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ALU 201 > chapter 13 - CAD > Flashcards

chapter 13 - CAD Flashcards

1
Q

what is the most common cause of death in adults in the US

A

CAD

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2
Q

what is the prognosis of CAD dependent on

A

number of coronary vessels obstructed by plaque and the severity of obstruction/occlusion

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3
Q

is left ventricular dysfunction an important factor in predicting survival outcomes in CAD

A

yes

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4
Q

evidence of _________ will usually predict reduced survival in the absence of medical or surgical intervention

A

ongoing ischemia

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5
Q

what does risk factor analysis include (CAD)

A

age and gender, genetic predisposition such as familial dyslipidemias, lipids, obesity, HTN, DM, homocysteine and CRP

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6
Q

the coronary arteries are major blood vessels that emerge from the _______ to supply the heart muscle with ______ and ______

A

aortic root, oxygen and nutrients

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7
Q

what are the 3 layers of the coronary arterial wall

A

intima, medial, adventitia

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8
Q

what is the name of the open space through which blood flows in the coronary arteries

A

lumen

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9
Q

Myocardial ischemia occurs when the ________ cannot meet the ________ in a region of the ventricle

A

myocardial oxygen supply…. myocardial oxygen demand

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10
Q

myocardial infarction refers to the _________ that occurs following prolonged ischemia

A

irreversible myocardial cell injury and death

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11
Q

myocardial oxygen demand is controlled by:

A

heart rate, contractility of the myocardium, LV wall tension

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12
Q

what classification system is often use to classify the severity of angina

A

Canadian Cardiovascular Society

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13
Q

what anginal symptoms are presumptive evidence of typical angina with 90% likelihood of angiographically significant disease

A

CP with exercise, effort and emotion, and relief with rest or NTG

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14
Q

coronary revascularation offers high probability for relief or improvement of angina symptoms over what time period

A

5-10 yrs

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15
Q

what is prinzmetal angina (variant angina pectoris) and what can it be associated with

A

CP at rest, ST-segment elevation on ECG, associated with acute MI, severe cardiac arrhythmias, sudden death

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16
Q

what is cardiac syndrome C

A

angina or angina-like chest pain with a normal coronary angiogram. no EKG changes.

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17
Q

what is silent myocardial ischemia

A

episodes of asymptomatic ischemia, with objective evidence of coronary insufficiency

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18
Q

most people with unstable angina have ____

A

multi vessel CAD

19
Q

approximately 1/4 of all deaths are due to ____

A

MI

20
Q

more than 50% of deaths from MI occur within ______ of the event and are attributable to ______

A

one hour, arrhythmias, often ventricular fibrillation

21
Q

what labs are done and repeated after 8-24 hrs if suspected MI

A

CPK, MB fraction, myoglobin and cardiac-specific troponin (T and I)

22
Q

what are the most specific and sensitive biomarkers for MI

A

cardiac troponins

23
Q

more than 20 hrs after MI the ______ may return to normal and _____ can be elevated instead

A

CPK, LDH

24
Q

what is the major cause of death for people with CAD and how is it defined

A

sudden cardiac death, death from cardiac disease within one. hour of the onset of symptoms in someone who was not expected to die

25
Q

most sudden cardiac deaths are due to _____

A

arrhythmias occurring in presence of chronic coronary or structural heart disease. less often - cardiomyopathy, inherited depolarization abnormalities.

26
Q

what is a stress test terminated by

A

reading maximal heart rate, marked EKG changes, sig BP changes, or reproduction of typical chest pain

27
Q

what is indication of myocardial ischemia

A

ST-segment depression, radionuclide imaging defects or wall motion abnormalities on echo

28
Q

what are possible explanations for false-positive tests (for MI)

A

ventricular hypertrophy, MVP, conduction abnormalities

29
Q

possible explanations for false negative tests for MI include

A

failure to achieve adequate HR, baseline EKG changes that limit the interpretation of exercise tracings, meds that suppress the development of ischemia

30
Q

how is PET useful to test for CAD

A

identifies how much of the heart has been damaged by infarction and how much is still viable

31
Q

what degree of stenosis is usually considered significant (for CAD)

A

50-70% or greater

32
Q

proximal lesion implies the stenosis is ____

A

close to the origin of the artery

33
Q

distal lesions are those that occur _______

A

near the terminal portions of the imaged artery

34
Q

the prognosis of CAD will be directly related to the amount of damage that could occur should the lesion undergo sudden and total occlusion, termed the ______

A

myocardium at risk

35
Q

in CAD, survival is best in what scenario

A

single-vessel disease where obstruction is limited to one artery

36
Q

in CAD, intermediate survival rates in what type of disease

A

two vessel or doubele vessel disease

37
Q

worst prognosis for CAD in what situation

A

triple vessel disease

38
Q

lesions in what artery are most significant (CAD)

A

left main

39
Q

do distal lesions or proximal lesions have greater risk

A

proximal

40
Q

are LAD lesions associated with large amount of myocardium at risk? why or why not?

A

yes, because this artery provides blood flow to the functionally important anterior, septal, and apical walls of the LV.

41
Q

when myocardial oxygen supply cannot meet demand it is:

  1. angina
  2. hypoxia
  3. ischeima
  4. infarction
A

3, ischemia

42
Q

all of the following findings on a post-myocardial infarction exercise test can help identify individuals at high risk for recurrent event EXCEPT:

  1. angina symptoms
  2. low exercise capacity
  3. rising systolic BP
  4. ischemic ST-segment depression at low workloads
A
  1. rising systolic BP
43
Q

which of the following statements regarding adenosine stress testing is/are accurate?
A. its results are typically less accurate than the results of standard exercise testing
B. it is used for individuals who are unable to undergo standard exercise testing
C. it requires concurrent radionuclide or echocardiographic imaging

A

B and C

ALU 201 (20 decks)

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