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Echo > IHD (Ischemic Heart Disease) > Flashcards

IHD (Ischemic Heart Disease) Flashcards

1
Q

Inflammatory process involving the parietal and visceral layers of the pericardium; may lead to a pericardial effusion

A

Pericarditis

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2
Q

What is Dressler’s syndrome?

A

a type of inflammation of the pericarditis

  • Dressler syndrome is believed to be an immune system response after damage to heart tissue or to the pericardium (i.e. heart attack, surgery or traumatic injury).
  • Symptoms include chest pain, which may be similar to chest pain experienced during a heart attack.
  • Dressler syndrome may also be called post-myocardial infarction syndrome, post-traumatic pericarditis, post-cardiac injury syndrome and post-pericardiotomy syndrome.
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3
Q

Bulge in the LV wall that persists during diastole and systole with akinesis or dyskinesis

A

true aneurysm

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4
Q

Post MI illness that presents with fever, pericarditis, pericardial effusion, and pleuritis

A

Dressler’s syndrome

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5
Q

Pseudo-aneurysm

A
  • Narrow perforation of the LV free wall with a false chamber that has a saccular or globular contour
  • occurs when a blood vessel wall is injured and the leaking blood collects in the surrounding tissue. It is sometimes called a false aneurysm
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6
Q

Akinetic/dyskinetic area causes the blood to pool and this complication can develop; most common location is at the apex

What is this?

A

LV thrombus

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7
Q

Rupture of the IVS that creates a shunt between the ventricles

A

VSD

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8
Q

Collection of fluid within the pericardial space

A

pericardial effusion

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9
Q

Most often associated with an inferior MI; may result in MR

A

papillary muscle dysfunction

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10
Q

Most often associated with in inferior MI; may result in RV dilatation, segmental WMA, TR, VSD, or PFO

A

RV infarction

*isolated RV infarction is rare

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11
Q

Results when the support apparatus of the MV becomes disrupted

A

MR

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12
Q

Ventricular fibrillation/tachycardia/ectopic beats; atrial fibrillation/tachycardia, atrioventricular block, sinus bradycardia etc…

What are these called?

A

Arrhythmias

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13
Q

When a coronary artery occlusion slows or blocks the blood supply, the demand placed in the heart exceeds the supply, and the myocardium that is fed by that artery progresses through three stages; what are they?

A
  1. ischemia
  2. injury
  3. infarction
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14
Q

IHD is also known as:

A
  • CAD
  • CHD: coronary heart disease
  • atherosclerosis
  • narrowing/hardening of the arteries
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15
Q

In order for the heart to function properly and efficiently, the heart’s supply of O2 blood must meet the demand placed on the heart

T or F ?

A

T

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16
Q

Ischemia is caused by….

A

increased demand, decreased supply or both

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17
Q

myocardial cell injury occurs when….

A

ischemic process is more severe

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18
Q

MI occurs when…..

A

myocardial ischemia exceeds the heart’s threshold, for an extended period, and results in irreversible myocardial cell damage or death (necrosis)

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19
Q

When do most MIs occur?

A

early in the morning, during excessive physical activity, or both

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20
Q

MI severity depends on….

A
  • the level of occlusion within the coronary artery
  • length of time of the occlusion
  • presence/absence of collateral circulation
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21
Q

MI Classification System: EKG

What is STEMI (ST-segment elevation MI)

A
  • 70% of MIs
  • plaque rupture causes complete occlusion of an already atherosclerotic major coronary artery
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22
Q

MI Classification System: EKG

NSTEMI or NON STEMI (Non-ST segment elevation MI)

A
  • 30% of MIs
  • partial occlusion of an already atherosclerotic major coronary artery or complete occlusion of a minor coronary artery
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23
Q

MI Classification System: Anatomic

Transmural MI

A

MI extends the entire thickness of the heart wall (endocardium, myocardium, and epicardium)

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24
Q

MI Classification System: Anatomic

Non-Transmural STEMI

aka: ?

