ischaemic heart disease

Question 1

what are the two kinds of ischaemic heart diseases?

Answer 1

chronic coronary artery disease (CAD)
acute coronary syndrome (ACS)

Question 2

what is the goal for patients with chronic CAD?

Answer 2

maintain balance between myocardial oxygen supply and demand

Question 3

what is the goal for patients with ACS?

Answer 3

to restore or keeping open the coronary artery lumen

Question 4

what causes symptoms of CAD and cardiac abnormalities?

Answer 4

hyperaemic stress
coronary flow reduction and endothelial dysfunction

Question 5

what are the two vessels in coronary vasculature?

Answer 5

large, proximal epicardial vessels, and small,
distal endocardial vessels

Question 6

what happens in epicardial vessels during disease state?

Answer 6

artery blood flow is limited by the extent of epicardial vessel stenosis

Question 7

what is atheroma?

Answer 7

lesion that forms in vasculature leading to occlusion

Question 8

what are the symptoms on angina pectoris?

Answer 8

result of myocardial ischaemia causing discomfort in chest

Question 9

what is chronic CAD associated with?

Answer 9

the build up of atheroma in epicardial coronary arteries

Question 10

what is Atherosclerosis?

Answer 10

hardening of arteries with gathering of fatty deposits in tunic media and tunica intima

Question 11

what is Atherosclerosis a response to?

Answer 11

injury and perpetuation of inflammatory response

Question 12

what other arteries can atherosclerosis effect?

Answer 12

carotid arteries
peripheral artery disease

Question 13

what does endothelial dysfunction mean?

Answer 13

pathologic endothelial cell regulation which is caused by abnormal vascular tone and pro-thrombotic properties

Question 14

what does endothelial damage cause?

Answer 14

decreases antiplatelet and anticoagulant mechanisms

Question 15

what can cause an inflammatory response?

Answer 15

infiltration of myocytes and differentiation to macrophages

Question 16

what are symptoms of Atherosclerosis?

Answer 16

‘Distinctive plaque with necrotic core/fatty acid deposition, foam cells, fibrous cap’

Question 17

when do you see Acute coronary syndromes (ACS) ?

Answer 17

fissuring or rupture of atherosclerotic
plaques

Question 18

what are the three types of acute coronary syndrome?

Answer 18

unstable angina, non-ST elevation MI, and ST elevation MI

Question 19

when does a non-ST elevation myocardial infarction occur?

Answer 19

when unstable plaque ruptures but doesn’t completley close up the epicardial
coronary artery

Question 20

how is mortality in STEMI reduced?

Answer 20

relief of obstruction

Question 21

what are the treatments for ischaemic heart disease?

Answer 21

focus on reduction of myocardial oxygen demand
β1-adrenoceptor antagonists
Organic nitrates
Sublingual nitroglycerin tablets

Question 22

what do β1-adrenoceptor antagonists do?

Answer 22

reduce myocardial oxygen demand by reducing heart rate and contraction

Question 23

what do organic nitrates do?

Answer 23

dilation of peripheral capacitance veins, decreasing preload wchih reduces myocardial oxygen demand

Question 24

what do Sublingual nitroglycerin tablets or nitroglycerin sprays?

Answer 24

immediate release of exertional angina

Question 25

what is the challenge of long term use of nitrate?

Answer 25

tolerance

Question 26

what do calcium blockers do?

Answer 26

decrease calcium influx causing reduction in contraction of myocytes and vascular smooth muscles which decreases oxygen demand
also causes systemic vascular resistance

Question 27

where are Thrombolytics used?

Answer 27

‘pharmacologic management of STEMI’

Question 28

what are lipoproteins?

Answer 28

‘macromolecular aggregates which transport triglycerides and cholesterol in the blood’
triglycerides and cholesterol contained in the hydrophobic core

Question 29

what are Apolipoproteins?

Answer 29

insert themselves into the coat of lipoproteins stabilizing them and acting as ligands

Question 30

what happens during cholesterol transport?

Answer 30

binding of apolipoprotein B100 to LDL receptors encouraged LDL internalization of vesicles and fusion of vesicles with lysosomes
LDL reecptors recycled to surface
lipoprotein particles are hydrolyzed to amino acids
decrease in activity of enzyme controlling cholesterol synthesis
increase Cholesterol storage and export
decrease Uptake of LDL

Question 31

what are the problems with elevated LDL?

Answer 31

transforms into oxidized LDL which effects vascular function

Question 32

what is a widely used treatment for hypercholesterolemia?

Answer 32

‘statins which reduces the extent of hepatic cholesterol synthesis’

Question 33

what is the result in reduction in the extent of hepatic cholesterol synthesis?

Answer 33

‘increased hepatic LDL receptor expression increases clearance of cholesterol containing lipoprotein particles from the
bloodstream’

Question 34

what are the causes of heart failure?

Answer 34

coronary artery disease
Cardiomyothopathies
Hypertension
Valve diseases
Arrhythmias