100114 chronic coronary artery disease Flashcards
chronic ischemic heart disease
most commonly caused by obstruction of coronary arteries by atheromatous plaque
location, quality, duration, aggravating or alleviating factors, and associated symptoms of angina
retrosternal location: radiates to or occasionally isolated to neck, jaw, shoulders, arms, or epigastrium
pressure, squeezing, tightness, heaviness, burning, indigestion
under 2-10 minutes
made worse by exertion, cold weather, emotional stress
relieved by rest or nitroglycerin
associated symptoms: dyspnea. S3, S4, or murmur of papillary dyxfxn during pain
what on EKG signals infarction?
Q wave (although some leads may have small Q waves normally due to their location)
in acute STEMI, what would you observe in sequence on EKG?
immediately before MI starts–T wave inversion
within hours after MI–marked ST elevation and upright T wave
hours later–significant Q, ST elevation, upright T
hours to a day or two later–significant Q, less ST elevation, marked T inversion
days to weeks later–significant Q, T wave inversion
weeks, months, years–significant Q only
ST elevation signals
injury
Q wave signals
infarct
if you see Q wave in leads II, III, avF, what does this signal?
infarct in inferior wall
V5, V6, I, aVL together-if you see STEMI signs on EKG, represent what location of the heart?
lateral wall
anterior wall STEMI would show irregulaties in which leads on EKG?
V2 to V4
if II, III, aVF are the leads depicting primary EKG changes, what is the likely vessel involved?
RCA
if V1 and V2 are the leads depicting primary EKG changes, what is the likely vessel involved?
LAD
if I, aVL, V5-V6 are the leads depicting primary EKG changes, what is the likely vessel involved?
CIRC
if infarct is in posterior heart, what lead would you see prominent changes in EKG?
V1–you would see prominent R
coronary angiography is used
in diagnosing coronary heart disease-to look at obstruction
invasive procedures
lesions greater than 70% are considered significant
white tissue on MRI could indicate
scar tissue (after tissue infarct)
revascularization can be used for symptomatic chronic coronary lesions-true or false?
true
-PCI (balloon, stent), surgical bypass
however, for most pts with chronic angina, revascularization shouldnot constitute initial management strategy before evidence based medical therapy (like phamacologic antianginal therapy, therapetuic lifestyle changes) is initiated and optimized
if scarring of myocardium has occurred, will balloon angioplasty (PTCA) help?
no
bypass graft (an invasive procedure, have to open up chest wall ) may be better than PCI for
left main artery obstruction
multiple vessels involved
diabetics
sequela of chronic coronary artery disease
chronic chest discomfort (stable angina)
cardiomyopathy (heart failure)
left ventricular aneurysms
ventricular arrhthmias/sudden death