A
  • aka: subendocardial MI
  • MI does not extend the entire thickness of the heart wall; limited to the endocardium or endocardium and myocardium
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25
Q

MI Classification System: Clinical

Type 1

A

spontaneous MI due to plaque, rupture, thrombotic occlusion

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26
Q

MI Classification System: clinical

Type 2

A

MI due to supply and demand issue

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27
Q

MI Classification System: clinical

Type 3

A

MI associated with sudden death

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28
Q

MI Classification System: clinical

Type 4a

A

MI associated with PCI (percutaneous coronary intervention)

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29
Q

MI Classification System: clinical

Type 4b

A

MI associated with in-stent thrombosis

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30
Q

MI Classification System: clinical

Type 5

A

MI associated with CABG: coronary artery bypass graft

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31
Q

What is PCI ?

A

Percutaneous coronary intervention (PCI) refers to a family of minimally invasive procedures used to open clogged coronary arteries

During a PCI procedure, a balloon-tipped catheter is threaded over a guide wire until it reaches the narrowed area (as identified in an angiogram). When in position, the balloon is inflated at high pressure, compressing the obstructing atheromatous plaque and enlarging the inner diameter of blood vessels so that blood flows more readily. This procedure is known as balloon angioplasty.

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32
Q

What is CABG ?

A

Coronary artery bypass grafting (CABG), also known as heart bypass surgery, is a procedure to restore blood flow to areas of your heart

CABG restores blood flow by using blood vessels from other parts of your body to create a detour around blockages.

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33
Q

What are the etiologies/causes of IHD?

A
  • atherosclerosis: defined by the changes in the intimal lining of the arteries
  • coronary thrombus
  • embolus
  • coronary artery spasm: causes temporary coronary artery obstruction; linked to spasms in other arteries (similar to a migraine or Raynaud’s syndrome), chronic allergies, smoking, heavy consumption of alcohol, menstruation, some chemotherapy, low magnesium
  • decreased blood flow
  • congenital coronary anomalies
  • increased demand/myocardial workload: sue to physical exertion, severe hypertension, hypertrophic cardiomyopathy, severe AS, emotional stress
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34
Q

What are the risk factors of IHD?

A
  • hyperlipidemia
  • diabetes mellitus
  • hypertension
  • tabacco use
  • male gender (*gender difference narrows as age increases)
  • family history (atherosclerotic arterial disease)
  • obesity
  • aging
  • sedentary lifestyle
  • chronic stress
  • type “A” personality
  • sleep apnea
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35
Q

Property of Blood Composition

Blood has two distinct fractions. What are those two?

A

formed elements (blood cells) & plasma

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36
Q

Property of Blood Composition

What are the components of formed elements?

A
  • erythrocytes: makes up 45% of the formed elements
  • leukocytes
  • thrombocyte

*note: leukocytes & platelets approximately 1% each & the rest (55%) is plasma

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37
Q

Property of Blood Composition

What is hematocrit?

A

the percentage of RBCs present

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38
Q

Property of Blood Composition

What is anemia?

A

a decrease in the number of RBCs

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39
Q

Property of Blood Composition

What is polycythemia?

A

an increase in the number of red blood cells in the body. The extra cells cause the blood to be thicker, and this, in turn, increases the risk of other health issues, such as blood clots

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40
Q

Property of Blood Composition

What is leukopenia?

A

a decrease in WBCs

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41
Q

Property of Blood Composition

What is erythropoiesis?

A

the production of RBCs by the bone marrow

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42
Q

Chemistry of MI

A
  1. Decrease of oxygen supply leading to hypoxia
  2. Myocardium shifts to an anaerobic metabolism
  3. Fatty acid an carbohydrate oxidation decreases
  4. ATP production decreases
  5. Glycolysis is accelerated (increased uptake in glucose by heart)
  6. Glucose is not easily oxidized in the mitochondria and converted to
    lactate
  7. Intracellular pH decreases resulting in decreased contractility
  8. Reperfusion of injured myocytes is possible if handled quickly
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43
Q

MI occurs when myocardial ischemia exceeds the heart’s threshold, for an extended period, and results in irreversible myocardial cell damage or death.

