Adult Cardio 3 (Coronary Artery Disease) Flashcards
Coronary artery disease is also known as…
Ischemic heart disease
Coronary artery disease is caused by a blocked ___ in a branch of the left coronary artery
Lumen
___ ___ ___ is the leading cause of death, with coronary artery disease being the largest percentage of that
Cardiovascular disease
The creation of ___ drugs started the decline in prevalence of coronary artery disease
CABG
____ is an aging process that happens over a long period of time
Atherscleorosis
Between ___-___ years of age is when you might start to see the thickening of the endothelium (beginning of the atherosclerosis process)
10-20
Massive occlusions caused by atherosclerosis happen between __-__ years of age, typically
50-60
Massive occlusions caused by atherosclerosis can cause…
-Myocardial infarction
-Ischemia, stroke, TIA
-UA
-Acute limb ischemia
-CV death
___ ___ ___ describes connections or anastomoses between 2 branches of the same coronary artery or connections/branches between the same right coronary artery and left coronary artery
Collateral coronary circulation
What is the functional importance of collateral coronary circulation?
Protects the heart
Gradual coronary artery ___ results in growth of collaterals
Occlusion
What two things will facilitate collateral growth?
-Nitric oxide
-Vascular endothelial growth factors
The degree of left ventricle deterioration is ____ related to the presence of collaterals
Inversely
The incidence of ventricular aneurysm formation after myocardial infarction is ___ when significant collaterals are present
Decreased
The risk for severe dysrhythmias after myocardial infarction is ____ when significant collaterals are present
Decreased
The presence of collaterals expands the “window of ___” in which reperfusion strategies are effective after myocardial infarction
Time
___ people are more likely to develop collateral circulation because they have more time
Older
___ people have more severe and more deadly occlusion (more severe symptoms like crushing chest pain)
Younger
Older people might have more ____ symptoms with MI
Atypical
Women might also have atypical symptoms because they usually have MI ___ years after men due to estrogen which slows down atherosclerotic process (they have more time for collateral circulation)
10
___ ___ is more common in elderly people
Unstable angiotensin (blood pressure)
Chest pain is also known as ____
Angina
People may have __-__% occlusion before they are symptomatic
50-75%
___% what patients have chest pain plus one or more other symptoms
90
___-___% may be symptomatic during increased myocardial oxygen demand
50-75
Symptoms and outcomes are dependent upon ___ vs ___
Ischemia (reduced blood flow); infarction (no blood flow)
Infarction causes ____ activation, aggregation, and adherence
Platelet
Common symptoms other than angina:
-Dyspnea
-Diaphoresis
-N/V (due to vagus nerve innervation)
-Syncope (due to systolic dysfunction)
The continuum of ischemic heart disease:
-Coronary artery disease
-Ischemia
-Myocardial infarction
Definition of coronary artery disease:
Any vascular disorder that causes narrowing/occlusion of coronary arteries
Definition of ischemia (angina):
Local state in which myocardial O2 supply is diminished to the extent that myocardial cellular metabolism is impaired
What are four types of ischemia?
-Stable
-Variant (Prinzmetal’s) (Vasospasm)
-Silent
-Unstable (acute coronary syndrome)
Myocardial infarction is the ___ of acute coronary syndrome
Endpoint
Myocardial infarction causes ___ necrosis
Myocyte
What are the two types of MI?
-ST elevation MI
-Non-ST elevation MI
Within the progression of coronary artery disease, is systolic or diastolic function impaired first?
Diastolic
If someone has a normal ___, it does not mean that they definitely don’t have heart issues
EKG
Ischemia is an imbalance between ___ and ___
Supply and demand
What can cause increased O2 demand?
-Hyperthermia
-Hyperthyroidism
-Sympathomimetic toxicity
-Hypertension
-Anxiety
-AV fistula
-Hypertrophic CMP
-Aortic stenosis
-Dilated CMP
-Tachycardia
What can cause decreased O2 supply?
-Anemia
-Hypoxemia (pneumonia, asthma, COPD, sleep apnea)
-Sickle cell
-Sympathomimetic toxicity
-Hyperviscosity (polythemia, leukemia)
-Aortic stenosis
-Hypertrophic CMP
Acute coronary syndrome starts when atherosclerotic ___ with a lipid-rich core and thin fibrous cap forms
Plaque
What may cause rupture of this plaque?
-Shear force
-Inflammation
-Apoptosis
-Macrophage-derived degradative enzymes
After the plaque has ruptured, what may cause thrombus formation over the lesion, plus vasoconstriction of the vessel?
-Increased inflammation with release of multiple cytokines
-Platelet activation
-Production of thrombin and vasoconstrictors
Acute decrease in coronary blood flow then leads to…
-Unstable angina
-Myocardial infarction
Mitochondria needs ___ to generate ATP
Oxygen
When O2 is reduced, there is not enough ___ being produced
Energy
What are some major users of ATP?
