cardiac ischemia Flashcards
what is hyperlipidemia
elevation of lipids
What lipids make up hyperlipidemia
fat
triglycerides
cholesterol
What is the job of total cholesterol
maintain cell membranes
building block for some nutritional absorption and hormone synthesis
What is LDL and what does it do
low density lipo protein
atherosclerotic plaque formation
What is HDL and what does it do
High density lipo-protein
bring cholesterol back to the liver
What are triglycerides
stored energy
breaks down for cellular metabolism
where are triglycerides stored
adipose and liver
What is primary hyperlipidemia from
familial
polygenetic source
type 1-4
*can cause xanthomas, atherosclerosis, hepatosplenomegally
What is secondary hyperlipidemia from
diet
medication
Dm
CKD
inflammatory states
What structure is located in the tunica externa
vaso vasorum
What is the vaso vasorum
vessels that feed the layers of thicker and larger vessels
In diseased vessels, where does the smooth muscle end up
migrates from the tunica media to the intima
Where does atherosclerosis occur in vessels
within the intima of the arteries
What type of cells make up atherosclerosis
foam cells
what are foam cells
main cellular component of an atheroma
What is a fatty streak
first stage in development of atherosclerosis
What is the process of atherosclerosis
muscle cells undergo apoptosis within fatty streak
monocytes will accumulate (which are engorged with cholesterol)
this makes foam cells and leads to plaque build up
What occurs as foam cells increase the inflammatory response to the area
foam cells will die and a necrotic core will develop
What leads to the rapid progression of atherosclerosis and eventually CAD
Thinner vessels that are created from the disease process rupture
What is a calcified atherosclerotic plaque called
atheroma
What causes unstable angina
atheroma cause remodeling with vascular expansion so the lumen size stays intact… leads to unstable plaques
What causes stable angina
no remodeling from the atheroma leading to closure of the lumen
What is anoxia
acute loss of O2
What is ischemia
decreased blood flow to tissue causing hypoxia
what is hypoxia
lack of oxygen in the tissue
What is infarction
complete block of blood flow to tissue
when do coronary vessels fill
diastolic relaxation
What is the progression in acute coronary syndrome
stable angina
unstable angina
NSTEMI
STEMI
What are the symptoms of ischemia
chest pain
+/- radiation
Where are the classic places chest pain radiates
both arms
jaw
What should be in question if chest pain radiates into the patients back
dissection
What are symptoms of angina
dyspnea
nausea
diaphoresis
fatigue
What is angina
chest discomfort (pressure / heavy / tight)
Generally sub sternal and to the left
What does the oxygen demand of the cardiac muscle outweighing the oxygen being delivered lead to
myocardial ischemia
When does stable angina occur
chronic ischemic heart disease
What sign shows that someone has chronic ischemic heart disease
if they have reproducible angina
-discomfort comes on routine
-pain stops as activity stops
What are symptoms of stable angina
dyspnea
pain away from substernal area
nausea
fatigue
daiphoresis
*occurs with increased cardiac demand
When do symptoms of stable angina occur
when the heart rate and o2 demand increase beyond the supply ability
-exertion
-anxiety
-HTN
-LV / RV hypertrophy
What are the typical ACS descriptors
Onset: gradual / variable
Provocation: exertion increases sx
Quality:pressure / achey/ tightness
Radiation: arms / neck
Site: can be diffuse
Time: <30min
What is a type 1 MI
from a coronary atherothrombosis
What is a type 2 MI
supply demand mismatch
what is a type 3 MI
leads to sudden death, no confirmation on labs/ECG
What is a type 4 MI
post PCI infarct
What is a type 5 MI
post CABG infarct
What does one minute without blood supply do to the cardiac tissue
pallor which leads to decreased contractility
If ischemia persists and there is no cardiac contraction for 3-5 minutes, what happens
ATP depletes
glycogen stores are used up
lactate accumulates
What are types of acute coronary syndromes
unstable angina
NSTEMI
When
is ACS typically noticed
new/acute onset when patient has minimal exertion or at rest
What causes ACS
atherosclerotic plaque rupture of the coronary artery
When does someone have unstable angina
when it takes less exertion or stress than before to induce sx
sx last longer
severity of discomfort is increased
What differentiates unstable angina with an acute MI
unstable angina has no signs of necrosis
What occurs within the heart during an NSTEMI
disruption of plaque which leads to partial / intermittent blockage
ischemic disease
apoptosis/ necrosis of myocytes
troponin is released
What signs will be seen on an EKG for an NSTEMI
T wave inversion
or
ST depression
What occurs in the heart during a STEMI
plaque ruptures which causes thrombosis of coronary artery causing an acute vessel occlusion
leads to transmural myocardial ischemia and ST elevation of ECK
What is transmural myocardial ischemia
complete obstruction of blood flow
What is J point elevation
> 1mm in in 2+ consecutive leads showing that ST elevation
What is RV infarction associated with
RCA occlusion
What signs will a patient have that has RV infarction
increased JVP
Decreased CO
hypotension
What disease processes mimic a STEMI
acute pericarditis
myopericarditis
LVH
aortic dissection
severe hypercalcemia
What causes prinzmetal angina
coronary vasospasm
How is coronary vasospasm defined
nitrate responsive angina with transient EKG findings
What causes coronary vasospasm
Hyperactivity of smooth muscle
increased vagal tone can cause an endogenous release of vasoconstrictors
What are triggers for coronary vasospasm
cocaine
smoking
botulism
Kounis syndrome
What is kounis syndrome
chest pain post allergic reaction
What are some complications of ischemia
Arrhythmias (usually afib)
Blocks
Cardiogenic shock
ventricular free wall rupture
VSD
acute mitral regurge
increased pulm pressure -> pulm edema
Where is papillary muscle dysfunction most common
posteriomedial papillary muscle
What may cause a rupture of a papillary muscle
STEMI
or
NSTEMI
When are ventricular wall ruptures most common
elderly
female
first MI
*rare if ventricular hypertrophy is present at baseline
Where are ventricular wall ruptures most common
anterior infarcted areas of the heart
What is the main cause of a mural thrombi
STEMI
Who is at risk for a mural thrombi
Patients who have had an apical aneurysm