T or F ?

A

T

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44
Q

Myocardial cell injury occurs when the ischemic process is more severe.

T or F ?

A

T

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45
Q

______ is a ST segment elevation MI and account for _____ of MIs.

A

STEMI

70%

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46
Q

Angina Signs

  • CP (chest pain) due to IHD; demand > O2 supply due to 1+ coronary artery is narrowed/blocked
  • Described as pressure/fullness/squeezing that may radiate to the jaw/shoulder/arm/back
A

angina pectoris

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47
Q

Angina Signs

  • usually predictable, manageable, and effort induced
  • triggers: emotional stress, extreme temperature (hot/cold), large meals, smoking
  • lasts seconds to minutes *usually < 5min
  • relieved by rest/NTG (nitroglycerin)
A

stable angina pectoris

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48
Q

Angina Signs

  • AKA: acute coronary syndrome
  • unexpected CP, treat as an emergency
  • usually at rest/sleep/with little exertion
  • most common cause: atherosclerosis, blood clots
  • tends to last longer than stable angina
  • may worsen with time and may lead to an MI
  • rest/meds may not relieve CP
A

unstable angina pectoris

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49
Q

Angina Signs

  • rare, usually younger patients
  • chronic condition
  • occurs at rest, usually early in the morning
  • can be very painful
  • relieved with meds to control spasm
  • often associated with ST segment elevation
  • thought to be due to coronary artery spasm, possibly due to: cold weather exposure, stress, vasoconstrictors, smoking and cocaine abuse
A

variant angina

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50
Q

Angina Signs

What are the other names for variant angina?

A

Prinzmetal’s Angina

Angina Inversa

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51
Q

Additional Signs and Symptoms of IHD?

A
  • epigastric discomfort, nausea, vomiting
  • SOB
  • sweating
  • tachy/bradycardia
  • impairment cognitive function
  • syncope/near syncope
  • cardiogenic shodk
  • sudden cardiac death
  • new murmur post MI due to:
    • ischemic MR caused by LV dilatation, pap muscle ischemia, infarct, rupture, irregular rhythm
    • ischemic VSD
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51
Q

Additional Signs and Symptoms of IHD?

A
  • epigastric discomfort, nausea, vomiting
  • SOB
  • sweating
  • tachy/bradycardia
  • impairment cognitive function
  • syncope/near syncope
  • cardiogenic shodk
  • sudden cardiac death
  • new murmur post MI due to:
    • ischemic MR caused by LV dilatation, pap muscle ischemia, infarct, rupture, irregular rhythm
    • ischemic VSD
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52
Q

MI can be silent/asymptomatic

T or F?

A

T

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53
Q

What are the complications of MI?

A

DARTH VADER

  • Death
  • Arrhythmia
  • Rupture of: free ventricular wall/septum/pap muscle
  • Tamponade
  • Heart failure
  • Valve disease
  • Aneurysm of ventricle
    • true aneurysm- a bulge in the ventricular wall that persists during diastole and systole with akinesis or dykinesis
    • pseudo-aneurysm- a narrow perforation of the ventricular free wall with a false chamber
  • Dressler’s syndrome
  • Embolism
  • Recurrence/MR

*pericardial effusion, pericarditis, cardiogenic shock, L/R ventricular failure, VSD, RV infarction

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54
Q

What is myocardial stunning?

A

After a brief episode of severe ischemia there is a prolonged myocardial dysfunction with a gradual return of contractile activity due to reperfusion.

prolonged, post‐ischemic ventricular dysfunction that occurs after brief periods of nonlethal ischemia.

