Ischaemic heart disease and atherosclerosis

What are the two broad categories of ischaemic heart disease?

Chronic coronary artery disease and acute coronary syndromes.

What is the therapeutic goal in chronic CAD?

Maintain balance between myocardial oxygen supply and demand.

What is the therapeutic goal in ACS?

Restore and maintain coronary artery patency.

What characterises chronic CAD?

Impaired coronary vasodilator activity and endothelial dysfunction.

What triggers angina in chronic CAD?

Increased oxygen demand during exertion exceeding supply.

Where do atheromas most commonly form?

Epicardial coronary arteries.

What is stable angina?

Predictable chest pain at reproducible workloads due to fixed coronary stenosis.

What is atherosclerosis?

Hardening of arteries with lipid

What initiates atherosclerosis?

Endothelial dysfunction due to injury or turbulent flow.

What are major risk factors for atherosclerosis?

Genetics

What is a fatty streak?

Early lesion of lipid‑laden foam cells in the intima.

What is endothelial dysfunction?

Loss of normal endothelial regulation of tone

What anti‑thrombotic factors are reduced in endothelial dysfunction?

Nitric oxide and prostacyclin.

What is the role of monocytes in atherosclerosis?

They infiltrate the intima

What is oxidized LDL?

LDL modified by free radicals that promotes inflammation and foam cell formation.

What is a fibrous cap?

A layer of smooth muscle and collagen covering an atherosclerotic plaque.

What is plaque rupture?

Breaking of the fibrous cap exposing thrombogenic material

What causes acute coronary syndromes?

Rupture of unstable plaques leading to thrombosis.

What are the three ACS subtypes?

Unstable angina

What is unstable angina?

New or worsening chest pain without troponin elevation.

What is NSTEMI?

Partial coronary occlusion causing myocardial injury with troponin elevation.

What is STEMI?

Complete coronary occlusion causing transmural infarction.

What determines infarct size?

Duration of occlusion and mass of myocardium supplied.

What biomarkers indicate myocardial infarction?

Troponins released from damaged myocardium.

What is the main treatment goal in STEMI?

Rapid reperfusion of the occluded artery.

How do β‑blockers treat angina?

Reduce heart rate and contractility

How do nitrates treat angina?

Dilate veins to reduce preload and myocardial oxygen demand.

What is nitrate tolerance?

Reduced drug effect with continuous use requiring nitrate‑free intervals.

How do calcium channel blockers treat angina?

Reduce Ca²⁺ entry

What are thrombolytics used for?

Dissolving clots in STEMI to restore perfusion.

What are lipoproteins?

Particles transporting cholesterol and triglycerides in blood.

What is the structure of a lipoprotein?

Amphipathic lipid monolayer surrounding a hydrophobic core with apolipoproteins.

What is apoB100?

Apolipoprotein on LDL that binds LDL receptors.

What happens when LDL binds its receptor?

Internalization

What is hypercholesterolemia?

Elevated LDL cholesterol increasing risk of atherosclerosis.

What is oxidized LDL’s role in atherosclerosis?

Attracts monocytes

How do statins lower cholesterol?

Inhibit HMG‑CoA reductase

What is the effect of statins on LDL receptors?

Increase expression

What is heart failure?

Inability of the heart to pump sufficient blood to meet metabolic demands.

What conditions commonly lead to heart failure?

Long‑standing CAD