IHD

Question 1

Where does IHD occur?

Answer 1

Coronaries of the heart

Question 2

What age group and gender does cardiovascular conditions affect more?

Answer 2

Greater age = more prevalent

<75 = female prevalence

>75 = male prevalence

Question 3

Steps in coagulation cascade.

Answer 3

Proteins involved in coagulation always present in blood

Activated by exposed collagen and tissue factor

In the end fibrin is formed

Fibrin can be lysed (fibrinolysis)

Natural inhibitors of coagulation and promotors of fibrinolysis are present in blood and on the endothelium.

Question 4

What are the clinical syndromes of IHD?

Answer 4

Angina

Myocardial infarction

Sudden cardiac death

Question 5

3 types of Angina?

Answer 5

Stable = predictable

Unstable = appear at rest or at antime. Not linked with exercise

Variant = different pathology. spasm and don’t contract

Question 6

What leads to myocardial ischaemia?

Answer 6

ATP depletion —-> increased intracellular sodium

Anaerobic production of ATP —-> acidosis

ATP depletion —-> abnormalities of transmembrane ion transport —-> arrhythmias

Both myocardial contraction and relaxation are energy dependant

Metabolic products accu,ulate locally, possibly causing the pain

Question 7

What are the complications of MI?

Answer 7

Acute (immediate/within hours)

Arrhythmias

Acute heart failure, pulmonary oedema, cardiogenic shock

While healing - rupture

Question 8

How long does death take from cardiac causes?

Answer 8

Within one hour of onset of symptoms, or without symptoms.

Majority related to coronary atherosclerosis + thrombosis causing acute ischaemia

In 25% is the first manifestation of coronary atherosclerosis / IHD.

Question 9

What causes acute ischaemia?

Answer 9

ATP —-> depletion —-> abnormalities of transmembrane ion transport —-> formation of AP outside the specialised conduction system that spread erractically around the ventricular myocardium.

Question 10

What are some fixed risk factors?

Answer 10

Age

Sex

Genes

Question 11

What are some modifyable risk factors?

Answer 11

Cigarette smoking

Hypertension

Hyperlipidaemia

Diabetes

Question 12

How much narrowing of lumen need occur for symptoms to be present?

Answer 12

70%

Question 13

Complications of IHD

Answer 13

Cardiac arrhythmias

Congestive heart failure

Dressler’s syndrome

MI

Mitral regurgitation

Pericarditis

Pulmonary embolism

Shock

Stroke

Ventricular aneurysm