Ischaemic Heart Disease

Question 1

What does atheroscleortic coronary disease cause?

Answer 1

• Chronic coronary insufficiency
  
  • Angina
• Unstable coronary disease
  
  • MI or sudeen ischaemic coronary death
• Heart failure
• arrythmia
  
  • acute ischaemic
  • Scar related

Question 2

Epicardial

Answer 2

Outer surface of the heart

Question 3

Endocardial =

Answer 3

inner surface of the heart

Question 4

subendocardial region =

Answer 4

water-shed area of perfusion and first to become ischaemic

Question 5

Types of coronary artery imaging in humans

Answer 5

• Coronary angiography
• CT
• MRI

Question 6

What are the risk factors for atherosclerotic coronary artery disease?

Answer 6

• age
• hypertension
• hypercholestrolemia
• smoking
• diabetes
• obesity
• physical inactivity

Question 7

Patholoy of an atherosclerotic plaque

Answer 7

• Fatty streak
• fibro-fatty plaue - fibrous cap forms over it
• Plaque distribution
  
  • rupture
  • corrosion

Question 8

How do plaques form?

Answer 8

• Disturbance to the endothelium
• upregulation of adhesion molecules
• Traps monocytes and macrophages which sit in the sub endothelial layer
• uptake of oxidised LDL forming foam cells
• Foam cells released cytokines caused release of collagen

Question 9

Symptoms of angina

Answer 9

• gripping central chest pain
• radiation to the arm, jaw and teeth
• clear and precise relationship to exercise
• worse after food and in the cold
• no autonomic fibres
• flat of hand/fist to describe pain

Question 10

Cause of angina?

Answer 10

sub-endocardial ischaemia

Question 11

Mechanisms in realtion to basic physiology of angina

Answer 11

Mismatch of blood supply to demand because of epicardial stenosis

Supply = coronary blood flow

demand = myocardial oxygen consumption

Question 12

What was coronary flow reserve be able to accomodate?

Answer 12

myocardial O₂ demand

Question 13

What are the 2 regulatory systems that control coronary circulation?

Answer 13

• autoregulation (myogenic control)
• metabolic regulation

Question 14

What are the determinants of myocardial oxygen consumption?

Answer 14

Varibale per unit mass of tissue:

• Tension development - LV pressure and volume
• Contractility
• HR

Fixed per unit mass of tissue = basal activity

Mass of tissue

Question 15

tests of inducible ischaemia

Answer 15

• exercise stress test
• dobutamine stress echo
• myocardial perfusion imaging with either exercise or pharmacological stress
• cardia magnetic resoance imaging (cMR)

Question 16

Anatomica assessment of coronary disease

Answer 16

• CT coronary angiography
• invasive angiography (more accurate)

Question 17

Anatomic and functional assessment of coronary disease

Answer 17

• Invasive angiography and fractional flow reserve (FFR)
• cMR
• Novel CT

Question 18

What are the aims of drug treatment of angina?

Answer 18

Reductaion in myocardial oxygen consumption

Reducation in the variability of coronary flow reserve

Question 19

What techniques are used for revascularisation?

Answer 19

Percutaneous coronary intervention (stents and balloons)

Coronary artery bypass grafting (CABG)

Question 20

What is the clinical presentation of an MI?

Answer 20

Chest pain - severe

Associated autonomic symptoms; nausea, sweating, terror

Breathlessness

Question 21

Causes of myocardial infarction?

Answer 21

1. Plaque rupture
2. Plaque erosion
3. Coronary embolism
4. Coronary artery spasm/drugs
5. coronary anaomaly
6. spontaneous coronary dissection

Question 22

Events modifying presentation of an MI

Answer 22

• Time of day
• inflammatory activity
• infection
• elevation of BP
• Catecholamines

Question 23

Raised cardiomyocyte markers in the blood during an MI

Answer 23

• Troponin
• Creatine kinase MB isoform (CKMB)
• Creatine phosphokinase (CPK)
• AST
• Myoglobin

Question 24

Immediate consequences of a STEMI

Answer 24

• Ventricular arrhytmia and death
• Acute left HF

Question 25

Early complications of a STEMI

Answer 25

• Myocardial rupture
• Mitral valve insufficiency
• Ventricular septal defect
• Mural thrombosis and embolisation

Question 26

Late complications of a STEMI

Answer 26

• LV dilation and heart failure
• Arrhythmia
• recurrent myocardial infarction