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PHA 415 - Therapeutics III > Exam 3 - Ischemic Heart Disease > Flashcards

Exam 3 - Ischemic Heart Disease Flashcards

1
Q

What does IHD stand for?

A

Ischemic Heart Disease

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2
Q

What is the term for a lack of oxygen to the heart?

A

ISCHEMIA

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3
Q

What does CAD stand for?

A

Coronary Artery Disease

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4
Q

What is the most common cause of IHD?

A

CAD

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5
Q

___ ____ ____ (___) is ischemia caused by blockages in the arteries.

A

CORONARY ARTERY DISEASE (CAD) is ischemia cause by blockages in the arteries.

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6
Q

T/F: Endothelium of the blood vessels secrete both good and bad mediators.

A

TRUE

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7
Q

T/F: CAD is an inflammatory process that is due to chronic inflammation.

A

TRUE

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8
Q

What regulates coronary blood flow by the endothelium?

A

MEDIATORS

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9
Q

Name the four mediators (hint: “A PEN”) dealing with regulation of coronary blood flow by the endothelium.

A

1) A = Adenosine
2) P = Prostacyclin (PGI2)
3) E = Endothelin-1 (ET-1)
4) N = Nitric Oxide (NO)

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10
Q

Which mediator is formed by ATP during stress?

A

ADENOSINE

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11
Q

Adenosine is a potent vaso____.

A

Adenosine is a potent vasodilator.

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12
Q

Which mediator causes relaxation of smooth muscle in response to stress?

A

NITRIC OXIDE

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13
Q

Nitric Oxide limits ____ _____.

A

Nitric oxide limits PLATELET ACTIVATION

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14
Q

T/F: Prostacyclin does not limit platelet activation because only Nitric Oxide does.

A

FALSE

-Prostacyclin (PGI2) also limits platelet activation, as does Nitric Oxide

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15
Q

Which mediator is also a drug that is used during cardiac stress testing?

A

ADENOSINE

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16
Q

______ is an anti-arrhythmic that slows down heart rate.

A

ADENOSINE is an anti-arrhythmic that slows down hear rate.

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17
Q

T/F: NSAIDs are a type of prostaglandin, which is why we want to avoid NSAIDs in cardiac patients.

A

TRUE

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18
Q

What happens when you take NSAIDs and why is it a concern?

A

You block prostaglandins, even the beneficial PGI2 (Prostacyclin)

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19
Q

Which mediator is a type of prostaglandin?

A

PROSTACYCLIN (PGI2)

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20
Q

T/F: Prostacyclin is a vasodilator with a lot of basal secretion.

A

FALSE
-Prostacyclin is a vasodilator with little basal secretion, which is why you don’t want to take NSAID because it blocks prostacyclin

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21
Q

Is prostacyclin (PGI2) beneficial?

A

YES

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22
Q

Which of the four mediators is the worst/only “bad” mediator?

A

Endothelin-1 (ET-1)

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23
Q

Why is Endothelin-1 (ET-1) bad?

A

Because it a vasoconstrictor

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24
Q

Which mediator is released in response to stimuli and acts as a vasoconstrictor?

A

Endothelin-1

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25
Q

What occurs in response to oxidative stress?

A

Endothelial dysfunction

-An imbalance in mediators; decrease in NO and increase in pro-adhesion molecules

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26
Q

Name some examples of oxidative stress.

A
  • Smoking

- Oxidized LDL cholesterol

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27
Q

What is the difference between early plaque and mature plaque?

A
  • Early plague = soft tissue plaque

- Mature plaque = has more calcium present

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28
Q

What stabilizes mature plaque and prevents events from happening?

A

Fibrous cap

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29
Q

With ischemia, what happens because of the lack of O2?

A

A decrease in blood flow in myocardium

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30
Q

What are the concerns with increased myocardial O2 demand in ischemia?

A
  • Heart rate
  • Contractility
  • Intramyocardial wall tension during systole
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31
Q

What is the concern when there is a decreased myocardial O2 supply in ischemia?

