Symposium: Ischaemic Heart Disease and Heart failure Flashcards
What is ischaemic heart disease?
cardiac muscle dysfunction due to inadequate blood supply to the myocardium
What are the two causes of ischaemic heart disease?
1) cardiac artery permanent obstruction caused by a thrombus
2) cardiac artery lumen narrowing by atheroma or myocardial hypertrophy
Which layer of the heart contains the coronary vessels?
epicardium
Describe the pathogenesis of ischaemic heart disease: (3)
1) a coronary artery is occluded
2) this causes acute/ coronary ischaemia
3) which causes myocyte dysfunction or death
What are the two syndromes that ischaemic heart disease can be split into?
1) angina pectoris
2) acute coronary syndrome
What is angina pectoris?
chest pain caused by transient ischaemia but doesn’t cause ischaemia
What is stable angina?
exercise induced chest pain relieved by rest or nitro-glycerine
What is unstable angina?
Chest pain that occurs at rest
What is Prinzmetal’s angina?
angina at rest due to coronary artery spasm
What are the three types of acute coronary syndrome?
1) acute myocardial infarction
2) unstable angina
3) sudden cardiac death
What is an NSTEMI?
infarction of subendocardial myocardium which is poorly perfused, in a hypotensive episode and atheromatous occlusion
Give 5 blood markers used for identifying cardiomyocyte damage:
1) troponins T and I
2) creatine kinase
3) myoglobin
4) lactate dehydrogenase isoenzyme 1
5) aspartate transaminase
How many afters after an MI are most blood markers detectable?
2-3 hours
When are troponins T and I at their peak level following an MI?
12-48 hours after the MI
True or false: troponins T and I are raised not just in MIS but also PEs and heart failure
True
For how many days does troponin remain detectable in the blood following an MI?
7 days
When are creatine kinase levels at their peak following an MI?
10-14 hours after the MI
For how many days does creatine kinase remain detectable in the blood following an MI?
3 days
True or false: myoglobin is not just seen in cardiac damage, but skeletal muscle damage too
True
Why is aspartate transaminase a less useful MI marker?
it is also detected in liver disease
When do myoglobin levels peak following an MI?
2 hours after the MI
What does the MONA MI treatment plan stand for
1) morphine
2) oxygen
3) nitrates
4) aspirin
What is the name of the MI treatment that stents vessels during an angiogram?
percutaneous coronary intervention
Give 6 complications of MIs:
1) arrhythmias
2) ventricular fibrillation
3) left ventricular failure
4) myocardial rupture
5) haemopericardium
6) mural thrombus
What is a mural thrombus?
a thrombus on the walls of a heart chamber
Give 6 key symptoms of heart failure:
1) dyspnoea
2) fatigue
3) weak pulse
4) pitting oedema
5) hypotension
6) pale skin
What is the most common cause of heart failure?
progressive deterioration of myocardial contractibility
Describe how ischaemic heart disease can cause heart failure:
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
Describe the effects of right sided heart failure:
blood pools and congests in peripheral tissues
Describe the effects of left sided heart failure:
blood pulls in lungs and pulmonary veins causing pulmonary oedema and hypoxia
What is the classification system of heart failure
NYHA (I is normal while IV is severe)
Give 5 complications of heart failure:
1) arrhythmias
2) thromboembolism (stroke, PE)
3) pulmonary congestion
4) muscle wasting
5) hepatic congestion and dysfunction
