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Chapter 21: Acquired Heart Disease

The bypass conduit with the highest patency rate is the

A. Radial artery

B. Internal thoracic artery

C. Greater saphenous vein

D. Radial artery

Answer: B

The most important criterion in conduit selection is graft patency. The conduit with the highest patency rate (98% at 5 years and 85–90% at 10 years) is the internal thoracic artery which is most commonly left attached proximally to the subclavian artery (although occasionally used as a free graft) and anastomosed distally to the target coronary artery. The use of both internal thoracic arteries has been shown to increase event-free survival in a number of studies. (See Schwartz 10th ed., pp. 743–744.)

Which of the following is true about angina pectoris?

A. Angina is typically substernal and may radiate to the left upper extremity.

B. “Typical” angina occurs in approximately 50% of patients with coronary disease.

C. “Atypical” angina occurs more commonly in men.

D. Angina is a typical symptom for mitral stenosis.

Answer: A

Angina pectoris is the pain or discomfort caused by myocardial ischemia and is typically substernal and may radiate to the left upper extremity, left neck, or epigastrium. The variety of presentations can make myocardial ischemia difficult to diagnose. Characteristics of chest pain that make myocardial ischemia less likely include: pleuritic chest pain, pain reproducible by movement or palpation, or brief episodes lasting only seconds. Typical angina is relieved by rest and/or use of sublingual nitroglycerin. Differential diagnoses to be considered include, but are not limited to, musculoskeletal pain, pulmonary disorders, esophageal spasm, pericarditis, aortic dissection, gastroesophageal reflux, neuropathic pain, and anxiety. (See Schwartz 10th ed., p. 742.)

A holosystolic murmer that is accompanied by a ventricular septal defect is associated with the following etiology

A. Ventricular filling that follows atrial contraction

B. Crescendo-decrescendo; occur as blood is ejected into the left and right ventricular outflow tracts.

C. Flow between chambers that have widely different pressures throughout systole.

D. A relative disproportion between valve orifice size and diastolic blood flow volume.

Answer: C

See Table 21-1. (See Schwartz 10th ed., Table 21-7, p. 748.)

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