Cardiology: Coronary Artery Disease and Angina

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Questions and Answers

What are the four classical components of Tetralogy of Fallot?

Mitral stenosis, large VSD, overriding aorta, right ventricular hypertrophy

Pulmonary stenosis, small VSD, overriding aorta, left ventricular hypertrophy

Pulmonary insufficiency, large VSD, overriding aorta, left ventricular hypertrophy

Pulmonary stenosis, large VSD, overriding aorta, right ventricular hypertrophy (correct)

What is a common symptom of cyanotic heart defects in infants?

Excessive sleepiness

Regular appetite

Frequent fevers

Difficulty breathing (correct)

Which of the following best describes heart valve insufficiency?

An abnormal heart sound recognized as a heart murmur

Failure to open completely, leading to impaired outflow

Complete closure without any backflow

Failure to close completely, resulting in blood reflux (correct)

In what way does squatting affect tetralogy of Fallot symptoms?

It alleviates symptoms Signup and view all the answers

What is a significant cause of heart valve disease in underdeveloped countries?

Rheumatic heart disease Signup and view all the answers

What condition may result if a large ventricular septal defect (VSD) leads to right heart hypertrophy?

Eisenmenger’s syndrome Signup and view all the answers

What happens to the foramen ovale after birth in a typical scenario?

It closes shortly after birth. Signup and view all the answers

What is a key clinical sign of a patent ductus arteriosus (PDA)?

Machine-like sound over the heart Signup and view all the answers

Which of the following conditions is characterized by a right-to-left shunt?

Tetralogy of Fallot Signup and view all the answers

What can occur if the foramen ovale remains patent after birth?

Paradoxical embolus Signup and view all the answers

What is a common symptom of stable angina?

Stable pattern for more than a month Signup and view all the answers

What typically triggers stable angina?

Heavy exertion or stress Signup and view all the answers

Which condition is characterized by chest discomfort that occurs at rest?

Unstable angina Signup and view all the answers

What is a major clinical manifestation of myocardial infarction (MI)?

Death of heart muscle cells Signup and view all the answers

Which of the following is a symptom that can indicate myocardial infarction in women?

Dyspnea and fatigue Signup and view all the answers

How long does stable angina typically last?

5 to 20 minutes Signup and view all the answers

Which of the following is a defining feature of unstable angina?

Unpredictable pattern Signup and view all the answers

What test is commonly used to evaluate myocardial infarction?

ECG Signup and view all the answers

What is a common complication of rheumatic fever that affects the heart?

Aortic valve stenosis Signup and view all the answers

At what age group does rheumatic fever most commonly affect children?

6 to 15 years Signup and view all the answers

Which of the following is a major criterion for the diagnosis of rheumatic fever?

Erythema marginatum Signup and view all the answers

Which autoimmune reaction occurs due to rheumatic fever?

Antibodies binding to cardiac myosin Signup and view all the answers

What is a symptom of Sydenham's chorea associated with rheumatic fever?

Rapid uncontrolled movement of hands and arms Signup and view all the answers

What is the incidence rate of rheumatic fever in untreated cases of strep pharyngitis?

3% Signup and view all the answers

Which condition is characterized by a mid diastolic murmur and poor prognosis due to left atrial arrhythmia?

Mitral valve stenosis Signup and view all the answers

Which type of valve defect is characterized by backward flow of blood due to improper closure?

Mitral valve insufficiency Signup and view all the answers

What is the most common valve disorder in the industrialized world?

Mitral valve prolapse Signup and view all the answers

Which of the following describes the previously mentioned Aschoff bodies?

Painless granulomas with necrotic center Signup and view all the answers

Which condition may lead to elevated blood pressure and head bobbing with each heartbeat?

Aortic valve insufficiency Signup and view all the answers

What is the typical treatment for bacterial endocarditis?

High dose antibiotics Signup and view all the answers

What symptom is often associated with more severe aortic valve stenosis?

Shortness of breath Signup and view all the answers

Which form of cardiomyopathy is defined by etiology within the heart muscle?

Intrinsic cardiomyopathy Signup and view all the answers

What is a common feature of acute bacterial endocarditis?

Rapid destruction of heart valves Signup and view all the answers

Which of the following is NOT a symptom of mitral valve stenosis?

