Chronic Ischemic Heart Disease Flashcards
Risk factors for atherosclerotic vascular diseasE?
Age, Family History, Diabetes, HTN, Smoking, Cholesterol (biggest increase in risk), Obesity, Sedentary Lifestyle
What is Metabolic Syndrome?
Any three out of... HTN Abdominal obesity Low HDL High Triglycerides High Blood Sugar
Metabolic Syndrome is associated with…
Inflammation, Coagulation Abnormalities, Progression to DM type II
Manifestations of Choronary Artery Disease?
Chronic Stable Angina Unstable Angina Myocardial Infarction Ischemic Cardiomyopathy Sudden Cardiac Death
Ischemic Heart Disease Physical Exam findings
Check pulses for evidence of atherosclerosis
Often an S4 in periods of ischemia
Possibly totally normal
Ischemic Heart Disease EKG findings
Evidence of prior infarction (Q Waves)
Evidence of LVH
ST and T wave changes
Two important components of ischemic heart disease evaluation (the stuff he made red)
Stress testing
Measure LV function
Angina pectoris – what is it, what symptoms present with it
visceral discomfort that s diffuse and substernal that turns on over the course of several minutes
Angina pectoris is also usually accompanied with what symptoms?
Dyspnea, Diaphoresis, Nausea, Light-headedness
Difference between typical angina and atypical angina?
Typical – Substernal, brought on by exertion, relieved by rest
Atypical – Missing one or more of above features
Four classifications of Angina in the Canadian CV Society Classification
I - No Angina
II – ON more than usual activity
III - On less than usual activity
VI - At rest or with any activity
Three ways that atherosclerosis makes problems…
Obstruction, Aneyursms, Embolism
Describe the sensation of aortic dissection
Excruciating, ripping, sudden anterior radiating to the back
Symptoms of Pulmonary embolism
Sudden onset of dyspnea and pleuritic pain
Symptoms of GERD
Substernal burning. Lasts 10-60 minutes. Related to meals
Secondary causes of Myocardial Ischemia
Severe anemia, hypoxemia, uncontroled HTN, severe LVH, Uncontrolled Tachy, Thyrotoxicosis
Most common EKG change in ischemic heart?
What else tends to be around?
Non-specific ST-T changes (ex. T wave inversion)
Abnormal Qs from previous infarcts, conduction abnormalities (LBB, LAFB)
Stress Test Modalities
Exercise ECG
Stress imaging modalities
What drugs can be used in a stress test of someone who cannot exercise?
Dobutamine (Echo), Vasodilators (Nuclear imaging)
Describe the Ischemic Cascade
Decreased Relaxation –> Systolic Dysfxn –> Decreased Filling –> decreased ST –> Angina
Pros of an Exercise stress ECG
Low Cost, Versatile, Validated, No IV
Cons of an exercise stress ECG
High false positive, Unreliable with abnormal resting ECG findings False negative (failure to achieve HR)
Target HR in an exercise stress test
85% of age predicted maximal HR
What ST changes are associated with Chronic Ischemia?
Horizontal ST depression
Downsloping ST depression