55
Q

What is myocardial hibernation?

A

chronic hypofusion (decreased perfusion) of the myocardium; reversible, cause of LV dysfunction

56
Q

What is the difference between myocardial hibernation and myocardial stunning?

A

Stunned myocardium is viable (workable) myocardium salvaged (recovered) by coronary reperfusion that exhibits prolonged postischemic dysfunction after reperfusion.

Hibernating myocardium is ischemic myocardium supplied by a narrowed coronary artery in which ischemic cells remain viable but contraction is chronically depressed

57
Q

Myocardial hibernation is caused by a chronic hypoperfusion of the myocardium and it is reversible.

T or F ?

58
Q

What are the diagnostic tests to detect MI ?

A
  • 12-lead EKG/ECG: can show signs of damage from an MI in progress or a previous MI
  • Blood test: checks the level of
    • triglycerides
    • cholesterol
    • sugar
    • proteins
    • cardiac markers/enzyme: creatine kinase myocardial band (CK-MB), troponin I & troponin T
  • echo: chamber size, function, WMA *cannot differentiate between old and new damage
  • chest x-ray: detects heart failure, fluid around the heart, enlarged heart, aortic aneurysm, lung disorders, and other causes of symptoms
  • stress echo with 12 lead EKG: is contraindicated (not recommended) immediately following an MI and is not as specific as cath lab to the exact location or degree of coronary blockage; however it is able to evaluate heart’s functional response to stress and detect WMA
  • nuclear stress test: detects perfusion abnormalities
  • cardiac cath/angiography: the gold standard to determine the presence, location, and severity of coronary blockages
59
Q

Ischemic Cascade

A
  • perfusion abnormality
  • diastolic dysfunction
  • strain abnormality
  • localized systolic dysfunction
  • ischemic ECG changes
  • chest discomfort
  • cardiac enzyme release
60
Q

MI Treatment

A
  • bed rest with telemetry (Telemetry – A portable device that continuously monitors patient ECG, respiratory rate and/or oxygen saturations while automatically transmitting information to a central monitor)
  • medical therapy:
    • O2
    • pain management
    • thrombolytic therapy (clot busters)
    • antiplatelet therapy - prevent additional platelet activation
    • aspirin - greatly reduces MI mortality
    • nitrates - vasodilator effect
    • beta blockers - decrease arrhythmia, additional ischemia/infarct, MI size and mortality
    • cath lab: PCI (percutaneous coronary intervention), PTCA (percutaneous transluminal coronary angioplasty), atherectomy, coronary stent
    • surgical options: CABG (coronary artery bypass graft surgery), IABP (intra-aortic balloon pump), AICD (automatic implantable cardioverter-defibrillator), LVAD/RVAD (left/right assist device), heart transplant
    • mini-thoracotomy: minimally invasive, robotically assisted surgery that can be used for CABG without cardiopulmonary bypass
    • long-term, life style changes/control risk factors
    • cardiac rehabilitation and long-term medication
61
Q

PCI

A

Percutaneous Coronary Intervention (PCI, formerly known as angioplasty with stent) is a non-surgical procedure that uses a catheter (a thin flexible tube) to place a small structure called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup, a condition known as atherosclerosis

62
Q

PTCA

A

Percutaneous transluminal coronary angioplasty (PTCA) also called percutaneous coronary intervention (PCI) is a minimally invasive procedure to open blocked or stenosed coronary arteries allowing unobstructed blood flow to the myocardium.

63
Q

atherectomy

A

An atherectomy is a procedure that utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel. The catheter is inserted into the artery through a small puncture in the artery, and it is performed under local anesthesia.

Angioplasty — A balloon is inflated to open the vessel. Angioplasty and stent placement — After the balloon is used, a mesh frame called a stent will be placed in the vessel to support the walls. Atherectomy — The plaque is removed using a rotating shaver or laser.

