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Questions and Answers
What is the most common cause of ischemic heart disease?
What is the most common cause of ischemic heart disease?
Which of the following is NOT a risk factor for coronary atheroma?
Which of the following is NOT a risk factor for coronary atheroma?
What type of angina occurs due to a stable atherosclerotic plaque?
What type of angina occurs due to a stable atherosclerotic plaque?
What is the duration of ischemia required to lead to infarction?
What is the duration of ischemia required to lead to infarction?
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What type of infarction occurs due to complete occlusion of the blood vessel lumen?
What type of infarction occurs due to complete occlusion of the blood vessel lumen?
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What is the characteristic of ischemic cardiac chest pain?
What is the characteristic of ischemic cardiac chest pain?
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What is the typical duration of ischemic cardiac chest pain?
What is the typical duration of ischemic cardiac chest pain?
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What is NOT a characteristic of ischemic cardiac chest pain?
What is NOT a characteristic of ischemic cardiac chest pain?
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What is a characteristic of atypical chest pain in myocardial infarction?
What is a characteristic of atypical chest pain in myocardial infarction?
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What is a common feature of right ventricular myocardial infarction?
What is a common feature of right ventricular myocardial infarction?
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What is a complication of myocardial infarction that can occur within 24 hours?
What is a complication of myocardial infarction that can occur within 24 hours?
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What is a characteristic of pericarditis?
What is a characteristic of pericarditis?
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What is a complication of myocardial infarction that can occur between 3-14 days?
What is a complication of myocardial infarction that can occur between 3-14 days?
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What is a characteristic of left ventricular myocardial infarction?
What is a characteristic of left ventricular myocardial infarction?
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What is a characteristic of atypical chest pain in myocardial infarction in diabetes mellitus?
What is a characteristic of atypical chest pain in myocardial infarction in diabetes mellitus?
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What is a complication of myocardial infarction that can occur after 14 days?
What is a complication of myocardial infarction that can occur after 14 days?
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Study Notes
Ischemic Heart Disease
- Ischemic heart disease is caused by a reduced oxygen supply to the heart, often due to atherosclerotic plaques in the coronary vessels, embolus, or vasospasms.
- Increased oxygen demand can also contribute to ischemic heart disease, triggered by factors such as tachycardia, left ventricular hypertrophy, or exertion.
Risk Factors for Coronary Atheroma
- Modifiable risk factors:
- BMI > 30
- Diabetes mellitus
- Hypertension
- Tobacco use
- Increased LDL/decreased HDL
- Ethanol consumption
- Non-modifiable risk factors:
- Age > 65 years
- Relatives with CAD/family history
Classifications of Ischemic Heart Disease
- Stable angina:
- Caused by stable atherosclerotic plaques
- Pain occurs during exertion
- Subendocardial ischemia
- Unstable angina:
- Caused by plaque rupture and thrombus formation
- Pain occurs at rest or progresses rapidly over a short period
- Subendocardial ischemia
- Subendocardial infarction (NSTEMI):
- Ischemia for longer than 30 minutes leads to infarction (cell death)
- Pain occurs at rest or progresses rapidly over a short period
- Subendocardial infarction
- Transmural infarction (STEMI):
- Complete occlusion of blood vessel lumen and infarct of the entire thickness of the myocardium
- Pain occurs at rest or progresses rapidly over a short period
- Transmural infarction
Clinical Features of Ischemic Cardiac Chest Pain
- Typical:
- Discomfort/pressure (dull, crushing) lasting > 2 minutes
- Provoked by activity/exercise
- Radiation (arms, jaws)
- Does not change with respiration/position
- Associated with sweating/nausea
- Relieved by rest/nitroglycerin
- Atypical:
- Pain localised with one finger
- Constant pain lasting for a few days
- Fleeting pains lasting for a few seconds
- Pain reduced by movement/palpation
- No pain (diabetes mellitus, elderly, post heart transplant)
Pathophysiology and Clinical Features
- Right ventricular MI:
- Jugular venous distension
- Oedema (lower extremities)
- Hepatomegaly
- Ascites
- Hypotension
- Clear lungs
- Bradycardia/AV block
- Left ventricular MI:
- Pulmonary oedema
- Shortness of breath
- Hypotension
- S4 heart sound
- Reflex tachycardia
MI Complications
- 0-24 hours:
- Sudden cardiac death
- Acute heart failure
- 24 hours-3 days:
- Pericarditis
- Inflammation
- Frictional rub
- Pericardial effusion
- 3-14 days:
- Rupture syndromes
- Ventricular septal defect
- Free wall rupture -> cardiac tamponade
- Papillary muscle rupture -> mitral regurgitation
- 14 days-months:
- LV aneurysms
- Risk of thrombus formation
Pericarditis
- Inflammation of the pericardium often due to a viral illness
- Causes retrosternal, sharp, and localised chest pain
- A pericardial rub may be heard on auscultation of the chest
- Saddle-shaped ST elevations may be present in an ECG
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Description
This quiz covers the causes of ischemic heart disease, including reduced oxygen supply and increased oxygen demand, as well as the risk factors for coronary atheroma.
