Ischemic Heart Disease - Coronary Circulation Anatomy and Pathophysiology
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Questions and Answers

Which of the following is NOT a characteristic of patients who would have limited value in cardiac function assessment?

  • Stable cardiac function
  • Cardiac function is unstable
  • Cardiac function cannot be assessed (correct)
  • Able to be assessed clinically

Which of the following is NOT a component of the Revised Cardiac Risk Index as described in the text?

  • Insulin-dependent diabetes
  • Preoperative serum creatinine > 3.0 mg/dl (correct)
  • Ischemic heart disease
  • Congestive heart failure

According to the ACC/AHA guidelines mentioned in the text, which of the following is the recommended non-invasive cardiac testing method for patients who are unable to exercise?

  • Stress Echo
  • Stress ECG
  • Positron emission tomography
  • Dipyridamole-thallium scintigraphy (correct)

Which of the following is NOT mentioned in the text as a preoperative cardiac intervention option?

<p>Implantable cardioverter-defibrillator (ICD) placement (D)</p> Signup and view all the answers

Which of the following is the recommended timeframe for initiating statin therapy prior to surgery?

<p>At least 45 days preoperatively (D)</p> Signup and view all the answers

Which of the following is the recommended class of evidence for the use of calcium channel blockers in the perioperative period?

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

Which of the following statements about the coronary arterial system is correct?

<p>The left anterior descending artery supplies the anterior wall of the left ventricle and the anterior two-thirds of the interventricular septum. (A)</p> Signup and view all the answers

In the context of coronary circulation, what is meant by 'dominance'?

<p>The determination of which artery, the right coronary artery or the left circumflex, supplies the posterior descending coronary artery. (A)</p> Signup and view all the answers

Which of the following structures is typically supplied by the right coronary artery?

<p>The atrioventricular node (C)</p> Signup and view all the answers

What is the approximate ratio of myocardial capillary blood vessels to myofibrils in the coronary microcirculation?

<p>1:1 (C)</p> Signup and view all the answers

What is the primary function of the collateral circulation in the coronary arterial system?

<p>To supply oxygenated blood to the myocardium when the main coronary arteries are occluded. (D)</p> Signup and view all the answers

Which of the following statements accurately describes the coronary venous system?

<p>It is a complex network of veins that follow the same distribution pattern as the coronary arteries. (A)</p> Signup and view all the answers

Why is Atracurium associated with histamine release?

<p>It increases heart rate and blood pressure (C)</p> Signup and view all the answers

Which monitoring method is considered the gold standard for intraoperative diagnosis of ischemia?

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

What is a major disadvantage of using pulmonary artery occlusion pressure as a monitoring tool?

<p>Insensitive in the absence of global ischemia (C)</p> Signup and view all the answers

How should hypotension be managed during surgery in the presence of ischemia?

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

What are some specific concerns in the postoperative management of patients with increased potential for myocardial ischemia?

<p>Pain and inadequate ventilation (D)</p> Signup and view all the answers

Why may a transplanted heart show higher than normal resting heart rate and lack sympathetic response to laryngoscopy?

<p>Due to complete denervation (A)</p> Signup and view all the answers

Which of the following statements regarding preoperative evaluation of cardiac patients is correct?

<p>Asking the patient if they wake up at night short of breath or sleep flat on their back can provide valuable information. (C)</p> Signup and view all the answers

Which of the following statements regarding preoperative medication management is correct?

<p>Hypoglycemic agents and drugs affecting coagulation are typically continued throughout the perioperative period. (B)</p> Signup and view all the answers

Which of the following is an essential component of the preoperative physical exam for cardiac patients?

<p>All of the above are essential components of the preoperative physical exam for cardiac patients. (D)</p> Signup and view all the answers

Which of the following statements regarding preoperative testing for cardiac patients is correct?

<p>Preoperative testing is only indicated if the results will change the management of the patient. (B)</p> Signup and view all the answers

Which of the following statements regarding preoperative medication management for cardiac patients is incorrect?

<p>Hypoglycemic agents should be continued throughout the perioperative period to maintain blood sugar control. (C)</p> Signup and view all the answers

Which of the following findings during the preoperative physical exam would be of particular concern for a cardiac patient undergoing surgery?

<p>Presence of jugular venous distention (JVD). (C)</p> Signup and view all the answers

Which of the following is true regarding the coronary venous system?

<p>The great cardiac vein runs with the left anterior descending (LAD) artery. (D)</p> Signup and view all the answers

Which of the following factors does not directly affect left ventricular blood flow?

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

Which of the following statements accurately describes the effects of extravascular compression on coronary blood flow?

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

Which of the following factors does not further compromise subendocardial blood flow?

<p>Increased aortic diastolic pressure (D)</p> Signup and view all the answers

Which of the following is not a major determinant of myocardial oxygen consumption?

<p>Coronary perfusion pressure (A)</p> Signup and view all the answers

Which of the following statements about metabolic control of coronary blood flow is accurate?

<p>Potential mediators of vasodilation include adenosine, bradykinin, nitric oxide, carbon dioxide, and hydrogen ions. (A)</p> Signup and view all the answers

Which of the following statements about neural control of coronary blood flow is accurate?

<p>α-adrenergic receptors are more prevalent in the intramuscular arteries, while β-adrenergic receptors are more prevalent in the epicardial vessels. (A)</p> Signup and view all the answers

Which of the following statements about atherosclerosis is accurate?

<p>A vulnerable plaque is characterized by a high lipid content, thin fibrous cap, decreased number of smooth muscle cells, and increased macrophage activity. (D)</p> Signup and view all the answers

Which of the following statements about acute coronary syndromes is accurate?

<p>The extent of plaque rupture and duration of occlusion are more important than the degree of stenosis in determining the severity of acute coronary syndromes. (A)</p> Signup and view all the answers

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