64
Q

CABG

A

A coronary artery bypass graft involves taking a blood vessel from another part of the body (usually the chest, leg or arm) and attaching it to the coronary artery above and below the narrowed area or blockage.

This new blood vessel is known as a graft. The number of grafts needed will depend on how severe your coronary heart disease is and how many of the coronary blood vessels are narrowed.

65
Q

IABP

A

An intra-aortic balloon pump (IABP) is a type of therapeutic device. It helps your heart pump more blood. You may need it if your heart is unable to pump enough blood for your body.

The IABP consists of a thin, flexible tube called a catheter. Attached to the tip of the catheter is a long balloon. This is called an intra-aortic balloon, or IAB. The other end of the catheter attaches to a computer console. This console has a mechanism for inflating and deflating the balloon at the proper time when your heart beats

66
Q

AICD

A

The automatic implantable cardioverter-defibrillator (AICD) is a device designed to monitor the heartbeat. This device can deliver an electrical impulse or shock to the heart when it senses a life-threatening change in the heart’s rhythm. Like a pacemaker, the AICD is small enough to be implanted under the skin in the upper chest. The AICD system consists of:

  • A pulse generator that can send an electrical impulse or shock to the heart
  • Electrodes that sense the rhythm of the heart and deliver a shock to the heart muscle
  • Batteries designed to last four to five years and deliver about 100 shocks
  • A small computer chip that tells the AICD when to deliver a shock
67
Q

RVAD

A

A ventricular assist device helps your heart pump blood when the pumping muscle has become weak. A right ventricular assist device (RVAD) pumps blood from your right ventricle or right atrium into your pulmonary artery and to the lungs.

68
Q

Papillary muscle dysfunction is most often associated with _______ and results in MR

A

inferior MI

69
Q

An MI causing sudden death is a type IV.

T or F ?

A

F

it’s type 3

70
Q

The formed elements of blood are:

A

erythrocytes

leukocytes

thrombocytes

71
Q

_____ is an MI in which there is an ST elevation of 70% and plaque rupture that causes complete occlusion of an already atherosclerotic major coronary artery

72
Q

Systolic wall thickening and motions should be observed and graded accordingly. Ischemia/infarction should be considered with a diastolic wall thickness of ____ or _____ less than adjacent myocardium

A

< 7 mm

30%

74
Q

MI: 2D Echo Findings

_____ are seen in areas of ischemia or infarct

A

WMA (wall motion abonormalities)

75
Q

MI: 2D Echo Findings

Old infarct may show as an area of ____ and increased _____ due to scarred tissue and lack of blood supply

A

thinning

echogenicity

76
Q

MI: 2D Echo Findings

Those subendocardial MI may not show signs of a RWMA (regional wall motion abnormalities)

T or F ?

77
Q

MI: 2D Echo Findings

RWMA can persist up to 30 min or longer with temporary occlusion. RWMA may persist but may improve over several months with reperfusion by PTCA or thrombolytic therapy.

T or F ?

78
Q

MI: 2D Echo Findings

Anterior MI may reveal up to 40% ischemic LV myocardium and generally has worse LV systolic function than inferior MI.

T or F ?

79
Q

MI: 2D Echo Findings

Degree of LV systolic dysfunction correlates with survival of patients with ischemic heart disease.

T or F?

80
Q

MI: 2D Echo Findings

Risk of thrombus in area of akinesis or dyskinesis is generally greater than that of the adjacent myocardium.

T or F ?

81
Q

MI: 2D Echo Findings

Patients with small MIs or who are treated with tPA or streptokinase at an early stage may not necessarily demonstrate WMA on 2-D

T or F ?

