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IPC Cardiology 1 > Atherosclerosis and Ischemic Heart Disease Patho > Flashcards

Atherosclerosis and Ischemic Heart Disease Patho Flashcards

1
Q

Risk factors of atherosclerosis

Non-modifiable

A
  • Male >45 years
  • Female >55years
  • Family History of premature CAD–>Male <55,Female<65
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2
Q

Risk factors of Atherosclerosis

Modifiable

A
  • Smoking
  • Hypertension
  • Dyslipidemia
  • Diabetes
  • Obesity
  • Physical inactivity
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3
Q

What is ischemia?

A

Inadequate blood supply to an organ or tissue–> tissue damage and necrosis

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4
Q

How do arteries respond to ischemia?

A

They vasodilate to increase oxygen delivery to the tissue

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5
Q

What are the coronary arteries?

A
  • They lay on the outside of the heart
  • They supply oxygen to the myocardium
  • Start just above the aortic root
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6
Q

Development of coronary artery disease

A
  1. Atherosclerotic plaque build up in the coronary aeteries
  2. Vessels vasodilate to continue bring blood to the myocardium
  3. When oxygen demand increases above baseline, the vessels can’t vasodilate further
  4. Demand>supply = Ischemia + chest pain
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7
Q

Oxygen demand and supply in the myocardium

A
  • Oxygen supply
    1. Coronary blood flow
    2. Arterial blood O2 content
  • Oxygen demand
    1. Heart Rate
    2. Contractility
    3. Ventricular Wall tension(Preload and Afterload)

When oxygen and demad are equal the heart is working normally and there is no ischemia

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8
Q

When oxygen supply is less than demand what happens?

A

The coronary arteries vasodilate to meet demand

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9
Q

If the oxygen demand keeps increasing due to factors such as exercise, emotional stress,med or diseases that increase BP, what happens?

A

The coronary arteries can not vasodilate nay further an as such results in ischemia

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10
Q

What are the characteristics of chest pain(angina)?

A
  • Quality—>Pressure or heavy weight on chest,crushing, burning, tightness
  • Location–>substernal, may radiate , but not common
  • Duration–>0.5-20mins
  • Precipitating Factors–>Exercise,cold weather, postprandial,emotional stress
  • Relieving factors—>resting, sublingual nitroglycerin
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11
Q

Types of angina

A
  • Typical angina(meets all of the characteristics)
  • Atypical angina(meets 2/3 of the characteristics)
  • Non-cardiac angina(meets 1 or none of the characterstics)
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12
Q

Where can angina radiate to ?

A
  • Neck
  • Jaw
  • Chest
  • Shoulder
  • Arm
  • Upper abdomen
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13
Q

Atypical angina characterisitic equivalents

Present in women,older adults and pts w/diabetes

A
  • Anxiety
  • Shortness of breath
  • weakness
  • fatigue
  • indigestion
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14
Q

Presentations of Ischemic Heart Disease(IHD)

A
  • Chronic Coronary disease(CCD)
  • Acute Coronary Syndromes(ACS)
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15
Q

Presentation of patients with Chronic Coronary diesease(CCD)

A
  • Stable angina
  • Patients discharged after Acute coronary syndrome(ACS)
  • Patients diagnosed with CCD based on screening
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16
Q

Presentations of patients with Acute coronary syndrome(ACS)

A
  • Unstable angina
  • NSTEMI
  • STEMI
17
Q

What are the charateristics of Chronic Coronary Disease?

A
  • Stable Angina—>chronic angina precipitated by activity or upset, relieved at rest
  • Patient discharged after ACS—>Patients are considered to have CCD after they are discharged for an acute coronary syndrome
  • Patient diagnosed with CCD—> patients may have risk factors of or symptoms consistent with CCD for which a screening test is completed(ex: stress test) and CCD is identified
18
Q

What are the charateristics of Acute Coronary Syndrome(ACS)?

