Vascular Disease History and Symptoms
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Questions and Answers

What is the characteristic feature of atherosclerosis in medium and large-sized arteries?

  • Diminished oxygen supply to target organs
  • Endothelial dysfunction
  • Buildup of lipids and cholesterol (correct)
  • Vascular inflammation

    • Which theory of atherogenesis is most widely accepted?

  • Oxidative stress theory
  • Inflammatory theory
  • Response-to-injury theory (correct)
  • Infectious theory

    • What are the probable causes of endothelial injury in atherosclerosis?

  • Oxidized low-density lipoprotein (LDL) cholesterol
  • Toxins from cigarette smoking
  • Infectious agents (correct)
  • Hyperglycemia

    • Which molecules are exhibited by endothelial cells in response to dysfunction, similar to those seen in acute inflammation?

    <p>ICAM-1 and E-selectin</p> Signup and view all the answers

    What do tissue macrophages act as in the intima of the vessel wall in atherosclerosis?

    <p>Scavenger cells, taking up LDL cholesterol</p> Signup and view all the answers

    What is the consequence of endothelial injury in atherosclerosis?

    <p>Vascular inflammation</p> Signup and view all the answers

    Which risk factor is associated with the development of atherosclerosis, atherosclerotic cardiovascular disease, and stroke?

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

    What is associated with a decreased incidence of stroke and, to a lesser degree, atherosclerotic cardiovascular disease?

    <p>Dietary and pharmacological treatment of hypertension</p> Signup and view all the answers

    What is the most common adverse effect of HMG-CoA reductase inhibitors?

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

    What has yielded important reductions in coronary heart disease events in patients with diabetes mellitus?

    <p>Cholesterol lowering with HMG-CoA reductase inhibitors</p> Signup and view all the answers

    What has been difficult to confirm in the prevention of macrovascular disease for patients with diabetes mellitus?

    <p>Strict glycemic control</p> Signup and view all the answers

    What is associated with a reduced incidence of coronary heart disease when consumed at 20 g/day or less in men?

    <p>Moderate alcohol intake</p> Signup and view all the answers

    What is associated with increases in total mortality, cancer mortality, and cardiovascular disease mortality?

    <p>High intakes of red or processed meat</p> Signup and view all the answers

    What does convincing evidence exist that lowers the risk of subsequent coronary heart disease events and overall mortality?

    <p>Lowering serum cholesterol and treating dyslipidemia</p> Signup and view all the answers

    What is the risk factor for the development of atherosclerosis, atherosclerotic cardiovascular disease, and stroke?

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

    What is the result of the focal accumulation of serum lipoproteins within the intima of the vessel wall?

    <p>Formation of a fibrous plaque</p> Signup and view all the answers

    What is the consequence of progressive luminal narrowing, vascular remodeling, and compromised oxygen supply to the target organ?

    <p>Stable angina pectoris</p> Signup and view all the answers

    What leads to the formation of a stable atherosclerotic plaque?

    <p>Proliferation of smooth muscle layer</p> Signup and view all the answers

    What may result in exposure of the thrombogenic contents of the core of the plaque to the circulating blood?

    <p>Rupture of the fibrous cap</p> Signup and view all the answers

    What is characteristic of stable plaques?

    <p>Thick fibrous cap with calcification</p> Signup and view all the answers

    What is the leading cause of death in the developed world?

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

    What consequence may result from inflammation dominating over repair mechanisms of smooth muscle cells?

    <p>Thrombus formation</p> Signup and view all the answers

    What may occur due to organization of thrombus and incorporation within the plaque after a plaque rupture?

    <p>'Complicated' lesion formation</p> Signup and view all the answers

    What is characteristic of vulnerable plaques?

    <p>'Lipid-rich' core and a thin fibrous cap</p> Signup and view all the answers

    What plays an important role in the predisposition to plaque rupture?

    <p>'Inflammation'</p> Signup and view all the answers

    What age do most cases of atherosclerotic vascular disease become clinically apparent?

    <p>40 and older</p> Signup and view all the answers

    What is true about the symptoms of mild atherosclerosis?

    <p>Patients may present with clinically important symptoms and signs of disease and myocardial infarction</p> Signup and view all the answers

    Which of the following is a common manifestation of peripheral vascular disease?

    <p>Intermittent claudication</p> Signup and view all the answers

    What is a characteristic symptom of mesenteric angina?

