week 3 : acute coronary syndromes

Question 1

what is arteriosclerosis ? and how it is different from atherosclerosis ?

and what are the most common arteries affected ?

Answer 1

hardening and thicking of arterial wall causing the loss of elasticity

atherosclerosis : chronic inflammatory disorder
in medium and large arteries
buildup of cholesterol plaques

1 abdominal aorta
2 coronary
3 popliteal
4 carotid

Question 2

what are the characteristic changes in chronic stable angina in each of the following ?

vessels
ischemia
predictability
safety
effect of GTN spray

Answer 2

1 fixed stenosis
2 demand led ischemia, demand of oxygen causes angina
3 predictable
4 safe
5 get relieved

Question 3

how atherosclerosis take place?

Answer 3

endothelium damage
accumulation of the ldl
entry of the macrophages
formation of the form cells
fatty streak
platelets and endothelial cells stimulate smooth muscle cell proliferation and migration from media to the intima
formation of plaque : can cause stable angina
rapture of the plaque ; formation of fibrin clot

Question 4

what are coronary artery disease ?
and what is acute coronary syndrome ?

Answer 4

stable angina
variable angina
acute coronary syndrome

unstable angina
NSTEMI
STEMI
chronic ischemic heart disease
sudden cardiac death

Question 5

difference between chronic stable angina and the acute coronary syndrome

Answer 5

chronic stable angina
fixed stenosis
demand led ischemia
predictable
safe
acute coronary syndrome
dynamic stenosis
supply led ischemia
unpredictable
dangerous

Question 6

steps in platelet plug formation

Answer 6

primary hemostasis
endothelial damage
exposure
adhesion :attachment of vwf
activation : adp and thromboxane
A2
aggregation : accumulation of more
platelets
secondary hemostasis
fibrin clot formation

Question 7

What is the immediate complication of the STEMI ?

Answer 7

atrial fibrillation

Question 9

symptoms of mi

Answer 9

severe central chest pain
radiating to jaw and arm, usually to left
similar to angina but more severe and prolonged
associated with sweating, nausea and vomiting

Question 10

what are the durations of pain for angina and MI ?

effect of GTN spray

associated symptoms

Answer 10

angina : 10 min, relief, none
MI ; 30 min, no effect, sweating, nausea, vomiting

Question 11

ECG changes in STEMI

Answer 11

st segment elevation
t- wave inversion
q wave formation,

Question 12

early treatment of STMI

Answer 12

analgesia : morphine IV
anti-emetic IV
aspirin 300mg
clopidogrel 600mg
GTN if BP>90mmHg
oxygen if hypoxic
primary angioplasty
thrombolysis (if angioplasty not available within 120 minutes)

treatment is based on the prevention of activation of platelet aggregation
using aspirin and clopidogrel
and in some cases PCI

Question 13

mode of action of aspirin and clopidogrel

Answer 13

aspirin inhibits the COX enzyme which produces thromboxane A2 (platelet aggregator)

clopidogrel binds to the adp receptors present on the surface of platelet, resulting in inhibition of platelet aggregation.

Question 14

risk of thrombolytic therapy

Answer 14

failure to re-perfuse
hemorrhage
hypersensitivity

Question 15

what are the complications of MI?

Answer 15

structural : (cardiac rupture
ventricular septal defect
mitral valve regurgitation)
functional :(ventricular disfunction)
arrhythmic:(Afib)
death

Question 16

Diagnostic biomarkers for MI

Answer 16

troponin complex
TnT TnI these are the preferred biomarkers as they are nearly absolute myocardial specific