A
  • Unstable angina—>Increased frequeny or duration of angina episodes produce at a lower level of exertion or at rest
  • NSTEMI—>Myocardial necrosis resulting from prolonged interruption of the blood supply,generally results from an acute thrombus, but NO ECG changes
  • STEMI—>Myocardial necrosis resulting from prolonged interruption of the blood supply, generally results from an acute thrombus, with ECG changes
19
Q

Plaques and Plaque ruptures

A
  • Angina–>non thrombotic plaque(partially occluded)
  • NSTEMI–>thrombotic plaque(partially occluded)
  • STEMI–>thrombotic plaque(fully occluded)
20
Q

Coronary anatomy

A
  • Left coronary anatomy–> supplies left side of the heart
  • Right coronary artery–>supplies the right side of the heart
  • Circumflex artery–> supplies back of the heart
21
Q

Cardiac biomarkers that help to recognise cell necrosis

A
  • Myoglobin and ck isoforms—>creatine kinase released when muscle tissues necrosize
  • Troponin—>Gold standard for ACS, draw q6H, until they peakn then stop

Levels of troponin equals size of cardiac arrest

22
Q

Testing and diagnosis of CAD/IHD

A
  • Functional Testing
    1. Exercise stress test
    2. Pharmacological stress test
  • Anatomical testing
    1. Coronary CT Angiography(Gold standard)
    2. Coronary Artery Calcium scoring
23
Q

What entails an exercise stress test vs a nuclear exercise stress test?

A
  • Exercise stress test
    1. Vitals are taken at rest
    2. Patient begins to walk on treadmill
    3. Vitals recorded evry 3 mins as treadmill intensity increases
    4. Exercise until reaching or nearing max heart rate
    5. Gradually cool down
  • Nuclear exercise stress test
    1. Electrodes placed on chest for ECG. IV line started
    2. Begin walking on treadmill
    3. Vitals recorded every 3 minutes as treadmill intensity increases
    4. Near max HR, radioactive tracer delivered through IV
    5. Lie under gamma camera for 15-20 mins while images are taken of blood flow to heart

If there are any abnormalities on either tests then patient is sent to do a Coronary Angiogram

24
Q

What is a Coronary Artery Calcium testing?

Looking for calcification of the coronary arteries

A
  • Used for ASYMPTOMATIC patients to determine if there is build-up within the coronary arteries
  • Uses CT scan(w/out dye)
  • Calculates the mass of calcium
  • Score per page
25
Q

What is cardiac catherization?

A
  • Diagnosis–>examine heart valves, take blood or heart muscle samples
  • Treatment–>can be used to treat narrowed heart valve
26
Q

What is a stent procedure?

A

Surgical procedure that utilizes a stent and balloon to widen an artery by ‘squishing’ plaque permanently by inflated balloon and stent.

27
Q

What is a peripheral artery disease(PAD)?

A

Atherosclerosis that occurs within the narrow arteries of the your periphery

28
Q

What are the the risk factors of PAD?

A
  • Cigarette smoking
  • Obesity
  • Diabetes Melllitus
  • High BP
  • Hyperlipidemia
  • Physical inactivity
29
Q

Most common arteries associated with PAD

A
  • Aortoiliac
  • Femoral
  • Popliteal
  • Tibial
30
Q

Symptoms and clinical presentation of PAD

A
  • Aortoiliac–>pain in buttocks,hips and thighs
  • Femoral artery–>Thigh, calf
  • Popliteal and Tibial–> Calf,ankle and foot

Signs of advanced disease
->Cool to touch
->Lack of pulses in the limbs
->Gangrene

31
Q

Intermittent Claudication(IC)

A
  • Pain when walking in the buttocks, thighs, or calves
  • Often relieved with rest
  • Severe cases will have pain at rest
32
Q

Chronic Limb-Threatening Disease(CLTI)

A
  • Chronic decreased flow that can lead to ulcerations, gangrene, infections
  • Patients with diabetes and smokers highest risk
33
Q

Acute Limb Ischemia(ALI)

A
  • Medical emergency
  • Requires immediate revascularization to prevent limb loss

Most severe case

34
Q

Screening for PAD

A
  1. 65 years and older
  2. 50-64 years with risk factors for cardivasculat disease or family history of PAD
  3. Less than 50 years with DM and one additional risk factor for CV disease
  4. Any age with known atherosclerotic disease in another vascular bed
35
Q

Diagnosis of PADusing the Ankle-Brachial Index

A
  • > 1.4—->non-compressible
  • 1-1.4—->normal
  • 0.8-0.9—->some PAD
  • 0.5-0.8—–>Moderate PAD
  • < 0.5——–>Severe PAD

IPC Cardiology 1 (6 decks)

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