A

T

*streptokinase: s a thrombolytic medication and enzyme. As a medication it is used to break down clots in some cases of myocardial infarction (heart attack), pulmonary embolism, and arterial thromboembolism. The type of heart attack it is used in is an ST elevation myocardial infarction (STEMI)

*tPA (tissue plasminogen activator): is a drug used to break up a blood clot and restore blood flow to the brain. A tPA can only be administered within a few hours after stroke symptoms appear, so it is extremely important to call 911 at the first sign of a stroke

82
Q

MI: 2D Echo Findings

TTE tends to miss IHD because the heart may perfuse adequately at rest; therefore a stress echo should be performed.

T or F ?

83
Q

Myocardial Infarction (MI) Regional Wall Motion Abnormalities Wall Motion Score Index

score 1

wall motion?

definition?

A

wall motion: normal

definition: systolic wall thickening > 40%

84
Q

Myocardial Infarction (MI) Regional Wall Motion Abnormalities Wall Motion Score Index

score 2

wall motion?

definition?

A

wall motion: hypokinetic

definition: systolic wall thickening < 30%

85
Q

Myocardial Infarction (MI) Regional Wall Motion Abnormalities Wall Motion Score Index

score 3

wall motion?

definition?

A

wall motion: akinetic

definition: systolic wall thickening < 10%

86
Q

Myocardial Infarction (MI) Regional Wall Motion Abnormalities Wall Motion Score Index

score 4

A

wall motion: dyskinetic

definition: systolic wall thinning with myocardial segment moving outward during systole

87
Q

Myocardial Infarction (MI) Regional Wall Motion Abnormalities Wall Motion Score Index

score 5

A

wall motion: aneurysmal

definition: fixed defect

88
Q

WMSI (wall motion segment index) =

A

sum of wall motion scores/number of segments visualized

89
Q

Wall Motion Segment Artery Relationships

apical/apical septal

90
Q

Wall Motion Segment Artery Relationships

apical lateral

91
Q

Wall Motion Segment Artery Relationships

mid inferoseptal

A

RCA or LAD

92
Q

Wall Motion Segment Artery Relationships

basal inferoseptal

93
Q

Wall Motion Segment Artery Relationships

mid/basal anterolateral

94
Q

Wall Motion Segment Artery Relationships

mid/basal inferior

95
Q

Wall Motion Segment Artery Relationships

apical inferior/anterior and apical free wall

96
Q

Wall Motion Segment Artery Relationships

mid/basal anteroseptal

97
Q

Wall Motion Segment Artery Relationships

mid/basal inferolateral

98
Q

EKG MI

ST elevation

A

myocardial injury

99
Q

EKG MI

T inversion

A

myocardial injury

100
Q

EKG MI

Q wave

A

myocardial necrosis

101
Q

Methods of Determining Cardiac Perfusion

a test that uses X-rays to help your doctor find narrowing or blockage in one or more of your coronary arteries.

the evaluation of the coronary arterial system with the injection of a radiopaque dye into the right and left coronary arteries. A decrease in a coronary artery diameter of 70% or greater is considered significant coronary artery disease

A

Coronary arteriography

102
Q

Methods of Determining Cardiac Perfusion

utilizes the radioisotope Thallium- 201 to evaluate the presence and severity of coronary artery disease. A cold spot will be displayed in areas with myocardial ischemia or infarction

A

Nuclear: Myocardial perfusion imaging

Myocardial perfusion is an imaging test. It’s also called a nuclear stress test. It is done to show how well blood flows through the heart muscle. It also shows how well the heart muscle is pumping. For example, after a heart attack, your doctor may order this test to find areas of damaged heart muscle. This test may be done during rest and while you exercise.

A myocardial perfusion scan uses a tiny amount of a radioactive substance, called a radioactive tracer. The tracer travels through the bloodstream and healthy heart muscle absorbs it. On the scan, the areas where tracer has been absorbed look different from the areas that do not absorb it. Areas that are damaged or don’t have good blood flow do not absorb the tracer.

103
Q

Methods of Determining Cardiac Perfusion

uses the radioisotope technetium-99 pyrophosphate to detect myocardial infarction. A hot spot will be displayed in the area of myocardial infarction.

