Ischaemic Heart Disease

Question 1

What are the signs and symptoms of angina?

Answer 1

• strangling sensation in the chest
• pain in left shoulder/arm
• breathlessness
• nausea
• sweating
• pale skin

Question 2

What are the three main coronary arteries?

Answer 2

• Right Coronary Artery
• Left Circumflex Branch
• Left Anterior Descending branch

Question 3

What are the three main properties of the coronary circulation?

Answer 3

• High basal rate of Oxygen
• High Capillary Density
• High Oxygen Extraction

Question 4

What are three problems associated with coronary circulation?

Answer 4

• Oxygen extraction is at a high rate
• Systole impairs coronary perfusion
• Coronary arteries are end arteries

Question 5

What three things can cause poor myocardial perfusion?

Answer 5

• Coronary artery narrowing (atheroma, thrombus,vasospasm)
• Aortic valve stenosis (filling of heart chamber leads to compression of endocardial arteries)
• Increased heart rate

Question 6

What are the risk factors for atherosclerosis?

Answer 6

Arterial hypertension

• dyslipidaemia
• cigarette smoking

Question 7

What does myocardial ischaemia lead to?

Answer 7

• DNA fragmentation
• Membrane damage
• Cell death infarct (dysrhythmias,cardiac work)
• Pain (dysrhythmias,cardiac work, sympathetic activity)

Question 8

What are three ways to diagnose ischaemic heart disease?

Answer 8

• ECG (stressed/relax)
• Angiogram
• Biochemical Markers (aspartate transaminase, lactate dehydrogenase, Creatine Kinase and Troponin C)

Question 9

What is the role of Beta-adrenoceptor blockers (2 examples)?

Answer 9

• Reduce HR
• Prevent Response to exercise
• Reduce force of contraction
• Reduce arterial BP
• Decrease demand
• Increase Perfusion

(atenolol/propranalol)

Question 10

What is the role of Nitrates (1 example)?

Answer 10

• Smooth muscle relaxed
• Reduce cardiac load
• Aids coronary perfusion (glycerol trinitrate)

Question 11

What is the role of Calcium channel blockers (2 examples)?

Answer 11

• Inhibit calcium influx to VSM / Cardiomyocytes/Conducting cells
• Aid coronary perfusion
• Reduce HR
• Reduce Afterload

(Amlodipine/Verapamil)

Question 12

What is the role of ACE inhibitors (2 examples)?

Answer 12

Reduce preload, reduce afterload

(captopril/enalapril).

• widen, or dilate, your blood vessels.
• increases the amount of blood your heart pumps
• lowers blood pressure.
• They also raise blood flow, which helps to lower your heart’s workload.

Question 13

What are four drugs to prevent thrombus formation?

Answer 13

• Aspirin/Clopidogrel (stop platelet adhesion)
• Heparin (anticoagulant)
• Fibrinolytic agents

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Question 14

What are three non-pharmacological interventions?

Answer 14

• Coronary Artery Bypass
• Angiplasty- balloon widen artery
• Angiogenesis - new blood vessels form from pre-existing