Symposium: Ischaemic Heart Disease and Heart failure

Question 1

What is ischaemic heart disease?

Answer 1

cardiac muscle dysfunction due to inadequate blood supply to the myocardium

Question 2

What are the two causes of ischaemic heart disease?

Answer 2

1) cardiac artery permanent obstruction caused by a thrombus

2) cardiac artery lumen narrowing by atheroma or myocardial hypertrophy

Question 3

Which layer of the heart contains the coronary vessels?

Answer 3

epicardium

Question 4

Describe the pathogenesis of ischaemic heart disease: (3)

Answer 4

1) a coronary artery is occluded

2) this causes acute/ coronary ischaemia

3) which causes myocyte dysfunction or death

Question 5

What are the two syndromes that ischaemic heart disease can be split into?

Answer 5

1) angina pectoris

2) acute coronary syndrome

Question 6

What is angina pectoris?

Answer 6

chest pain caused by transient ischaemia but doesn’t cause ischaemia

Question 7

What is stable angina?

Answer 7

exercise induced chest pain relieved by rest or nitro-glycerine

Question 8

What is unstable angina?

Answer 8

Chest pain that occurs at rest

Question 9

What is Prinzmetal’s angina?

Answer 9

angina at rest due to coronary artery spasm

Question 10

What are the three types of acute coronary syndrome?

Answer 10

1) acute myocardial infarction

2) unstable angina

3) sudden cardiac death

Question 11

What is an NSTEMI?

Answer 11

infarction of subendocardial myocardium which is poorly perfused, in a hypotensive episode and atheromatous occlusion

Question 12

Give 5 blood markers used for identifying cardiomyocyte damage:

Answer 12

1) troponins T and I

2) creatine kinase

3) myoglobin

4) lactate dehydrogenase isoenzyme 1

5) aspartate transaminase

Question 13

How many afters after an MI are most blood markers detectable?

Answer 13

2-3 hours

Question 14

When are troponins T and I at their peak level following an MI?

Answer 14

12-48 hours after the MI

Question 15

True or false: troponins T and I are raised not just in MIS but also PEs and heart failure

Answer 15

True

Question 16

For how many days does troponin remain detectable in the blood following an MI?

Answer 16

7 days

Question 17

When are creatine kinase levels at their peak following an MI?

Answer 17

10-14 hours after the MI

Question 18

For how many days does creatine kinase remain detectable in the blood following an MI?

Answer 18

3 days

Question 19

True or false: myoglobin is not just seen in cardiac damage, but skeletal muscle damage too

Answer 19

True

Question 20

Why is aspartate transaminase a less useful MI marker?

Answer 20

it is also detected in liver disease

Question 21

When do myoglobin levels peak following an MI?

Answer 21

2 hours after the MI

Question 22

What does the MONA MI treatment plan stand for

Answer 22

1) morphine

2) oxygen

3) nitrates

4) aspirin

Question 23

What is the name of the MI treatment that stents vessels during an angiogram?

Answer 23

percutaneous coronary intervention

Question 24

Give 6 complications of MIs:

Answer 24

1) arrhythmias

2) ventricular fibrillation

3) left ventricular failure

4) myocardial rupture

5) haemopericardium

6) mural thrombus

Question 25

What is a mural thrombus?

Answer 25

a thrombus on the walls of a heart chamber

Question 26

Give 6 key symptoms of heart failure:

Answer 26

1) dyspnoea

2) fatigue

3) weak pulse

4) pitting oedema

5) hypotension

6) pale skin

Question 27

What is the most common cause of heart failure?

Answer 27

progressive deterioration of myocardial contractibility

Question 28

Describe how ischaemic heart disease can cause heart failure:

Answer 28

it causes weakening of the myocardium, causing hypertrophy or thinning of the heart wall, which has less contractability meaning the heart cannot pump blood to meet metabolic demands

Question 29

Describe the effects of right sided heart failure:

Answer 29

blood pools and congests in peripheral tissues

Question 30

Describe the effects of left sided heart failure:

Answer 30

blood pulls in lungs and pulmonary veins causing pulmonary oedema and hypoxia

Question 31

What is the classification system of heart failure

Answer 31

NYHA (I is normal while IV is severe)

Question 32

Give 5 complications of heart failure:

Answer 32

1) arrhythmias

2) thromboembolism (stroke, PE)

3) pulmonary congestion

4) muscle wasting

5) hepatic congestion and dysfunction