42 Questions
What is the typical duration of typical angina?
Minutes
According to Heberden, how did he describe the discomfort of angina pectoris?
A sense of strangling and anxiety
What symptoms are particularly common in the elderly with angina pectoris?
Syncope
How is angina pectoris typically precipitated?
Exercise
How is angina pectoris usually relieved?
Rest and nitroglycerin
What does severe ongoing ischemia indicate when angina pain is not relieved within 5-10 minutes?
Unstable angina or AMI
What is the most common cause of myocardial ischemia?
Coronary atherosclerotic narrowing
Which factor determines myocardial wall stress?
LV pressure
In which Canadian Cardiovascular Society Classification does angina occur with slight limitations of ordinary activity?
2
What can transient LV and papillary muscle dysfunction result from?
Angina attacks
What is a strong predictor of morbidity and mortality in patients with established CAD?
B-type natriuretic peptide
When does the ECG become abnormal in approximately 50% of patients with normal baseline ECG?
During exercise stress testing
What is the main purpose of 24-hour Holter monitoring in patients with chest pain and suspected arrhythmias?
To evaluate the total ischemic burden
What does echocardiography provide important information about in patients with CCS?
Cardiac anatomy and systolic cardiac function
When should stress testing not be used as a diagnostic procedure?
When the pretest probability of stable angina pectoris is 90%
What is the purpose of myocardial perfusion imaging?
To identify areas of reduced blood flow in the heart muscle
What is the purpose of magnetic resonance imaging in suspected CAD?
To provide useful information on cardiac anatomy and systolic cardiac function
What markers are included in biochemical tests for screening dyslipidemias and insulin resistance?
Fasting lipid profile, fasting glucose, lipoprotein Lp (a), small dense LDL, apolipoprotein B
Which antithrombotic drug may be considered for specific high-risk situations of stenting?
Ticagrelor
In patients with aspirin intolerance, what is the recommended alternative antithrombotic drug?
Clopidogrel
What is the mainstay medical therapy for variant (Prinzmetal’s) angina in the absence of significant atherosclerotic CAD?
Nitrates and Ca antagonists
What is the recommended duration of adding clopidogrel to aspirin following coronary stenting?
6 months
In what type of patients should statin treatment be considered, irrespective of LDLC levels?
Patients with established CAD
What is responsible for episodes of myocardial ischemia in Variant (Prinzmetal’s) Angina Pectoris?
Coronary vasospasm
What is associated with the development of vasospastic angina in Variant (Prinzmetal’s) Angina Pectoris?
Cocaine use
What should be avoided in the treatment of Variant (Prinzmetal’s) Angina Pectoris?
Exposure to cold environment
What is the general recommendation for patients with a high risk of ischaemic events and without high bleeding risk for long-term secondary prevention?
Adding a second antithrombotic drug to aspirin
What is the recommended antithrombotic drug following stenting, in addition to aspirin?
Clopidogrel 75 mg daily following appropriate loading
What should patients with stable angina and coexisting hypertension, heart failure, or diabetes be considered for?
ACE inhibitors treatment
What is not recommended in the treatment of chronic CAD according to the text?
Estrogenic Replacement therapy
Which type of diagnostic test is indicated for patients with stable angina who are clinically determined to be at high risk for future cardiac events?
Coronary Ct angiography
What is the primary effect of nitrates in the coronary circulation?
Dilation of epicardial stenosis
Which medication should be implemented with a 10 to 12 hour nitrate-free interval to prevent tolerance?
Isosorbide Dinitrate
Which class of medication enhances myocardial O2 supply and reduces myocardial O2 demand?
Calcium Channel Antagonists
What is the primary effect of ACE inhibitors in patients with CAD?
Enhance coronary endothelial vasomotor function
Which medication is recommended for immediate relief of angina?
Nitroglycerin Tablets
What is the mechanism of action of low-dose aspirin in preventing subsequent MI, stroke, and death?
Inhibits platelet cyclooxygenase-1
'Abrupt withdrawal of β-blockers can precipitate unstable angina and MI' - This statement is true because:
'B-blockers block the surges of sympathetic activity during exercise'
'Isosorbide 5-Mononitrate' should be administered once daily because:
'It does not undergo first-pass hepatic metabolism'
'Anatomical non-invasive evaluation, by visualizing the coronary artery lumen and wall using an intravenous contrast agent, can be performed with:' This statement is true for which diagnostic test?
'Coronary Ct angiography'
'TREATMENT ANGINA RELIEF: Nitroglicerine for immediate relief of angina' - This statement is true for:
'Nitroglycerin Tablets'
'Exercise: the conditioning effect of exercise lowers the heart rate and increases the cardiac output at any given level of myocardial O2 consumption.' This statement is related to which type of treatment?
'Nitrates'
Test your knowledge of myocardial perfusion imaging and coronary angiography, including indications for coronary angiography and anatomical non-invasive evaluation.
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