    <p>Epigastric pain</p> Signup and view all the answers

    What is a common symptom of abdominal aortic aneurysm?

    <p>Pulsatile abdominal mass</p> Signup and view all the answers

    Which condition may present with symptoms of digital necrosis and myocardial infarction?

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

    What is a risk factor for the development of atherosclerosis and stroke?

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

    Which parameter reflects systemic inflammation and adds to the predictive value of lipid parameters in determining the risk of first myocardial infarction?

    <p>HsC-reactive protein</p> Signup and view all the answers

    What is associated with high triglycerides and low high-density lipoprotein (HDL) cholesterol, and is a risk factor for vascular disease?

    <p>Atherogenic dyslipidemia</p> Signup and view all the answers

    What imaging technique is used to visualize arterial and venous vessels throughout the body, including the coronary arteries?

    <p>Coronary angiography</p> Signup and view all the answers

    What imaging study can provide images of the thickness and acoustic density of the vessel wall?

    <p>Intravascular ultrasound</p> Signup and view all the answers

    What are the typical characteristics of angina pectoris?

    <p>Crescendo increase in intensity of pain and relief by rest and nitroglycerin</p> Signup and view all the answers

    What is the definition of INOCA (ischaemia and no obstructive coronary artery disease)?

    <p>Ischaemia without obstructive coronary artery disease</p> Signup and view all the answers

    What is the clinical manifestation of acute myocardial ischemia?

    <p>Sense of strangling, anxiety</p> Signup and view all the answers

    What is the consequence of pain not being relieved within 5-10 minutes after rest or nitroglycerin?

    <p>Unstable angina or AMI</p> Signup and view all the answers

    What are the associated symptoms of angina pectoris?

    <p>Dyspnea, fatigue</p> Signup and view all the answers

    What is the typical duration of typical angina?

    <p>Pain lasting for a few minutes</p> Signup and view all the answers

    Which type of patient is coronary angiography indicated for?

    <p>Patients with stable angina and low ejection fraction</p> Signup and view all the answers

    What is the treatment of choice for acute angina episodes?

    <p>Sublingual nitroglycerin</p> Signup and view all the answers

    What is the active metabolite of isosorbide dinitrate?

    <p>Isosorbide 5-mononitrate</p> Signup and view all the answers

    What effect do beta-blockers have on myocardial oxygen demand?

    <p>Decrease oxygen demand</p> Signup and view all the answers

    Which medication can prevent angina for up to 40 minutes when taken prophylactically prior to physical activities?

    <p>Sublingual nitroglycerin</p> Signup and view all the answers

    What is the primary driver for symptomatic coronary thrombosis?

    <p>Platelet activation and aggregation</p> Signup and view all the answers

    How do ACE inhibitors act in patients with CAD and impaired LV function?

    <p>Enhance coronary endothelial vasomotor function</p> Signup and view all the answers

    Which medication acts via irreversible inhibition of platelet cyclooxygenase-1?

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

    Which subclass of calcium channel antagonists is very useful in the treatment of vasospastic angina?

    <p>Dihydropyridines (e.g., nifedipine)</p> Signup and view all the answers

    Which medication block the platelet P2Y12 receptor?

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

    What do nitrates induce in the coronary circulation?

    <p>Endothelium-independent vasodilatation</p> Signup and view all the answers

    Which medication is recommended for all patients with CAD in conjunction with diabetes and/or impaired LV function?

    <p>ACE inhibitors</p> Signup and view all the answers

    What is the recommended alternative to aspirin for patients with aspirin intolerance or a history of ischaemic stroke?

    <p>Clopidogrel 75 mg daily</p> Signup and view all the answers

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

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

    What is regarded as being at very high risk for cardiovascular events and statin treatment must be considered, irrespective of LDLC levels?

    <p>Patients with established CAD</p> Signup and view all the answers

    For which patients should ACE inhibitors be considered for treatment?

    <p>Patients with stable angina with coexisting hypertension, heart failure, diabetes</p> Signup and view all the answers

    What condition is associated with episodes of myocardial ischemia that last several minutes, often occur at rest, and are frequently worse in the morning?

    <p>Variant (Prinzmetal’s) Angina Pectoris</p> Signup and view all the answers

    What can provoke vasospasm by iv ergonovine during cardiac catheterization?