A

Coronary blood flow (atherosclerosis)

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32
Q

In ischemia, what is the most common problem?

A

Decreased myocardial O2 supply

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33
Q

When demand ___ supply, this is ischemia.

A

When demand > supply, this is ischemia.

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34
Q

What is another name for LCA (Left Coronary Artery)?

A

LEFT MAIN (coronary artery)

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35
Q

Which is the major artery that comes off the aorta?

A

Left Main

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36
Q

What does the Left Main Coronary Artery split into?

A
  • LAD

- Circumflex

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37
Q

T/F: The Left Main artery branches off to posterior and anterior portion of the heart.

A

TRUE

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38
Q

Which arteries perfuse most of the heart?

A

Left Main

LAD

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39
Q

What artery is also known as the widow maker?

A

Left Main Coronary Artery

40
Q

Which artery has a blockage if it is an Inferior MI?

A

Right Coronary Artery

41
Q

What three forms does Ischemic Heart Disease present?

A

1) Silent ischemia
2) Stable ischemic heart disease
3) Acute Coronary Syndrome (ACS)

42
Q

T/F: Silent ischemia presents with many symptoms and patients are very aware it is occurring.

A

FALSE

-Silent ischemia has no symptoms

43
Q

Name a type of stable ischemic heart disease discussed in lecture.

A

Chronic stable (exertional) angina

44
Q

T/F: Chronic stable (exertional) angina usually lasts less than 20-30 min and occurs upon exercise.

A

TRUE

45
Q

____ ____ (_____) ____ can occur before a patient is aware they have CAD or after their diagnosis and/or treatment.

A

CHRONIC STABLE (EXERTIONAL) ANGINA can occur before a patient is aware they have CAD or after their diagnosis and/or treatment.

46
Q

ACS = ____ ____

A

ACS = HEART ATTACK

47
Q

What does UA stand for?

A

UNSTABLE ANGINA

48
Q

What does NSTEMI stand for?

A

Non-ST elevated MI

49
Q

What does STEMI stand for?

A

ST elevated MI

50
Q

Which is the most “mild” form of ACS?

A

UA

51
Q

What is another name for angina pectoris?

A

CHEST PAIN

52
Q

T/F: Women have a delay to presentation of symptoms in heart attack.

A

TRUE

53
Q

In what ways can myocardial ischemia be characterized (signs/symptoms)?

A
  • Crushing pain - may radiate to left jaw, shoulder, and arm
  • Pressure - “Elephant sitting on chest”
  • Burning over sternum - common in women
  • Tightness, squeezing of chest or throat
  • SOB
  • Sweating, vomiting because of pain
54
Q

UA, NSTEMI, and STEMI are examples of what?

A

ACS

55
Q

A patient presents to the ER with crushing pain that radiates to left jaw, shoulder, and arm may be experiencing what?

A

Myocardial ischemia

56
Q

A female patient presents to the ER with burning over the sternum, what is a possible concern?

A

Possible myocardial ischemia

57
Q

What 3 things can angina pectoris be precipitated or caused by?

A

1) Exertion
2) Cold
3) Emotional stress, anger

58
Q

T/F: Angina pectoris is relieved by rest only.

A

FALSE

-Angina pectoris is relieved by rest or nitroglycerin (NTG)

59
Q

How long can angina pectoris last?

A

0.5-30 minutes

60
Q

T/F: Angina pectoris can be chronic in some patients.

A

TRUE

61
Q

What is given to some patients who present to the ER with angina pectoris to differentiate from reflux?

A

GI cocktail (viscous lidocaine, Mag)

62
Q

T/F: In a patient having chest pain for more than 20 minutes, it is considered an acute event.

A

TRUE

63
Q

T/F: Ischemia always causes angina.

A

FALSE

-Ischemia may not always cause angina - i.e. Silent ischemia

64
Q

____ present initially with angina first, ___ frequently have an acute event.

A

WOMEN present initially with angina first, MEN frequently have an acute event.

65
Q

Why do you want to call emergency services instead of driving a patient to the ER?

