Chest pain

Question 1

ST elevation in II, III, aVF

location

blood supply

Answer 1

Inferior

RCA

Question 2

ST elevation: I, aVL, V6

location

blood supply

Answer 2

Lateral wall

LCX

Question 3

ST elevation: V1-V4

location

blood supply

Answer 3

Anterior wall

LAD

Question 4

ST elevation in V1-V2

locaiton

blood supply

Answer 4

Antero-septum

LAD

Question 5

Gross appearance of MI: <12 ;

12-24 hrs ;

1-14 days ;

> 2 weeks

Answer 5

hrs not apparent, tetrazolium stain shows pale areas 2-3 hrs post-occurrence

dark red-blue mottling

sharply defined yellow-tan area then hyperemic peripheral zone

gray-white scar

Question 6

Histology of MI:

Answer 6

4-12 hours wavy fibers;

12 hrs - 7 days coagulative necrosis ongoing, neutrophils, by 7 days macrophages;

7-14 days granulation tissue, collagen begins to deposit;

>14 days more collagen, dense fibrous scar

Question 7

• usually an atherosclerotic narrowing that only causes problems during exercise when demand for O2 is increased.

Answer 7

Stable angina

Question 8

change in the frequency of angina, change in the amount of activity that provokes angina, change in the duration of angina, no longer relieved by nitroglycerin

Answer 8

Unstable angina-

Question 9

-> degradation product of cross-linked fibrin, usually elevated with acute DVT
High sensitivity for PE, but low specificity

Answer 9

D-dimer

Question 10

Virchow’s triad:

Answer 10

stasis, hypercoaguable state, endothelial injury

Question 11

Difference between true and false aneurysm

Answer 11

Aneurysm: True -> involves all 3 layers, False (pseudoaneurysms) -> wall defect leading to extravascular hematoma

Question 12

Pathogenesis of aneurysm

Answer 12

loss of smooth muscle cells - thickening of intima due to atherosclerosis -> ischemia of inner media; systemic HTN narrows vasa vasorum -> ischemia of outer media

Question 13

Common -> location of aneurysms:

atherosclerosis -> _____;

HTN -> _____

Answer 13

abdominal aorta

ascending aorta

Question 14

-> intimal tear w/in 10 cm of aortic valve, occurs betw middle and outer third of wall, in media, usually extends anterograde, ruptures “out”, may re-enter and form a double-barrel, ascending aorta most common

Answer 14

Aortic dissection

Question 15

Aortic dissection: type A always involves the

Answer 15

ascending aorta

Question 16

sudden onset of severe pain. Pain is constant, distressing, life threatening, unrelenting

Answer 16

aortic dissection:

Question 17

Where is the dissection: hypotension, pulse deficits in upper extremities, aortic regurg, cardiac tamponade as late complication

Answer 17

Proximal dissection

Question 18

Where is the dissection: hypertension, pulse deficits in lower extremities

Answer 18

Distal dissection ->

Question 19

What is our first line tx for aortic dissection?

Answer 19

Beta blockers are first line treatment for aortic dissection: Goals: 60 bpm, SBP 100-120.

Question 20

How do we manage type A and type B aortic dissectin differently

Answer 20

Type A dissection: surgery. Type B dissection- medically managed. Elective aneurysm repair at > 6cm.

Question 21

Failure to increase blood pressure or HR w/ exercise is

Answer 21

a bad prognostic sign

Question 22

imbalance betw supply and demand for O2 and nutrients & removal of metabolites

Answer 22

IHD:

Question 23

Why is ischemia worse then hypoxia?

Answer 23

Ischemia worse than hypoxia b/c lack of perfusion prevents removal of metabolites

Question 24

Cuases of decreased blood flow to heart

Answer 24

1.) fixed atherosclerotic narrowing, 2.) acute plaque change, 3.) thrombosis overlying ruptured plaque, 4.) Vasospasm

Question 25

1.) Fixed obstruction: narrowing > 70% =

; >90% =

Answer 25

symptomatic ischemia w/ exercise

isch at rest

Question 26

Difference between Total and Incomplete Occlusion

Answer 26

3.) Coronary thrombosis: TOTAL occlusion -> acute transmural MI or sudden cardiac death,

INCOMPLETE occlusion (mural thrombus) -> unstable angina, acute subendocardial infarction, sudden death, emboli

Question 27

Difference between Transmulra and subendocardial infarct

Answer 27

MI:

• *- transmural** -> ST elevation, full thickness, confined to distribution of 1 vessel
• *- subendocardial infarct** -> ST depression, necrosis limited to inner 1/3, may extend beyond perfusion of 1 vessel

Question 28

Elevations in ____- and _____ after acute MI persist up to 10 days, peak ____ values OR the 72-96 hr values correlate with infarct size

Answer 28

cTnl and cTnT

cTnT

Question 29

____ begins to rise 4-6 hrs after onset of infarct (at 12 hrs elevation seen in all pts), return to baseline w/in 36-48 hrs

Answer 29

CK-MB

Question 30

_____is more specific to MI than CK-MB, but CK-MB is useful to determine if a second MI occured as it returns to normal much quicker

Answer 30

Troponin

Question 31

Chronic ischemic heart dz often seen in elderly, what do we see?

Answer 31

elderly pts w/ progressive heart failure due to ischemic myocardial damage, enlarged heart w/ LV hypertrophy and dilation

Question 32

Complications of MI:

Answer 32

cardiogenic shock (w/ damage to 40% or more of LV), arrhythmia (early in course), myocardial rupture (3-7 days; tamponade, aneurysm, VSD, papillary muscle), pericarditis (2-3 days)