    <p>Atherosclerotic CAD</p> Signup and view all the answers

    In the absence of significant atherosclerotic CAD, what are the mainstay of medical therapy for variant angina?

    <p>Nitrates and Ca antagonists</p> Signup and view all the answers

    What should be avoided to prevent exacerbation of variant angina if unopposed alphareceptor-mediated vasoconstriction occurs?

    <p>Beta blockers</p> Signup and view all the answers

    What is the most common cause of myocardial ischemia?

    <p>Coronary atherosclerotic narrowing</p> Signup and view all the answers

    Which factor is significant in determining myocardial oxygen demand?

    <p>Myocardial wall stress</p> Signup and view all the answers

    What is the characteristic feature of Stable Angina Pectoris?

    <p>No change in the frequency of angina attacks during the last 60 days</p> Signup and view all the answers

    What is an important predictor of morbidity and mortality in patients with established CAD?

    <p>High-sensitive C-reactive protein (CRP)</p> Signup and view all the answers

    Which diagnostic test is helpful in evaluating the total ischemic burden and is recommended for patients with chest pain and suspected arrhythmias?

    <p>Holter ECG monitoring</p> Signup and view all the answers

    Which procedure can identify areas of reduced blood flow in the heart muscle and is often combined with stress for diagnostic purposes?

    <p>Myocardial perfusion imaging</p> Signup and view all the answers

    When should exercise stress testing be avoided as a diagnostic procedure for stable angina pectoris?

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

    Which type of diagnostic test has inferior diagnostic performance compared with imaging tests and has limited power to rule-in or rule-out obstructive CAD?

    <p>Exercise ECG</p> Signup and view all the answers

    What is important in assessing LV wall motion abnormalities and systolic function during stress testing?

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

    Which imaging technique may be considered when echocardiography is inconclusive for patients with suspected CAD?

    <p>Magnetic resonance imaging</p> Signup and view all the answers

    What role does B-type natriuretic peptide (BNP) play in patients with established CAD?

    <p>It suggests LV failure and predicts morbidity and mortality</p> Signup and view all the answers

    Which marker can be used to prognosticate patients with established CAD?

    <p>High-sensitive C-reactive protein (CRP)</p> Signup and view all the answers

    Which term refers to myocardial infarction with no obstructive coronary artery disease?

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

    What is the characteristic duration of typical angina?

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

    Which imaging technique may be considered when echocardiography is inconclusive for patients with suspected CAD?

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

    What is the typical symptom associated with angina pectoris?

    <p>Chest pain</p> Signup and view all the answers

    What are Heberden's descriptions of angina pectoris?

    <p>Sense of strangling and anxiety</p> Signup and view all the answers

    What is the result of progressive luminal narrowing, vascular remodeling, and compromised oxygen supply to the target organ?

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

    What is the most common cause of myocardial ischemia?

    <p>Coronary atherosclerotic narrowing</p> Signup and view all the answers

    What is the characteristic feature of stable angina pectoris?

    <p>No change in the frequency, duration, precipitating factors or ease of relief of angina attacks during the last 60 days</p> Signup and view all the answers

    Which test is helpful in evaluating the total ischemic burden and recommended for patients with chest pain and suspected arrhythmias?

    <p>Holter ECG monitoring</p> Signup and view all the answers

    Which diagnostic test has inferior diagnostic performance compared with imaging tests and limited power to rule-in or rule-out obstructive CAD?

    <p>Exercise stress testing (treadmill protocol)</p> Signup and view all the answers

    What is important in assessing LV wall motion abnormalities and systolic function during stress testing?

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

    What biochemical test can be used to prognosticate patients with established CAD?

    <p>B-type natriuretic peptide (BNP)</p> Signup and view all the answers

    What factor reflects systemic inflammation and adds to the predictive value of lipid parameters in determining the risk of first myocardial infarction?

    <p>High-sensitive C-reactive protein (CRP)</p> Signup and view all the answers

    What is usually normal during an angina episode, but becomes abnormal in about 50% of patients with normal baseline ECG?

    <p>Resting ECG</p> Signup and view all the answers

    What imaging study will provide important information about cardiac function and anatomy?

    <p>Magnetic resonance imaging (CMR)</p> Signup and view all the answers

    Which test is not needed, and should not be used as a diagnostic procedure, when the pretest probability of stable angina pectoris is 90%?

