IHD Flashcards
Cornerstone in the diagnosis of acute and chronic IHD
ECG
MC underlying cause of myocardial ischemia and injury
obstruction of coronary arteries by atherosclerosis
Infection associated w/ ACCELERATED atherosclerosis
Chlamydophila pneumoniae
MC cause of anterior chest musculoskeletal pain
costochondral and chondrosternal syndromes
Myocardial perfusion occurs during this time
diastole
The initial lesion of atherosclerosis
fatty streak
Major features of METABOLIC SYNDROME
central obesity hyperglycemia hypertriglyceridemia hypertension low HDL cholesterol
Age when lipid screening should start
> 20 years (fasting lipid profile: total cholesterol, TGL, LDL and HDL
repeated every 5 years
Key feature of metabolic syndrome
central adiposity
Most accepted and unifying hypothesis to describe pathophysiology of metabolic syndrome
Insulin resistance
Driving force behind metabolic syndrome
obesity
MC cause of myocardial ischemia
atherosclerotic disease of epicardial coronary artery
MC major vessel involved in MI
LAD artery
Sites of predilection for atherosclerotic plaques to develop d.t. increased turbulence
branch points in the EPICARDIAL ARTERIES
Time frame for REVERSIBLE damage in myocardium
< 20 mins for total occlusion in the absence of collaterals
Most widely used test for both the diagnosis of IHD and estimating the prognosis
electrocardiographic stress testing
MC pathophysiologic cause of UNSTABLE angina
plaque rupture or erosion w/ superimposed non-occlusive thrombus
ABSOLUTE CONTRAINDICATIONS to NITRATE use
hypotension
sildenafil (or similar drug) in previous 24-48 hrs
MC artery involved in Prinzmetal Angina
RCA
Main agents for acute episodes and to abolish recurrent episodes of Prinzmetal’s angina
nitrates and calcium blockers (Nifedipine)
Necrosis seen in MI
COAGULATION necrosis (preserved architecture, faded details)
Earliest detectable feature of MYOCYTE NECROSIS
sarcolemmal membrane disruption (leads to leakage of cardiac enzymes into circulation)
Time frame where GROSS changes in MI occur
12 hrs after the onset of symptoms
Color changes in MI
4 hrs - mottling
1 wk - bright yellow
2 wks - surrounding red granulation tissue
2 mos - gray-white scar
Fibrinous Pericarditis post MI
Dressler syndrome
Sites of myocardial rupture in MI
free wall > IVS > papillary muscle
Preferred biochemical markers for MI
cardiac specific troponin T and cardiac specific troponin I
Preferred biochemical markers for re-infarction
CK-MB
Level of coronary artery stenosis sufficient to produce ischemia
70% (critical stenosis)
Primary cause of OUT-OF hospital deaths from STEMI
ventricular fibrillation
Primary cause of IN hospital deaths from STEMI
pump failure
Greatest delay usually occurs between
onset of pain and patient’s decision to call for help
Principal goal of FIBRINOLYSIS
prompt restoration of full coronary arterial patency
Extent of LV involvement that results in cardiogenic shock
infarction > 40%
MC complication of ANGIOPLASTY
restenosis
MC thrombi found in NSTEMI (composed mainly of platelets)
white thrombi
MC thrombi found in STEMI (composed mainly of cells and fibrin )
red thrombi
MC cause of sudden cardiac death
CAD
MC arrhythmia post-MI
PVC
MC lethal arrhythmia post-MI
ventricular fibrillation
