IHD

Question 1

Mention each type and cause of ischemia

Answer 1

⬆️demand:⬆️hypertension
⬇️supply: hypotension / shock
⬇️oxygenation : pneumonia or CHF
⬇️oxygen carrying capacity:anemia

Question 2

Define angina

Answer 2

Ischemic induced pain that doesn’t cause myocytes death

Question 3

When cell death occurs in heart due ischemia the clinical manifestation is present as

Answer 3

MI

Question 4

Sudden cardiac death is caused by

Answer 4

After MI or due to lethal arrhythmia

Question 5

What is the acute clinical presentation of IHD

Answer 5

Acute coronary syndrome : catastrophic manifestations
of unstable angina, acute MI, and SCD

Question 6

Ratios of obstruction in stable and unstable angina

Answer 6

70-75% stable
90% unstable which results in MI or sudden death

Question 7

Ischemia induce which molecules to induce autonomic afferent

Answer 7

Adenosine and bradykinin

Question 8

Types of angina

Answer 8

Typical/ stable
Crescendo/unstable
Prinzmetal/variant

Question 9

Which type of angina Responds to vasodilators such as nitroglycerin and calcium channel
blockers.

Answer 9

Variant

Question 10

Variant angina occurs at

Answer 10

• Occurs at rest
• Caused by coronary artery spasm.
• Completely normal vessel can be affected.

Question 11

Episodic chest pain associated with particular levels of exertion
- Crushing or squeezing substernal sensation, that can radiate down the
left arm or to the left jaw (referred pain)
All indicate which type of angina and can be solved

Answer 11

Typical
By rest (reducing demand) or by drugs such as
nitroglycerin (vasodilator

Question 12

Which type of angina is Associated with plaque disruption and superimposed thrombosis,and/or vasospasm.

Answer 12

Unstable

Question 13

Unstable occurs at

Answer 13

Increasingly frequent pain, precipitated by progressively less exertion or
even occurring at rest.

Question 14

Calcium channel blockers can be used in which type of angina

Answer 14

Variant

Question 15

Risk factors of MI

Answer 15

Atherosclerosis and increased age( occurs at any age) and DM

Question 16

Myocardial chemical response to ischemia

Answer 16

Within seconds of vascular obstruction: aerobic
glycolysis ceases drop in ATP➡️
accumulation of potentially noxious metabolites
(e.g., lactic acid) in the cardiac myocytes.

Question 17

Due to drop in atp myocardial cells will lose the ability to

Answer 17

Contract

Question 18

Within few minutes of ischemia which Ultrastructural changes occur

Answer 18

myofibrillar relaxation, glycogen depletion, cell
and mitochondrial swelling
These early changes are potentially reversible.

Question 19

Severe ischemia lasting

Answer 19

20-40min

Question 20

irreversible damage and coagulative necrosis of myocardium indicates

Answer 20

Severe ischemia

Question 21

Irreversible injury of ischemic myocytes first
occurs in

Answer 21

subendocardial zone:
- The last area to receive blood delivered by the
epicardial vessels

Question 22

infarct usually achieving its full extent within 3 to 6 hours

Answer 22

3 to 6 hours

Question 23

Describe the difference between myocardial , infraction types in terms of thickness

Answer 23

Transmural Involve the full thickness of the ventricle while Subendocardial limited to the inner third of the myocardium

Question 24

Non-ST elevation infarcts is characteristic of

Answer 24

Subendocardial infarction

Question 25

features of an acute MI depend on:

Answer 25

The size and distribution of the involved vessel - The rate of development and the duration of the occlusion - Metabolic demands of the myocardium - Extent of collateral supply

Question 26

Vessels involved in 40% to 50% of all MI

Answer 26

proximal left anterior descending (LAD) artery occlusion

Question 27

Vessel that result, in infraction in most of right ventricle

Answer 27

30% to 40%: Proximal right coronary artery (RCA)

Question 28

Infraction of the left lateral ventricle is caused by

Answer 28

15% to 20% : proximal left circumflex (LCX) artery

Question 29

Silent infarcts percentages

Answer 29

10% to 15%of MIs - Common in diabetes mellitus - Elderly.

Question 30

Describe MI pain

Answer 30

Pain typically lasts several minutes to hours, and is not relieved by nitroglycerin or rest.

Question 31

Clinical futures of MI

Answer 31

Severe, crushing substernal chest pain (or pressure) that can radiate to the neck, jaw, epigastrium, or left arm. The pulse generally is rapid and weak, and patients are often diaphoretic and nauseous . • With massive MIs (involving more than 40% of the left ventricle): cardiogenic shock develops. And severe hypotension

Question 32

Q waves, ST segment changes, and T wave inversions • Arrhythmias And cardiac enzymes All indications of??????

Answer 32

MI

Question 33

death rate for MI

Answer 33

7%

Question 34

A 1/3 of persons with (??????) will die, usually of an arrhythmia within an hour of symptom onset.

Answer 34

STEMI. ST segment elevation MI