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
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.
3
Q
Bulge in the LV wall that persists during diastole and systole with akinesis or dyskinesis
A
true aneurysm
4
Q
Post MI illness that presents with fever, pericarditis, pericardial effusion, and pleuritis
A
Dressler’s syndrome
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
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
7
Q
Rupture of the IVS that creates a shunt between the ventricles
A
VSD
8
Q
Collection of fluid within the pericardial space
A
pericardial effusion
9
Q
Most often associated with an inferior MI; may result in MR
A
papillary muscle dysfunction
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
11
Q
Results when the support apparatus of the MV becomes disrupted
A
MR
12
Q
Ventricular fibrillation/tachycardia/ectopic beats; atrial fibrillation/tachycardia, atrioventricular block, sinus bradycardia etc…
What are these called?
A
Arrhythmias
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
- ischemia
- injury
- infarction
14
Q
IHD is also known as:
A
- CAD
- CHD: coronary heart disease
- atherosclerosis
- narrowing/hardening of the arteries
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
16
Q
Ischemia is caused by….
A
increased demand, decreased supply or both
17
Q
myocardial cell injury occurs when….
A
ischemic process is more severe
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)
19
Q
When do most MIs occur?
A
early in the morning, during excessive physical activity, or both
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
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
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
23
Q
MI Classification System: Anatomic
Transmural MI
A
MI extends the entire thickness of the heart wall (endocardium, myocardium, and epicardium)
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
25
_MI Classification System:_ Clinical
Type 1
**spontaneous MI** due to plaque, rupture, thrombotic occlusion
26
_MI Classification System:_ clinical
Type 2
MI due to supply and demand issue
27
_MI Classification System:_ clinical
Type 3
MI associated with sudden death
28
_MI Classification System:_ clinical
Type 4a
**MI associated with PCI** (percutaneous coronary intervention)
29
_MI Classification System:_ clinical
Type 4b
MI associated with in-stent thrombosis
30
_MI Classification System:_ clinical
Type 5
MI associated with CABG: coronary artery bypass graft
31
What is PCI ?
**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.
32
What is CABG ?
**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.
33
What are the etiologies/causes of IHD?
* **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
34
What are the risk factors of IHD?
* 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
35
_Property of Blood Composition_
Blood has two distinct fractions. What are those two?
formed elements (blood cells) & plasma
36
_Property of Blood Composition_
What are the components of formed elements?
* erythrocytes: makes up **45%** of the formed elements
* leukocytes
* thrombocyte
\*note: leukocytes & platelets approximately **1%** each & the rest (_55%) is plasma_
37
_Property of Blood Composition_
What is hematocrit?
the percentage of RBCs present
38
_Property of Blood Composition_
What is anemia?
a decrease in the number of RBCs
39
_Property of Blood Composition_
What is polycythemia?
**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
40
_Property of Blood Composition_
What is leukopenia?
a decrease in WBCs
41
_Property of Blood Composition_
What is erythropoiesis?
the production of RBCs by the bone marrow
42
Chemistry of MI
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
43
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 ?
T
44
Myocardial cell injury occurs when the ischemic process is more severe.
T or F ?
T
45
\_\_\_\_\_\_ is a ST segment elevation MI and account for _____ of MIs.
STEMI
70%
46
_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
angina pectoris
47
_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)
stable angina pectoris
48
_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
unstable angina pectoris
49
_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_
variant angina
50
_Angina Signs_
What are the other names for variant angina?
Prinzmetal's Angina
Angina Inversa
51
Additional Signs and Symptoms of IHD?
* 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
51
Additional Signs and Symptoms of IHD?
* 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
52
MI can be silent/asymptomatic
T or F?
T
53
What are the complications of MI?
