Coronary Heart Disease Overview

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the first action to take when a patient presents with suspected acute myocardial infarction?

Start a beta-blocker

Conduct a coronary angiography

Provide high-flow oxygen (correct)

Administer oral nitrates

Which enzyme is commonly used as a biochemical marker for diagnosing myocardial infarction?

Alkaline phosphatase

Creatine kinase-MB (CK-MB) (correct)

Lactate dehydrogenase (LDH)

Aspartate aminotransferase (AST)

What are the common symptoms of myocardial infarction apart from chest pain?

Persistent headache and vision changes

High fever and chills

Nausea and partial paralysis

Breathlessness and syncope (correct)

What does the development of a Q wave in an ECG indicate during a myocardial infarction?

Change in ventricular repolarization Signup and view all the answers

Why are serial estimations of cardiac biomarkers important in diagnosing myocardial infarction?

They provide diagnostic value through concentration changes Signup and view all the answers

Which of the following is NOT a characteristic symptom of myocardial infarction?

Swelling in the limbs Signup and view all the answers

What should be considered for patients at moderate or high risk of myocardial infarction?

Coronary angiography for revascularization Signup and view all the answers

If a beta-blocker is contraindicated in the management of myocardial infarction, what alternative medication may be considered?

Calcium channel blocker Signup and view all the answers

What is the primary underlying cause of coronary heart disease?

Atheroma and its complications Signup and view all the answers

Which of the following is defined as myocardial necrosis due to acute occlusion of a coronary artery?

Myocardial infarction Signup and view all the answers

What is the clinical manifestation associated with transient myocardial ischaemia?

Angina pectoris Signup and view all the answers

Which factor can precipitate chronic stable angina?

Heavy exercise Signup and view all the answers

What is a significant characteristic of unstable angina?

Pain that occurs at rest or with minimal exertion Signup and view all the answers

Which of the following is NOT a risk factor commonly associated with coronary heart disease?

Excessive hydration Signup and view all the answers

Which of the following is NOT a component of the management of angina pectoris?

Immediate surgical intervention Signup and view all the answers

What type of alterations are seen in the ECG changes during acute ST-elevation myocardial infarction?

Elevated ST segments Signup and view all the answers

What is the main type of myocardial dysfunction resulting from ischemia or infarction?

Systolic dysfunction Signup and view all the answers

What should patients with stable angina avoid for safety?

Engagement in vigorous exercise after a heavy meal Signup and view all the answers

Which class of drugs is used as anti-anginal treatment?

Nitrates Signup and view all the answers

What type of heart condition is characterized by rapid worsening angina or angina at rest?

Unstable angina Signup and view all the answers

Which medication type is used in both antiplatelet and anticoagulant therapy for acute chest pain management?

Aspirin Signup and view all the answers

What is the primary purpose of serial measurements of biochemical markers in chest pain assessment?

To determine the extent of physical damage Signup and view all the answers

Which of the following surgical options is used for the treatment of ischemic heart disease?

Percutaneous coronary intervention (PCI) Signup and view all the answers

What lifestyle change is recommended to manage stable angina effectively?

Quit smoking Signup and view all the answers

Which medication is preferable for the initial management of stable angina?

Aspirin 300 mg (preferably chewing) Signup and view all the answers

What is a common complication associated with myocardial infarction?

Ischaemia Signup and view all the answers

Which of the following is NOT part of the management protocol for unstable angina?

Immediate deployment of thrombolytics Signup and view all the answers

Which of the following is a mechanical complication of myocardial infarction?

Mitral regurgitation due to papillary muscle damage Signup and view all the answers

What is the initial measure in the management of acute ST-elevation myocardial infarction?

Reperfusion therapy Signup and view all the answers

Which investigation is useful in diagnosing stable angina?

Stress perfusion scanning Signup and view all the answers

What is the role of clopidogrel in the management of coronary heart disease?

It helps maintain vessel patency Signup and view all the answers

Which of the following is a main characteristic of unstable angina?

Chest pain occurring at rest Signup and view all the answers

Which of the following factors is considered an independent risk factor for coronary heart disease?

Family history Signup and view all the answers

What role does HDL cholesterol have in heart health?

