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Cardiology Exam 1 > Coronary Atherosclerosis and Myocardial Ischemia > Flashcards

Coronary Atherosclerosis and Myocardial Ischemia Flashcards

1
Q

coronary atherosclerosis - definition:

A

-fatty infiltration of the tunica intima (endothelial layer) of a coronary artery, w/ or w/out significant luminal narrowing

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2
Q

pathogenesis of atherosclerosis:

A

-response to injury –> endothelium expresses immune system adhesion molecules (Inflammation) –> more macrophages +other shit –> marcophages eat lipids that have been modified or oxydized == foamy cell ==> accumulation and plaques and so on

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3
Q

Cells that participate in atherosclerosis

A

1) endothelium
2) smooth muscle cells)
3) macrophages
4) platelets

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4
Q

What are the lesions of atherosclerosis:

A

1) fatty streak - earliest evidence
2) intimal thinkening
3) fibrous plaque - advanced lesion (interrupt laminar flow and other stuff)

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5
Q

risk markers for atherosclerosis:

A
  • smoking
  • diabetes
  • HTN
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6
Q

ischemia definition:

how problem happens?

A

-reduced tissue perfusion
-issue of supply and demand
-supply is reduced (ASCVD or coronary spasm)
AND/OR
-demand is increased (exercise, anxiety, pain…)

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7
Q

factors of demand:

A
  • HR
  • contractility
  • systolic wall tension
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8
Q

Myocardial ischemia

-diagnosis:

A

1) Symptoms
- chest discomfort: not necessarily chest pain (angina pectoris), pressure, tightness, band-like
- most often exertional
- DOE
- nausea
- other GI
- referred to jaw, shoulder, ulnar L arm
- excessive FATIGUE

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9
Q

Differential for chest pain:

A
  • costochondritis
  • GI (esophageal spasm, GERD, biliary colic)
  • aortic dissection
  • pericarditis
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10
Q

Angina pectoris definition:

A
  • heavy, pressure, band-like, crushing

- can be silent

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11
Q

unstable angina is:

A
  • new onset of ischemia
  • subjectively worse discomfort
  • onset with less activity
  • angina at rest (angina decubitus)
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12
Q

stable angina is:

A

same pattern of symptoms everytime

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13
Q

treadmill + unstable angina - what to do?

A

DONT DO IT! THEY COULD INFARCT!

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14
Q

Men vs women angina?

A

women according to the statistics but men probably just dont talk about it

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15
Q

Myocardial ischemia - history:

A
  • angina last <30 min usually
  • symptoms lasting a few seconds ARE NOT ANGINA
  • onset is gradual - abrupt onset IS NOT ANGINA
  • relieved by: stopping activity or meds (nitrates)
  • worsened by: increased work or lying down (inc venous return and inc size of heart)
  • ask about risk markers
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16
Q

myocardial ischemia

-physical exam:

A
  • may be normal
  • various cardiac findings - cardiomegaly, murmurs, S4,
  • look for evidence of other disease - HTN, DM, atherosclerosis
  • fundoscopic exam!
17
Q

S4 heart sound may be?

A

-heart ischemia!!! - bc the ventricle cant relax - relaxation TAKES ENERGY IN THE HEART

18
Q

Myocardial ischemia - testing:

A
  • resting ECG
  • basic labs (lipid panel, H/H, CBC, lytes, BUN, creatinine, urinalysis for protein or glucose
  • exercise stress testing
  • echogardiography
19
Q

What is used to diagnose atypical chest discomfort?

A

-stress testing

20
Q

Use stress testing to follow people with:

A

stable angina
post MI
post revascularization

21
Q

Give what drugs for pharmacologic stress testing?

A
  • adenosine, dipyridamole (vasodilate=inc HR and work)

- dobutamine (inc contractility)

22
Q

ST depression indicates:

A

subendocardial ischemia

23
Q

ST elevation indicates:

A

full thickness ischemia

24
Q

Stop stress test if you see:

A

ST elevation
dev of angina
-dev of ventricular dysrhythmia

25
Q

How do you inc your predictive power when doing testing?

A
  • add imaging (echo or nuclear)

- SHOW THE AREA

26
Q

Reducing myocardial injury:

A

1) inc supply
- reperfusion
- coronary vasodilation
2) dec oxygen deman
- beta blockers
- dec BP
- reduce preload
- reduce circulatin catecholamines

27
Q

What do nitrates do?

A

1) decrease preload (venodilators)
- dec LV filling = dec LV size and less wall tension
2) coronary dilation, possibly even in stenotic segments
3) enhance endothelial function
3) antiplatelet activity

Reduce oxygen demand and probably inc supply to some extent

28
Q

Beta blockers - what do they do?

A
  • dec HR and contractility=dec Oxygen demand

- no effect on supply

29
Q

(cardioselective) beta blockers used?

A

atenolol

metoprolol

30
Q

calcium antagonists - what do they do?

A
  • variable properties depending on molecule
  • prevention of spasm (relaxed vasomotor tone)
  • reduction of afterload
  • some (verapamil, diltiazem) reduce contractility and/or HR
31
Q

Short acting calcium antagonist use?

A

do not use == cause death

32
Q

dihydropyridine do what with myocardial ischemia?

A

-reduce contractility BUT INC HR

Cardiology Exam 1 (24 decks)

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