Coronary Heart Disease

Question 1

What is CHD/IHD characterized by

Answer 1

Insufficient delivery of oxygenated blood to the myocardium relative to the demand. Atherosclerosis of epicardial coronary arteries

Question 2

Sequelae of CHD include

Answer 2

Angina pectoris
Myocardial infarction
Dysrhythmias
Heart Failure
Sudden cardiac death

Question 3

Common etiology of CHD

Answer 3

Known risk factors
Artherosclerosis with narrowing of the arterial lumen -> thrombosis formation
Coronary Vasospasm
Endothelial cell dysfunction –(microcirculation)
Left ventricular hypertrophy due to aortic stenosis

Question 4

Uncommon etiology of CHD

Answer 4

Emboli, respiratory failure, anemia, hypovolemia

Question 5

Congenital etiology of CHD

Answer 5

Left anterior descending coronary artery originating from the pulmonary artery

Question 6

What values are the indicators for total cholesterol?

Answer 6

<200mg/dl is desireable
> 240 mg/dl is high risk

Question 7

What value is an indicator for HDL cholesterol?

Answer 7

<40mg/dl is low to undesirable

Question 8

What value is an indicator for LDL cholesterol?

Answer 8

<130mg/dl is desirable

Question 9

What are the defences for coronary atherosclerosis?

Answer 9

1.Local control of vascular tone
2. Maintenance of an antithrombic surface
3. Control of inflammatory cell adhesion and diapedesis

Question 10

What is the result of coronary atherosclerosis?

Answer 10

1. Inappropriate constriction
2. Luminal thrombus formation
3. Abnormal interactions between blood cells and the activated vascular endothelium.

Question 11

Coronary perfusion can be altered by:

Answer 11

-Large, stable atherosclerotic plaque
-Acute platelet aggregation and thrombosis
-Vasospasm
-Failure of autoregulation of the microcirculation by endothelial cell damage
-Poor perfusion pressure (hypovolemia)

Question 12

In coronary artery disease, coronary arteries are unable to

Answer 12

dilate and increase flow in response to demand

Question 13

CHD Clinical Presentation

Answer 13

Angina pectoris: chest pain, sob, diaphoresis, nausea, emesis

Question 14

How is CHD classified?

Answer 14

-Stable or typical angina
-Unstable angina
-Myocardial infarction

Question 15

Vulnerable plaques have:

Answer 15

-large lipid core with thin cap
-fissured or ruptured cap
-active inflammation within the plaque
-epithelial denudation with platelet adherence

Question 16

Acute coronary syndrome chest pain is…

Answer 16

usually more severe and lasts longer than typical angina

Question 17

If the left main coronary and left anterior descending artery is the site of acute coronary syndrome then you have:

Answer 17

severe cardiac failure-hypotension-shock

Question 18

If the circumflex coronary and left anterior descending arteries are the site of acute coronary syndrome then you have:

Answer 18

pericardial effusion - tamponade
mitral valve damage

Question 19

If the posterior ventricular artery is the site of acute coronary syndrome then your __ is affected causing ___

Answer 19

AVN, bradycardia

Question 20

What are the immediate effects of acute coronary syndrome?

Answer 20

MI leads to drop in CO, triggering compensatory responses including sympathetic activation

Question 21

Sympathetic nervous system activation during ACS leads to increased myocardial workload by increasing:

Answer 21

-heart rate
-contractility
-blood pressure

Question 22

IHD treatment

Answer 22

-decreased workload/O2 demand
-control pain
-control dysrhythmias
-manage heart failure
-treat or prevent clots/emboli