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 Interventional
Cardiology
1133 Questions: An Interventional
Cardiology Board Review
THIRD EDITION

Editors
Debabrata Mukherjee, MD
Chairman and Professor
Department of Internal Medicine
Paul L. Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas

Richard A. Lange, MD, MBA

President and Dean
Paul L. Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas

Saurav Chatterjee, MD
Fellow, Interventional Cardiology
Temple University Hospital
Philadelphia, Pennsylvania

Leslie Cho, MD
Director, Women’s Cardiovascular Center
Preventive Cardiology & Rehabilitation
Cleveland Clinic Foundation
Cleveland, Ohio

David J. Moliterno, MD
Chairman and Professor
Department of Internal Medicine
Gill Heart and Vascular Institute
University of Kentucky
Lexington, Kentucky
Managing Editor
Nadia M. Whitehead
Texas Tech University Health Sciences Center El Paso
El Paso, Texas
Acquisitions Editor: Sharon Zinner
Development Editor: Mary Woodman
Editorial Coordinator: Mary Woodman/Annette Ferran
Editorial Assistant: Virginia Podgurski
Marketing Manager: Rachel Mante Leung
Production Project Manager: Bridgett Dougherty
Design Coordinator: Stephen Druding
Manufacturing Coordinator: Beth Welsh
Prepress Vendor: SPi Global

Third edition

Copyright © 2019 Wolters Kluwer

Copyright © 2011 Wolters Kluwer Health/Lippincott Williams & Wilkins. Copyright © 2006 Lippincott Williams & Wilkins, a Wolters Kluwer
business. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any
means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without
written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this
book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright.
To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at
[email protected], or via our website at lww.com (products and services).

987654321

Printed in China

Library of Congress Cataloging-in-Publication Data

Names: Mukherjee, Debabrata, editor.
Title: 1133 questions : an interventional cardiology board review / [edited by] Debarata Mukherjee.
Other titles: 1001 questions | Interventional cardiology board review
Description: Third edition. | Philadelphia : Wolters Kluwer, [2019] | Preceded by 1001 questions / editors, Debabrata Mukherjee, Leslie Cho,
David J. Moliterno. c2012. | Includes index.
Identifiers: LCCN 2018015044 | ISBN 9781496386212
Subjects: | MESH: Cardiovascular Diseases—diagnosis | Cardiovascular Diseases—therapy | Examination Questions
Classification: LCC RC669.2 | NLM WG 18.2 | DDC 616.10076—dc23 LC record available at https://lccn.loc.gov/2018015044

This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy,
comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration
of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to
the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and
not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments.

Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses,
indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should
consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the
manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and
identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a
narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury
and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any
person of this work.

LWW.com
 “To interventional fellows and colleagues everywhere for their hard work and dedication to
patient care; to my parents for their infinite patience, love, and understanding; and to
Suchandra, for her love and support.”
—DEBABRATA MUKHERJEE

“To interventional fellows worldwide who will use this text to expand their knowledge and
advance our field … and to my parents, wife and sons who’ve taught me more about issues of
the heart than any
cardiology text.”
—RICHARD A. LANGE

“To my parents, my wife and my daughter—who inspire me to keep learning—and to my

innumerable mentors over the years.”
—SAURAV CHATTERJEE

“With gratitude to the interventional fellows at Cleveland Clinic past, present, and future for their
dedication and hard work.”
—LESLIE CHO

“To our chapter authors and interventional cardiology teachers worldwide; thoughtful questions
and thorough answers will continue to advance the field and guide us all in contemporary
medical practice.”
—DAVID J. MOLITERNO
 PREFACE

