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Cardio > CAD > Flashcards

CAD Flashcards

1
Q

ischemic heart disease is a

A

consequence of atherosclerosis of the coronary arteries

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2
Q

major factors that predispose to coronary heart disease

A
  1. elevated blood cholesterol
  2. HTN
  3. Cigarette smoking
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3
Q

non-modifiable risk factors for CAD

A
  1. age
  2. sex
  3. genetics
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4
Q

what do we see in pathology in CAD

A

dimished coronary perfusion due to fixed atherosclerotic narrowing of epicardial arteries

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5
Q

pathogenesis in CAD (5)

A
  1. chronic coronary obstruction
  2. acute plaque change
  3. coronary thrombosis
  4. vasoconstriction
  5. inflammation
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6
Q

coronary obstructions usually occur

A

within the first 2 cm of the left anterior descending and the left circumflex arteries and the entire length of the right coronary artery

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7
Q

hallmark of CAD

A

coronary atherosclerotic plaque rupture or disruption

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8
Q

types of MI

A
  1. transmural
  2. subendocardial
  3. multifocal microinfarction
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9
Q

transmural infarction:

  1. extends from
  2. 3 arteries involvement
A
  1. extends from endocardium to the epicardium- LV

2. LAD, RCA or LXC

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10
Q

subendocardial infarction:

  1. affects the
  2. due to
A
  1. affects the inner one third to one half of the LV, usually circumferential, not necessary in the distribution of any one coronary artery
  2. due to hypoperfusion states
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11
Q

multifocal microinfarction

A

involves small intramural vessels in the setting of microemboli, vasculitis or vasospasm

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12
Q

MI in first 12-24 hr.

A

pallor, red blue hue (dark mottling)
wavy fibers
contraction band necrosis
deeply eosinophili

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13
Q

in an MI the first changes occur in the

A

subendocardial zone, more through the myocardium wall in the form of a wavefront

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14
Q

MI in 2-4 days

A
  1. mottling with yellow- tan infarct center
  2. PMNs
  3. interstitial hemorrhage and edema
  4. myocytes are clearly necrotic
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15
Q

M 5-10 days

A
  1. sahrply outlined border (hyperemic)
  2. central pale, yellowish necrotic region
  3. lymphocytes
  4. fibroblast proliferation with collagen deposition
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16
Q

risk for free wall rupture in MI is highest

A

5 days of onset

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17
Q

MI 10 days- 2 weeks

A
  • depressed, soft, gelatinous area

- granulation tissue

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18
Q

risk for ventricular aneurysm formation in MI

A

2-8 weeks post MI

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19
Q

MI 2-8 weeks

A
  • gray white scar
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20
Q

MI complications (6)

A
  1. contractile dysfunction-cardiogenic shock
  2. arrhythmias
  3. muocardial rupture
  4. aneurysms
  5. mural thrombosis and embolism
  6. pericarditis
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21
Q

occurs in 10-15% of patients after an acute MI, usually indicates a large infarct causing L ventricular failure, hypotension, pul. vascular congestion and transudation

A

contractile dysfunction cardiogenic shock

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22
Q

prognosis of MI

A

overall mortality is 30% for first year and survivors have a 3-4% with each passing year

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23
Q

MI therapy (3)

A
  1. thrombolytic enzymes
    2, Percutaneous transluminal coronary angioplasty
  2. coronary artery bypass grafting
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24
Q

reperfusion injury

A

new cellular damage to tissues that cells are already lethally injured

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25
Q

Chronic ischemic Heart disease:

  1. who is affected?
  2. what do we see
A
  1. elderly pt. with CHF, previous hx of angina and MI and post-infarct cardiac decompensation
  2. myocardial atrophy with inerstitial fibrosis
26
Q

What are the two most common causes of death in the US?

A

Heart disease and cancer

27
Q

What is the most common cause of heart disease?

A

Coronary artery disease

28
Q

What is the pathological hallmark in acute coronary syndromes?

A

Coronary atherosclerotic plaque rupture or disruption

29
Q

What type of infarction extends from the endocardium to the epicardium and conforms to the distribution of one of the three major coronary arteries?

A

A transmural infarction

30
Q

A myocardial infarction that is 5-10 days old shows which gross macroscopic features?

A

A sharply outlined hyperemic border with central pale, yellowish, necrotic region

31
Q

A myocardial infarction that is 2-4 days old will show which microscopic features?

