Ischaemic Heart Disease

Question 1

What is the difference between Thrombosis and an Embolism

Answer 1

Thrombosis is a blood clot that forms in vessel. Embolism is a blood clot that occludes a vessel at a secondary site

Question 2

What are the 3 primary processes where Ischemia arises

Answer 2

1. Atherosclerosis (Stenosis is narrowing of the arteries)
2. Thromboembolism (the obstruction of blood flow by a clot)
3. Vasospasm (a muscular spasm often in non-occluded vessels

Question 3

What are the two methods of evaluating a MI clinically

Answer 3

Via Cardiac Markers and Electrocardiogram

Question 4

What are the two surgical treatments for Ischaemic Heart Disease in humans

Answer 4

1. Percutaneous Coronary Intervention (PCI) also known as a Stent
2. Coronary Artery Bypass Graft

Question 5

Describe the difference between angina, STEMI and nonSTEMI

Answer 5

angina = MI Symptoms with NO electrocardiogram symptoms and NO cardiac biomarkers
STEMI = ST elevation myocardial infarct = Q-wave MI
nonSTEMI = No ST-Elevation BUT Positive Cardiac Markers = Non Q-wave MI

Question 6

Detail the two procedures that are used to restore blood flow, why would you choose one over the other?

Answer 6

1. Percutaneous Coronary Intervention (PCI) = Access via the femoral artery with a catheter, using a balloon to expand the artery and then a stent to hold it in place.
2. Coronary Artery Bypass Graft (CABG) = bypassing the blocked artery
   Which is preferred, PCI is preferred for less complex, and for severe PCI is still used however there is less reoccurrence with CABG

Question 7

Describe the role of cavin/caveolin/eNOS and nitric oxide in regulating cardiac stiffness

Question 8

Describe the history of research into the cardiovascular effects of hormone replacement therapy, what was the first research and what are the current recommendations

Question 9

Define systolic and diastolic dysfunction, how is it measured using echocardiography

Question 10

What is Diastolic function

Answer 10

The process allows the left ventricular to fill with sufficient blood at a low pressure to prevent pulmonary congestion

Question 11

What is Diastolic Dysfunction, what are its comorbidities and causes

Answer 11

Diastolic dysfunction is an impairment in the relaxation, affecting the left ventricle. It can occur with aging, diabetes, and hypertension. Causes are usually due to fibrosis and insufficient uptake of calcium into the SR

Question 12

How is diastolic dysfunction measured in echocardiography

Answer 12

It uses the E/A ratio which is a measurement of blood flow through the mitral valve
E = Flow through the mitral valve during early diastole forms the ‘E’ wave
A = Towards the end of diastole the left atrial contraction can be seen as the ‘A’ wave

Question 13

What is the E/A ratio for Grade 1 diastolic function and why?

Answer 13

E/A is less than 1 caused by
Stiffening of the left ventricle reduces passive filling reducing E-wave
The left atria compensate by increasing atrial pressure
This increases the A-wave

Question 14

What is the E/A ratio for Grade 2 diastolic function and why?

Answer 14

The E/A ratio is greater than 0.8 and looks normal
Atrial pressure increases which increases early filling
Diastolic dysfunction cannot be detected using this method with
this level of dysfuntion

Question 15

What is the E/A ratio for Grade 3 diastolic function and why?

Answer 15

The E/A ratio becomes greater than 1.5
Severe diastolic dysfunction
Atrial pressure continues to rise
Early ventricular filling become more restricted

Question 16

What are the links between sex and Ischaemia

Answer 16

Males more likely to die from cardiovascular disease (CVD) than females
* across almost all age groups
* Likelihood of death 2-3x higher in males (25-74 years)
Men are twice as likely to have a coronary event as women
Men die from CHD at an earlier age than women
* women lag ~5 years behind males

Question 17

Why study heart disease in females?

Answer 17

• Heart disease is the leading cause of death for women in Australia
• Women are almost three times
  more likely to die of it than breast cancer
• Kills 25 Australian women each day
• Risk increases following menopause
• 60% of women don’t know that heart disease is the number one killer of Australian women.

Question 18

Explain the HRT Debarcle

Answer 18

Initial research into HRT suggested it was bad
* More thorough interrogation suggests that time since menopause onset is an important factor

Question 19

Why do Diebectic females have worse ischaemic heart disease

Answer 19

• Impaired glucose tolerance more than fasting hyperglycemia
• Mouse models of diabetes show a similar pattern

Question 20

What are recognised as low-risk HT in Menopause Hormone Therapy

Answer 20

• Recent menopause
• Normal weight
• Normal blood pressure

Question 21

What are recognised as intermediate-risk HT in Menopause Hormone Therapy

Answer 21

• Diabetes
• Smoking
• Obesity
• Hyperlipidemia

Question 22

What are recognised as high-risk HT in Menopause Hormone Therapy

Answer 22

• Congenital heart disease
• Venous thrombosis
• Pulmonary embolism
• Breast cancer