Module 6

Question 1

Artherosclerosis

Answer 1

disease of the arteries that leads to plaque and fatty material building up in the inner walls

Question 2

What does myocardial oxygen supply depend on?

Answer 2

Quantity of oxygen and the rate of which coronary blood is flowing.

Question 3

What determines oxygen content

Answer 3

hemoglobin content and systemic oxygenation

Question 4

What does coronary blood flow depend on

Answer 4

coronary perfusion pressure
coronary vascular resistance 
external compression
intrinsic regulation
local metabolites
endothelial factors
neural innervations

Question 5

What does myocardial oxygen demand depend on?

Answer 5

ventricular wall stress, heart rate and contractility

Question 6

Endothelial(interior surface of blood vessels) dysfunction

Answer 6

contributes to ischemia by causing inappropriate vasoconstriction(narrowing of blood vessels) and loss of normal antithrombotic(reduction in blood clots) properties.

Question 7

Vasoconstriction

Answer 7

narrowing of blood vessels that occur because not enough nitric oxide(vasodilator) is released. Can be amplified in individuals with coronary artery disease(CAD) who already have notably reduced vasoconstriction.

Question 8

Atherosclerosis risk factors

Answer 8

Non modifiable- age, gender, family history
modifiable(can be changed for primary and secondary prevention)- smoking, hypertension, dyslipidemia, diabetes mellitus, estrogen deficiency, inactivity and obesity.

Question 9

Stable angina

Answer 9

Chronic and predictable- brought on by exertion or emotional stress. caused by either fixed or obstructive plaque in one or more arteries. Retrosternal pain that can radiate to other parts of the chest, left arm, shoulder, lower jaw or neck. Does not vary with movement(even breathing) and an attack is usually under 10 min. ECG changes include temporary ST depression without permanent myocardial damage.

Question 10

Unstable angina

Answer 10

when stable angina suddenly increases in frequency and starts to occur in lesser period of exercise or even at rest. In many cases it is followed by myocardial infarction. Most patients have history of stable angina related to severe artherosclerosis.

Question 11

Variant angina

Answer 11

random episode of chest pain (often at rest with ST segment elevation) caused by a coronary artery spasm with no atherosclerotic lesion. usually episodes are self limiting but can be prevented or terminated by calcium channel blockers or nitrates. Diagnosis can be confirmed by injecting ergonovine (vasoconstrictor) in supervised conditions during coronary arteriography

Question 12

Coronary Arteriography

Answer 12

a procedure where a catheter is threaded through an artery in the groin, neck or arm to the coronary arteries. Dye is put into the coronary arteries with the catheter and X-rays of the heart (angiogram) are taken. Useful in diagnosis of CAD.

Question 13

Silent Ischemia

Answer 13

no noticeable discomfort (asymptomatic). May occur in patients with symptomatic angina as well. May be the only sign of CAD in some cases- requires detection by lab and ECG techniques.

Question 14

Syndrome X

Answer 14

Chest pain that seems to be ischemic in origin with no significant arteriosclerosis.
basis of pain could be caused by:
-inadequate vasodilator reserve of the coronary resistance vessels
-microvascular dysfunction, vasospasm, and sensitivity to pain.

Question 15

Angina Pectoris

Answer 15

Chest pain caused by myocardial oxygen demand exceeding supply.
Most common symptom of myocardial ischemia