Myocardial Perfusion Imaging and Coronary Angiography Quiz

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Questions and Answers

What is the typical duration of typical angina?

Minutes (correct)

Hours

Seconds

Days

According to Heberden, how did he describe the discomfort of angina pectoris?

A feeling of happiness and satisfaction

A peaceful sensation in the chest

A pleasant and agreeable sensation in the chest

A sense of strangling and anxiety (correct)

What symptoms are particularly common in the elderly with angina pectoris?

Syncope (correct)

Nausea

Headache

Fever

How is angina pectoris typically precipitated?

Exercise Signup and view all the answers

How is angina pectoris usually relieved?

Rest and nitroglycerin Signup and view all the answers

What does severe ongoing ischemia indicate when angina pain is not relieved within 5-10 minutes?

Unstable angina or AMI Signup and view all the answers

What is the most common cause of myocardial ischemia?

Coronary atherosclerotic narrowing Signup and view all the answers

Which factor determines myocardial wall stress?

LV pressure Signup and view all the answers

In which Canadian Cardiovascular Society Classification does angina occur with slight limitations of ordinary activity?

2 Signup and view all the answers

What can transient LV and papillary muscle dysfunction result from?

Angina attacks Signup and view all the answers

What is a strong predictor of morbidity and mortality in patients with established CAD?

B-type natriuretic peptide Signup and view all the answers

When does the ECG become abnormal in approximately 50% of patients with normal baseline ECG?

During exercise stress testing Signup and view all the answers

What is the main purpose of 24-hour Holter monitoring in patients with chest pain and suspected arrhythmias?

To evaluate the total ischemic burden Signup and view all the answers

What does echocardiography provide important information about in patients with CCS?

Cardiac anatomy and systolic cardiac function Signup and view all the answers

When should stress testing not be used as a diagnostic procedure?

When the pretest probability of stable angina pectoris is 90% Signup and view all the answers

What is the purpose of myocardial perfusion imaging?

To identify areas of reduced blood flow in the heart muscle Signup and view all the answers

What is the purpose of magnetic resonance imaging in suspected CAD?

To provide useful information on cardiac anatomy and systolic cardiac function Signup and view all the answers

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 Signup and view all the answers

Which antithrombotic drug may be considered for specific high-risk situations of stenting?

Ticagrelor Signup and view all the answers

In patients with aspirin intolerance, what is the recommended alternative antithrombotic drug?

Clopidogrel Signup and view all the answers

What is the mainstay medical therapy for variant (Prinzmetal’s) angina in the absence of significant atherosclerotic CAD?

Nitrates and Ca antagonists Signup and view all the answers

What is the recommended duration of adding clopidogrel to aspirin following coronary stenting?

6 months Signup and view all the answers

In what type of patients should statin treatment be considered, irrespective of LDLC levels?

Patients with established CAD Signup and view all the answers

What is responsible for episodes of myocardial ischemia in Variant (Prinzmetal’s) Angina Pectoris?

Coronary vasospasm Signup and view all the answers

What is associated with the development of vasospastic angina in Variant (Prinzmetal’s) Angina Pectoris?

Cocaine use Signup and view all the answers

What should be avoided in the treatment of Variant (Prinzmetal’s) Angina Pectoris?

Exposure to cold environment Signup and view all the answers

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 Signup and view all the answers

What is the recommended antithrombotic drug following stenting, in addition to aspirin?

Clopidogrel 75 mg daily following appropriate loading Signup and view all the answers

What should patients with stable angina and coexisting hypertension, heart failure, or diabetes be considered for?

ACE inhibitors treatment Signup and view all the answers

What is not recommended in the treatment of chronic CAD according to the text?

Estrogenic Replacement therapy Signup and view all the answers

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 Signup and view all the answers

What is the primary effect of nitrates in the coronary circulation?

Dilation of epicardial stenosis Signup and view all the answers

Which medication should be implemented with a 10 to 12 hour nitrate-free interval to prevent tolerance?

Isosorbide Dinitrate Signup and view all the answers

Which class of medication enhances myocardial O2 supply and reduces myocardial O2 demand?

Calcium Channel Antagonists Signup and view all the answers

What is the primary effect of ACE inhibitors in patients with CAD?

Enhance coronary endothelial vasomotor function Signup and view all the answers

Which medication is recommended for immediate relief of angina?

Nitroglycerin Tablets Signup and view all the answers

What is the mechanism of action of low-dose aspirin in preventing subsequent MI, stroke, and death?

