Questions to prepare for classes and examination
• Definition of coronary insufficiency. The main cuases of coronary insufficiency.
• Mechanisms of injury to the myocardial cells during ischemia and reperfusion: role of Ca2+, oxygen free radicals, and leukocytes.
• Adaptive mechanisms developing during acute and chronic coronary insufficiency.
• Biochemical, mechanical and electrical changes elicited in the myocardium during ischemia. Signs of reversible and irreversible ischemic injury.
• The syndromes of coronary insufficiency: angina pectoris, myocardial infarction, chronic ischemic heart disease, sudden coronary death.
• Methods of diagnostics of myocardial infarction.
• Cardiac arrhythmias: types, mechanisms of development, hemodynamic consequences.
• Reentry arrhythmias: conditions required for reentry, types and mechanisms of reentry, examples of arrhythmias based on reentry.
N 87
A 46-year-old patient was admitted to the intensive care unit with complaints of intense retrosternal pain and squeezing in the chest which lasted 1.5 hours. During the last week the patient worked hard, slept little, and smoked more than usually; he also drank too much coffee and tea. The patient reported that before the current episode he had no health problems and went in for sports. On examination: the patient's condition is guarded; he is pale, and has evidence of acrocyanosis. Auscultation shows an unremarkable pattern of breathing at the rate of 28 per minute, no evidence of rales; the heart sounds are muffled and arrhythmic; blood pressure is 100/70 mm Hg. ECG reveals recurrent atrial fibrillation at the rate of 360 per minute, right bundle branch block; the ST segment elevation in leads I, Vl, V1-V4. Blood test shows: leukocytes 9.2x109/L, other parameters are unremarkable.