Syncope Signup and view all the answers

Study Notes

Coronary Artery Disease (CAD)

Major clinical manifestations include stable angina pectoris, unstable angina pectoris, and myocardial infarction (MI)
Angina pectoris: Ischemia leads to clinical symptoms but no death of heart muscle cells.
MI: Ischemia is severe and leads to clinical symptoms and death of heart muscle cells.

Angina Pectoris

Sudden onset of chest discomfort including pressure, heaviness, burning, choking sensation, and pain.
Typically radiates to the left chest and arm.
Frequently precipitated by triggers such as after heavy meals, going from warm to cold environments, emotional or physical stress.
Usually lasts for a few minutes.
Relieved by nitrites (vasodilators).
Can radiate to the abdomen causing "indigestion."
ECG is typically normal, but stress ECG may show changes.
A coronary angiogram may be used to diagnose angina pectoris.
Prinzmetal’s angina is caused by vasospasm of coronary arteries.

Stable vs. Unstable Angina

Stable Angina: Predictable, triggered by activity, exertion, or stress. Usually resolves quickly (5-20 minutes) when resting. Pattern remains stable for > 1 month.
Unstable Angina: Angina occurs at rest, without a trigger, and the pattern of angina changes. Symptoms may not go away and are more severe than previous angina. Can be the first experience of angina or occur within a few weeks.
Stable angina can convert to unstable angina.
Unstable angina can be called "preinfarction angina."
Unstable angina can lead to MI.

Myocardial Infarction (MI)

Symptoms: Chest pain, discomfort, nausea, vomiting, arrhythmia, loss of consciousness, and possibly sudden death.
Pain radiates to the left arm, jaw, back, and epigastrium (stomach area).
Many patients have had previous angina pectoris.
Women: frequently dyspnea, weakness, and fatigue.
1/3 of MIs are silent.
Diagnosis:
- ECG: ST-elevation MI (STEMI).
- Cardiac Enzymes: Creatine phosphokinase MB (CK-MB) and Troponin I or T.
- Non-ST-elevation MI (NSTEMI): ST not elevated but cardiac enzymes are elevated.

Atrial Septal Defect (ASD)

A left-right shunt develops if the septum wall does not form properly.
Consequences are usually not as severe as VSD.
No symptoms before age 30.
Eventually, right heart hypertrophy develops.
Systolic murmur is present.
If the foramen ovale does not close, it is called "patent foramen ovale" (PFO).
Thrombus can go from the right heart to the left heart and cause a stroke.

Patent Ductus Arteriosus (PDA)

In the fetus, blood from the right heart bypasses the lungs via shortcuts (foramen ovale & ductus arteriosus) to the aorta.
After birth, the lungs unfold, and blood goes through the lungs.
The ductus arteriosus normally closes by 15 hours after birth.
If the duct does not close, blood moves from the aorta (higher blood pressure) into the lungs, increasing blood flow through the lungs and decreasing oxygenated blood in the aorta.
The heart has to work much harder.
Clinically: machine-like sound over the heart.
Right-to-left shunts can cause cyanosis.

Tetralogy of Fallot (ToF)

Right-to-left shunt causing cyanosis.
Four components:
- Pulmonary stenosis
- Large VSD
- Overriding aorta (large aortic valve arises from both left and right ventricle)
- Right ventricular hypertrophy.
Most common cyanotic heart defect (5% of congenital heart disease).
Cyanosis manifests days to weeks after birth.
Diagnosis: Cyanosis, failure to thrive, difficulty breathing, typical posture, clubbing of fingers and toes, protrusion of sternum.
Squatting improves symptoms.
Blalock-Taussig (Thomas) shunt (connecting subclavian artery to pulmonary artery).
Surgery repairs pulmonary stenosis and VSD.

Heart Valves

Heart valve disease is more frequent for the valves of the left heart due to higher pressures in the left ventricle.
Aortic valve and Mitral valve are most commonly affected.
Stenosis: Failure to open completely = outflow impaired.
Insufficiency: Failure to close completely = reflux of blood.
Abnormal heart sound is called a "murmur."
Rheumatic heart disease (rheumatic fever) is a major cause in underdeveloped countries.
Other causes: Damage to valves after MI, infections, heart dilation, mitral valve prolapse, senile calcific aortic stenosis, IV drug abuse, genetic (Marfan syndrome, Ehlers-Danlos syndrome), and drugs.