-Actin
-Myosin
-Sodium-potassium pump
Since actin and myosin are ___ in proximity than the sodium-potassium pump, they will get most of the oxygen (the sodium-potassium pump suffers more)
Closer
Without the sodium-potassium pump, the ___ of the cell is messed up and the cell will remain in repolarization for longer periods of time
Polarity
___ would then start and this would indicate ischemia
Hypokenesis (smaller range of motion of body)
The dysfunction of the sodium-potassium pump cause too much ___ to get into the cells, causing the cell to swell
Sodium
With too much sodium in the cell, you might go into ____ because energy is being used to get sodium into the cell
Acidosis
Severe acidosis leads to ___ and lots of damage to nearby cells; you would be able to detect troponin in the blood
Necrosis
If there is less severe acidosis, you might see ____which would not damage nearby cells (no troponin in the blood)
Apoptosis
Less severe acidosis might cause problems since it is less symptomatic and might go ____
Undetected
Characteristics of an unstable plaque:
-Inflammatory cells
-Thin fibrous cap
-Few smooth muscle cells
-Eroded endothelium
-Activated macrophages
Characteristics of a stable plaque:
-Lack of inflammatory cells
-Thick fibrous cao
-More smooth muscle cells
-Intact endothelium
-Foam cells
Local risk factors for plaque rupture:
-Cap fatigue
-Atheromatous core (size/consistency)
-Coronary hemodynamics
-Cap thickness/consistency
-Mechanical injury
-Cap inflammation
Systemic risk factors for plaque rupture:
-Smoking
-Cholesterol
-Diabetes Mellitus
-Homocysteine
-Impaired fibrinolysis
____ use their membrane to form clots
Platelets
Platelets are activated because they think there is a ___ in the artery, but there is really just a crack in the endothelial layer of the heart
Cut
____ is the first line therapy for MI because it is anti-platelet (we want to get rid of the clot)
Aspirin
If patient has unstable angina, after doing a history, physical exam, ECG, and looking at cardiac markers, you can determine if there is ___ elevation or not
ST
If someone has ST elevation, is is presumed an ___ ___
Acute MI
If someone has no ST elevation, look at ___ __ ___ and ECGs
Serial marker sampling
If someone has positive markers, it is presumed __ __
Acute MI
If someone has negative markers, it could indicate one of what two things?
-Unstable angina
-Noncardiac chest pain
____ infarction, also known as (STEMI), involves all 3 muscle layers of the heart
Transmural
A non-transmural (non-STEMI) infarction can be classified as one of what two things?
-Subendocardial
-Subepicardial
Subendocardial non-STEMIs involve what two muscle layers?
-Endocardium
-Myocardium
Subendocardial non-STEMIs are more ____ because blood supply to the endocardium is at greater risk due to the mechanics of systolic compression on these vessels
Common
Subepicardial non-STEMIs involve what two muscle layers?
-Epicardium
-Myocardium
STEMI MIs have ___ ___, which is more concerning
Full occlusion
Non-STEMIs are problematic because they might not be ____
Detected
What should we look for when diagnosing STEMI vs non-STEMI?
-Patient’s story
-Physical exam
-Electrocardiogram
-Cardiac markers
What should we look for during history and physical exam?
-Precipitating factors
-Chest pain (differentials)
-N/V
-Diarrhea
-Weakness
-Dizziness
-Palpations
-Cold perspiration
Pain in the lungs might indicate….
-Pneumothorax
-Pulmonary embolism
Main in the musculoskeletal regions might indicate…
-Non-specific pain
-Cocaine abuse
Pain in the heart might indicate…
-MI
-Aortic dissection
-Pleural effusion
-Heart failure
-Coronary artery disease
-Heart valve diseases
-Atrial fibrilation
GI pain might indicate…
-Acid reflux disease
-Esophageal rupture
CPK is a cardiac biomarker which would rise 4-8 hours after MI, peak ___-___ hours after, and normalize in 3-4 days
12-24
CK-MB is a cardiac biomarker which would rise 4-6 hours after MI, peak ___-___ hours after, and normalize 2-3 days after
12-24
Troponin is a cardiac biomarker that would rise 3-12 hours after MI, peak __-__ days after, and normalize 1-2 weeks after
1-2
The goal is for EMS to balloon time to be within ___ minutes after the onset of symptoms
90
Total ischemia time should be less than ___ minutes from time of symptom onset to balloon
120
Sending a patient to the cath lab __-__ hours after symptoms might be deadly due to reperfusion injury
3-4
If it has been 304 hours since onset of MI symptoms, sending the patient to the cath lab causes creation of ___ ___ ___ (if the mitochondria does not deactivate the ROS, it goes to the DNA and causes cell death)
Reactive oxygen species
Reperfusion injury causes ____ levels to skyrocket and cause widespread necrosis which could cause death
Troponin
___ ___ happens in 50-70% of cases and causes sudden death
Ventricular fibrilation
With ventricular fibrillation, the heart starts fibrillating instead of ____ (causes death)
Contracting
____ ___ is another mechanism of how occlusion can lead to death; it causes multiorgan failure
Cardiogenic shock
With ___ ___, the left ventricle fails, so blood backs up into the lungs and causes breathing problems and death
Pulmonary edema
