8.1 Ischemic Heart Disease

Question 1

What is the usual cause of ischemic heart disease?

Answer 1

Atherosclerosis of the coronary arteries

Question 2

Stable Angina

Answer 2

Chest pain with exertions as there is some occlusion of the coronary arteries resulting in reversible damage

Question 3

How long does the pain from stable angina last?

Answer 3

20 minutes or less

Question 4

What is the EKG change with stable angina?

Answer 4

ST depression - subendocardial ischemia

Question 5

Unstable Angina

Answer 5

Chest pain that is due to thrombosis with incomplete occlusion and it can occur at rest - reversible injury to myocytes

Question 6

What is the EKG change with unstable angina?

Answer 6

ST depression

Question 7

Prinzmetal Angina

Answer 7

Vasospasm of the coronary artery that is unrelated to exertion

Question 8

What is the EKG change with Prinzmetal angina?

Answer 8

ST elevation due to transmural ischemia

Question 9

What are the main features of myocardial infarction?

Answer 9

Complete block of the coronary arteries due to thrombosis from rupture atherosclerotic plaque

Question 10

Are the symptoms of MI relieved by nitroglycerin?

Answer 10

No

Question 11

What parts of the heart are affected with LAD occlusion?

Answer 11

Anterior Wall

Anterior Septum

Question 12

What parts of the heart are affected with Right coronary artery occlusion?

Answer 12

Posterior Wall

Posterior Septum

Question 13

What parts of the heart are affected with Left Circumflex artery occlusion?

Answer 13

Lateral Wall of LV

Question 14

What is generally not affect by MI?

Answer 14

Right Ventricle

Question 15

What is the most common type of infarction?

Answer 15

Transmural

Question 16

What is used to diagnose MI?

Answer 16

Troponin I in the blood - peaks at 24 hrs

Question 17

What is the use of CK-MB as a marker?

Answer 17

It can detect recurrent MI as it will go down in 3 days

Question 18

What is used to treat MI?

Answer 18

Nitrates
Beta Blockers
ACE-I
O2
Aspirin or Heparin

Question 19

What are the complications of reperfusion via fibrinolysis after an MI?

Answer 19

• Contraction Band Necrosis

- Reperfusion Injury

Question 20

Why would enzymes increase after the administration of fibrinolysins?

Answer 20

Reperfusion injury will cause further release of enzymes

Question 21

MI 4-24 hrs - Complication

Answer 21

Coagulative Necrosis - Arrhythmia

Question 22

MI 1-3 days - Complication

Answer 22

Neutrophils - Fibrinous Pericarditis

Question 23

MI 4-7 days - Complication

Answer 23

Macrophages - Rupture

Question 24

MI 1-3 wks - Complication

Answer 24

Granulation

Question 25

MI 1 month and beyond - Complication

Answer 25

Scar Formation - Aneurysm and Dressler Syndrome

Question 26

Dressler Syndrome

Answer 26

Rare but inflammation of pericardium can cause pericarditis that occurs 6-8 weeks after MI due to autoimmune antibodies