**DARTH VADER**
* **D**eath
* **A**rrhythmia
* **R**upture of: free ventricular wall/septum/pap muscle
* **T**amponade
* **H**eart failure
* **V**alve disease
* **A**neurysm 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
* **D**ressler's syndrome
* **E**mbolism
* **R**ecurrence/MR
\*pericardial effusion, pericarditis, cardiogenic shock, L/R ventricular failure, VSD, RV infarction
54
What is **myocardial stunning**?
**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
What is **myocardial hibernation**?
chronic **hypofusion** (decreased perfusion) of the myocardium; **reversible**, cause of LV dysfunction
56
What is the difference between **myocardial hibernation** and **myocardial stunning**?
**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
Myocardial hibernation is caused by a chronic hypoperfusion of the myocardium and it is reversible.
T or F ?
T
58
What are the diagnostic tests to detect MI ?
* **12-lead EKG/ECG**: can show signs of damage from an MI in progress or a previous MI
* **Blood tes**t: 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
Ischemic Cascade
* perfusion abnormality
* diastolic dysfunction
* strain abnormality
* localized systolic dysfunction
* ischemic ECG changes
* chest discomfort
* cardiac enzyme release
60
MI Treatment
* 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
**PCI**
**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
**PTCA**
**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
**atherectomy**
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
**CABG**
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
**IABP**
**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
**AICD**
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
RVAD
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
Papillary muscle dysfunction is most often associated with _______ and results in MR
inferior MI
69
An MI causing sudden death is a type IV.
T or F ?
F
it's type 3
70
The formed elements of blood are:
erythrocytes
leukocytes
thrombocytes
71
\_\_\_\_\_ 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
STEMI
72
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
\< 7 mm
30%
73
74
_MI: 2D Echo Findings_
\_\_\_\_\_ are seen in areas of ischemia or infarct
WMA (wall motion abonormalities)
75
_MI: 2D Echo Findings_
Old infarct may show as an area of ____ and increased _____ due to scarred tissue and lack of blood supply
thinning
echogenicity
76
_MI: 2D Echo Findings_
Those subendocardial MI may not show signs of a RWMA (regional wall motion abnormalities)
T or F ?
T
77
_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 ?
T
78
_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 ?
T
79
_MI: 2D Echo Findings_
Degree of LV systolic dysfunction correlates with survival of patients with ischemic heart disease.
T or F?
T
80
_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 ?
T
81
_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 ?
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
_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 ?
T
83
_Myocardial Infarction (MI) Regional Wall Motion Abnormalities Wall Motion Score Index_
score 1
wall motion?
definition?
wall motion: normal
definition: systolic wall thickening \> 40%
84
_Myocardial Infarction (MI) Regional Wall Motion Abnormalities Wall Motion Score Index_
score 2
wall motion?
definition?
wall motion: **hypokinetic**
definition: systolic wall thickening \< 30%
85
_Myocardial Infarction (MI) Regional Wall Motion Abnormalities Wall Motion Score Index_
score 3
wall motion?
definition?
wall motion: akinetic
definition: systolic wall thickening \< 10%
86
_Myocardial Infarction (MI) Regional Wall Motion Abnormalities Wall Motion Score Index_
score 4
wall motion: dyskinetic
definition: _systolic wall thinning_ with myocardial segment moving **outward** during systole
87
_Myocardial Infarction (MI) Regional Wall Motion Abnormalities Wall Motion Score Index_
score 5
wall motion: aneurysmal
definition: fixed defect
88
WMSI (wall motion segment index) =
sum of wall motion scores/number of segments visualized
89
_Wall Motion Segment Artery Relationships_
apical/apical septal
LAD
90
_Wall Motion Segment Artery Relationships_
apical lateral
LAD or CX
91
_Wall Motion Segment Artery Relationships_
mid inferoseptal
RCA or LAD
92
_Wall Motion Segment Artery Relationships_
basal inferoseptal
RCA
93
_Wall Motion Segment Artery Relationships_
mid/basal anterolateral
LAD or CX
94
_Wall Motion Segment Artery Relationships_
mid/basal inferior
RCA
95
_Wall Motion Segment Artery Relationships_
apical inferior/anterior and apical free wall
LAD
96
_Wall Motion Segment Artery Relationships_
mid/basal anteroseptal
LAD
97
_Wall Motion Segment Artery Relationships_
mid/basal inferolateral
RCA or CX
98
_EKG MI_
ST elevation
myocardial injury
99
_EKG MI_
T inversion
myocardial injury
100
_EKG MI_
Q wave
myocardial necrosis
101
_Methods of Determining Cardiac Perfusion_
## Footnote
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
**Coronary arteriography**
102
_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
**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
_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.