A

Nuclear imaging

104
Q

Methods of Determining Cardiac Perfusion

may be used to evaluate right heart and left heart ventricular ejection fraction, valvular regurgitation and intracardiac shunts

A

Radionuclide angiography (MUGA)

A multigated acquisition scan (also called equilibrium radionuclide angiogram or blood pool scan) is a noninvasive diagnostic test used to evaluate the pumping function of the ventricles (lower chambers of the heart). During the test, a small amount of radioactive tracer is injected into a vein. A special camera, called a gamma camera, detects the radiation released by the tracer to produce computer-generated movie images of the beating heart. The MUGA scan is a highly accurate test used to determine the heart’s pumping function

105
Q

______ utilizes the radioisotope Thallium 201 to elevate the presence and severity of coronary artery disease

A

Nuclear: Myocardial perfusion imaging

106
Q

Myocardial cell injury occurs when the ischemic process is more severe.

T or F ?

107
Q

______ is a ST-segment elevation MI and accounts for _____ of all MIs.

108
Q

_____ MI is subendocardial MI that does not extend the entire thickness of the heart wall.

A

Non-transmural

109
Q

_____ MI is associated with sudden death.

110
Q

In order for the heart to function properly and efficiently, the _____ of oxygenated blood to the heart must equal the ______ placed on the heart.

A

supply

demand

111
Q

There are 6 risk factors for IHD, to include ______

A
  • hyperlipidemia
  • diabetes
  • HTN
  • tobacco use
  • male
  • family history
112
Q

Atherosclerosis is a cause of IHD; it is defined by changes in the intimal lining of the arteries that begin as a fatty streak, build fibrous plaque, and then become a complicated lesion that can never completely block off an artery.

T or F ?

113
Q

Coronary artery thrombosis may result from a piece of plaque that breaks off and blocks a coronary vein.

T or F ?

A

F

*coronary artery thrombus occurs due to rupture or erosion of preexsisting coronary artery plaque, resulting in the artery’s complete occlusion

*note: venous thrombosis: is when the blood clot blocks a vein, whereas arterial thrombosis is when the blood clot blocks an artery.

114
Q

Coronary artery ______ causes temporary coronary artery obstruction.

A

spasm

*coronary artery spasm: a sudden tightening of the muscles within the arteries of your heart. When this occurs, your arteries narrow and prevent blood from flowing to your heart. Coronary artery spasms are brief and temporary. However, they can potentially lead to further heart complications, such as a heart attack.

You’re more likely to have these spasms if you have conditions that can affect the heart, such as high cholesterol or high blood pressure.

Coronary artery spasms are also known as coronary artery contractions.

115
Q

Increased demand or myocardial workload due to exertion, hypertension, hypertrophic cardiomyopathy, emotional stress, or severe aortic stenosis can cause IHD.

T or F ?

116
Q

Unstable angina pectoris ________

Choose the best explanation:

  1. lasts seconds to minutes
  2. is also known as prinzmetal’s angina
  3. is usually at rest or with little exertion
  4. is usually predictable
A

3: usually occurs at rest/sleep/with little exertion

  1. lasts seconds to minutes - tends to last longer than stable angina, may worsen with time, and may lead to MI
  2. is also known as prinzmetal’s angina /variant angina/angina inversa, not unstable angina
    1. is usually predictable - unexpected CP, treat as an emergency
117
Q

Stable angina pectoris is ______

Choose the best explanation:

  1. rare, usually in younger patients
  2. relieved by rest or Nitroglycerin
  3. unexpected CP
  4. all of the above
A

2: predictable, manageable, and effort induced (trigger: emotional stress, hot/cold temperature, large meals, smoking), lasts seconds to minutes (usually < 5 min), and relieved by rest or Nitroglycerin

  1. rare, usually in younger patients = variant angia/Prinzmetal’s angina/angina inversa
  2. relieved by rest or Nitroglycerin
  3. unexpected CP - predictable, manageable
118
Q

Ischemic MR due to _____ can cause a new murmur post MI.

