CARDIAC CONSEQUENCES OF ATHEROMA

Question 1

what are the stages of atheroma?

Answer 1

endothelial dysfunction
fatty streak formation in the tunica intima as lipoproteins can enter
inflammation
foam cell formation (macrophages digest LDL)
foam cells release their content, forming the atheroma
calcium salts and firous tissue accumulates within the atheroma and a hard plaque forms
smooth muscel cells migrate to the surface forming a fibrous cap

Question 2

what are risk factors for atheroma?

Answer 2

smoking
DM
obesity
lipids
hypertension
stress
lack of exercise
FHx
male
>45

Question 3

what is stable angina?

Answer 3

central tight chest pain brought on by exercise and relieved by rest. This occurs when an atheroma causes deficient blood flow to the heart muscle during exertion O2 doesnt meet demands

Question 4

what is unstable angina?

Answer 4

central tight chest pain brought on at exercise or rest and has a very unstable pattern. This is the stage just before an MI - caused by further narrowing

Question 5

what are ECG findings during angina?

Answer 5

ST depression

Question 6

what are the inferior leads of the heart?

and if these are abnormal which artery is likely to be affected?

Answer 6

2,3 and aVF

right coronary artery

Question 7

what are the lateral leads of the heart?

and if these are abnormal which artery is likely to be affected?

Answer 7

V5, V6, 1 and aVL

left circumflex artery

Question 8

what are the anterior leads of the heart?

and if these are abnormal which artery is likely to be affected?

Answer 8

V1, V2, V3, V4

left anterior descending

Question 9

what are the cardiac blood markers?

Answer 9

elevated troponin I and T

elevated CK-MB

Question 10

how long does troponin remain elevated?

Answer 10

7-10 days

Question 11

how logn does CK-MG remain relevated for?

Answer 11

48 hours

Question 12

what is the cardiac marker Ck-MB most useful for?

Answer 12

detecting a second MI after the first due to its short elevation time

Question 13

what can cause elevated troponin?

Answer 13

PE
pulmonary hypertension
septicaemia
subarachnoid haemorrhage
hypertension
AF
aortic stenosis
renal dysfunction
MI

Question 14

how do we treat MIs?

Answer 14

primary percutaneous coronary intervention and give low molecular weight heparin with this
aspirin and a secondary antiplatelet therapy
statins
anti ischaemics like beta blockers and nitrates

Question 15

what are some complications of an MI?

Answer 15

myocardial rupture
interventricular septum rupture
papillary muscle rupture
left ventricular dysfunction
left ventricular aneurysm
sudden cardiac death

Question 16

what is ischaemic heart disease?

Answer 16

an imbalance between the myocardial blood flow and the metabolic demand of the myocardium

Question 17

what are the 3 potential pathogenesis of an MI?

Answer 17

occlusive intracoronary thrombus
vasospasm
emboli

Question 18

what is a transmural infarct?

Answer 18

involving the entire thickness of the ventricular wall from endocardium to epicardium

Question 19

what is a subendocardial infarct?

Answer 19

multifocal areas of necrosis confined to the inner 1/3rd to 1/2th of the ventricular wall

Question 20

how can coronary artery disease be diagnosed?

Answer 20

ECG
nuclear stress test
echocardiography
coronary angiograph
PET scanning

Question 21

what are 2 examples of percutaneous coronary interventions?

Answer 21

angiopkasty and stents

Question 22

what surgery can be done for coronary artery disease?

Answer 22

coronary bypass surgery - bypassing lood flow around 1 or more narrowed vessels using a graft