    <p>Exercise stress testing (treadmill protocol)</p> Signup and view all the answers

    What marker suggests LV failure and is a strong predictor of morbidity and mortality in patients with established CAD?

    <p>B-type natriuretic peptide (BNP)</p> Signup and view all the answers

    Which medication is considered the treatment of choice for acute angina episodes?

    <p>Nitroglycerin Tablets</p> Signup and view all the answers

    What is the active metabolite of Isosorbide Dinitrate?

    <p>Isosorbide 5-Mononitrate</p> Signup and view all the answers

    Which medication prolongs exercise duration and offers sustained antianginal effects for 12 hours without significant nitrate tolerance or rebound phenomena?

    <p>Nitroglycerin Transdermal Patches</p> Signup and view all the answers

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

    <p>Dilation of epicardial stenosis</p> Signup and view all the answers

    Which medication has the potential to worsen heart failure in patients with left ventricular dysfunction?

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

    What is the effect of beta-blockers on myocardial oxygen demand?

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

    Which medication reduces mortality and re-infarction in post-myocardial infarction patients?

    <p>Beta-blockers</p> Signup and view all the answers

    What is the recommended treatment for all patients with coronary artery disease in conjunction with diabetes and/or impaired left ventricular function?

    <p>ACE Inhibitors</p> Signup and view all the answers

    Which medication block the platelet P2Y12 receptor?

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

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

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

    What is the recommended alternative to aspirin for patients with aspirin intolerance or a history of ischaemic stroke?

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

    What medication is recommended following appropriate loading, in addition to aspirin, for 6 months following coronary stenting?

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

    Which drug does not require metabolic activation?

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

    Which drug should be considered for patients with a high risk of ischaemic events and without high bleeding risk?

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

    What is the mainstay of medical therapy in the absence of significant atherosclerotic CAD?

    <p>Nitrates and Ca antagonists</p> Signup and view all the answers

    For which condition should ACE inhibitors be considered for treatment?

    <p>Stable angina with coexisting hypertension</p> Signup and view all the answers

    Which type of patients are regarded as being at very high risk for cardiovascular events and must be considered for statin treatment, irrespective of LDLC levels?

    <p>(Stable) Angina Pectoris patients</p> Signup and view all the answers

    (Variant) Angina Pectoris may occur due to exposure to which substances that promote vasoconstriction?

    <p>(Alpha-agonists)</p> Signup and view all the answers

    What is the typical duration of typical angina?

    <p>Relieved within minutes by rest and nitroglycerin</p> Signup and view all the answers

    What is the characteristic feature of stable angina pectoris?

    <p>Pain increasing with exercise, cold, or carbohydrate-rich meals</p> Signup and view all the answers

    What is the most common cause of myocardial ischemia?

    <p>Coronary artery disease</p> Signup and view all the answers

    What is regarded as being at very high risk for cardiovascular events and must be considered for statin treatment, irrespective of LDLC levels?

    <p>Patients with established CAD</p> Signup and view all the answers

    What is the risk factor for the development of atherosclerosis, atherosclerotic cardiovascular disease, and stroke?

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

    What role does B-type natriuretic peptide (BNP) play in patients with established CAD?

    <p>It predicts morbidity and mortality</p> Signup and view all the answers

    What is the most common cause of myocardial ischemia?

    <p>Coronary atherosclerotic narrowing</p> Signup and view all the answers

    In the context of myocardial ischemia, what factors affect myocardial oxygen demand?

    <p>Heart rate, myocardial contractility, myocardial wall stress</p> Signup and view all the answers

    What is the characteristic feature of Stable Angina Pectoris?

    <p>Slight limitations of ordinary activity</p> Signup and view all the answers

    Which diagnostic test has limited power to rule-in or rule-out obstructive CAD?

    <p>Resting ECG</p> Signup and view all the answers

    What is the result of the focal accumulation of serum lipoproteins within the intima of the vessel wall?

    <p>Atherosclerotic plaque</p> Signup and view all the answers

    What diagnostic test is recommended for patients with chest pain and suspected arrhythmias?

    <p>24-h Holter monitoring</p> Signup and view all the answers

    Which medication is recommended following appropriate loading, in addition to aspirin, for 6 months following coronary stenting?

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

    What is the mainstay of medical therapy in the absence of significant atherosclerotic CAD?

    <p>Beta-blockers</p> Signup and view all the answers

    What are the probable causes of endothelial injury in atherosclerosis?

