Myocardial Ischaemia Part 2

hat is the function and structure of coronary arteries? (4 points)

1. Deliver blood to myocardial cells

2. Located on the epicardium (outer surface of the heart)

3. Known as epicardial arteries

4. Blood flow is pulsatile and occurs during diastole

What is myocardial ischaemia and its cause? (2 points)

1. Occurs when myocardial cells do not receive enough oxygenated blood

2. Due to an imbalance between oxygen supply and demand

What leads to myocardial infarction (MI)? (3 points)

1. If oxygen demand exceeds supply for too long

2. Leads to irreversible damage to myocardial cells

3. Results in tissue death

Q: How does atherosclerosis develop and cause ischaemia? (4 points)

1. Damage to artery wall (e.g. from smoking, hypertension) triggers inflammation

2. Fatty plaques (atheroma) form in artery walls

3. Ruptured plaques activate platelets and thrombus formation

4. Thrombi may embolize and block blood vessels elsewhere

How is coronary artery disease (CAD) classified? (2 points)

1. Chronic Coronary Syndromes (CCS): symptoms stable or controlled

2. Acute Coronary Syndromes (ACS): symptoms due to sudden reduct

What is stable angina and how is it characterised? (4 points)

1. Predictable chest pain due to reduced blood flow (ischaemic pain)

2. Triggered by effort (exercise, cold, stress)

3. Relieved by rest or medication

4. Short-lived, reproducible

What conditions are included under Acute Coronary Syndrome (ACS)? (3 points)

1. Unstable angina

2. Non-ST Elevation Myocardial Infarction (NSTEMI)

3. ST Elevation Myocardial Infarction (STEMI)

What are symptoms of acute coronary syndrome? (6 points)

1. Severe chest, jaw, neck, or back pain

2. Breathlessness

3. Nausea and vomiting

4. Light-headedness

5. Sweating

6. Cardiac arrest in severe cases

How does infarct development progress in MI? (5 points)

1. Begins in subendocardium and extends to subepicardium

2. Forms a transmural infarct within 24 hours

3. Cell death occurs by coagulation necrosis

4. Neutrophils infiltrate and granulation tissue forms

5. Results in ventricular remodelling

What are the complications of MI? (6 points)

1. Heart failure

2. Arrhythmias (VT, VF, SVT, heart block)

3. Ventricular ectopic beats

4. Intracardiac thrombus

5. Cardiac rupture

6. Pericarditis

What diagnostic methods are used for coronary artery disease? (5 points)

1. Electrocardiogram (ECG)

2. Troponin blood test

3. Clinical history

4. Coronary angiography

5. Imaging (CT, MRI, echocardiogram)

What are treatment options for STEMI? (4 points)

1. Primary Percutaneous Coronary Intervention (PPCI)

2. Thrombolysis

3. Medical management (when intervention unavailable)

4. Possible Coronary Artery Bypass Grafting (CABG)

What are treatment options for NSTEACS? (4 points

1. Percutaneous Coronary Intervention (PCI)

2. CABG (for severe three-vessel disease)

3. Angiogram

4. Medical management

What are the 5 types of acute coronary syndrome? (5 points)

1. Type 1: Plaque rupture (most common)

2. Type 2: Oxygen supply-demand imbalance

3. Type 3: Sudden death with MI symptoms

4. Type 4: MI related to stenting

5. Type 5: MI related to bypass grafts

What is variant angina and how is it different? (2 points)

1. Also called Prinzmetal angina or coronary artery spasm

2. Occurs at rest and without underlying coronary artery disease

: What is the final summary of myocardial ischaemia? (3 points)

1. Heart needs its own blood supply via coronary arteries

2. Atherosclerosis narrows arteries, restricting blood flow

3. This causes chronic or acute coronary syndromes