Atheroma

Question 1

Define atheroma

Answer 1

a build up of fatty material on the inside wall of an artery
initiated by chronic injury to endothelium by smoking/hypertension/hyperlipidaemia = chronic inflammation
progresses as WBC, fat and blood infiltrate injury

Question 2

Define atherosclerosis

Answer 2

the progressive narrowing and hardening within an artery potentially resulting in complete blockage

Question 3

Clinical manifestation

Answer 3

can occur in any artery:

• coronary artery = heart attacks/angina
• aorta = aneurysm due to weakening of walls
• carotid = narrowing causes strokes
• peripheral vascular disease

Question 4

Ischaemic heart disease

Answer 4

imbalance between supply and demand of the heart for oxygenated blood
- decrease O2 and nutrients substrates and inadequate metabolite removal

Question 5

Causes of IHD

Answer 5

decrease flow/no flow of oxygenated blood = atheroma, spasm, embolism
increased demand for O2 = thyrotoxicosis, myocardial hypotrophy

Question 6

Fixed and reversible risk factors of IHD

Answer 6

Fixed:
positive family history
male sex
age
genetic factors
Potentially reversible with treatment:
hyperlipidaemia
smoking
hypertension
diabetes
lack of exercise
obesity
alcohol consumption

Question 7

Signs and symptoms of IHD

Answer 7

chest pain (central, crushing, radiating to L arm/jaw)
shortness of breath
palpitations
nausea, sweating, pale

Question 8

Clinical presentation & diagnosis

Answer 8

Stable Angina - plaque disruption & spasm, induced by effort, resolved by rest/GTN
Unstable angina - + partial thrombosis, possible emboli, occurs at rest, lasts longer
NSTEMI, STEMI & sudden death- plaque rupture, thrombosis

Question 9

Investigations for IHD

Answer 9

obs = BP, pulse, sats, resp rate
bloods (inc cardiac enzymes)
chest X-ray
ECG
exercise tolerance test

Question 10

Consequences of MI

Answer 10

cardiac arrest, arrhythmias, pericarditis, valvular defects, deep vein thrombosis, pulmonary embolus

Question 11

Treatment of IHD

Answer 11

oxygen, aspirin, pain relief
Angina = lifestyle, nitrates, B-blockers
Acute coronary syndromes = thrombolytic therapy
angioplasty & stenting
coronary heart bypass graft

Question 12

Hyperlipidaemia

Answer 12

LDL = bad cholesterol that is delivered to tissues
HDL = good cholesterol, mobilizes cholesterol from tissues and transports it to liver to be excreted in bile

Question 13

How to prevent/modify an atheroma?

Answer 13

Stop smoking
Control hypertension
Weight reduction
Increase exercise
Moderation of alcohol
Increase HDL, decrease LDL

Question 14

What is stable angina?

Answer 14

plaque disruption and spasm, induced by effort, resolved with rest, GTN

Question 15

What is unstable angina?

Answer 15

plaque disruption, spasm, partial thrombosis and embolism, occurs at rest