Ischemic Heart Disease

Question 1

What arteries are the major supply blood to the heart?

Answer 1

coronary arteries

Question 2

What is ischemic heart disease?

Answer 2

the imbalance of myocardial oxygen btw supply and demand

Question 3

What are the causes of ischemic heart disease?

Answer 3

atherosclerosis of coronary arteries

hypotension

severe anemia

Question 4

Why does atherosclerosis of coronary arteries lead to ischemic?

Answer 4

because it decreases the blood flow around the heart

Question 5

How does atherosclerosis of coronary arteries decrease blood flow?

Answer 5

increase the resistance to flow

platelet aggregation -> more narrowing arteries

Question 6

How many % of proximal narrowing vessel can be compensated by distal dilation?

What % ___ cant be compensated? What will resutl?

Answer 6

60%

>70%

ischemic heart disease

Question 7

What will result when endothelial dysfunction occur?

Answer 7

platelet aggregations and inappropriate constriction of coronary arteries occur

Question 8

myocardial hypoxia

Answer 8

ATP decreases

Question 9

What are the consequences of ischemic heart disease?

Answer 9

myocardial hypoxia

accumulation of waste products

necrosis of myocardial tissues

Question 10

dypsnea

Answer 10

shortness/ difficulty of breathing

Question 11

pulmonary congestion

Answer 11

the accumulation of blood in the lung

Question 12

arrhythmias

Answer 12

irregular heart beat

Question 13

what does high pressure in left atrium & pulmonary veins will cause?

Answer 13

pulmonary congestion & dypsnea

Question 14

what are the waste metabolites accumulated in the heart if ischemic heart disease occur ?

Answer 14

serotonin, ADP & lactate

Question 15

What does accumulation of waste products will cause with ischemic heart disease?

Answer 15

angina & arrhythmias

Question 16

What does myocardial hypoxia cause?

Answer 16

reduction of ventricular systole & distole relaxation

higher diastolic pressure in left atrium & pulmonary veins

Question 17

What are myocardial oxygen supply dependent on?

Answer 17

oxygen content of blood (constant)

coronary blood flow (manageable)

Question 18

aortic regurgitation

what is the consequence of this?

Answer 18

the heart valve diseases that keep the aortic valve from completely closing

reverse blood flow from aorta to left ventricle

Question 19

what will affect the oxygen content of blood?

Answer 19

the amount of Hb concentration & degree of systematic oxygenation

Question 20

What will influence the coronary flow?

Answer 20

perfusion pressure

local metabolites

coronary vascular resistance

Question 21

perfusion pressure

What will reduce this pressure?

Answer 21

aortic diastolic pressure

hypotension & aortic regurgitation

Question 22

What factor will influence the coronary vascular resistance?

Answer 22

the intrinsic coronary tone & the physically impact on coronary arteries

Question 23

What determine the increase extraction of oxygen from coronary blood flow?

Answer 23

vasodilator vs vasoconstrictor

Question 24

what are the metabolic factors that vasodilators?

Answer 24

ADP, H+, CO2 & lactate

Question 25

What are the endothelial cells vasodilator? endothelial cells vasoconstrictor?

Answer 25

NO, prostacyclin & EDHF Endothelin I

Question 26

What are the neural vasodilator of coronary vessels? neural vasoconstrictor?

Answer 26

alpha-adrenergic receptor beta- adrenergic receptor

Question 27

What is the myocardial oxygen demand dependent on?

Answer 27

ventricular wall stress HR contractility

Question 28

Why does the HR increase require more oxygen?

Answer 28

because the heart require more ATP

Question 29

What chemical increase the contractility of the heart?

Answer 29

Catecholamine

Question 30

ventricular wall stress what is its relationship with oxygen consumption?

Answer 30

the intraventricular pressure divided by the thickness of the wall the more wall stress, the more oxygen is needed

Question 31

when can the intraventricular pressure increase?

Answer 31

when there is hypertension or aortic stenosis

Question 32

intraventricular pressure

Answer 32

the blood pressure within the heart's ventricles

Question 33

What happen to the thickness of ventricular wall when it hypertrophy? What does this mean to the wall stress? To oxygen demand?

Answer 33

the wall getting thicker reduce the wall stress oxygen demand decrease

Question 34

What will result in the ventricular wall hypertrophy?

Answer 34

increase ventricular filling (EDV increases)

Question 35

coronary perfusion pressure

Answer 35

the pressure that drives the coronary blood pressure

Question 36

What does the ECG of stable angina different from normal ECG?

Answer 36

ST segment elevates or depresses T wave invert or become flat line

Question 37

What is the symptoms of unstable angina different from stable angina?

Answer 37

the exertional pain is more accelerated the plagues rupture with subsequent formation of clot (thrombosis) myocardial infarct can occur

Question 38

Do both stable & unstable angina vasoconstrict or vasodilate?

Answer 38

vasoconstrict

Question 39

What symptoms does variant angina have?

Answer 39

intense vasospasm although there is no overt plagues

Question 40

What test can we use to diagnose the silent ischemia?

Answer 40

stressing test with ECG recording

Question 41

what is syndrome X?

Answer 41

the patients with symptom of angina without demonstrable of atherosclerosis

Question 42

What drug can we use to treat ischemic syndromes? what is its effect?

Answer 42

sublingual nitroglycerin relax the VSMC -\> decrease venous return & oxygen demands

Question 43

coronary revascularization Examples of some methods?

Answer 43

the methods of restoring the blood flow in coronary vessels stent, angioplasty, coronary bypass graft

Question 44

The steps of coronary artery stent

Answer 44

stents, in its orginal collapsed state, is advanced to stenosis, on a ballon catheter ballon is inflated -\> stent expanded ballon is deflated and catheter is removed, leaving the stent permanently in space

Question 45

What do beta-blockers drugs do?

Answer 45

decrease the HR and contractility