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Cardiology > 267 IHD > Flashcards

267 IHD Flashcards

Ischemic Heart Diease

1
Q

ECG changes not characteristic of ischemia

A

Up sloping or Junctional ST segment changes

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2
Q

Signs (not symptoms) when stress testing has to be stopped

A

ST segment depression of more than 0.2 mV
Development of ventricular tachyarrhythmia
Fall in systolic blood pressure of more than 10 mmHg

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3
Q

Is a condition in which there is inadequate supply of blood and oxygen to a portion of the myocardium; typically when there is an imbalance between myocardial oxygen supply and demand

A

ischemic heart disease

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4
Q

most common cause of myocardial ischemia

A

atherosclerotic disease of an epicardial coronary artery

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5
Q

Major determinants of myocardial oxygen demand

A

heart rate, myocardial contractility and myocardial wall tension (stress)

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6
Q

when does majority of blood flow to the coronary arteries happen

A

diastole

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7
Q

75% of the total coronary resistance to flow occurs where

A

three sets of arteries 1. large epicardial arteries R1, 2. prearteriolar vessels R2, 3. arteriolar and intramyocardial capillary vessels R3

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8
Q

ischemic ST segment response in stress testing

A

Flat or downslopin depression of the ST segment more than 0.1 mv below the baseline and lasting for more than 0.08 s

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9
Q

non diagnostic ST segment response in stress testing

A

T wave abnormalities, conduction disturbances, ventricular arrhythmias

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10
Q

when is an exercise test negative

A

when heart rate 85% of maximal predicted for age and sex is not achieved

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11
Q

When should stress testing be discontinued

A

chest discomfort, severe shortness of breath, dizziness, severe fatigue, ST segment depression more than 0.2 mV, fall in SBP of more than 10 mmHg, ventricular tachyarrythmia

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12
Q

contraindication to stress testing

A

rest angina in the last 48 hrs, unstable rhythm, severe aortic stenosis, acute myocarditis, uncontrolled heart failure, severe pulmonary hypertension, active infective endocarditis

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13
Q

best treated with CABG

A

patients with stenosis of the left main coronary artery and those with three-vessel IHD
(especially with diabetes and/or impaired LV function)

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14
Q

changing oxygen needs of the heart with exercise and emotional stress affect coronary vascular resistance and in this manner regulate the supply of oxygen and substrate to the myocardium

A

metabolic regulation

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15
Q

coronary resistance vessels also
adapt to physiologicalterations in blood pressure to maintain coronary
blood flow at levels appropriate to myocardial needs

A

autoregulation

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16
Q

major site of atherosclerosis disease

A

Epicardial coronary arteries

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17
Q

major risk factors for atherosclerosis

A

(high levels of plasma low-density lipoprotein [LDL], low plasma high-density lipoprotein [HDL], cigarette smoking, hypertension, and diabetes mellitus

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18
Q

The combination of a “vulnerable vessel” in a patient with “vulnerable blood” promotes a state of ________ especially true in patients with diabetes mellitus

A

state of hypercoagulability and hypofibrinolysis

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19
Q

predilection for atherosclerotic plaques to develop at sites of

A

increased turbulence in coronary flow, such as at branch points in the epicardial arteries

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20
Q

Segmental atherosclerotic narrowing of epicardial coronary arteries is caused most commonly by

A

commonly by the formation of a plaque, which is subject to rupture or erosion of the cap separating the plaque from the bloodstream

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21
Q

Upon exposure of the plaque contents to blood, two important and interrelated processes are set in motion:

A

(1) platelets are activated and aggregate, and (2) the coagulation cascade is activated, leading to deposition of fibrin strands

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22
Q

critical obstructions in vessels, such as ______ are particularly hazardous

A

left main coronary artery and the proximal left anterior descending coronary artery

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23
Q

True or false. Chronic severe coronary
narrowing and myocardial ischemia frequently are accompanied by
the development of collateral vessels, especially when the narrowing develops gradually

A

True.

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24
Q

The relatively
poor perfusion of the _____ causes more intense ischemia
of this portion of the wall (compared with the ______)

A

The relatively poor perfusion of the subendocardium causes more intense ischemia of this portion of the wall (compared with the subepicardial region).

25
Q

The severity and duration of the imbalance between myocardial oxygen supply and demand determine whether the damage is reversible ____

A

Less than 20 mins in the absence of collaterals

26
Q

The severity and duration of the imbalance between myocardial oxygen supply and demand determine whether the damage is permanent

A

More than 20 mins

27
Q

Transient T-wave inversion probably reflects

A

nontransmural, intramyocardial ischemia

28
Q

transient ST-segment depression often reflects

A

patchy subendocardial ischemia

29
Q

ST-segment elevation is thought to be caused by

A

caused by more severe transmural ischemia

30
Q

True or false. Exercise stress tests in asymptomatic persons may show evidence of silent myocardial ischemia

A

True.

31
Q

This episodic clinical syndrome is due to transient myocardial ischemia.

