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Flashcards in 126 Angina Deck (70)
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Define hypoxia

Lack of O2 in tissues leading to decreased aerobic oxidative respiration followed by cell injury


Define ichaemia

INadequate blood flow to a part of the body caused by constriction or occlusion of artery or decreased venous drainage leading to lack of O2 and essential metabolites 


What are the 4 things which cause cell damage?

  1. Decreased ATP
  2. Membrane damage
  3. Increased intracellular calcium
  4. Increase in O2 derived free radicals


What is the outcome when there's decreased ATP in the cell?

  • decreased Na+/K+ pump therefor influx of Ca2+, H2O and Na+ and efflux of K+ causing ER swelling and loss of microvilli
  • Increased anaerobic glycolysis ---> decreased glycogen and decreased pH --> clumping of chromatin
    • detachment of ribosomes meaning decreased protein synthesis


What is the outcome of membrane damage of a cell?

  • decreased ATP synthesis including decreased phosphlipid synthesis
  • increased intracellular Ca2+ which activates phospholipases and proteases which causes breakdown of the cytoskeleton



Which 4 enzymes are activated by increased intracellular calcium during cell injury?

  1. ATPase
  2. Phospholipase
  3. Protease - breakdown of the cytoskeleton and membrane
  4. Endonuclease - breakdown of chromatin


What is reperfusion injury?

Reperfusion of ischaemic tissues - the WBC returning to the tissues release ILs and free radicals which further damages the cells. Re-introduction of O2 to the tissue causes damage to proteins, DNA and cell membrane


What is the contents of the core of an artherosclerotic plaque?

  • LDL cholesterol
  • cellular debris
  • cholesterol crystals
  • foam cells


Which cells form foam cells within the core of an artherosclerotic plaque?



What is the initial step in the formation of an atherosclerotic plaque?

Irritation of the endothelium causing endothelial dysfunction


What do foam cells release within an atherosclerotic plaque?

Proteinases which break down collagen


Which layer of the artery wall does LDL cholesterol accumulate in to cause formation of an atherosclerotic plaque?

Tunica intima


Which cells form the fibrous cap on an atherosclerotic plaque?

Smooth muscle cells - lay down collagen, elastin and proteoglycan


Which cells are seen in histology of myocardium 4-12 hours post MI?



How long after an MI does coagulation necrosis start?

4-12 hours


How long after an MI does neutrophil infiltration start?

12-24 hours


How long after an MI does phagocytosis of myocardium by macrophages happen?

3-7 days


Define angina pectoris

Reversible ischaemia to the myocardium brought on by increased workload and releived by rest which is normally caused by CAD


Name the 4 life threatening causes of chest pain

  1. MI
  2. PE
  3. TnPTx
  4. Dissecting aortic aneurism


Name some pulmonary causes of chest pain (4 listed)

  1. PE
  2. TnPTx
  3. Pneumonia
  4. Pleuritis



Name some GIT causes of chest pain (8 listed)

  • oesophagitis
  • oesophageal spasm
  • reflux
  • cholecystitis
  • cholecholithiasis
  • ascening cholangitis
  • peptic ulcer
  • pancreatitis


Name 3 causes of non-atherosclerotic CAD (6 listed)

  1. congenital anomalies of the coronary arteries
  2. arteritis
  3. coronary ectasia (abnormal dilation of the coronary arteries)
  4. Radiotherapy induced CAD
  5. Syndrome X (normal coronary arteries but with micrvascular disease)
  6. Prinzmentals angina


What is syndrome X?

Angina but with normal coronary arteries - microvascular disease


What is Prinzmentals angina?

Spasm of the coronary arteries which happens cyclically - even at rest.


What is defined as Class I angina?

Pain with strenuous excercise


What is defined as Class IV angina?

Inability to perform activities of daily living and angina at rest


Which functional tests can be performed to diagnose angina? (5 listed)

  • ETT
  • Stress echo
  • Myocardium perfusion testing
  • PET scan
  • Stress MRI



Which drug is used in a stress echo for diagnosis of angina? What is its MOA?

Dobutamine - cardiac stimulant action by directly stimulating β1 receptors to increase contractility and stroke volume


Which drug is used in myocardial perfusion testing (scintigraphy)? MOA?

Adenosine - inhibits slow inward Ca2+  current and activation of adenylate cyclase in SM cells --> relaxation and increased blood flow to coronary arteries.

Relatively low perfusion seen in stenotic coronary arteries


Which anatomical tests enables visualisation of the histology of the coronary arteries?

Invasive coronary angiography with intravascular ultrasound