Cardiovascular and Pulmonary: Cardiovascular Disease: Acute Coronary Syndrome/Coronary Artery Disease

Question 1

Characteristics

Answer 1

• Imbalance of myocardial oxygen supply and demand resulting in ischemic chest pain
• Lumen must be at least 70% occluded for symptoms to be present

Question 2

CAD: ECG Presentation

Answer 2

• Presents as ST segment changes of greater than 1mm or T wave inversion in multiple leads

Question 3

Angina Pectoris

Answer 3

• Chest pain or pressure due to ischemia

- Can be accompanied by Levine’s Sign (patient clenches fist over chest)

Question 4

Angina Pectoris: Imbalance between myocardial oxygen supply and demand caused by

Answer 4

Increased demands on heart including

• Exertion
• Emotional stress
• Smoking
• Extremes of temp
• Overheating
• Tachyarrhythmias

Question 5

Angina Pectoris: Imbalance between myocardial oxygen supply and demand caused by: May also see

Answer 5

• Vasospasm symptoms at rest

Question 6

Angina Pectoris: Three Major Types: Stable

Answer 6

• Classic exertional angina occurring during exercise or activity
• Occurs at a predictable rate, pressure product

Question 7

Angina Pectoris: Three Major Types: Stable: Treatment

Answer 7

• Rest and or nitroglycerine

Question 8

Angina Pectoris: Three Major Types: Unstable Angina

Answer 8

• Coronary insufficiency at any time without any precipitating factors or exertion
• Chest pain increases in severity, frequency, and duration
• Increases risk for lethal MI or arrhythmia

Question 9

Angina Pectoris: Three Major Types: Unstable Angina: Treatment

Answer 9

• Refractory to treatment

- Pain is difficulty to control

Question 10

Angina Pectoris: Three Major Types: Variant Angina

Answer 10

• Caused by vasospasm of coronary arteries in the absence of occlusive disease

Question 11

Angina Pectoris: Three Major Types: Variant Angina: Treatment

Answer 11

• Responds well to Nitroglycerine or calcium channel blocker long term

Question 12

Angina Pectoris: Symptom Description: Women

Answer 12

Describe sensations of:
- Discomfort
- Crushing
- Pressing
- Bad ache
When referring to angina

Question 13

Angina Pectoris: Symptom Description: Older adults

Answer 13

Presents more often with atypical

• Absence of chest pain
• Dyspnea
• Diaphoresis
• Nausea
• Vomitting
• Syncope

Question 14

Myocardial Infarction: Zones of Infarction: Zone of Infarction

Answer 14

• Necrotic, electrically inert tissue

- ST segment deviation greater then 1 mm

Question 15

Myocardial Infarction: Zone of Injury

Answer 15

• Area immediately adjacent to central zone
• Tissue is non contractile
• Cells undergoing metabolic changes

Question 16

Myocardial Infarction: Zone of Injury: Presentation in ECG

Answer 16

• Electrically unstable

- Elevated ST segments in leads over injured area

Question 17

Myocardial Infarction: Zone of Ischemia

Answer 17

• Outer area

- Cells undergoing metabolic changes

Question 18

Myocardial Infarction: Zone of Ischemia: Presentation on ECG

Answer 18

• Electrically unstable

- T wave inversion

Question 19

Myocardial Infarction: Infarction Sites: Transmural

Answer 19

• Full thickness of myocardium

- ST elevated MI (STEMI)

Question 20

Myocardial Infarction: Infarction Sites: Non-transmural

Answer 20

• Subendocardial
• Subepicardial
• Intramural Infarctions
• Non ST elevated MI (Non-STEMI)

Question 21

Myocardial Infarction: Sites of coronary artery occlusion: Inferior MI

Answer 21

• Right ventricle infarction
• Disturbances in upper conduction system
• Right coronary artery

Question 22

Myocardial Infarction: Sites of coronary artery occlusion: Lateral MI

Answer 22

• Ventricular Ectopy

- Circumflex artery

Question 23

Myocardial Infarction: Sites of coronary artery occlusion: Anterior MI

Answer 23

• Disturbances of lower conduction system

- Left anterior descending artery