Chapter 43: The Evaluation and Management of Stable Ischemic Heart Disease

Chapter 43: The Evaluation and Management of Stable Ischemic Heart Disease

A 65-year-old man with a history of obstructive coronary artery disease (CAD) is evaluated in your clinic. He complains that he develops chest pain walking approximately one city block and climbing one flight of stairs. Which of the following Canadian Cardiovascular Society (CCS) angina classes best describes the patient’s symptoms?

A. CCS I

B. CCS II

C. CCS III

D. CCS IV

E. None of the above are correct

The answer is C. (Hurst’s The Heart, 14th Edition, Chap. 43) Canadian Cardiovascular Society (CCS) angina classification is described in Table 43-1. This patient’s symptoms are most consistent with class III (option C).

All of the following are criteria for defining vulnerable plaque except:

A. Active inflammation (eg, monocyte, macrophage, ± T-cell infiltration)

B. Thin cap with large lipid core

C. Endothelial denudation with superficial platelet aggregation

D. Fissured plaque

E. Luminal stenosis > 60%

The answer is E. (Hurst’s The Heart, 14th Edition, Chap. 43) Major criteria for the defining vulnerable plaque include options A through D.¹ Additionally, luminal stenosis > 90% is also a major criterion. Minor criteria include: superficial calcified nodule, glistening yellow appearance (pathologic diagnosis), intraplaque hemorrhage, outward remodeling, and endothelial dysfunction.

A 64-year-old woman presents to your clinic with progressive exertional chest pressure over the past several months. All of the following are advantages of stress ...