L9,10 Pathology of the heart

Question 1

What does the left anterior descending (LAD) artery supply? (3)

Answer 1

1. anterior wall of left ventricle
2. anterior 2/3 of IV septum
3. apex

Question 2

What does the right coronary artery supply? (3)

Answer 2

1. Posterior wall of LV
2. Posterior 1/3 of IV septum
3. Right ventricle

Question 3

Which artery supplies the lateral wall of left ventricle?

Answer 3

Left circumflex artery

Question 4

Name the arteries in descending order of incidence of ischemic heart disease.

Answer 4

1. LAD 50%
2. Right coronary artery 30%
3. Left circumflex artery 20%

Question 5

Posterior interventricular artery/ posterior descending artery supplies?
It is from which 2 arteries?

Answer 5

supply AV node

From
90% RCA
10% left circumflex artery

Question 6

What is the MC of ischemic heart disease?

Answer 6

Coronary atherosclerosis

Question 7

What are the 4 clinical manifestations of ischemic heart disease?

Answer 7

1. Stable angina 
Acute coronary syndrome
2. Unstable angina
3. STEMI
4. NSTEMI

Question 8

What are the main differences between stable angina and acute coronary syndrome?

Answer 8

Stable angina: pain on exertion
ACS:
Chest pain at rest

Question 9

Stable angina is chronic ischemic heart disease with ?

Answer 9

Chronic heart failure - progressive cardiac decompensation

Question 10

Difference of STEMI and NSTEMI other than in ECG?

Answer 10

STEMI: transmural MI
NSTEMI: sub-endocardial MI

Question 11

Which part of the myocardium is most vulnerable to ischemia?(1) Why? (2)

Answer 11

Subendocardial myocardium
1. Last area to receive blood from epicardial coronary arteries > more susceptible to cardiac compression during systole

2. Blood flow restricted to diastole

Question 12

Chronic vs acute atherosclerotic lesion?

Answer 12

1. Chronic atherosclerotic lesion
   - Coronary artery occluded at slow rate > collateral perfusions are developed > protected against MI
2. Acute
   - infarction
   - acute plaque changes - rupture/fissuring/ulceration of plagues, intra-plague hemorrhage
   - subendothelial collagen and thrombogenic necrotic material exposed
3. platelet aggregation: mechanical occlusion + TXA2-induced thrombosis & vasospasm
4. Tissue factors activate coagulation cascade

Question 13

What is acute myocardial infarction?

Answer 13

irreversible ischemic necrosis of myocardium

Question 14

What are the 2 patterns of AMI?

Answer 14

1. Transmural necrosis (STEMI)
   - fullness of ventricle, usually due to chronic atherosclerosis + acute thrombosis, ST elevation + Q wave
2. Subendocardial necrosis (NSTEMI)
   - inner 1/3 myocardium due to transient ischemia, Q wave absent

Question 15

Most common complication of acute myocardial infarction?

Answer 15

Arrhythmia;

ventricular arrhythmia as the most common cause of death

Question 16

Most common complication of acute myocardial infarction?

Answer 16

Arrhythmia;

ventricular fibrillation as the most common cause of death