Insightful questions have been used throughout the ages as a metric to assess one’s knowledge, but when
coupled with carefully delivered answers, they can become a powerful teaching tool. This book of
questions and annotated answers covering the field of interventional cardiology is meant to serve as a
helpful resource for individuals preparing for the interventional cardiovascular medicine board exam, as
well as for clinicians who wish to perform an in-depth self-assessment on individual topics or the full
spectrum of cardiovascular medicine. The book has many key features, which we believe will make the
reader successful in passing the boards and improving clinical practice.
Of foremost importance, the areas covered are relevant not only to the day-to-day practice of
interventional cardiology but have also been modified to fit the scope and content of the actual board
examination. The book begins with several chapters dedicated to the anatomy and physiology associated
with interventional cardiology and the pathobiology of atherosclerosis and inflammation. This
corresponds to the 15% of the board examination, which targets material in the basic sciences. The
subsequent chapters focus on the essential interventional pharmacotherapy of antiplatelets, anticoagulants,
and other commonly used medications in the catheterization laboratory and outpatient setting for patients
with atherosclerosis. These chapters correspond to the next 15% of the boards centering on
pharmacology. A similar-sized 15% of the board examination is directed toward imaging; this book
includes specific chapters on radiation safety, catheterization laboratory equipment and technique,
contrast agents, and intravascular ultrasound. The two largest areas of the examination, each covering
25% of the content, include case selection management and procedural techniques. This review book
dedicates several chapters to comprehensively cover these areas as well. Finally, we have included
chapters for the miscellaneous remaining areas covered by the board examination, including peripheral
vascular disease, cerebrovascular and structural heart interventions, ethics, statistics, and epidemiology,
as well as a chapter directed at improving test-taking skills.
Also essential to the quality and appropriateness of the questions and annotated answers is the
expertise of the chapter authors. We are fortunate to have assembled the “who’s who” of academic
interventional cardiology. The contributing authors from leading medical centers around the world have
over 8,000 articles cited in PubMed. We are greatly indebted to these authors who are recognized both for
their interventional expertise and for their teaching skills. In the end, the true value of this textbook is not
only the relevance of the questions and the outstanding quality of the authors but also the value of the
annotated answers. The text includes more than 1,000 questions and over 400 figures and tables. The
corresponding answers have been appropriately detailed to provide relevant facts, information, and up-
to-date journal citations.
The practice of interventional cardiology is exciting, rewarding, and a privilege each of us enjoys.
Likewise, it has been our privilege to work with the superb contributors, our colleagues in interventional
cardiology, and Ms. Nadia Whitehead at Texas Tech University Health Sciences Center El Paso and Ms.
Mary Goodman at Wolters Kluwer for their editorial assistance. It is our personal hope that you will
enjoy this book and that it will be a valuable resource to you in passing the board examination and
providing the highest quality care possible to your patients
 Debabrata Mukherjee, MD
Richard A. Lange, MD, MBA
Saurav Chatterjee, MD
Leslie Cho, MD
David J. Moliterno, MD
 CONTRIBUTORS