A

PMN’s , necrotic myocytes, interstitial edema, and hemorrhage.

32
Q

Which complication can occur two to eight weeks post infarction?

A

Ventricular wall aneurysm

33
Q

Insufficient oxygen delivery relative to demand causes _______that can manifest as “angina”

A

myocardial ischemia

34
Q

decreased oxygen delivery due to (4)

A
  1. decreased perfusion pressure
  2. increased coronary artery resistance to blood flow
  3. increased microvascular resistance to blood flow
  4. decreased blood oxygen
35
Q

increased oxygen demand due to (4)

A
  1. tachycardia
  2. increased contractility
  3. increased LV wall stress
  4. ventricular hypertrophy
36
Q

flow limiting disease

A
  1. stable occlusive atheroma/ acute thrombus

2. vasospasm

37
Q

clinical manifestation of stable CAD

A
  1. chest pain
  2. SOB
  3. syncope
38
Q

Stress Myocardial perfusion imaging

A

identifies flow-limiting or obstructive CAD

39
Q

gold standard for dx. CAD

A

coronary angiography

40
Q

NSTEMI

A

no st elevation but there might be depression

- troponin elevation

41
Q

STEMI

A
  • troponin elevation

- ST segment elevation

42
Q

Typically LAD occlusion
ST Elevation:
I and aVL
V2-V5
Substantial amount of myocardium may be in jeopardy particularly for proximal LAD disease
May significantly reduce LV systolic function causing pump/heart failure

A

anterior stemi

43
Q

Typically RCA occlusion but may alternatively be LCx
Associated GI symptoms common (e.g. burping)
ST Elevation: II, III, aVF
Nitroglycerin induced hypotension
Bradycardia from vagal influences
AV node block if AV node ischemic
Proximal RCA occlusion can cause RV infarction

A

inferior stemi

44
Q

NSTEMI may be caused by a

A

demand ischemia as opposed to a new plaque rupture

45
Q 
Coronary artery thrombosis
Can be STEMI or NSTEMI
No obvious change in myocardial oxygen demand
Typical symptoms of MI
Elevated troponin
A

MI type I

46
Q

Atherosclerotic blockage usually present but without coronary artery thrombosis
Transient increased myocardial oxygen demand
Tachycardia: sepsis
Elevated BP: stop meds
May not be associated with chest pain or typical symptoms
Elevated troponin

A

MI type II

47
Q

Restoring blood flow in infarct related artery less than 6 hours from symptom onset provides survival advantage.

A

true

48
Q

After 6-hours revascularization may improve survival while also reducing symptoms, heart failure and potentially arrhythmia.

A

true

49
Q

acute MI interventions (3)

A
  1. PCI
  2. thrombolytic therapy
  3. surgical therapy such as a CABG
50
Q

time is

A

muscle

51
Q

which medications can lessen remodeling following infarction

A

ACEi and BB

52
Q

Acute MI complications (4)

A
  1. Pump failure and shock
  2. ventricular arrhythmia
  3. mechanical complications
  4. VSD
53
Q

Progressive CAD leading to another MI:

  1. Medical therapy for ASCVD: (2)
  2. Revascularization: (2)
A

Progressive CAD leading to another MI:

  1. Medical therapy for ASCVD: Statin, ASA
  2. Revascularization: PCI or CABG
54
Q

Systolic Dysfunction leading to CHF:

  1. Medical therapy: (3
  2. Revascularization
A

Systolic Dysfunction leading to CHF:

  1. Medical therapy: ACEi, beta-blocker, Aldosterone receptor blocker
  2. Revascularization
55
Q

Scar and Systolic Dysfunction leading to VT/VF: treatment

A

Defibrillator

56
Q

major cause of cardiac death

A

ischemic heart disease

57
Q

Pressure is lost owing to viscous friction along the entrance and throat of the narrowed section

A

Poiseuille’s law

58
Q

The pressure gradient across a stenosis is determined by

A

the sum of viscous and separation losses

59
Q

Resistance to blood flow is directly proportional to __________and inversely proportional to the _______ to the fourth power

A

Resistance to blood flow is directly proportional to length of stenotic segment and inversely proportional to the radius of the minimum diameter to the fourth power

60
Q

Insufficient oxygen delivery relative to demand causes myocardial ischemia that can manifest as

A

“angina”

61
Q

Provides assessment of the amount of myocardium at risk, which is proportional to outcome

A

myocardial perfusion imaging test

Cardio (26 decks)

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