Ischemic Heart Disease I

Question 1

Atherosclerosis has a _______ asymptomatic period.

Answer 1

long

Question 2

List the stages of coronary artery occlusion.

Answer 2

(1) normal; (2) fatty streak; (3) fibrous plaque; (4) occlusive plaque; and (5) rupture plaque

Question 3

Smoking increases risk of coronary artery disease by _________.

Answer 3

50%

Question 4

Describe the mechanisms by which hypertension leads to coronary artery disease.

Answer 4

It (1) increases shearing stress; (2) increases tension on vessel walls; (3) circulating hypertension hormones have negative effects on endothelial walls; and (4) causes hypertrophic cardiomyopathy.

Question 5

What is the dyslipidemic triad?

Answer 5

High LDL, low HDL, and high triglycerides

Question 6

Why is LDL deleterious?

Answer 6

When oxidized, it becomes pro-inflammatory and atherogenic

Question 7

Why is HDL beneficial?

Answer 7

It prevents the oxidation of LDL and has anti-inflammatory and anti-thrombotic effects.

Question 8

Lipid-laden macrophages are __________.

Answer 8

pro-inflammatory

Question 9

Inflammation, cholesterol, HDL, and LDL are ____________.

Answer 9

independent predictors of CAD risk

Question 10

What is stable angina?

Answer 10

A form of CAD in which the coronary arteries are only partially occluded, leading to angina upon exertion.

Question 11

What are some metabolic differences between skeletal muscle and cardiac muscle?

Answer 11

Even at rest, a near-maximal amount of oxygen is extracted from the coronary arteries; thus, in response to increased demand, the heart has to increase flow of blood.

Question 12

The drop in pressure across an occlusion is dependent on ______________.

Answer 12

the length of the plaque and the diameter of the occlusion

Question 13

What is autoregulation?

Answer 13

The coronary arteries automatically dilate and constrict in response to changes in pressure such that flow stays constant.

Question 14

What factors increase myocardial oxygen demand?

Answer 14

Heart rate, contractility, and wall tension

Question 15

Myocardial infarction is distinguished from unstable angina by ___________ at rest.

Answer 15

severe, unremitting angina at rest

Question 16

Deaths due to coronary heart disease have been decreasing since 1968 owing to better ___________.

Answer 16

anti-hypertensive medications and statins

Question 17

What are three factors that have been shown to increase risk of ischemic heart disease?

Answer 17

Smoking, hypertension, and dyslipidemia

Question 18

Even at rest, the myocardium extracts _______________.

Answer 18

a near-maximum amount of oxygen from the coronary arteries, so to increase oxygen the heart must increase flow

Question 19

Autoregulation is controlled at the level of the ____________.

Answer 19

small arterioles

Question 20

What are four pathophysiologies and treatment strategies for chronic stable angina due to decreased oxygen supply?

Answer 20

(1) for decreased perfusion pressure, treat the hypotension; (2) for decreased diastolic time, give ß-blockers; (3) for increased coronary resistance, give vasodilators; (4) for decreased oxygen content, treat the anemia or hypoxemia.

Question 21

What are four pathophysiologies and treatment strategies for chronic stable angina due to increased oxygen demand?

Answer 21

(1) for increased systolic pressure, treat the hypertension; (2) for increased heart rate, give rate-controlling agents; (3) for increased wall tension, give agents to reduce ventricle dilation; (4) for increased inotropic states, give agents that inhibit contractility.

Question 22

In terms of vessel occlusion, untable angina is defined as ___________.

Answer 22

near-complete occlusion of the vessel

Question 23

Troponin is usually _________ is unstable angina.

Answer 23

normal

Question 24

Nearly 100% of cells in the affected area will be dead at ______ minutes.

Answer 24

4.5