Mitral Valve Insufficiency

Also called mitral regurgitation.
Bad prognosis due to late detection and rapid enlargement of the left atrium and left ventricle.
Most commonly caused by mitral prolapse.
Other causes: Rheumatic fever, ischemic heart disease, bacterial endocarditis, Fen-Phen (fenfluramine), Marfan syndrome.
No symptoms for years, sudden decompensation, and heart failure.
Treatment: Urgent replacement of mitral valve.
Systolic murmur is present.

Mitral Valve Stenosis

Narrowing of the mitral valve.
Early symptoms include shortness of breath, pulmonary edema, "mitral face" with cyanosis of the lips, left atrial hypertrophy, pulmonary hypertension, coughing tinged with blood, and arrhythmia of the left atrium.
Thrombosis is possible.
Bad prognosis.
Mid-diastolic murmur (low rumbling) is present.

Aortic Valve Insufficiency

"Aortic Regurgitation".
Dilation of the aortic root, valve disease.
Aortic valve does not completely close.
Combined concentric and eccentric left ventricular hypertrophy.
Typically asymptomatic for a long time.
Elevated blood pressure can lead to "head bobs" with the heartbeat.
Early diastolic murmur, decreasing.

Aortic Valve Stenosis

Narrowing of the aortic valve.
Mid-systolic murmur is present.
Mild to moderate stenosis may not show symptoms.
More severe stenosis shows shortness of breath, angina pectoris, syncope, chest pain, and left heart failure.

Mitral Valve Prolapse

Most common valve disorder in the industrialized world (3% of the population).
Usually not a significant finding and discovered by chance.
The cause is unknown - more frequent with Marfan syndrome.
Degenerative disorder of the mitral valve.
Usually found by ultrasound.
Sometimes a heart sound is present.
Good prognosis.
Antibiotic coverage is required for tooth extractions.
Can lead to mitral valve insufficiency.

Rheumatic Fever

Less frequent in developed countries due to treatment of strep throat with antibiotics.
Significant in underdeveloped countries.
Usually affects children 6 to 15 years of age after strep throat or scarlet fever with Group A beta hemolytic Streptococcus pyogenes.
RF symptoms occur several weeks (2-4 weeks) after the actual strep infection.
Rheumatic fever can involve joints, heart, skin, and brain.
An autoimmune reaction caused by antibodies formed against Strep A that also bind to tissue in joints and the heart.
Can be prevented by antibiotic treatment of people with group A strep.
People who have had RF frequently have relapses after infection with Strep.

Diagnosis of Rheumatic Fever (Jones Criteria)

Major Criteria:
Carditis (congestive heart failure, murmur, pericarditis, dyspnea)
Migratory polyarthritis (very painful inflammation of large joints moving from joint to joint)
Sydenham’s chorea (rapid uncontrolled movement of hands and arms; occurs late in disease)
Erythema marginatum (long lasting rash that starts as macules, then form rings)
Subcutaneous nodules (Aschoff bodies, painless granulomas with a necrotic center surrounded by inflammatory cells)
Minor Criteria:
Fever
Arthralgia = joint pain without swelling
Laboratory abnormalities (enhanced ESR, leukocytosis)
ECG abnormalities (prolonged PR interval)
Evidence for Group A Strep infection.

Bacterial Endocarditis

Colonization of heart valves by bacteria.
Leads to the development of thrombi mixed with bacteria called "vegetations."
Vegetations are very friable and easily dislodge.
Mostly bacteria, but also fungi, rickettsia, and chlamydia.
Subacute and acute forms.
Acute bacterial endocarditis quickly destroys heart valve and endocardium, leading to death within days or weeks.
Clinically: Spiking fever with no clear cause, bacteremia (Streptococci, Staphylococcus aureus, Enterococci), septic emboli, petechiae, heart murmur, and splinter hemorrhages.
Treatment with high-dose antibiotics.

Cardiomyopathy

"Extrinsic" cardiomyopathies have an etiology outside of the heart muscle.
"Intrinsic" cardiomyopathies have an etiology within the heart muscle.
Most cardiomyopathies are extrinsic (ischemia = coronary artery disease).

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Description

Explore key concepts of Coronary Artery Disease (CAD) and Angina Pectoris in this informative quiz. Learn about clinical manifestations, triggers, symptoms, and diagnostic methods. This quiz is essential for students and healthcare professionals alike, enhancing your understanding of heart-related issues.