1. The risk of dying as a result of cardiovascular disease increases with advancing age. Approximately what percent of persons who die of coronary heart disease are older adults – age 65 or older?
2. Modifiable risk factors that increase the risk of acute myocardial infarction (MI) include all of the following except:
- Food allergies
- Lack of physical activity
3. The overwhelming majority of strokes are ischemic. The percentage of strokes attributable to intracerebral hemorrhage is:
4. More than 60% of stroke deaths occur in:
- Native Americans
- Mexican Americans
- Persons age 45-64
5. Risk of ischemic stroke is reduced among women with all of the following characteristics except:
- Low BMI
- Regular exercise
- Healthy diet
- Menopause before age 42
6. Transient ischemic attacks (TIA) are associated with all of the following except:
- Increased risk of stroke in the first 30 days following the TIA
- Increased risk of stroke in the first 90 days following the TIA
- Increased risk of death within one year of the TIA
- Increased risk of congenital heart disease
7. High blood pressure is less common among women who:
- Are age 45 and younger
- Are obese
- Use oral contraceptives
- Are African American
8. By definition, prehypertension is untreated systolic or diastolic pressure ranging from:
- Systolic pressure of 120-139 mm Hg or diastolic pressure of 80-89 mm Hg
- Systolic pressure of 110-129 mm Hg or diastolic pressure of 70-79 mm Hg
- Systolic pressure of 130-149 mm Hg or diastolic pressure of 90-99 mm Hg
- Systolic pressure of 130-149 mm Hg and diastolic pressure of 90-99 mm Hg
9. The most commonly occurring congenital cardiovascular defect is:
- Tetralogy of Fallot
- Ventricular septal defects
- Coarctation of the aorta
- Hypoplastic left heart syndrome
10. Among postmenopausal women with coronary heart disease the strongest risk factor for heart failure is:
- First child after age 30
- No children
- Diet low in fruit and vegetables
11. Heart disease is the leading cause of death among men and women of all races and ethnic groups, however mortality varies by ethnicity. The group with the lowest mortality is:
- African Americans
- Native Americans or Alaska Natives
- Asian or Pacific Islanders
12. Reducing cholesterol and blood pressure may reduce all of the following except:
- Heart disease mortality
- Incidence of nonfatal myocardial infarction
- Risk of developing heart disease
- Risk of congenital heart disease
13. The most commonly occurring arrhythmia is:
- Atrial fibrillation
- Ventricular tachycardia
- Ventricular fibrillation
14. Symptoms such as shortness of breath, fatigue, weakness, difficulty breathing when recumbent, weight gain, and swelling in the lower extremities may indicate:
- Atrial fibrillation
- Heart failure
- Cardiac arrest
15. To reduce the risk of heart disease total cholesterol levels should be less than:
- 100 mg/dL
- 60 mg/dL
- 200 mg/dL
- 150 mg/dL
16. Which condition has a 95% risk of death?
- Myocardial infarction
- Atrial fibrillation
- Heart failure
- Sudden cardiac arrest
17. Atrial septal defect is:
- A congenital heart defect in which there is a hole between the heart’s two lower chambers
- A congenital heart defect in which there is a hole between the heart’s two upper chambers
- A nonfatal cardiac arrhythmia
- Enlargement of the atria
18. Which of the following groups is not at increased risk of developing endocarditis?
- Patients with artificial heart valve or implanted medical devices in the heart or blood vessels
- Patients with congenital heart defects
- Persons with poor dental hygiene and gum disease
- Persons with elevated cholesterol levels
19. Which of the following statement about mitral valve prolapse is false?
- It is generally asymptomatic and requires no treatment
- It affects less than 3% of the population
- It is more common in persons with connective tissue disorders such as Marfan syndrome
- All people with mitral valve prolapse require immediate medical or surgical treatment
20. The risks associated with stents include all of the following except:
- Blood clot at the stent site
- Rupture of an aneurysm
- Blocked blood flow to the lower body
- Elevated cholesterol or triglyceride levels
Answers and Explanations
About 81% of people who die of CHD are age 65 or older.
Modifiable risk factors – cigarette smoking, abnormal blood lipid levels, hypertension, diabetes, abdominal obesity, a lack of physical activity, and alcohol over-consumption account for more than 90% of the risk of an initial acute MI.
87% of strokes are ischemic, 3% result from subarachnoid hemorrhage, and 10% are due to intracerebral hemorrhage.
Because strokes tend to occur in older persons and women live longer than men, more women die of strokes. The AHA reports that more than 60% of stroke deaths in 2006 occurred in women.
According to the Framingham Heart Study, women with early menopause (before age 42) have twice the stroke risk of other women in different age groups.
The risk of stroke is highest in the 30 days following TIA, and the 90-day risk ranges from 3-17.3%. In the year following TIA, 25% of patients die.
More men than women suffer from high blood pressure until age 45. From ages 45-64, the rates are comparable for men and women. After age 65, many more women than men have high blood pressure. Women who are older, obese, or take oral contraceptives are at higher risk for high blood pressure.
An estimated 25 -37% of persons age 20 and older in the U.S. are prehypertensive.
Ventricular septal defects are the most common. Many close spontaneously; however, approximately 15% require intervention during the first year of life.
Among postmenopausal women with CHD, those with diabetes are at greatest risk of heart failure.
Native Americans or Alaska Natives have the lowest reported death rates from heart disease, followed by Asians or Pacific Islanders, Hispanics/Latinos, African Americans, and whites.
Lowering elevated cholesterol levels and blood pressure may prevent the development of heart disease and reduce the incidence of nonfatal MI and overall heart disease mortality.
Atrial fibrillation is the most common problematic cardiac arrhythmia. An estimated 3-5% of Americans, most age 65 or older, suffer from atrial fibrillation. It is an electrical disturbance that causes the atria to quiver rather than pump effectively. As a result, blood may remain in the atrium and it may clot. Blood clots can cause a stroke if they block an artery that supplies blood to the brain.
Heart failure occurs when the heart is unable to pump sufficient quantities of blood to supply the organs with oxygen. Coronary artery disease, hypertension, and diabetes are common causes of heart failure.
For persons at risk for heart disease, LDL cholesterol should be <100 mg/dL and triglycerides should be < 150 mg/dL. HDL cholesterol, which is considered protective against heart disease, should be 60 mg/dL or higher.
Although immediate defibrillation to restore normal rhythm may be lifesaving, 95% of persons with sudden cardiac arrest die within minutes.
Atrial septal defect is a congenital heart defect; a hole between the atria that allows blood to pass from the left side of the heart to the right side. As a result, oxygen-rich blood may be pumped to the lungs rather than throughout the body. Some atrial septal defects close spontaneously; however, many require surgical repair.
Endocarditis is an infection of the lining of the heart’s chambers and valves. It is more common in men than women, and in addition to the groups identified above, injection drug users are also at increased risk of developing endocarditis.
Even people with symptoms attributable to mitral valve prolapse such as palpitations, shortness of breath, cough, dizziness and fatigue may not have significant backflow through the mitral valve. Mitral valve backflow may be more significant among persons with high blood pressure and persons with backflow sufficient to provoke serious symptoms such as arrhythmias or endocarditis may require surgery to repair the valve.
An estimated 1-2% of people who have stents placed develop a blood clot at the insertion site. The risk of blood clots is greatest in the months following stent placement. Most patients are prescribed aspirin or other anticlotting agents to prevent clot formation.