Cardiac consequences of atheroma

Question 1

The ‘most important’ consequence of atheroma is

Answer 1

Death (ventricular fibrillation)

Question 2

Anatomy of atheroma:

Answer 2

1. Fibrous cap

2. Soft interior

Question 3

What makes up soft interior of atheroma?

Answer 3

Lipids
Cholesterol
WBCs
Proteins
Calcium

Question 4

Non-modifiable risk factors for atheroma;

Answer 4

Age
Gender
FHx
Ethnicity

Question 5

Modifiable risk factors for atheroma:

Answer 5

Smoking
Diabetes
Obesity
Lipids
Hypertension
Stress, pollution, lack of exercise

Question 6

Timeline of atheroma

Answer 6

• Fatty streak
• Fibrous cap formation
• Core of lesion becomes necrotic (atheroma)
• Thinning and rupture of cap
• Arterial occlusion

Question 7

Why is a fibrous cap formed?

Answer 7

Bodies attempt to stabalise things

Question 8

Why is an atheroma a symptomatic?

Answer 8

Positive remodelling - vessel widens

Question 9

What occurs when a cap ruptures?

Answer 9

Inflammatory process - platelets adhere - thrombus formed

Question 10

Stable angina =

Answer 10

Angina on exertion

Question 11

What is included in acute coronary syndrome?

Answer 11

Unstable angina

Myocardial infarction

Question 12

How to diagnose stable angina:

Answer 12

• Hx
• Examination (often normal)
• Stress testing

Question 13

3 types of stress testing:

Answer 13

1. Exercise ECG
2. Stress echo
3. Myocardial perfusion scan

Question 14

What would happen on an exercise ECG with stable angina?

Answer 14

Normal = normal ECG
Exercise = ST depression

Question 15

What type of imaging is an echo?

Answer 15

Ultrasound

Question 16

What happens in a stress echo with angina?

Answer 16

Part of heart supplied will increased contractility, part of heart with narrowing won’t contract as well

Question 17

What happens in a myocardial perfusion scan?

Answer 17

Inject isotope - shows perfusion. Take images at rest and during exercise.

Question 18

How to diagnose MI:

Answer 18

History
ECG
Enzymes

Question 19

Most common blocked arteries in MI:

Answer 19

1. Left anterior descending
2. Right coronary artery
3. Left circumflex

Question 20

Left anterior descending supplies:

Answer 20

Anterior wall

LV septum

Question 21

Right coronary artery supplies:

Answer 21

Inferior/posterior wall

LV septum

Question 22

Left circumflex supplies:

Answer 22

Lateral wall of LV

Question 23

Subendothelial MI:

Answer 23

NSTEMI

Question 24

Transmural MI

Answer 24

STEMI

Question 25

In a normal ECG, what is Q =

Answer 25

First downward line after P

Question 26

In a normal ECG, what is R =

Answer 26

First upward line after P

Question 27

In a normal ECG, what is S =

Answer 27

First downward line after R

Question 28

What part of the ECG do we look at in an MI?

Answer 28

ST segment

Question 29

Name the '12 leads' on an ECG?

Answer 29

``` avR avL avF I II III V1-V6 ```

Question 30

Leads for left anterior descending (anterior) =

Answer 30

V1-V6

Question 31

Leads for right coronary artery (inferior)

Answer 31

II, III, avF

Question 32

Leads for circumflex artery (lateral)

Answer 32

I, avL, V5, V6

Question 33

Enzymes to check for makers of MI:

Answer 33

CK-MB Troponin I Troponin T Myoglobin

Question 34

Most sensitive markers of MI

Answer 34

Troponin

Question 35

Troponin is sensitive but not

Answer 35

Specific

Question 36

What else may increase troponin?

Answer 36

``` hypertension septicaemia PE subarachnoid haemorrhage AF ```

Question 37

What makes up the troponin complex?

Answer 37

Troponin C: ca2+ Troponin I: inhibitory Troponin T: tropomyosin binding

Question 38

To diagnose MI, what has to happen to troponin?

Answer 38

Rise and/or fall in troponin level measured a few hours apart (need multiple blood tests)

Question 39

Complications of MI: 0-24 hrs

Answer 39

Arrhythmia Cardiac death Cardiogenic shock

Question 40

Complications of MI: 1-3 days

Answer 40

Pericarditis

Question 41

Complications of MI: up to 2 weeks

Answer 41

Myocardial rupture

Question 42

Complications of MI 3 weeks +

Answer 42

Heart failure

Question 43

What can occur if myocardial rupture is incomplete

Answer 43

False aneurysm

Question 44

What would a patient present with with interventricular septum rupture:

Answer 44

Hypotension Loud murmur Very ill

Question 45

Papillary muscle most likely to break:

Answer 45

Posteriomedial

Question 46

Heart failure symptoms:

Answer 46

``` SOB Peripheral oedema Orthopnoea PND fatigue ```

Question 47

What can happen with a left ventricular aneurysm:

Answer 47

Arrythmias | Thrombus formation

Question 48

Sudden cardiac death can occur in what MI?

Answer 48

STEMI

Question 49

Treatment for NSTEMI:

Answer 49

Anti-platelets LWMH Statin Anti-ischemic

Question 50

Examples of anti-ischemic

Answer 50

Beta-blockers | Nitrates

Question 51

Treatment for STEMI:

Answer 51

Quick reperfusion: - Fibrinolysis - Angioplasty - Percutaneous coronary intervention