ischaemic heart disease

Question 1

whereare typical sites for MI

Answer 1

where arteries branch of into other arteries

Question 2

what are the requirements of coronary artery disease

Answer 2

apolopoprotein b containing lipporteins
cardiovascular damage
high LDL-C alone can still cause develop CAD

Question 3

what are the 2 conclusions about lowering ldl-c and CAD

Answer 3

1. benefit of lowering ldl-c anytime reduces risk

2. maintaining lower ldl-c throughout life substantially reduces risk

Question 4

what are the 4 types of coronary events

Answer 4

stable angina: stable atherosclerotic plaque limits O2, during periods of myocardial demand = area of ischaemia
unstable angina: incomplete or dynamic thrombus
Non-St elevation myocardial infarction: incomplete thrombus/occluded but stable coronary vessel
ST elevated myocardial infarction: occlusive and sustained thrombus

Question 5

what does cardiac troponin do
and what happens to them in MI
what does their presence in blood indicate

Answer 5

reg interaction of actin and myosin in cardiac muscle + skeletal muscle
released in MI bc membrane and cardiomyocyte damage
indicates severe iscaemia within myocardium

Question 6

what is plaque rupture

Answer 6

frequent cause of thrombus

disrupted fibrous cap that exposes thrombogenic core

Question 7

what are the mechanisms of plaque rupture

Answer 7

where cap is thinnest and most infiltrated by foam cells

thing caps = dec smooth muscle cells, less collagen, infiltration of macs

Question 8

what happens when plaque doesnt rupture? (in case of diagnosis during autopsy)

Answer 8

plaque erosion
absence of endothelium beneath thrombus
less inflammation
coronary vasospasm => localised endothleial damage
erosion common adjacent to plaque rupture = importance of serial sectioning

Question 9

what makes plaque vulnerable to burst

Answer 9

presence and size of necrotic core
thin, fibrous cap
plaque size + stenosis severity
greater inflammation 
less calcification

Question 10

treatment and management of CAD/ischaemic heart disease

Answer 10

percutaneous coronary intervention (revascurlarised) for STEMI/NSTEMI
optimal med therapy = anti-platelet therapy, statin, control risk factors
stable CAD = OMT and anti-anginal agents (nitroglycerin, Ca chan blockers)