Ischemic Heart Disease I

Question 1

What is the difference between stable Angina and Acute Vascular Events?

Answer 1

The rupture of plaque/fissure and thrombosis causes effort angina to progress to a vascular event.

Question 2

Treatable Risk Factors for CAD with consequent reduced risk

Answer 2

Smoking
Hypertension
Dyslipidemia

Question 3

Smoking Risk Mechanism

Answer 3

• Thrombogenic Tendency
• Aryl Hydrocarbon Compounds that promote atherosclerosis
• Vasospasm

Question 4

Hypertension Mechanism of Risk

Answer 4

1) Shear stress = direct endothelial cell injury
2) Pathologic cell signaling causing oxidant stress
3) Increased hormone circulation
4) Left Ventricular Hypertrophy

Question 5

Dyslipidemic Triad

Answer 5

High LDL Cholesterol
Low HDL Cholesterol
High Triglycerides
(Independent Risk Factors)

Question 6

Oxidized LDL is…?

Answer 6

Inflammatory & Atherogenic
Injures vascular Endothelium
Causes progressive increase in plaque volume
Activates inflammatory cells and platelets

Question 7

HDL Beneftis

Answer 7

OPPOSES Atherothrombosis

Question 8

What type of risk factors are LDL and HDL

Answer 8

Independent

Question 9

Lipid-laden Macrophages. Where are they? What do they cause?

Answer 9

Reside in the arterial wall plaque and are highly pro-inflammatory

Question 10

Extravascular inflammation risk?

Answer 10

May also increase the risk of atherosclerotic cardiovascular events

Question 11

Circulating markers of inflammation provide information about?

Answer 11

Future CV Risk. Example CRP.

Question 12

Stable Coronary Artery Disease Pathophys

Answer 12

Obstructive coronary lesion limits coronary flow and causes myocardial ischemia

Question 13

Cardinal Symptom of Stable CAD

Answer 13

Angina Pectoris

Question 14

Coronary Circulation Differences from Skeletal Muscle

Answer 14

1) Depends on aerobic metabolism
2) Near-Maximal of O2 is extracted from Coronary arterial blood (must increase blood flow rate)
3) The left ventricle is perfused in DIASTOLE ONLY

Question 15

Autoregulation occurs at the level of

Answer 15

Small Arterioles

Question 16

Autoregulation allows for

Answer 16

Moderate changes in perfusion pressure

Question 17

In CAD, autoregulation is exhausted when

Answer 17

Pressure drops significantly across a stenosis which leads to ischemia

Question 18

Tachycardia can compromise

Answer 18

Coronary Flow!!

Question 19

Frank Spasm is also known as

Answer 19

Rest Angina

Question 20

Increased Vascular tone causes

Answer 20

Exercise-induced angina

Question 21

Decreased Vascular tone causes

Answer 21

NO ANGINA!

Question 22

Stable Angina Treatment: Perfusion Pressure (↑ O2 Supply)

Answer 22

Strategy: Prevent Hypotension

Question 23

Stable Angina Treatment: Diastolic Time (↑ O2 Supply)

Answer 23

Strategy: Rate Slowing Drugs (Beta-Blockers)

Question 24

Stable Angina Treatment: Coronary Resistance (↑ O2 Supply)

Answer 24

Strategy: Vasodilator Drugs (Nitrates, Ca2+ Channel Blockers), coronary angioplasty or bypass surgery

Question 25

Stable Angina Treatment: O2 Content (↑O2 Supply)

Answer 25

Strategy: Treat Anemia and Hypoxemia

Question 26

Factors that increase myocardial O2 Demand

Answer 26

1) Heart Rate
2) Wall Tension
3) Inotropic State

Question 27

Unstable Angina

Answer 27

1) Near-complete occlusion of vessel with thrombus
2) Trop’s usually negative
3) May not result in permanent damage if treated successfully
4) High risk of recurrent events in first year

Question 28

Acute MI

Answer 28

1) Persistent and severe coronary flow reduction
2) Thrombus with complete vessel occlusion
3) Severe and unremitting chest discomfort at rest
4) Reperfusion is the key to treatment

Question 29

Consequences of MI

Answer 29

Within minutes:

1) Diastolic Dysfunction
2) Systolic Dysfunction
3) ECG Signs of MI
4) Symptoms (chest pain, dyspnea, arrythmias)

Within 1 hour:
Myocardial Necrosis and infarction!

Question 30

Markers of Vascular Inflammation and Myocardial injury in unstable CAD

Answer 30

CRP
Troponin
Creatine Kinase