Chronic Stable Angina

Question 1

atherosclerotic narrowing of one or more major coronary arteries

Answer 1

Coronary heart disease (CHD)/coronary artery disease (CAD) - Includes angina pectoris, unstable angina, acute myocardial infarction

Question 2

imbalance between myocardial oxygen supply and demand resulting from atherosclerotic CAD

Answer 2

Ischemic heart disease (IHD)

Question 3

clinical syndrome of myocardial ischemia characterized by a deep, poorly localized chest or arm discomfort associated with physical exertion or emotional stress and relieved promptly by rest or nitroglycerin

Answer 3

Angina Pectoris

Question 4

constellation of clinical symptoms that are compatible with acute myocardial ischemia

Answer 4

Acute coronary syndrome

Question 5

i. ST-segment elevation requiring immediate reperfusion therapy (STEMI)
ii. May be referred to as Q-wave MI

Answer 5

Acute myocardial infarction (AMI)

Question 6

i. Ischemia is severe enough to cause sufficient myocardial damage and the release of markers of myocardial injury
ii. May be referred to as non-Q-wave MI

Answer 6

Non-ST-segment elevation MI (NSTEMI)

Question 7

No biochemical markers of myocardial necrosis are released

Answer 7

Unstable Angina

Question 8

clinical syndrome of rest pain and reversible ST-segment elevation without enzyme elevation indicating AMI, usually due to coronary vasospasm

Answer 8

Variant angina

Question 9

percutaneous placement of a catheter in the femoral artery and advancement through the vasculature to the tip of the coronary arteries; radiocontrast dye is injected to determine the location and extent of atherosclerosis

Answer 9

Coronary angiography

Question 10

also known as angioplasty, a balloon catheter is placed during angiography and is inflated to re-open the diseased vessel; an intracoronary stent can then be placed to maintain patency of the vessel

Answer 10

Percutaneous coronary intervention

Question 11

Pathophysiology of Ischemic Heart Disease/Coronary Artery Disease

Answer 11

1. Myocardial demand exceeds supply (perfusion)

2. Atherosclerosis

Question 12

Myocardial oxygen demand (MVO2) is determined by

Answer 12

work load

Question 13

Determinants of myocardial oxygen demand

Answer 13

heart rate, contractility, intramyocardial wall tension during systole

Question 14

Oxygen supply is determined by

Answer 14

coronary blood flow and oxygen extraction

Question 15

Normal oxygen extraction

Answer 15

70 – 75%

Question 16

Oxygen extraction plateaus at

Answer 16

80%

Question 17

can limit oxygen supply and cause ischemia

Answer 17

Atherosclerotic plaques

Question 18

atherosclerotic plaques are Usually caused by

Answer 18

significant CAD (defined angiographically)

i.  70% diameter stenosis of at least one major epicardial artery
ii.  50% diameter stenosis of the left main coronary artery

Question 19

Describe Atherosclerosis

Answer 19

a. Endothelial dysfunction