L1: coronary artery disease

Question 1

what is the main cause of coronary artery disease?

Answer 1

atherosclerosis of coronary arteries with thrombus formation

Question 2

what is the cause of most acute coronary syndromes ?

Answer 2

plaque rupturing leading to sudden occlusion of vessel

Question 3

risk factors for ischemic heart disease other than the obvious ones :

Answer 3

-impaired glucose tolerance

-poly-saturated fatty acid deficiencies

-hyperfibrinogenemia and hyperhomocysteinemia

-low levels of antioxidant vitamins (A,C,E)

-Protein S and C deficiencies

Question 4

transient myocardial ischemia :

Answer 4

angina pectoris, occurring due to imbalance between oxygen requirement and supply

Question 5

risk factors of coronary artery disease presenting during physical examination :

Answer 5

-precipitating diseases :
anemia
thyrotoxicosis
obesity
aortic valve disease
pregnancy
arrhythmias

-left ventricular failure :
signs of LVF:
basal crept , crackles , cardiomegaly , 3rd heart sound and murmur of papillary muscle dysfunction

-signs of atherosclerosis :
bruits on carotid vessels
weak pulse
xanthomas for hyperlipidemia

Question 6

acute coronary syndrome includes:

Answer 6

unstable angina
non ST elevation myocardial infarction
ST elevation myocardial infarction

Question 7

ST or non ST classification is used to :

Answer 7

guide which patients should be considered fro acute reperfusion therapy

Question 8

signs of myocardial infarction :

Answer 8

signs of sympathetic over-activity :
pallor / perspiration / tachycardia

signs of vagal stimulation :
bradycardia

sings of myocardial dysfunction(LVF):
cold extremities , oligouria , hypotension , low pulse pressure , quite first heart sound , 3rd heart sound , diffuse apical impulse , fine crackles at base of lung

signs of tissue damage :
fever / leucocytosis / raised ESR

signs of pericarditis :

Question 9

blood tests done as myocardial infarction investigations :

Answer 9

creatine kinase MB
cardiac troponins T and I
AST
LDH

Question 10

Signs that indicate myocardial infarction apon x-ray of chest :

Answer 10

acute pulmonary edema or congestion

Question 11

echocardiography :

Answer 11

assess ventricular function and detects complications such as ventricular septal or chordae tendinea rupture producing acute mitral regulation and pericardial effusion

Question 12

emergency treatment of myocardial infarction :

Answer 12

-aspirin (150-300mg to be chewed)

-sublingual glyceryl trinitrate sublingually (0.4-1mg)

-oxygen (2-4L/min)

Question 13

immediate complications of acute myocardial infarction :

Answer 13

arrhythmias and conduction disturbances :
* Sinus bradycardia
* Ventricular ectopics
* Ventricular tachycardia
* Ventricular fibrillation
* Idioventricular rhythm
* Atrial fibrillation
* Heart block

post myocardial angina

acute circulatory failure

pericarditis

mechanical complications :
* Papillary muscle dysfunction or rupture
* Rupture of interventricular septum
* Rupture of ventricle

thrombosis and embolisim

sudden death

Question 14

late complications of acute myocardial infarction :

Answer 14

post-myocardial infraction syndrome (Dressler’s syndrome)

ventricular aneurysm