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CABS cardiology > cardiac ischemia > Flashcards

cardiac ischemia Flashcards

1
Q

what is hyperlipidemia

A

elevation of lipids

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2
Q

What lipids make up hyperlipidemia

A

fat
triglycerides
cholesterol

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3
Q

What is the job of total cholesterol

A

maintain cell membranes
building block for some nutritional absorption and hormone synthesis

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4
Q

What is LDL and what does it do

A

low density lipo protein

atherosclerotic plaque formation

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5
Q

What is HDL and what does it do

A

High density lipo-protein

bring cholesterol back to the liver

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6
Q

What are triglycerides

A

stored energy

breaks down for cellular metabolism

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7
Q

where are triglycerides stored

A

adipose and liver

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8
Q

What is primary hyperlipidemia from

A

familial
polygenetic source
type 1-4

*can cause xanthomas, atherosclerosis, hepatosplenomegally

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9
Q

What is secondary hyperlipidemia from

A

diet
medication
Dm
CKD
inflammatory states

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10
Q

What structure is located in the tunica externa

A

vaso vasorum

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11
Q

What is the vaso vasorum

A

vessels that feed the layers of thicker and larger vessels

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12
Q

In diseased vessels, where does the smooth muscle end up

A

migrates from the tunica media to the intima

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13
Q

Where does atherosclerosis occur in vessels

A

within the intima of the arteries

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14
Q

What type of cells make up atherosclerosis

A

foam cells

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15
Q

what are foam cells

A

main cellular component of an atheroma

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16
Q

What is a fatty streak

A

first stage in development of atherosclerosis

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17
Q

What is the process of atherosclerosis

A

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

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18
Q

What occurs as foam cells increase the inflammatory response to the area

A

foam cells will die and a necrotic core will develop

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19
Q

What leads to the rapid progression of atherosclerosis and eventually CAD

A

Thinner vessels that are created from the disease process rupture

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20
Q

What is a calcified atherosclerotic plaque called

A

atheroma

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21
Q

What causes unstable angina

A

atheroma cause remodeling with vascular expansion so the lumen size stays intact… leads to unstable plaques

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22
Q

What causes stable angina

A

no remodeling from the atheroma leading to closure of the lumen

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23
Q

What is anoxia

A

acute loss of O2

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24
Q

What is ischemia

A

decreased blood flow to tissue causing hypoxia

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25
Q

what is hypoxia

A

lack of oxygen in the tissue

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26
Q

What is infarction

A

complete block of blood flow to tissue

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27
Q

when do coronary vessels fill

A

diastolic relaxation

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28
Q

What is the progression in acute coronary syndrome

A

stable angina
unstable angina
NSTEMI
STEMI

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29
Q

What are the symptoms of ischemia

A

chest pain

+/- radiation

30
Q

Where are the classic places chest pain radiates

A

both arms
jaw

31
Q

What should be in question if chest pain radiates into the patients back

A

dissection

32
Q

What are symptoms of angina

A

dyspnea
nausea
diaphoresis
fatigue

33
Q

What is angina

A

chest discomfort (pressure / heavy / tight)

Generally sub sternal and to the left

34
Q

What does the oxygen demand of the cardiac muscle outweighing the oxygen being delivered lead to

A

myocardial ischemia

35
Q

When does stable angina occur

A

chronic ischemic heart disease

36
Q

What sign shows that someone has chronic ischemic heart disease

A

if they have reproducible angina
-discomfort comes on routine
-pain stops as activity stops

37
Q

What are symptoms of stable angina

A

dyspnea
pain away from substernal area
nausea
fatigue
daiphoresis
*occurs with increased cardiac demand

38
Q

When do symptoms of stable angina occur

A

when the heart rate and o2 demand increase beyond the supply ability
-exertion
-anxiety
-HTN
-LV / RV hypertrophy

39
Q

What are the typical ACS descriptors

A

Onset: gradual / variable
Provocation: exertion increases sx
Quality:pressure / achey/ tightness
Radiation: arms / neck
Site: can be diffuse
Time: <30min

40
Q

What is a type 1 MI

A

from a coronary atherothrombosis

41
Q

What is a type 2 MI

A

supply demand mismatch

42
Q

what is a type 3 MI

A

leads to sudden death, no confirmation on labs/ECG

43
Q

What is a type 4 MI

A

post PCI infarct

44
Q

What is a type 5 MI

A

post CABG infarct

45
Q

What does one minute without blood supply do to the cardiac tissue

A

pallor which leads to decreased contractility

46
Q

If ischemia persists and there is no cardiac contraction for 3-5 minutes, what happens

A

ATP depletes
glycogen stores are used up
lactate accumulates

47
Q

What are types of acute coronary syndromes

A

unstable angina
NSTEMI

48
Q

When
is ACS typically noticed

A

new/acute onset when patient has minimal exertion or at rest

49
Q

What causes ACS

A

atherosclerotic plaque rupture of the coronary artery

50
Q

When does someone have unstable angina

A

when it takes less exertion or stress than before to induce sx

sx last longer

severity of discomfort is increased

51
Q

What differentiates unstable angina with an acute MI

A

unstable angina has no signs of necrosis

52
Q

What occurs within the heart during an NSTEMI

A

disruption of plaque which leads to partial / intermittent blockage

ischemic disease

apoptosis/ necrosis of myocytes

troponin is released

53
Q

What signs will be seen on an EKG for an NSTEMI

A

T wave inversion
or
ST depression

54
Q

What occurs in the heart during a STEMI

A

plaque ruptures which causes thrombosis of coronary artery causing an acute vessel occlusion

leads to transmural myocardial ischemia and ST elevation of ECK

55
Q

What is transmural myocardial ischemia

A

complete obstruction of blood flow

56
Q

What is J point elevation

A

> 1mm in in 2+ consecutive leads showing that ST elevation

57
Q

What is RV infarction associated with

A

RCA occlusion

58
Q

What signs will a patient have that has RV infarction

A

increased JVP
Decreased CO
hypotension

59
Q

What disease processes mimic a STEMI

A

acute pericarditis
myopericarditis
LVH
aortic dissection
severe hypercalcemia

60
Q

What causes prinzmetal angina

A

coronary vasospasm

61
Q

How is coronary vasospasm defined

A

nitrate responsive angina with transient EKG findings

62
Q

What causes coronary vasospasm

A

Hyperactivity of smooth muscle

increased vagal tone can cause an endogenous release of vasoconstrictors

63
Q

What are triggers for coronary vasospasm

A

cocaine
smoking
botulism
Kounis syndrome

64
Q

What is kounis syndrome

A

chest pain post allergic reaction

65
Q

What are some complications of ischemia

A

Arrhythmias (usually afib)
Blocks
Cardiogenic shock
ventricular free wall rupture
VSD
acute mitral regurge
increased pulm pressure -> pulm edema

66
Q

Where is papillary muscle dysfunction most common

A

posteriomedial papillary muscle

67
Q

What may cause a rupture of a papillary muscle

A

STEMI
or
NSTEMI

68
Q

When are ventricular wall ruptures most common

A

elderly
female
first MI

*rare if ventricular hypertrophy is present at baseline

69
Q

Where are ventricular wall ruptures most common

A

anterior infarcted areas of the heart

70
Q

What is the main cause of a mural thrombi

A

STEMI

71
Q

Who is at risk for a mural thrombi

A

Patients who have had an apical aneurysm

CABS cardiology (10 decks)

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