencing severe symptoms despite medical treatment.
- Used for patients with severe ischemia demonstrated in non-invasive tests.
- Used for high-risk patients, including those with left ventricular dysfunction.
- Stress ECG (treadmill test): Records the 12-lead ECG before, during, and after exercise.
Treatment for Stable CAD
- Goal of treatment:
- Slow down the progression of atherosclerosis.
- Decrease future events, including myocardial infarction.
- Decrease mortality.
- Treatments implemented:
- Medical therapy: includes non-pharmacological and lifestyle measures.
- Revascularization: includes percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG).
- Control of risk factors and associated disorders:
- Stop smoking.
- Manage hypertension, diabetes, anemia, infection, and chronic kidney disease.
- Lower LDL cholesterol.
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Description
This quiz covers the essential aspects of coronary circulation, focusing on the roles of the left and right coronary arteries. You'll learn about the branches of these arteries and their significance in supplying blood to the heart. Test your knowledge on the anatomy and function of coronary blood vessels.
