Order Interventional Coronary Physiology

Order Interventional Coronary Physiology
Order 5898344
Order Interventional Coronary Physiology
1 Myocardial oxygen demand is balanced by oxygen
supply. Which of the following is not involved in
increasing myocardial oxygen demand?
(A) Myocardial contractility
(B) R-R interval
(C) Left ventricular (LV) end diastolic dimension
(D) Diastolic relaxation
(E) Systolic pressure
Order Interventional Coronary Physiology
2 Coronary reserve is the ratio of maximal flow to
basal (resting) coronary blood flow. Which of the
following is most likely associated with a normal
increase in coronary flow reserve (CFR)?
(A) A 75-year-old man with left ventricular hypertrophy (LVH) and hypertension
(B) A 62-year-old woman with three-vessel coronary
artery disease (CAD)
(C) A 59-year-old man with 80% proximal left
anterior descending artery (LAD)
(D) A 39-year-old woman with insulin-dependant
diabetes mellitus since high school
(E) A 48-year-old man with 60% mid-LAD
3 Which of the following best states the rationale for
use of in-laboratory coronary physiology to assess
stenoses?
(A) The use of stress testing has a low specificity and
sensitivity
(B) The angiogram cannot provide enough information to determine flow for lesions 40% to
70% narrowed
(C) Chest pain syndromes are unreliable
(D) CAD is diffuse, obscuring the degree of atherosclerosis
(E) Intravascular ultrasound (IVUS) imaging shows
plaque distribution and flow limitations
4 Coronary flow velocity reserve using a Dopplertipped guidewire can measure coronary vascular
resistance (CVR) accurately. In addition to mean velocity, which of the following is required to measure
volumetric coronary flow?
(A) Peak instantaneous velocity
(B) Phasic systolic/diastolic flow ratio
(C) Mean vessel cross-sectional area
(D) Percent diameter narrowing
(E) Lesion length
5 CFR by Doppler is no longer used as a reliable indicator of lesion significance. Which of the following
explains this?
(A) Doppler was too difficult to use by the average
interventionalist
(B) The wire was too stiff
(C) An abnormal CVR did not necessarily mean that
the lesion was flow limiting
(D) The Doppler signal did not reflect volumetric
flow
(E) Pharmacologic hyperemia was unreliable compared to exercise
6 A 55-year-old man has atypical chest pain and
undergoes cardiac catheterization and coronary
angiography. His examination shows the following
angiogram of the LAD. What is the best way to
determine lesion significance?
185
186 900 Questions: An Interventional Cardiology Board Review
(A) Additional angiographic views with left anterior
oblique (LAO), steep cranial
(B) IVUS
(C) CFR
(D) Fractional flow reserve (FFR)
(E) Single photon emission computed tomography
(SPECT) myocardial perfusion imaging, next
day
7 After stenting a proximal LAD (see following figure)
in a 67-year-old woman with diabetes, the distal FFR
is still abnormal (FFR is 0.41). What is the best way
to assess the final result of stenting in this patient?
(A) IVUS
(B) CFR
(C) FFR during pullback
(D) SPECT scanning
(E) Relative coronary flow reserve (RCFR)
8 A 42-year-old man returns to your laboratory for
follow-up 3 years after cardiac transplantation. He
is asymptomatic. Routine angiography is normal.
The attending physician wants to evaluate his
microcirculatory responses to a new antirejection
drug. What is the best method to evaluate this agent?
(A) FFR
(B) RCFR
(C) CFR
(D) IVUS
(E) Magnetic resonance imaging (MRI)
9 A 60-year-old woman with diabetes mellitus has
atypical chest pain and an equivocal stress echocardiographic examination. She smokes one pack of
cigarettes per day. Her electrocardiogram (EKG) is
normal. Her weight is 285 pounds. She is 5 ft 2 in. tall.
On angiography, she has an intermediate stenosis as
shown below. Which is the best way to treat this
lesion?
(A) Rotablator
(B) Crush stenting
(C) Plain old balloon angioplasty
(D) Determine CFR for individual branches
(E) Determine FFR for individual branches
(F) Coronary artery bypass grafting (CABG)
10 You have performed both FFR and CFR on an
intermediate 60% diameter narrowing in the LAD in
Interventional Coronary Physiology 187
a patient with hyperlipidemia. CFR was 1.7 and FFR
was 0.88. What is the most likely explanation?
(A) The FFR overestimated lesion severity
(B) The FFR underestimated lesion severity
(C) There is an inadequate response to pharmacologic hyperemia
(D) There is an impairment of the microcirculation
(E) The lesion is physiologically significant
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