    <p>Lipoprotein Lp(a) and small dense LDL</p> Signup and view all the answers

    What medication block the platelet P2Y12 receptor?

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

    What is an important predictor of morbidity and mortality in patients with established CAD?

    <p>High-sensitivity C-reactive protein (CRP)</p> Signup and view all the answers

    For which condition should ACE inhibitors be considered for treatment?

    <p>Acute myocardial infarction</p> Signup and view all the answers

    Which diagnostic test is indicated for patients with stable angina who are clinically determined to be at high risk for future cardiac events?

    <p>Coronary angiography</p> Signup and view all the answers

    Which medication remains the treatment of choice for acute angina episodes?

    <p>Nitroglycerin tablets</p> Signup and view all the answers

    What is the active metabolite of isosorbide dinitrate?

    <p>Isosorbide mononitrate</p> Signup and view all the answers

    Which subclass of calcium channel antagonists is very useful in the treatment of vasospastic angina?

    <p>Dihydropyridines (e.g., nifedipine)</p> Signup and view all the answers

    Which drug requires a dosage schedule including a nitrate-free interval to prevent tolerance?

    <p>Isosorbide dinitrate</p> Signup and view all the answers

    What is the mainstay of medical therapy in the absence of significant atherosclerotic CAD?

    <p>Beta-blockers</p> Signup and view all the answers

    What medication can prevent angina for up to 40 minutes when taken prophylactically prior to physical activities?

    <p>Nitroglycerin tablets</p> Signup and view all the answers

    Which medication can prolong exercise duration and offer sustained antianginal effects for 12 hours without significant nitrate tolerance or rebound phenomena?

    <p>Nitroglycerin transdermal patches</p> Signup and view all the answers

    Which drug may worsen heart failure in patients with left ventricular dysfunction?

    <p>Calcium channel antagonists</p> Signup and view all the answers

    What is the driver for symptomatic coronary thrombosis, forming the basis for the use of antiplatelet drugs?

    <p>Platelet activation and aggregation</p> Signup and view all the answers

    What is the definition of INOCA (ischaemia and no obstructive coronary artery disease)?

    <p>Ischaemia with normal coronary arteries on angiography or non-obstructive coronary artery disease with luminal irregularities &lt;50%</p> Signup and view all the answers

    What are Heberden's descriptions of angina pectoris?

    <p>Pain that occurs during physical activity and resolves with rest</p> Signup and view all the answers

    What is the mainstay of medical therapy for variant angina in the absence of significant atherosclerotic coronary artery disease?

    <p>Nitrates and calcium antagonists</p> Signup and view all the answers

    What is the recommended antithrombotic drug following appropriate loading, in addition to aspirin, for 6 months following coronary stenting?

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

    Which medication is recommended as an alternative to aspirin in patients with aspirin intolerance and may be considered in preference to aspirin in peripheral artery disease or a history of ischemic stroke?

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

    In what specific high-risk situations of stenting may Prasugrel or Ticagrelor be considered?

    <p>Associated with high risk of stent thrombosis, complex left main lesion, or multivessel stenting</p> Signup and view all the answers

    For long-term secondary prevention in patients with a high risk of ischemic events and without high bleeding risk, adding a second antithrombotic drug to aspirin is recommended. Which antithrombotic drug combination is recommended?

    <p>Aspirin and Clopidogrel</p> Signup and view all the answers

    Which class of drugs should be managed with pharmacological and lifestyle intervention for patients with dyslipidemia?

    <p>Lipid-lowering drugs</p> Signup and view all the answers

    What is the recommendation for statin treatment in patients with established coronary artery disease (CAD)?

    <p>Must be considered, irrespective of low-density lipoprotein cholesterol (LDLC) levels</p> Signup and view all the answers

    When should ACE inhibitors be considered for the treatment of patients with stable angina?

    <p>With coexisting hypertension and heart failure</p> Signup and view all the answers

    What treatment is no longer recommended in the treatment of chronic CAD as per the text?

    <p>(Variant) Angina Pectoris treatment</p> Signup and view all the answers

    What medication does not require metabolic activation for its action?

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

    What characteristic feature is associated with episodes of myocardial ischemia in Variant (Prinzmetal’s) Angina Pectoris?

    <p>Lasting several minutes, occurring at rest, frequently worse in the morning, associated with transient ST-segment elevation</p> Signup and view all the answers

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