Harsh Agrawal, MD
Division of Cardiology
Paul L. Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas
Robert J. Applegate, MD
Cardiovascular Medicine
Wake Forest School of Medicine
Medical Center Boulevard
Winston-Salem, North Carolina
Subhash Banerjee, MD
University of Texas Southwestern Medical Center
Division of Cardiology
Veterans Affairs North Texas Health Care System
Dallas, Texas
Olivier F. Bertrand, MD, PhD
Québec Heart-Lung Institute
Laval University
Department of Mechanical Engineering
McGill University
Québec City, Québec, Canada
Sorin J. Brener, MD
Cardiac Catheterization Laboratory
New York—Presbyterian Brooklyn Methodist Hospital
Weill Cornell Medical College
Brooklyn, New York
Saurav Chatterjee, MD
Fellow, Interventional Cardiology
Temple University Hospital
Philadelphia, Pennsylvania
Adnan K. Chhatriwalla, MD
University of Missouri—Kansas City
Saint Luke’s Mid America Heart Institute
Kansas City, Missouri
Leslie Cho, MD
 Director, Women’s Cardiovascular Center
Preventive Cardiology & Rehabilitation
Cleveland Clinic Foundation
Cleveland, Ohio
Joaquin E. Cigarroa, MD
Knight Cardiovascular Institute
Oregon Health & Science University
Portland, Oregon
Antonio Colombo, MD
Interventional Cardiology Unit
San Raffaele Scientific Institute
EMO-GVM Centro Columbus Hospital
Milan, Italy
Harold L. Dauerman, MD
University of Vermont College of Medicine
Burlington, Vermont
Ali Denktas, MD
Division of Cardiology
Department of Medicine
Baylor College of Medicine
Houston, Texas
Steven P. Dunn, PharmD
Heart and Vascular Center
University of Virginia Health System
University of Virginia School of Medicine
Charlottesville, Virginia
Mouhammad Fathallah, MD
Department of Cardiovascular Medicine
Duke University Medical Center
Durham, North Carolina
Stephan D. Fihn, MD, MPH
Departments of Medicine and Health
Services
University of Washington
Seattle, Washington
Giuseppe Gargiulo, MD
Department of Cardiology, Inselspital
Bern University Hospital
Bern, Switzerland
Jay Giri, MD, MPH
Interventional Cardiology & Vascular Medicine
Division of Cardiovascular Medicine
 Perelman School of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
Kashish Goel, MBBS
Department of Cardiovascular Diseases
Mayo Clinic
Rochester, Minnesota
Ziyad M. Hijazi, MD, MPH
Weill Cornell Medical College
Cornell University
Department of Pediatrics
Sidra Medical and Research Center
Doha, Qatar
Terence Hill, MD
Department of Cardiovascular Medicine
Heart and Vascular Institute
Cleveland Clinic Foundation
Cleveland, Ohio
Elizabeth M. Holper, MD, MPH
Interventional Cardiology
Interventional Cardiology Research
The Heart Hospital Baylor Plano
Plano, Texas
Samuel E. Horr, MD
Department of Cardiovascular Medicine
Heart and Vascular Institute
Cleveland Clinic
Cleveland, Ohio
Sei Iwai, MD
Westchester Medical Center
New York Medical College
Hawthorne, New York
Alice K. Jacobs, MD
Cardiac Catheterization Laboratory
Boston University School of Medicine
Boston, Massachusetts
Hani Jneid, MD
Interventional Cardiology Research
Michael E. DeBakey VA Medical Center
Baylor College of Medicine
Houston, Texas
Ankur Kalra, MD
 Division of Cardiovascular Medicine
Department of Medicine
Case Western Reserve University School
of Medicine
Harrington Heart & Vascular Institute
University Hospitals Cleveland Medical Center
Cleveland, Ohio
David E. Kandzari, MD
Piedmont Heart Institute
Piedmont Healthcare
Atlanta, Georgia
Ryan Kaple, MD
Interventional Cardiology
Westchester Medical Center
New York Medical College
Valhalla, New York
Dimitri Karmpaliotis, MD, PhD
Columbia University Medical Center
New York Presbyterian Hospital
New York, New York
Waleed Kayani, MD
Division of Cardiology
Department of Medicine
Baylor College of Medicine
Houston, Texas
Morton J. Kern, MD
Division of Cardiology
Veterans Affairs Long Beach HealthCare System
Long Beach, California
University of California Irvine Medical Center
Orange, California
Richard A. Krasuski, MD
Adult Congenital Heart Disease Center
Duke University Medical Center
Durham, North Carolina
Richard A. Lange, MD, MBA
President and Dean
Paul L. Foster School of Medicine
Texas Tech University Health Sciences Center El Paso
El Paso, Texas
Azeem Latib, MD
Interventional Cardiology Unit
 San Raffaele Scientific Institute
EMO-GVM Centro Columbus Hospital
Milan, Italy
John J. Lazarus, MD
Department of Internal Medicine
University of Michigan Medical School
Ann Arbor, Michigan
Glenn N. Levine, MD
Cardiac Care Unit
Michael E. DeBakey VA Medical Center
Baylor College of Medicine
Houston, Texas
Tracy E. Macaulay, PharmD
College of Pharmacy
University of Kentucky
Lexington, Kentucky
Rajendra H. Mehta, MD, MS
Duke Clinical Research Institute
Duke University Medical Center
Durham, North Carolina
Timothy A. Mixon, MD
Interventional Cardiology, Division of Cardiology
Texas A&M College of Medicine
Scott & White Medical Center
Temple, Texas
David J. Moliterno, MD
Gill Heart and Vascular Institute
University of Kentucky
Lexington, Kentucky
Pedro R. Moreno, MD
Mount Sinai Health System
New York, New York
Debabrata Mukherjee, MD
Chairman and Professor
Department of Internal Medicine
Paul L. Foster School of Medicine
Texas Tech University Health Sciences
Center El Paso
El Paso, Texas
Srihari S. Naidu, MD
Hypertrophic Cardiomyopathy Program
Interventional Cardiology
 Westchester Medical Center
New York Medical College
Long Island, New York
Brahmajee K. Nallamothu, MD
Department of Internal Medicine
University of Michigan
Ann Arbor, Michigan
Craig R. Narins, MD
Divisions of Cardiology and Vascular
Surgery
University of Rochester School of Medicine
Rochester, New York
Stephane Noble, MD
Division of Cardiology
University Hospital of Geneva
Geneva, Switzerland
Hussein Othman, MD
Central Michigan University College
of Medicine
Detroit, Michigan
Devin Patel, MD
Division of Cardiovascular Medicine
Vanderbilt University Medical Center
Nashville, Tennessee
Timir K. Paul, MD, PhD
Department of Internal Medicine
Quillen College of Medicine
East Tennessee State University
Johnson City, Tennessee
Guillaume Plourde, MD, PhD
Québec Heart-Lung Institute
Université Laval
Québec, Canada
Abhiram Prasad, MD
Department of Cardiovascular Diseases
Mayo Clinic
Rochester, Minnesota
Mark Robbins, MD
Division of Cardiovascular Medicine
Vanderbilt University Medical Center
Nashville, Tennessee
Marco Roffi, MD
Division of Cardiology
University Hospital of Geneva
Geneva, Switzerland
Sonia Samtani, MD
Division of Cardiology
Irvine School of Medicine
University of California
Memorial Care Heart & Vascular Institute
Long Beach, California
Jacqueline Saw, MD
Interventional Cardiology
Vancouver General Hospital
University of British Columbia
Vancouver, Canada
Karen Segerson, MD
Department of Medicine
University of Washington
Seattle, Washington
Arnold H. Seto, MD
Division of Cardiology
Veterans Affairs Long Beach Health
Care System
Long Beach, California
University of California Irvine
Medical Center
Orange, California
Madhan Shanmugasundaram, MD
Sarver Heart Center
University of Arizona College of Medicine
Southern Arizona Veterans Affairs
Health Care System
Tucson, Arizona
Mehdi Shishehbor, DO, PhD, MPH
Director, Cardiovascular Interventional Center
Co-Director, Vascular Center
University Hospitals Harrington Heart &
Vascular Institute
Cleveland, Ohio
Michael H. Sketch Jr., MD
Department of Medicine
Duke University
Durham, North Carolina
Paul Sorajja, MD
Center for Valve and Structural Heart Disease
Minneapolis Heart Institute
Abbott Northwestern Hospital
Minneapolis, Minnesota
Hussam S. Suradi, MD
Rush Center for Structural Heart Disease
Rush University Medical Center
Structural Heart & Valve Center
St. Mary Medical Center
Munster, Indiana
Rajesh V. Swaminathan, MD
Duke University Medical Center
Duke Clinical Research Institute
Durham, North Carolina
Jay Thakkar, MD
Vancouver General Hospital
University of British Columbia
Vancouver, Canada
Marco Valgimigli, MD, PhD
Bern University Hospital
University of Bern
Bern, Switzerland
Amit N. Vora, MD, MPH
Department of Medicine
Duke University
Durham, North Carolina
Frederick G.P. Welt, MD
Division of Cardiovascular Medicine
Department of Medicine
Cardiac Catheterization Laboratory
University of Utah Health Sciences Center
Salt Lake City, Utah
Katherine Yu, MD
Olive View-UCLA Medical Center
University of California, Irvine
Long Beach, California
Khaled M. Ziada, MD
Interventional Cardiology
Gill Heart and Vascular Institute
University of Kentucky
Lexington, Kentucky
 CONTENTS

