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STABLE ISCHEMIC HEART DISEASE PRACTICE EXAM QUESTIONS AND ANSWERS
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STABLE ISCHEMIC HEART DISEASE PRACTICEEXAM QUESTIONS AND ANSWERS
1. A 56-year-old patient had coronary artery bypass graft (CABG) surgery
performed for refractory symptoms of angina despite maximally tolerated
medical therapy and multiple percutaneous coronary interventions. Which of the
following medications should be initiated following CABG surgery and
continued indefinitely to maintain the patency of the saphenous vein grafts?
Answer: Aspirin
The best answer is to initiate and continue aspirin indefinitely as it has been
shown to reduce the risk of SVG closure during the first year after CABG
surgery. While beta-blockers should also be initiated after surgery, they do not
impact graft patency. The data supporting the routine use of ACE inhibitors is
less clear following CABG surgery. While sublingual nitroglycerin may be
useful to relieve angina, it will not affect graft patency.
2. Which of the following best explains why ischemia does not typically occur
with exertion in patients with stable ischemic heart disease until coronary
stenosis reaches 70% or more of the luminal diameter?
Answer: Coronary flow reserve is exhausted as the degree of coronary stenosis
increases
When coronary atherosclerotic plaques exceed a critical threshold, typically
approximately 70% blockage, coronary reserve is used at rest to vasodilate the
obstructed coronary artery and maintain coronary blood flow. As a result, the
ability to adapt to increases in oxygen demand is diminished because coronary
flow reserve is exhausted, leading to ischemia. Thus, C is the best answer.
Which of the following patients with stable ischemic heart disease is more
likely to experience atypical symptoms of angina?
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