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cardiovascular > Ischaemic Heart Disease > Flashcards

Ischaemic Heart Disease Flashcards

1
Q

What part of the heart does the LAD supply?

A

The anterior part of the LV, the anterior part of the RV and the anterior 2/3rds of the IV septum

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2
Q

What part of the heart does the circumflex artery supply?

A

The lateral LV

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3
Q

What part of the heart does the posterior descending artery supply?

A

Inferior part of the LV, inferior part of the RV and posterior 1/3rd of the IV septum

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4
Q

What does the oxygen supply to the heart depend on?

A

oxygen content of blood and myocardial blood flow

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5
Q

What determines myocardial blood flow?

A

Perfusion pressure (pressure inside aorta), vascular resistance (effected by external pressure)

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6
Q

In which part of the cardiac cycle does myocardial blood flow occur?

A

Diastole

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7
Q

Why is subendocardial muscle most susceptible to ischaemia?

A

Because it is subjected to the greatest pressure potentially impairing blood flow

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8
Q

Why does the heart need increased blood flow with increased demand?

A

Because under normal conditions the heart will take almost all the oxygen out of the blood so to get more oxygen need more flow

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9
Q

How do you get increased supply?

A

vasodilation via adenosine, lactate, hydrogen ions, prostacyclin, NO and innervation

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10
Q

What does myocardial oxygen demand depend on?

A

ventricular wall stress (hypertrophy), heart rate, contractility

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11
Q

What is ischaemic heart disease?

A

A group of conditions where there is an imbalance between myocardial oxygen supply and demand including angina and MI - either chronic or acute

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12
Q

What part of coronary arteries does atherosclerosis mostly effect?

A

Epicardial parts

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13
Q

What percentage of narrowing will cause angina?

A

70%

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14
Q

What causes stable angina?

A

A stable plaque

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15
Q

What is the result of an unstable plaque?

A

unstable angina, sudden cardiac death, myocardial infarction

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16
Q

What causes the pain in a heart attack?

A

Anerobic production of ATP which causes acidosis and a build up of metabolic products which accumulate locally

17
Q

What is sudden cardiac death?

A

An unexpected fatal event within 1 hour of the beginning of symptoms in an apparently healthy subject

18
Q

What is the most usual cause of sudden cardiac death?

A

coronary atherosclerosis leading to ventricular fibrillation

19
Q

What happens to myocardial cells in myocardial infarction?

A

ATP depletion, generation of ROS, altered calcium homeostasis

20
Q

What are the different types of myocardial infarctions in terms of site and size?

A

full thickness regional infarction, regional subendocardial infarction, circumferential subendocardial infarction

21
Q

What are the cardiac markers of a myocardial infarction?

A

myoglobin, cardiac troponins T and I and the MB fraction of creatine kinase

22
Q

Which cardiac marker appears the earliest?

A

myoglobin

23
Q

Which cardiac marker persists for the longest?

A

troponins

24
Q

Which are the most sensitive and specific cardiac markers?

A

Troponins

25
Q

Which cardiac marker is the least specific?

A

myoglobin

26
Q

What are the immediate consequences of myocardial infarction?

A

arrhythmias (VT, VF, conduction defects, AF), acute cardiac failure, pulmonary oedema, cardiogenic shock

27
Q

What are the delayed consequences of myocardial infarction?

A

cardiac failure, rupture, thrombus formation, arrhtyhmias, infarct expansion, fibrinous pericarditis, papillary muscle dysfunction

28
Q

What factors influence complications?

A

Size, site and transmural extent of infarct

29
Q

What are other causes of ischaemic heart disease apart from atherosclerosis?

A

Thromboemboli, immune disorders of vessels, aortic dissection, LVH, tachycardia, hypoxaemia, shock

30
Q

What is the management for ischaemic heart disease?

A

lifestyle modification, pharmacological intervention, stents, coronary artery bypass

cardiovascular (36 decks)

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