Preface
Contributors
Abbreviations

1 Vascular Biology
Frederick G.P. Welt and Pedro R. Moreno

2 Anatomy and Physiology

Richard A. Lange and Joaquin E. Cigarroa

3 Principles of Radiation Use, Protection, and Basic Physics Concepts

Guillaume Plourde and Olivier F. Bertrand

4 Inflammation and Arterial Injury

Jay Giri and Harold L. Dauerman

5 Antiplatelet, Antithrombotic, and Thrombolytic Agents

David J. Moliterno and Tracy E. Macaulay

6 Pharmacogenomics and Drug—Drug Interactions

Timir K. Paul

7 Antiarrhythmics, Sedatives, and Lipid-Lowering Agents

Steven P. Dunn and David J. Moliterno

8 Inotropes, Vasopressors, and Vasodilators

Tracy E. Macaulay and David J. Moliterno

9 Guide Catheter Selection for Coronary Interventions

Timothy A. Mixon and Elizabeth M. Holper

10 Intravascular Contrast Agents

John J. Lazarus and Brahmajee K. Nallamothu

11 Elective Coronary Intervention

Rajesh V. Swaminathan

12 Percutaneous Coronary Intervention for Acute Coronary Syndromes

Madhan Shanmugasundaram

13 Primary, Rescue, and Facilitated Angioplasty

Amit N. Vora and Michael H. Sketch, Jr.
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