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A 40-year-old female airline pilot is seeing you for
recent-onset chest pain. Her symptoms arise in her
left inframammary region. They are reproducible
with physical exertion, but can be prolonged despite
rest. She inquires whether she should have a coronary
angiogram. Which of the following is the correct
answer?
(A) You reassure her that her symptoms are not
typical for angina pectoris
(B) A normal stress test would obviate the need for
a coronary angiogram
(C) You proceed directly to invasive coronary angiography
(D) You have her undergo a chest computerized
tomography (CT) coronary angiogram
2 A 74-year-old man with stable angina and diabetes
is found to have the findings shown on coronary
angiography (see following figures). Select the best
answer with regard to this patient:
(A) Coronary artery bypass grafting (CABG) is preferred over percutaneous coronary intervention
(PCI)
(B) An initial revascularization strategy of CABG or
balloon angioplasty results in similar survival
(C) The use of sirolimus-eluting stents has resulted
in similar long-term survival compared with
bypass grafting
(D) None of the above
3 A 55-year-old woman is referred to your office with
mild dyspnea. Six weeks ago, she had suffered a myocardial infarction and did not undergo reperfusion
therapy. Her referring physician had obtained a nuclear viability study and those images are shown in the
following figure. The study is interpreted as showing
a large area of nonviable myocardium involving the
anterior, apical, septal, and inferior regions. There
was also severe left ventricular and moderate right
ventricular enlargement. No myocardial ischemia is
278
Chronic Stable Angina: American College of Cardiology/ American Heart Association Guidelines 279
found. Her ejection fraction is calculated to be 22%.
Select the best management for this patient:
PET viability study
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Base
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VLA
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(A) Coronary angiography, followed by PCI of highgrade stenoses
(B) Coronary angiography, followed by bypass
grafting of high-grade stenoses
(C) Medical therapy only
(D) None of the above
4 A 69-year-old man is referred to you for coronary
angiography. He exercises frequently, and his symptoms of angina occur near the completion of his
regular 3-mile run. Before seeing you, the referring
physician has the patient undergo a treadmill study,
where he exercises for 7 minutes on the Bruce protocol with no electrocardiogram (EKG) evidence of
ischemia or precipitation of angina. The patient takes
no medications. His angiogram is shown in the following figure. Select the best management for this
patient:
(A) Initiation of a statin drug
(B) Referral to a cardiac surgeon
(C) PCI
(D) Stress echocardiography
5 A 60-year-old man with angina is referred to you.
His symptoms have been stable, but in the past
month they have begun to interfere with his job as
a construction worker. Apart from nicotine dependence, he has no other health problems. A recent
echocardiogram showed his ejection fraction to be
50%. His coronary angiogram is shown below. Select the false statement:
(A) Randomized trials have shown equivalent longterm survival with PCI versus CABG as the
initial strategy for these patients
(B) Data from trials of PCI versus CABG do not
apply to this case because those studies frequently enrolled much older, more severely
symptomatic patients with abnormal ventricular function
(C) Balloon angioplasty alone results in more repeat procedures, whose cumulative costs are
equivalent to those of an initial strategy of bypass grafting
(D) PCI is indicated
6 A 78-year-old man is referred after a treadmill
study. During exercise, his EKG became positive
for ischemia in conjunction with the onset of angina
soon after he had reached Stage 2 of the Bruce
protocol. His comorbidities include hyperlipidemia
and chronic obstructive pulmonary disease, which
has been stable with steroid inhalers. His coronary
angiogram is shown in the following figure. Which
of the following is correct?
280 900 Questions: An Interventional Cardiology Board Review
(A) PCI can be undertaken because the lesion does
not involve the distal left main or bifurcation
of the left anterior descending (LAD) and
circumflex arteries
(B) PCI can be performed if the minimal lumen
area measured by intravascular ultrasound is
<7.5 mm2
(C) PCI should not be performed
(D) PCI is indicated if a fractional flow reserve
measurement of the lesion is<0.75 or additional
noninvasive
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