Chapter 12 PowerPoint Flashcards
What is the most common cause of ischemic heart disease?
Atherosclerosis
What is atherosclerosis?
Plaque build up within coronary blood vessels causing a decrease in blood flow
Resulting in decrease O2
Reduction in CO2 and waste removal
What are the risk factors for atherosclerosis?
BAD HEART
BMI ≥ 30 (obesity; modifiable risk factor)
Age ≥ 65 (non-modifiable risk factor)
Diabetes Mellitus
Hypertension (most common risk factor)
EtOH (alcohol abuse)
An increase in LDL and a decrease in HDL (hyperlipidemia)
Relatives with CAD o e.g. relatives who passed away due to heart attack/MI
Tobacco use or Smoking increases endothelial injury and plaque formation
What are the 4 categories for ischemic heart disease?
Stable angina
Unstable angina
Subendocardial Infarct/NSTEMI
Transmural Infarct/STEMI
What is stable angina?
Stable plaque, Occlusion of 70%+
Chest pain with Exertion, resolves with rest
Subendocardial ischemia
What is unstable angina?
Unstable plaque, occlusion of 90%+
Chest pain at rest or worse with exertion
Subendocardial ischemia
What is subendocardial infarct?
Subendocardial Infarct/NSTEMI
Unstable Plaque, Thrombus formation
90%+ occlusion
Chest pain at rest and worse with exertion
Blood flow has been reduces for >30min
Irreversible damage (Death to tissue)
What is transmural infarct?
Transmural Infarct/STEMI
Unstable plaque, Thrombus formation
100% occlusion
Chest pain at rest, severe with exertion
Complete O2 loss
Entire myocardium from Endocardium to epicardial tissue infarct
What is acute coronary syndrome?
Acute Coronary Syndrome
A general term which encompasses:
Unstable angina
Subendocardial infarction / NSTEMI
Transmural infarct / STEMI
Symptoms for Ischemia or Infarction?
Nausea, Vomiting, Sweating Syncope, Sense of Impending Doom.
What does the onset in a time sense of ischemia or infarction look like?
Onset
<10 min Stable Angina
> Unstable Angina, NSTEMI, STEMI
Describe general facts/questions/diagnosis of ischemia or infaraction?
Onset
<10 min Stable Angina
> Unstable Angina, NSTEMI, STEMI
Provocation
What makes it Better or worse? Exertion?
Improve with rest or Nitro
Quality
Squeezing/stabbing/pressure chest pain
“Elephant on chest”
Radiation
Left Arm, Left Neck, Left Jaw
Epigastric Pain (Inferior STEMI)
Severity
Variable
Time
Constant
Atypical presentation (Silent)
Diabetics
Neuropathic
Elderly
Post Heart Transplant
No Chest pain
What will ischemia/infarct look like in the anterior portion (leads and artery affected)?
Left anterior descending artery
V1-V4
What will ischemia/infarct look like in the lateral portion (leads and artery affected)?
Left circumflex artery
I, aVL, V5, V6
What will ischemia/infarct look like in the inferior portion (leads and artery affected)?
Right coronary artery
II, III, aVF
What will ischemia/infarct look like in the posterior portion (leads and artery affected)?
Posterior descending artery
V7-V9
What are EKG markers for ischemia and infarct (stable angina)?
No ST segment elevation
What are EKG markers for ischemia and infarct (unstable angina)?
ST segment depression + TWI
What are EKG markers for ischemia and infarct (NSTEMI)?
ST segment depression + TWI
What are EKG markers for ischemia and infarct (STEMI)?
ST segment elevation + troponin
Wha is NSTEMI a typically a result of?
Non-ST seg elevation MI (NSTEMI)
Typical of subendocardial damage, ST segment depression
What are EKG markers for ischemia and infarct (STEMI)?
ST-segment elevation
What is STEMI typical of?
ST seg elevation MI (STEMI)
Typical transmural MI
What are the three phases of STEMI?
3 sequential phases
Acute – ST Elevation in affected area
Evolving – ST back to Baseline, Q wave present, T wave inversion
Stable Chronic (old) – permanent ECG changes
-ST elevation resolved
-S wave goes beyond baseline RSR’
-T wave inversion resolved
What does the presence of a Q wave mean and how big must it be to be significant?
Develop during MI
1/3rd in size and .04msec in width
Q wave in various leads indicated location of MI
Reason: Vector reflection
What is the treatment of myocardial ischemia and infarction?
Treat within 60-90 min of symptom onset
Dramatically decreases damage
Blood thinner
Percutaneous transluminal Coronary Angioplasty
“Time is Muscle”
How does Ventricular Preexcitation (Wolff-Parkinson-white pattern) appear on an ECG?
Chapter 12 slide 22
How does a LBBB appear on an ECG?
Chapter 12 slide 22
How does the use of digoxin appear on an ECG?
Chapter 12 slide 22
How does LVH and Hypokalemia with ST segment and T wave abnormalities appear on an ECG?
Chapter 12 slide 22
How does ventricular aneurysm appear on an ECG?
ECG shows MI, ST elevation at location of myocardial damage denoting Aneurysm
Ballooning of Myocardial wall
ST changes do not resolve on their own
How does pericarditis appear on an ECG?
Global ST segment Elevation
Every lead has ST segment.
Do not look at aVR
What is myocarditis?
Inflammation in the absence of ischemia
What is myocarditis often associated with?
Often associated with Pericarditis (Myopericarditis)
What are causes of myocarditis?
Viral – including coxsackie B virus, HIV, influenza A, HSV, adenovirus
Bacteria – including mycoplasma, rickettsia, Leptospira
Immune mediated – including sarcoidosis, scleroderma, SLE, Kawasaki’s disease
Drugs / toxins – including clozapine, amphetamines
How does myocarditis appear on an ECG?
Most common ECG Abnormalities
Sinus Tachycardia
Non-specific ST segment & T wave changes
