Heart & Blood Vessels (Atheroma and Ischaemic Heart Disease)

Question 1

Name the 5 main blood vessels supplying the heart with blood?

Answer 1

1) Aorta
2) Right coronary artery
3) Left main coronary artery
4) Left anterior descending coronary artery
5) Circumflex coronary artery

Question 2

Define an atheroma:

Answer 2

A build up of fatty material on the inside of an artery

Question 3

What can atheroma lead to and define:

Answer 3

Atherosclerosis = the narrowing and the hardening of the inside wall of the artery, which can eventually (over decades) cause a complete blockage of the artery

Question 4

In which countries of the world does atheroma contribute to almost half of the deaths?

Answer 4

Western countries

Question 5

What is the cause of atheromas?

Answer 5

The response to injury hypothesis:

1) Injury to the endothelium (walls of arteries)
2) Chronic Inflammatory process
3) During the inflammatory process, the macrophages will ingest LDL’s
4) This ingestion of LDL’s will cause a build up of plaque inside the artery

Question 6

What are the 6 different progressive stages of atheroma?

Answer 6

1) Normal vessel 
(injury)
2) Fatty streak
(lipid accumulation)
3) Plaque
(more lipid accumulation)
4) An increased plaque
5) An obstructive atheroscleotic plaque
6) Thrombosis

Question 7

What are the 3 common arteries that an atheroma is most likely to take place and the specific complications with each?

Answer 7

1) Aorta - aneurysms
2) Corotid artery - stroke
3) coronary artery - heart attacks/ angina

Question 8

Atherosclerotic plaques can go unnoticed by a patient because they can be asymptomatic - However, what are the 6 symptoms of an atherosclerotic plaque formation?

Answer 8

1) Thrombosis
2) Embolism
3) Haematoma
4) Aneurysms
5) Critical stenosis

Question 9

Describe how and the problem with plaques rupturing inside and outside of the plaque?

Answer 9

Inside:
The plaque is unstable, it can rupture inside and causing bleeding within, the plaque will increase in size and cause obstruction to the artery.
Outside:
The plaque is unstable, it can rupture outside, exposes the artery endothelium, this causes chronic inflammation process - so macrophages will migrate and digest LDL’s causing an increase to the plaque, obstructs the lumen

Question 10

Apart from the clinical manifestations, that are specific to atheromatic plaques occurring in different arteries, what are 4 other clinical manifestations that need to be considered?

Answer 10

1) Embolism
2) Renal Artery Stenosis
3) Bowel Ischaemia
4) Peripheral vascular disease

Question 11

How are atheromas treated?

Answer 11

REVASCULARISATION - the reopening of an artery. This is then followed by secondary prevention measures:
1) Diet 2) Smoking 3) Treating diabetes

Question 12

Which patients are more susceptible at getting the clinical manifestations with atheromas?

Answer 12

Diabetic patients

Question 13

Define Ischaemic heart disease:

Answer 13

An imbalance of the supply of O2 to the heart and an increased demand for the body to supply the rest of the body with O2

Question 14

What are the causes for an increased demand and a reduction in the supply of O2 to the heart?

Answer 14

Increased demand:
1) Thyrotoxicosis (increases metabolic rate)
2) Myocyte hypertrophy (increased muscle size = need more O2 to contract)
Reduction of supply:
1) Embolism
2) Atheroma
3) Coronary artery spasms (can’t supply the heart with blood = no O2 for the heart to pump)

Question 15

What is the main cause for ischaemic heart disease (90& of cases)?

Answer 15

Atherosclerotic plaque obstruction in the coronary arteries

Question 16

If 1 part of an artery is ischemic, does this mean the rest of the artery will be ischemic?

Answer 16

No - there can be patches of ischemia in the artery

Question 17

What are the 4 FIXED risk factors for developing ischaemic heart disease?

Answer 17

1) A positive family history
2) Genetic factors
3) Age
4) Male

Question 18

What are the 7 NON-FIXED risk factors for developing ischaemic heart disease?

Answer 18

1) Obesity
2) Lack of exercise
3) Hyperlipidemia (increase LDL’s)
4) Alcohol
5) Smoking
6) Decreased diabetic control
7) Increase B.P

Question 19

What are the 5 symptoms of ischemic heart disease?

Answer 19

1) Shortness of breath
2) Angina
3) Palpitations
4) Sweating, pale, nausea
5) Syncope

Question 20

What are the 4 measures used to see if a person is suffering from ischaemic heart disease & define and explain?

Answer 20

1) Stable angina = chest pain that lasts up to 20 minutes, and only occurs when exercising (plaque disruption)
2) Unstable angina = chest pain lasts longer and occurs at rest unexpectedly (plaque has caused thrombosis)
3) NSTEMI and STEMI = myocardial infarction (caused by the plaque rupturing)

Question 21

How do areas of ischaemic heart look overtime?

Answer 21

Pinker - hrs into recovery
Yellow - days into recovery
White - healed

Question 22

What are the 7 different complications from having ischaemic heart disease?

Answer 22

1) Myocardial Infarction
2) (4/5 days after MI) Vascular wall destruction
3) Arrhythmia
4) Valvular defects
5) Pericarditis, myocarditis, endocarditis
6) DVT
7) Pulmonary embolism

Question 23

What treatments are used for ischaemic heart disease?

Answer 23

As most are caused by atheromasclerotic plaques esp in the coronary arteries:

1) Treat atheroma - revascularisation
2) If in coronary arteries - Cornary Artery Bypass Graft (CABG) Bypassing the blockage and creating a new passageway for blood to reach the heart