A

Because of the presence of an AED

66
Q

What age for men is a risk factor for CAD?

A

> 45 years of age

67
Q

What age for women is a risk factor for CAD?

A

> 55 years of age or premature menopause

68
Q

T/F: Family history of CHD is not a risk factor for CAD.

A

FALSE
-Family history of Coronary Artery Disease (CAD) in a male primary relative <55 or female primary relative <65 is a risk factor for CAD

69
Q

What age of a male primary relative that has CAD is a risk factor for CAD in a patient?

A

<55 years

70
Q

What age of a female primary relative that has CAD is a risk factor for CAD in a patient?

A

<65 years of age

71
Q

In a patient that is a current smoker, has DM, and is of European descent, what are their risk factors for CAD?

A
  • Current smoker

- DM

72
Q

T/F: HTN >130/80 is a risk factor for CAD.

A

FALSE

-HTN >140/90 or on antihypertensive therapy is a risk factor for coronary artery disease

73
Q

_____ LDL and _____ HDL are risk factors for Coronary Heart Disease.

A

INCREASED LDL and DECREASED HDL are risk factors for Coronary Heart Disease.

74
Q

What HDL level is a risk factor for CAD?

A

<40

75
Q

What 5 things defines Metabolic Syndrome?

A

1) Increased waist circumference
2) Increased triglycerides
3) Increased BP
4) Increased glucose
5) Decreased HDL

76
Q

How many of the Metabolic Syndrome conditions are required to be a risk factor for CAD?

A

3 or more

77
Q

T/F: A patient that is South Asian is at high risk of developing Coronary Heart Disease.

A

TRUE

78
Q

What ABI is a risk factor for CAD?

A

<0.9

79
Q

What waist circumference in women and men is indicative of Metabolic Syndrome?

A

> 35 inches for women

>40 inches for men

80
Q

T/F: CKD is not a risk factor for CAD.

A

FALSE

-CKD is a risk factor for CAD

81
Q

Which chronic inflammatory conditions are risk factors for Coronary Artery Disease?

A
  • RA
  • Lupus
  • Psoriasis
  • HIV/AIDS
82
Q

What inflammatory mediators are risk factors for Coronary Artery Disease?

A
  • Increased homocysteine
  • Increased C-reactive protein (CRP)
  • Increased Lp(a)
  • Increased Apo B
83
Q

Which inflammatory mediator is a natural marker for inflammation?

A

CRP

84
Q

Which inflammatory mediator is the smallest, most atherogenic part of LDL and causes plaque buildup?

A

Lp(a)

85
Q

What kind of fat is a risk factor for CAD?

A

Visceral fat (abdominal)

86
Q

Which personality types are risk factors for CAD?

A

Type A & D

87
Q

Which inflammatory mediator causes inflammation?

A

Homocysteine

88
Q

Which mediator secreted by the endothelium causes smooth muscle relaxation in response to stress & has some anti-platelet activity?

A

NITRIC OXIDE

89
Q

Name the two treatment principles for Ischemic Heart Disease.

A

1) Optimize “medical therapy”

2) Revascularization

90
Q

What is meant by Med Treat or Medical therapy?

A

Medications & lifestyle changes

91
Q

Name the two revascularization procedures.

A

1) PTCI or PCI

2) CABG

92
Q

What is PTCI or PCI?

A

Percutaneous transluminal coronary intervention - AKA balloon angioplasty with a stent

93
Q

What is CABG?

A

Coronary artery bypass grafting - AKA open heart surgery or bypass surgery

94
Q

What is a CABG for?

A

Left Main

Blockages in multiple places

95
Q

What are the goals for IHD?

A
  • Decrease or prevent symptoms
  • Prevent coronary heart disease (CHD) events - ACS, arrhythmias, HF
  • Extend life - “Mortality Benefit”
96
Q

What does “SAAB” stand for?

A

S - Statin
A - Aspirin
A - ACE-I
B - Beta Blocker

PHA 415 - Therapeutics III (17 decks)

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