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

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

    <p>The atrioventricular node</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</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.</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.</p> Signup and view all the answers

    Why is Atracurium associated with histamine release?

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

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

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

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

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

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

    <p>Myocardial contractility</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.</p> Signup and view all the answers

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

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

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

    <p>Coronary perfusion pressure</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.</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.</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.</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.</p> Signup and view all the answers

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