A

papillary muscle ischemia, infarct, or rupture

119
Q

Signs and symptoms of IHD/MI include_______

Choose the one describes best

  1. asymptomatic
  2. chest/arm/jaw pain or pressure
  3. sweating/nausea
  4. all of the above
120
Q

12-lead EKG does not show signs of damage from an MI in progress or a previous MI.

T or F ?

A

F

12-lead EKG can show signs of damage from an MI in progress or a previous MI

121
Q

Cardiac markers/enzyme are used to detect injury and infarct, such as CK-MB, troponin I, and troponin T.

T or F ?

A

T

CK-MB (creatine kinase myocardial band)

122
Q

______ is the gold standard to determine the presence, location, and severity of CAD.

A

cardiac cath

123
Q

Stress echo is capable of detecting CAD by evaluating the heart’s _____ to stress by detecting wall motion abnormalities.

Choose the one describes bset

  1. abnormalities related
  2. electrical response
  3. functional response
  4. relationship
124
Q

_____ is an immediate goal when treating IHD.

Choose the one descibes best

  1. medical therapy
  2. restore normal coronary blood flow
  3. salvage functional myocardium
  4. all of the above
125
Q

_____ is a surgical treatment option for patients with IHD/MI.

  1. AICD
  2. IABP
  3. LVAD/RVAD
  4. all of the above
A

4

*all the surgical options are:

  • CABG: coronary artery bypass graft
  • IABP: intra-aortic balloon pump
  • AICD: automatic implantable cardioverter-defibrillator
  • LVAD: LV assist device
  • RVAD: RV assist device
  • heart transplant
126
Q

LV dilatation causes improper placement of the pap muscle resulting in _____

  1. improper contraction
  2. ischemia
  3. ruptured papillary muscle
  4. tenting
A

4

*tenting: incomplete closure of MV

127
Q

The cardiac sonographer should utilize all windows and views to assess left/right ventricular function and rule out WMA.

T or F ?

128
Q

WMAs are seen in areas of ischemia or infarct at rest; therefore, SE is not necessary.

T or F ?

A

F

*SE (stress echo) is contraindicated immediately following an MI, and is not as specific as the cath lab to the exact location or degree of coronary blockage; however, it is able to evaluate the heart’s functional response to stress and detect WMAs.

129
Q

Stenosis of ____ or greater is considered to be significant coronary artery disease.

130
Q

_______ is an increase in WBC and _________ is a deceased in WBC

A

leukocytosis

leukopenia

*note: polycythemia: an increase in the number of red blood cells in the body

131
Q

Ischemia/infarction should be considered with a diastolic wall thickness of > 7mm

T or F ?

A

F

Ischemia/infarction should be considered with a diastolic wall thickness of < 7 mm or 30% less than adjacent myocardium.

132
Q

List the factors that are considered the acute effects of Myocardial ischemia.

A
  1. SIGNIFICANT CAD (STENOSIS)
    IMPAIRS BLOOD FLOW TO
    MYOCARDIAL TISSUE (DECREASES
    OXYGEN)
  2. WHEN O2 DEMANDS EXCEEDS
    SUPPLY MYOCARDIAL ISCHEMIA
    DEVELOPS
  3. IF THERE IS COMPLETE CORONARY
    ARTERY OCCLUSION, MYOCARDIAL NECROSIS CAN
    OCCUR
  4. HYPOXIA CAUSES DECREASE IN
    MYOCARDIAL FUNCTION
133
Q

Anterior MI may reveal up to _____ ischemic LV myocardium and generally has worse LV systolic function than inferior MI.

134
Q

Old infarct may show as an area of thinning and
increased echogenicity due to scarred tissue and lack of blood supply.

T or F ?

Echo (35 decks)

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