Prevents oxidation of LDL Signup and view all the answers

What condition could potentially decrease oxygen supply to the myocardium?

Decreased duration of diastole Signup and view all the answers

How does obesity contribute to the development of coronary heart disease?

Promotes inflammation Signup and view all the answers

Which of the following is NOT a common precipitating activity for stable angina?

Resting quietly Signup and view all the answers

What is the primary function of triglycerides in relation to heart disease?

They lower HDL cholesterol levels Signup and view all the answers

Which of the following conditions increases myocardial oxygen demand?

Increased myocardial contractility Signup and view all the answers

What is a primary symptom of stable angina?

Chest pain that is induced by stress Signup and view all the answers

Study Notes

Coronary Heart Disease (CHD)

CHD is the most common form of heart disease and a leading cause of premature death in certain parts of the world.
It's almost always due to atheroma and its complications, particularly thrombosis in the coronary arteries.
CHD can manifest in various ways, including stable angina, unstable angina, myocardial infarction, heart failure, arrhythmias, and sudden death.

Stable Angina

Ischemia (reduced blood flow) due to fixed atheromatous stenosis (narrowing of the arteries) in one or more coronary arteries.
Symptoms are characterized by central chest pain, discomfort, or breathlessness, precipitated by exertion or stress, and promptly relieved by rest.
Activities that trigger angina include physical exertion, cold exposure, heavy meals, and intense emotions.

Unstable Angina/Non ST-elevation Myocardial Infarction (NSTEMI)

Ischemia is caused by dynamic obstruction of a coronary artery due to plaque rupture with superimposed thrombosis and spasm.
Characterized by new-onset severe angina, rapidly worsening angina, angina with minimal exertion or at rest.
Differentiated from NSTEMI by the absence of elevated myocardial necrosis markers in the blood.
Diagnosis relies on chest pain analysis, 12-lead ECG, and cardiac markers.

Myocardial Infarction (MI)

Myocardial necrosis (tissue death) caused by acute occlusion (blocking) of a coronary artery.
Occurs due to plaque rupture and thrombus formation.
Characterized by severe and prolonged chest pain, potentially in the same sites as angina but usually more severe. Other symptoms can include breathlessness, vomiting, and collapse or syncope.
Infarction progresses over several hours making prompt intervention crucial.

ST-Elevation Myocardial Infarction (STEMI)

Complete occlusion of the coronary artery.
Characterized by typical ECG changes and elevated plasma cardiac markers.

Investigations

Stable Angina: Resting ECG, exercise ECG, myocardial perfusion scanning, stress echocardiography, coronary arteriography
Unstable Angina/NSTEMI: Similar to stable angina, with additional focus on cardiac markers.
STEMI: ECG changes including ST elevation and presence of elevated cardiac markers.

Management

Stable Angina: Risk factor modification (blood pressure control, smoking cessation, weight loss, diabetes control), lifestyle modifications, aspirin, lipid-lowering therapy, anti-anginal therapy.
Unstable Angina/NSTEMI: Urgent medical stabilization, and angiography.
STEMI: Immediate access to medical/paramedical care, defibrillation facilities, bed rest, medication (aspirin, antiplatelets, anticoagulants, beta-blockers, calcium channel blockers).

Other Important Concepts

Lipid Profile: Necessary for assessing risk and includes testing of TSCH, HDL, LDL, TG, and VLDL levels.
Atherosclerosis: The buildup of plaque within the arteries, which narrows the lumen and reduces blood flow. This is a major contributor to CHD.
Myocardial Oxygen Demand: Factors affecting need such as heart rate, blood pressure, and myocardial contraction.
Myocardial Oxygen Supply: Factors affecting supply such as duration of diastole and coronary vasomotor tone (how constricted vessels are) which impact blood flow.
Drug therapy: (antiplatelet, lipid-lowering, anti-anginal medication including nitrates, Beta-blockers, and Calcium channel blockers) are key aspects of managing CHD.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers crucial aspects of Coronary Heart Disease (CHD), including its causes, symptoms, and types such as stable and unstable angina. Participants will explore how ischemia affects the heart and learn about the various manifestations of this condition. Aimed at enhancing understanding of cardiovascular health, this quiz is essential for students and healthcare professionals alike.