Coronary Artery disease

Question 1

What is chronic stable Angina?

Answer 1

Chest tightness, pain, and shortness of breath upon exertion, usually in the elderly

Question 2

What is the cause of Chronic Stable Angina

Answer 2

A problem of supply and demand i.e the supply of blood and oxygen is inadequate for myocardial demand

Question 3

What factors determine demand?

Answer 3

1. Sytolic BP

2. HR

Question 4

What is the Treadmill test?

Answer 4

To check effects of exertion on patients

Question 5

What are symptoms of acute coronary syndrom?

Answer 5

Patients complain of elephant sitting on their chest usually wakes them up while asleep

Question 6

What is the pathophysiology of acute coronary syndrome?

Answer 6

Rupture of Atherosclerotic plaque (in coronary artery) which causes most importantly:

1. Constriction of Coronary Artery
2. Blood clots form (Thrombotic state)

Question 7

What is not present in Acute coronary syndrome?

Answer 7

Mismatch of supply and demand

Question 8

What is the cause of an ST elevation in MI?

Answer 8

100% occlusion of a coronary artery

Question 9

What is the immediate course of action in a patient presenting with ST elevation MI?

Answer 9

Get them to Cath Lab ASAP

Question 10

What are the determinants of Myocardial O2 demand?

Answer 10

1. Sytolic BP

2. HR

Question 11

What is always associated with Angina Pectoris?

Answer 11

1. Sympathetic Overdrive/increased Catecholamine release
2. Patients become PALE
3. Diaphoresis

Question 12

What distinguishes an ST elevation acute MI from Acute coronary syndrome?

Answer 12

1. The ST elevation on ECG

2. Lack of complete occlusion of the artery

Question 13

What are the factors that could lead to rupture of Atherosclerotic plaque?

Answer 13

1. Diabetes (Glucose)
2. Smoking
3. Hypertension
4. Hypercholestrolemia (Lipoproteins)
5. Turbulent flow
6. Oxygen ROS
7. Cytokines

Question 14

What are the characteristics of Plaques which tend to rupture?

Answer 14

1. Large Lipid core
2. Not well formed
3. Thin Cap
4. Lots of Macrophages present
5. Low smooth muscle cell count

Question 15

What Blood cells play an integral role in ACS?

Answer 15

Platelets

Question 16

What class of Drugs play an important role in treatment of ACS?

Answer 16

Blood thinners

Question 17

What new class of drugs are showing great promise in targeting Platelet agreggation in ACS?

Answer 17

GpIIb/IIIa inhibitors

Question 18

Where does the pain normally radiate to in ACS?

Answer 18

Arm, Neck, Jaw, Epigastrium or between scapulae

Question 19

What are some of the common complications of MI?

Answer 19

1. Necrosis
2. Myocardial Rupture
   - Free Wall Of Ventricle
   - Interventricular Septum
   - Papillary Muscle

Question 20

CHF

Answer 20

Essentially is abnormal accumulation of Salt and water in the alveoli

Question 21

What is the function of Streptokinase in patients suffering from MI?

Answer 21

It dissolves the clots which may be causing the occlusion

Question 22

When is Streptokinase contraindicated?

Answer 22

1. Recent CVA (within 2 months), Intracranial or Intraspinal bleeding
2. Active Internal Bleeding
3. Intracranial Neoplasm
4. Puncture of Noncompressible artery