Coronary Heart Disease

Question 1

What are some examples of coronary heart disease?

Answer 1

*Ischaemic heart disease
*Atherosclerosis
*Angina, Acute Coronary Syndrome (ACS)

Question 2

What is ischaemia?

Answer 2

An inadequate blood supply to an organ or part of the body, especially the heart muscles.

Question 3

What is infraction?

Answer 3

Death of tissue resulting from a failure of blood supply?

Question 4

What is the cause of ischaemia and infraction?

Answer 4

*Atherosclerosis
*Embolus
*Vasospasm
*Vasculitis

Question 5

What are the risk factors for atherosclerosis?

Answer 5

*BMI over 30
*Over 65
*Diabetes
*Hypertension
*Ethanol consumption
*Altered lipids (autoimmune)
*Relatives with condition
*Smoking

Question 6

Summarise atherosclerosis

Answer 6

1. Damage to endothelial cells
2. LDL accumulation (tunica intima)
3. Monocytes attracted (cytokines / adhesion molecules) –macrophages
4. Foam cell production – release content
5. Smooth muscle cell proliferation

Question 7

What type of lipoprotein contributes to plaque build up?

Answer 7

Low Density Lipoprotein- LDL contribute to plaque and HDL do not.

Question 8

What is the action of statins?

Answer 8

Inhibition HMG CoA Reductase, this reduces the amount of cholesterol.

Question 9

What is acute coronary syndrome?

Answer 9

Unstable plaque build up in a blood vessel that causes a thrombus/clot in the vein blocking the blood vessel.

Question 10

What are the symptoms of acute coronary syndrome?

Answer 10

Chest pain, left arm , jaw , heavy weight on chest (elephant on your chest)
Diabetics can present as atypical – (neuropathy masks symptoms) – also elderly , post heart transplant
Diaphoresis
Feeling of impending doom

Question 11

What is stable angina?

Answer 11

*Stable plaque build up in a blood vessel.
*Only causes symptoms on exertion.
*Ischaemia – subendocardial (approx. 70% occlusion)

Question 12

What is unstable angina?

Answer 12

*Unstable Plaque (approx. 90% occlusion)
*Symptoms at rest
*Ischaemia - subendocardial

Question 13

What is NSTEMI (Non-ST-elevation myocardial infarction)?

Answer 13

*Subendocardial infarct
*Unstable plaque
*Thrombus formed (>90% occlusion) – long term ischaemia

Question 14

What is STEMI (ST-elevation myocardial infarction)?

Answer 14

*Transmural infarct
*Total occlusion

Question 15

What is Prinzmetals Angina/ Variant Angina?

Answer 15

*Not atherosclerosis
*Vasospasm
*EtOH, smoking, cocaine, female, triptans
*Usually at night
*Transmural Ischaemia
*Also see ST elevation, but troponins not increased
*Treatment – CCB, nitrates to vasodilation
*AVOID beta blockers esp. non selective

Question 16

What are the 3 types of angina?

Answer 16

*Stable angina
*Unstable angina
*Variant angina

Question 17

What are the time dependant complicarions of myocardial infraction?

Answer 17

*0-24 Hours- Ischaemia leads to arrhythmias – VT leading to VF and sudden cardiac death Significant infarct (LV) – lead to heart failure (cardiogenic shock, pulmonary oedema, reflex tachycardia)
*24h – 3 days- Rupture syndromes
*3 days- 14 days- Pericarditis Immune response to damage causes inflammatory reaction Can get pericardial effusions.
*14 days – 1 month- LV aneurysms Clot formation – thrombus (mural) – embolus – kidney/lung/brain Dressler’s syndrome immune response against pericardium