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Cardiology > CABS Cardiac Ischemia > Flashcards

CABS Cardiac Ischemia Flashcards

1
Q

Hyperlipidemia - two types are

A

Hyperlipidemia two types primary - familial
secondary - acquired (dietary, medication, DM)

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2
Q

Atherosclerosis is

A

hardening of the walls of the vessels such that they become less compliant, can restrict blood flow

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3
Q

The walls of the vessels are made up of what layers? (3)

A

tunica intima
tunica media
tunica externa - contains vasa vasorum

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4
Q

The tunica intima is?

A

inner layer of simple squamous endothelium - contains properties discussed in heme

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5
Q

The tunica media is?

A

smooth muscle layer, under autonomic control

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6
Q

The tunica externa is?

A

connective tissue layer
contains vasa vasorum - vessels that feed the layers of the thicker/ larger vessels

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7
Q

Atherosclerosis occurs within the ________ of the arteries.
________ cells will accumulate in this layer. Typically form in areas where there is repetitive ________ to the vessel wall

A

intima
foam cells
injury

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8
Q

Foam cells are?

A

lipid filled macrophages

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9
Q

_______ inflammatory states, __________ risk of atherosclerosis

A

increase
increase

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10
Q

First stage in development of atherosclerosis is

A

fatty streak

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11
Q

Development associated with stressors, increased
lipid deposition in the subendothelial space, increases proinflammatory mediators

A

fatty streak

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12
Q

within the fatty streak the muscle cells undergo

A

apoptosis

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13
Q

accumulation of monocytes that are engorged with cholesterol (foam cells) creates …

A

atherosclerotic plaques

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14
Q

after foam cells die and necrotic core develops smooth muscle cells will …

A

invade the intima increasing size of the plaque

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15
Q

the thinner vessels created secondary to this disease process (atherosclerosis) are more likely to

A

rupture

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16
Q

Cellular components of the atherosclerotic plaque include

A

macrophages
smooth muscle cells

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17
Q

Extracellular components of the atherosclerotic plaque include

A

lipids

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18
Q

Increased turbulence leads to increased pressure which can lead to increased ______ of the capsule wall

A

thinning

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19
Q

Ischemia is

A

decreased blood flow leading to hypoxia

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20
Q

Infarction is

A

blood flow is cut off leading to necrosis (cellular death)

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21
Q

Coronary vessels fill during

A

diastolic relaxation

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22
Q

Left coronary artery branches into

A

left circumflex
Left anterior descending

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23
Q

Left circumflex feeds the

A

anterior wall and lateral wall of the heart

24
Q

Left anterior descending feeds the

A

anterior and septal aspect of the heart

25
Q

Right coronary artery feeds the

A

right side of the heart and some of the inferior aspect of left ventricle
conduction system

26
Q

Angina is

A

chest discomfort (heavy, pressure, tight) located substernal or slightly to the left

27
Q

Myocardial Ischemia is

A

oxygen demand of the cardiac muscle outweighs the oxygen being delivered
supply and demand mismatch of O2

28
Q

Stable angina is

A

history of reproducible angina (exercise induced myocardial ischemia)
discomfort comes on a routine/ expected intervals

29
Q

Stable angina: sx last less than ______ minutes once provocative activity has stopped

A

20

30
Q

Acute myocardial infarction types (1&2)

A

Type 1 = d/t coronary atherothrombosis (unstable plaque that opened up)
Type 2 = d/t supply-demand mismatch (arrhythmia, septic, pH is off, etc)

31
Q

ACS Pathophysiology

A

plaque rupture
thrombogenic substrates released
activation of platelets
coagulation cascade

32
Q

Unstable angina is

A

new-onset angina or change in precipitating factors
(takes less exertion/ stress to induce sx than previous, may occur at rest)

33
Q

no necrosis =

A

unstable angina

34
Q

necrosis =

A

AMI (acute myocardial infarction)

35
Q

Acute myocardial infarction may lead to

A

decreased contractility which will further decrease profusion
includes STEMI and NSTEMI

36
Q

NSTEMI is m/c d/t

A

disrupted atherosclerotic plaque or partial blockage

37
Q

NSTEMI on ECG looks like

A

new horizontal or downsloping ST segment < 0.5 mm
T wave inversion > 1mm
(ST depression or inverted T wave) in 2 continuous leads

38
Q

STEMI typically begins with

A

atherosclerotic plaque rupture

39
Q

STEMI has ________ myocardial ischemia

A

transmural (complete obstruction of flow)

40
Q

STEMI on ECG looks like

A

ST elevation in two continuous leads (needs to be leads V2 and V3 - 2 mm elevation) J point is elevated above the isoelectric line

41
Q

Right ventricular infarction is associated with occlusion of what artery

A

right coronary artery occlusion

42
Q

Right ventricular infarction will have elevated ______ and decreased ______ d/t decreased ______ filling

A

JVP
CO
LV

43
Q

Right ventricular infarction is _____ STEMI

A

inferior
(ST elevation V1, 2, 3 and ST depression in V2)

44
Q

STEMI mimics =

A

Acute pericarditis - will show ST elevation in all the leads though
Myopericarditis - usually viral or autoimmune
Left ventricular hypertrophy
Aortic dissection
Severe hypercalcemia (electrolyte abnormalities)

45
Q

Coronary Vasospasm is

A

diffuse or focal spasm of the coronary arteries due to hyperactivity of smooth muscle (causes them to clamp down)
Presents like a STEMI (transient ECG findings)
may occur at rest

46
Q

Coronary Vasospasm tx

A

nitro STAT
call cath lab

47
Q

Coronary vasospasm trigger (drugs?)

A

cocaine, marijuana, ETOH, amphetamines

48
Q

Complications of ischemia include

A

decreased CO - decreased BP
Arrhythmias (m/c afib)
Blocks
Cardiogenic shock
Acute mitral regurg

49
Q

Papillary muscle dysfunction can be a complete or partial

A

rupture

50
Q

Papillary muscle dysfunction: Most common at the __________, causes _________.

A

posteromedial papillary muscle, causes acute mitral reguargitation

51
Q

Rupture of the wall is defined by

A

tear in the infarcted myocardium, typically occurs 72 hrs - 4 days after initial infarction

52
Q

Ventricular aneurysm is

A

complication of acute myocardial infarction, infarcted area of ventricle weakens, chamber will enlarge, overtime will scar and calcify
decreased CO and contactility –> hypotension

53
Q

Mural thrombi is m/c w/

A

anterior STEMI (LAD)

54
Q

Mural thrombi is associated with pts who have suffered with

A

apical aneurysm –> poor contractility of the apex with relative blood stasis

55
Q

Mural thrombi leads to

A

arterial embolic events

Cardiology (7 decks)

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