Robbins 9th ed - Chapter 12 - The Heart - Ischaemic Heart Disease (1)

Question 1

Atherosclerosis is the cause of reduced coronary perfusion in 90% of cases of IHD. What are three other causes of reduced coronary perfusion?

Answer 1

Vasospasm.
Arteritis.
Systemic hypoperfusion.
Emboli (e.g. from LA in AF).

Question 2

Atherosclerosis is the cause of reduced coronary perfusion in 90% of cases of IHD. Superimposed on this factor, what factors will bring about ischaemia?

Answer 2

Increased myocardial oxygen demand:
-	Tachycardia (Exercise, Fever, etc)
-	Hypertrophy
Reduced oxygen transport:
-	Anaemia
-	Lung disease
-	Carbon monoxide poisoning

Question 3

What are the three vessels involved in “triple vessel disease”?

Answer 3

LAD, Left circumflex, RCA

Question 4

What is the difference between stable angina and unstable angina (in terms of pathology)?

Answer 4

Stable angina does not involve plaque disruption. Unstable angina involves plaque disruption (resulting in thrombosis and vasoconstriction), but the reduction in coronary flow is still transient (as opposed to AMI, which is a permanent reduction in coronary flow).

Question 5

What is an eccentric plaque? What is a concentric plaque?

Answer 5

Concentric means “having the same centre”: these plaques involve the entire circumference of the vessel wall and are symmetrical, with the lumen remaining in the centre. Eccentric plaques are asymmetrical, pushing the lumen to one side. Eccentric plaques have a higher risk of acute plaque change.

Question 6

What are the rates of death from IHD in the developed world?

Answer 6

One in six deaths in USA in 2008.

Question 7

What stimulates vasospasm in people with coronary artery atherosclerosis?

Answer 7

During acute plaque change, platelets adhere and release mediators (thromboxane A2 and serotonin) that stimulate vasospasm.

Question 8

What are the predominant locations of atherosclerosis in coronary arteries?

Answer 8

The first few centimetres of the LAD and/or the LCX.

Question 9

With regard to timecourse, what is the definition of angina pectoris?

Answer 9

Myocardial ischaemia lasts 15 seconds to 15 minutes, WITHOUT cellular necrosis.

Question 10

What is Prinzmetal variant angina?

Answer 10

This does not involve atherosclerosis, but rather episodic and atypical angina due to coronary artery spasm.