Inhibits platelet cyclooxygenase-1 Signup and view all the answers

'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' Signup and view all the answers

'Isosorbide 5-Mononitrate' should be administered once daily because:

'It does not undergo first-pass hepatic metabolism' Signup and view all the answers

'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' Signup and view all the answers

'TREATMENT ANGINA RELIEF: Nitroglicerine for immediate relief of angina' - This statement is true for:

'Nitroglycerin Tablets' Signup and view all the answers

'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' Signup and view all the answers

Study Notes

Angina Pectoris Overview

Typical duration of angina ranges from a few minutes to 15-20 minutes.
Heberden described discomfort in angina pectoris as a "sensation of pressure, fullness, or tightness in the chest."
Common symptoms in the elderly with angina include fatigue, dyspnea, and atypical pain presentations.

Precipitation and Relief of Angina

Angina is typically precipitated by physical exertion, emotional stress, or heavy meals.
Relief of angina usually occurs with rest or the use of nitroglycerin within minutes.
Severe ongoing ischemia indicates a possibility of myocardial infarction if angina pain is not relieved within 5-10 minutes.

Causes and Risk Factors

The most common cause of myocardial ischemia is coronary artery disease (CAD).
Myocardial wall stress is determined by factors including left ventricular pressure and chamber dimensions.

Classification and Dysfunction

In the Canadian Cardiovascular Society Classification, angina occurs with "slight limitations of ordinary activity" at Class II.
Transient left ventricular (LV) and papillary muscle dysfunction can result from ischemia.

Cardiovascular Risk

The presence of coronary artery disease (CAD) is a strong predictor of morbidity and mortality.
Abnormal ECG may occur in approximately 50% of patients with normal baseline ECG during stress testing.

Diagnostic Tools

The primary purpose of 24-hour Holter monitoring is to assess heart rhythms in patients with suspected arrhythmias.
Echocardiography provides vital information about cardiac structure and function in patients with chronic coronary syndrome (CCS).
Stress testing should not be used in patients with unstable angina or severe aortic stenosis.

Imaging and Perfusion

Myocardial perfusion imaging assesses blood flow to heart muscles under stress and resting conditions.
Magnetic resonance imaging (MRI) is employed to evaluate suspected coronary artery disease (CAD) by visualizing heart structures.

Biochemical Markers and Antithrombotic Therapy

Biochemical tests for dyslipidemias typically include total cholesterol, low-density lipoprotein (LDL), and triglycerides.
In specific high-risk situations, clopidogrel may be considered as an antithrombotic after stenting.
For patients with aspirin intolerance, clopidogrel is the recommended alternative antithrombotic drug.

Variant Angina Management

The mainstay medical therapy for variant (Prinzmetal’s) angina, in the absence of significant atherosclerosis, includes calcium channel blockers.
Clopidogrel is recommended for a duration of at least 12 months following coronary stenting.
Statin treatment should be considered for all patients with established CAD, regardless of LDL-C levels.

Ischemia and Prevention

Episodes of myocardial ischemia in Variant Angina Pectoris are responsible for transient vasospasm.
Vasospastic angina development is often associated with stress and exposure to cold.
In treating Variant Angina Pectoris, avoiding beta-adrenergic agonists is crucial.

Long-term Management Strategies

Patients at high risk of ischemic events but without high bleeding risk should have long-term secondary prevention measures.
Post-stenting, dual antithrombotic therapy including aspirin and clopidogrel is standard practice.
For patients with stable angina and coexisting conditions like hypertension or heart failure, evaluation for revascularization might be necessary.

Recommendations Against Treatment

Certain treatments, such as routine use of antiarrhythmics or antianginal medications without clear indications, are not recommended in chronic CAD management.

Diagnostic Testing

High-risk patients with stable angina should undergo non-invasive imaging stress tests for better risk stratification.
Nitrates primarily dilate coronary blood vessels, improving blood supply to the heart muscle.

Medication Use

A 10 to 12-hour nitrate-free interval is necessary to prevent tolerance to nitrates.
Beta-blockers function to enhance myocardial oxygen supply while reducing demand, effectively managing angina.
ACE inhibitors benefit patients with CAD by reducing afterload and improving cardiovascular outcomes.

Emergency Responses

Nitroglycerin is the first-line medication for immediate relief of angina symptoms.
Low-dose aspirin works by inhibiting platelet aggregation, reducing the risk of myocardial infarction and stroke.

Special Considerations

Abrupt withdrawal of beta-blockers can precipitate unstable angina due to rebound tachycardia and increased myocardial oxygen demand.
Isosorbide 5-Mononitrate should be given once daily to maintain stable therapeutic levels without leading to tolerance.
Non-invasive anatomical evaluations can be performed using computed tomography (CT) or coronary angiography to visualize coronary arteries.

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Test your knowledge of myocardial perfusion imaging and coronary angiography, including indications for coronary angiography and anatomical non-invasive evaluation.