A

Stable angina pectoris

32
Q

clenched fist, to indicate a squeezing, central, substernal

discomfort

A

Levine’s sign

33
Q

Angina is rarely localized below the _____ or above the _____

A

Angina is rarely localized below

the umbilicus or above the mandible

34
Q

True or false. myocardial ischemic discomfort does not radiate to the trapezius muscles; that radiation pattern is more typical of pericarditis.

A

True

35
Q

True or false. Sharp, fleeting chest pain or a prolonged, dull ache localized to the left submammary area is rarely due to myocardial ischemia

A

True.

36
Q

Anginal “equivalents” are symptoms of myocardial

ischemia other than angina. They include ______

A

dyspnea, nausea, fatigue, and

faintness and are more common in the elderly and in diabetic patients

37
Q

Abnormal cardiac nociception is more difficult to manage and may be ameliorated in some cases by _____

A

imipramine

38
Q

these disorders may cause angina in the absence of

coronary atherosclerosis

A

Aortic stenosis, aortic regurgitation, pulmonary hypertension, and hypertrophic cardiomyopathy

39
Q

auscultatory signs

are best appreciated with the patient in _____

A

patient in the left lateral decubitus position

40
Q

The presence of _____ is a significant indication of increased risk of adverse outcomes from IHD

A

presence of LVH

41
Q

Stress testing is discontinued upon evidence of

A

chest discomfort, severe shortness of breath, dizziness, severe fatigue,
ST-segment depression >0.2 mV (2 mm), a fall in systolic blood pressure >10 mmHg, or the development of a ventricular tachyarrhythmia

42
Q

The ischemic ST-segment response generally is defined as

A

flat or downsloping depression of the ST segment >0.1 mV below baseline (i.e., the PR segment) and lasting longer
than 0.08 s

43
Q

True or false. Upsloping or junctional ST-segment changes
are not considered characteristic of ischemia and do not constitute a
positive test

A

True.

44
Q

True or false. Although T-wave abnormalities, conduction disturbances, and ventricular arrhythmias that develop during exercise should be noted, they are also not diagnostic.

A

True.

45
Q

True or false. Obstructive disease limited to the circumflex coronary artery may result in a false-negative stress test since the lateral portion of the heart that this vessel supplies is not well represented on the surface 12-lead ECG.

A

True.

46
Q

this vessel supplies is not well represented on the surface 12-lead ECG.

A

Coronary Circumflex artery

47
Q

Sensitivity of the exercise stress echocardiography

A

75% a negative result does not exclude CAD

48
Q

What does a negative stress testing ECG mean?

A

Negative means CAD is less likely a three vessel or left main CAD

49
Q

When can stress testing can be after uncomplicated MI

A

6 days after

50
Q

Contraindications to stress testing

A

rest angina within 48 h, unstable rhythm,
severe aortic stenosis, acute myocarditis, uncontrolled heart failure,
severe pulmonary hypertension, and active infective endocarditis.

51
Q

Most important, any of the following signs during noninvasive testing indicates a high risk for coronary events

A

inability to exercise for
6 min, i.e., stage II (Bruce protocol) of the exercise test;
a strongly positive
exercise test showing onset of myocardial ischemia at low workloads
(≥0.1 mV ST-segment depression before completion of stage II, ≥0.2 mV
ST-segment depression at any stage, ST-segment depression for >5 min
after the cessation of exercise, a decline in systolic pressure >10 mmHg
during exercise, or the development of ventricular tachyarrhythmias
during exercise);
the development of large or multiple perfusion
defects or increased lung uptake during stress radioisotope perfusion
imaging; and a decrease in LV ejection fraction during exercise on
radionuclide ventriculography or during stress echocardiography.

52
Q

Obstructive lesions of the _____ are associated with a greater risk than are lesions of the ______ because of the greater quantity of myocardium at risk.

A

left main (>50% luminal diameter) or left anterior descending coronary artery proximal to the origin of the first septal artery Than right or left circumflex coronary artery

53
Q

True or false. Cigarette smoking accelerates coronary atherosclerosis

A

True.

54
Q

central in aiming for long-term relief from angina, reduced need for revascularization, and reducltion in myocardial infarction and death.

A

treatment of dyslipidemia

55
Q

To minimize the effects of nitrate tolerance, the minimum effective dose should be used and a _____ kept free of the drug to restore any useful response(s)

A

minimum of 8 h each day

56
Q

The most common clinical indication for PCI

A

symptom-limiting angina pectoris, despite medical therapy, accompanied by evidence of ischemia during a stress test.

57
Q

Drug therapy in ischemic heart disease

A 
Nitrates
Beta blockers
Calcium channel blockers
Anti platelet
Add ons
ACEI
Statins
58
Q

Preferred procedure in CABG

A

Anastomosis of one or both of the internal mammary arteries or a radial artery to the coronary artery distal to the obstructive lesion is the preferred procedure.

59
Q

It is usual clinical practice to administer after the implantation of a bare metal stent

A

aspirin indefinitely and a P2Y12 antagonist for 1–3 months

Cardiology (14 decks)

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