Coronary Heart Disease

Question 1

Acute presentation of CHD

Answer 1

encompassed by ACS and includes angina, AMI

Question 2

Chronic aspect of CHD

Answer 2

Stable angina and heart failure

Question 3

T/F

coronary arteries fill in systole

Answer 3

False, they fill in diastole

Question 4

which zone of the heart is vulnerable to ischaemia

Answer 4

sub-endocardial zone

Question 5

Acute Coronary Syndrome

Answer 5

any condition that causes sudden, reduced BF to the heart. Its leading symptom os chestpain

Question 6

cardiac biomarkers of AMI

Answer 6

Creatine Kinase and Cardiac Troponin

Question 7

Creatine Kinase

Answer 7

in both heart and skeletal muscle

exists as a dimer in 3 isoforms- BB, MM and MB which is heart specific

Question 8

Cardiac Troponin

Answer 8

supersedes CK-MB as a biomarker

2 isoforms

Question 9

Cardiac troponin release after AMI

Answer 9

4-10hrs after AMI troponin is detected, peaks at 12-48hrs and then normal for the next 4-10 days

Question 10

Risk factors for angina

Answer 10

Hypertension, cholesterol, smoking

Question 11

angina can be precipitated by

Answer 11

exertion, cold, stress, large meals

Question 12

Treatment of angina

Answer 12

1. modif of risk factors
   
   • smoking, obesity, hypertension, hyperlipidemia, diabetes mellitus
2. surgical
   
   • angioplasty, stent
3. pharmacological
   
   • for acute
     
     • tPA
   • for relatively stable forms of angina
     
     • B1- antagonist
     • Ca2+ antagonist
     • vasodilators

Question 13

mechanisms of treatment of angina

Answer 13

increase coronary perfusion to increase O2 supply or decrease metabolic demand. btoh can be used too

Question 14

Nitrovasodilators cellular mechanism of action for angina treatment ( chronic and acute)

Answer 14

Nitrate donates NO from its structure –> increase in Guanyl cyclase (an enzyme that converts GTP to cGMP–> increased cGMP–> increased relaxation

Question 15

Nitrovasodilators systemic mechanism of action for angina treatment ( chronic and acute)

Answer 15

Venous dilation–> reduced venous pressure and preload and therefore a fall in cardiac O2 consumption

Arterial dilation–> reduced peripheral resistance and afterload and thus fall in cardiac O2 consumption

no effect of NO on cardiac and skeletal muscle

Question 16

when are Nitrates used for treatment

Answer 16

• acute attack of angina
• immediate prophylaxis (. if someone knows that they’re going to be exerting themselves)( can take a short acting from of ntiric vasodilators)
• chronically for stable angina

Question 17

limitations of NOs

Answer 17

• decreased BP associated with reflex tachycardia
• tendenacy to increase cardiac O2 consumption
• tolerance can develop thus we have a nitrate free period for 8hrs every 24hrs

Question 18

Adverse events of Nitrates

Answer 18

• Hypotension (fainting)(should not be combined with Viagra or similar drugs)
• Tachycardia
• Headache
• Flushing

Question 19

Define

Heart Failure

Answer 19

CO unable to meet metabolic demands

Question 20

Cardiac remodelling in HF can be caused by

Answer 20

• Acute heart failure
  
  • caused by events like trauma and AMI
• chronic heart failure
  
  • increasing incidence due to better treatments at prolonging life

Question 21

Systolic dysfunction in HF( cardiac remodelling)

Answer 21

when there impaired contraction thus HF with reduced ejection fraction (HFrEF)

Question 22

Diastolic dysfunction in HF( cardiac remodeling)

Answer 22

contraction is ok but impaired filling so that HF has preserved ejection fraction (HFpEF)

Question 23

Prevalence of HFpEF assocated with

Answer 23

• fibrosis
• older populations
• females
• hypertensives
• diabetes

Question 24

Infarct often remodels the heart such that…

Answer 24

there is thinning of the ventricular wall leading to a dilated ventricular space or systolic heart failure( HFrEF)

Question 25

Hypertension often remodels the heart such that…

Answer 25

there is hypertrophy in the heart and thus diastolic heart failure(HFpEF). Thus relaxation is impaired and there would be lower CO with exercise

Question 26

treatment for HF( mainly HFrEF)

Answer 26

• Lifetsyle changes
  
  • sodium, weight, diet, exercise
• we want to decrease cardiac workload
  
  • ACE inhibits, beta blockers, diuretic
• increase cardiac contractility

Question 27

ACE inhibitors mechanism of action and examples

Answer 27

• prevent ang II formation and inhib bradykinin breakdown
  
  • decreases peripheral resistance
  • increases sodium and water excretion

captopril, enalapril, perindopril

Question 28

ACE inhibitors used to treat…

Answer 28

Hypertension, heart failure as a first-line treatment and finally to preserve renal function in diabetes

Question 29

adverse effects of ACEi

Answer 29

• common
  
  • cough because of increased bradykinin
  • headache
  • marked hypotension because of a dosing problem
  • hyperkalemia
    
    • if too high can lead to cardiac arthymia
• infrequent
  
  • rash/itch, angioedema
• contraindications
  
  • pregnancy

Question 30

ARBs mechanism of action and examples

Answer 30

Inhibits the AT1 receptor which stoped ang induced vasoconstriction and aldosterone output.

it results in decrease in TPR and increase in Na and water excretion

Question 31

ARBs used to treat…

Answer 31

Hypertension, HF, Diabetic nephropathy and FOR PATIENTS INTOLERANT TO ACEi(who get the cough)

Question 32

ARBs adverse events

Answer 32

same as ACEi ( hypotension, hyperkalemia, angioedmea)