Day 3 Practice Exam Questions

Question 1

What are the signs and symptoms of ischaemic heart disease?

Answer 1

Fatigue
Dyspnoea
Chest pain on exercise (resolves with rest or GTN) - stable angina
ECG changes only present during exercise or with pain

Question 2

You are caring for a 48-year-old male who has been admitted to the ward after having a myocardial infarction. A 1st year student nurse knows that myocardial infarction is related to atherosclerosis but doesn’t know how atherosclerosis develops. Explain this to your colleague

Answer 2

• Progressive disease
• Build up of fatty plaques / atheroma
• Gradual narrowing of blood flow / stenosis
• Reduced blood flow through an artery
• Ischemia
• Chronic inflammatory response
• Injury to the inner lining / endothelium
• Inner lining / endothelium permeable to LDL particles
• LDL particles collect in inner wall / intima
• Monocytes attach endothelium / inner lining and become macrophages
• Phagocytosis / digestion of LDL causes foam cells
• Foam cells die
• Foam cells build an endothelium / inner wall to form fatty streak
• Fatty plaque releases growth factors
• Growth factors stimulate smooth muscles to produce fibrous material
• Fibrous material develops into fibrous plaque
• Advanced fibrous plaque reduces lumen size
• Fibrous plaque become a thrombus when occluding artery
• Fibrous plaque can rupture, parts of the plaque travel as an embolus and block arteries elsewhere

Question 3

Discuss the differences between the three different types of acute coronary syndrome (ACS)

Answer 3

Unstable angina
- Atheromatous plaque rupture
- ECG changes present-T wave may be flat or inverted. ST may be depressed
- Partial occlusion of a coronary artery
- No myocardial wall damage
- Troponin T levels normal

Non-ST Elevation MI (NSTEMI)
- ECG changes present-T wave inverted but ST is not elevated
- Total occlusion of a coronary artery - distal
- Partial thickness of myocardial wall is damaged
- Troponin T levels elevated

ST Elevation MI (STEMI)
- ECG changes present-ST Elevations on 12 Lead ECG
- Total occlusion of a coronary artery - proximal
- Full thickness of myocardial wall is damaged
- Troponin T levels elevated

Question 4

Impact of atherosclerosis: identify three potential arteries where atherosclerotic plaques may build and the subsequent conditions which manifest from blockage in these arteries

Answer 4

Coronary Arteries
- Ischaemic heart disease
- Stable angina
- Acute coronary syndrome / unstable angina / MI
- Cardiac arrest
- Heart failure

Carotid Artery
- Carotid artery stenosis
- Cerebral infarction / stroke

Aorta
- Aneurysm

Femoral/iliac arteries
- Peripheral vascular disease

Renal
- CKD