**Nuclear imaging**
104
_Methods of Determining Cardiac Perfusion_
## Footnote
may be used to evaluate right heart and left heart ventricular ejection fraction, valvular regurgitation and intracardiac shunts
**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
\_\_\_\_\_\_ utilizes the radioisotope Thallium 201 to elevate the presence and severity of coronary artery disease
**Nuclear: Myocardial perfusion imaging**
106
Myocardial cell injury occurs when the ischemic process is more severe.
T or F ?
T
107
\_\_\_\_\_\_ is a ST-segment elevation MI and accounts for _____ of all MIs.
STEMI
70%
108
\_\_\_\_\_ MI is subendocardial MI that does not extend the entire thickness of the heart wall.
Non-transmural
109
\_\_\_\_\_ MI is associated with sudden death.
type 3
110
In order for the heart to function properly and efficiently, the _____ of oxygenated blood to the heart must equal the ______ placed on the heart.
supply
demand
111
There are 6 risk factors for IHD, to include \_\_\_\_\_\_
* hyperlipidemia
* diabetes
* HTN
* tobacco use
* male
* family history
112
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 ?
F
113
**Coronary artery thrombosis** may result from a piece of plaque that breaks off and blocks a coronary vein.
T or F ?
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
Coronary artery ______ causes temporary coronary artery obstruction.
spasm
## Footnote
\***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
Increased demand or myocardial workload due to exertion, hypertension, hypertrophic cardiomyopathy, emotional stress, or severe aortic stenosis can cause IHD.
T or F ?
T
116
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
**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
3. 4. is usually _predictable_ - unexpected CP, treat as an emergency
117
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
**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
Ischemic MR due to _____ can cause a new murmur post MI.
papillary muscle ischemia, infarct, or rupture
119
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
4
120
12-lead EKG does not show signs of damage from an MI in progress or a previous MI.
T or F ?
F
12-lead EKG **can show** signs of damage from an MI in progress or a previous MI
121
Cardiac markers/enzyme are used to detect injury and infarct, such as CK-MB, troponin I, and troponin T.
T or F ?
T
CK-MB (creatine kinase myocardial band)
122
\_\_\_\_\_\_ is the gold standard to determine the presence, location, and severity of CAD.
cardiac cath
123
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
3
124
\_\_\_\_\_ 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
4
125
\_\_\_\_\_ is a surgical treatment option for patients with IHD/MI.
1. AICD
2. IABP
3. LVAD/RVAD
4. all of the above
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
LV dilatation causes improper placement of the pap muscle resulting in \_\_\_\_\_
1. improper contraction
2. ischemia
3. ruptured papillary muscle
4. tenting
4
\*tenting: incomplete closure of MV
127
The cardiac sonographer should utilize all windows and views to assess left/right ventricular function and rule out WMA.
T or F ?
T
128
WMAs are seen in areas of ischemia or infarct at rest; therefore, SE is not necessary.
T or F ?
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
Stenosis of ____ or greater is considered to be significant coronary artery disease.
70%
130
\_\_\_\_\_\_\_ is an increase in WBC and _________ is a deceased in WBC
leukocytosis
leukopenia
\*note: polycythemia: **an increase in the number of red blood cells in the body**
131
Ischemia/infarction should be considered with a diastolic wall thickness of \> 7mm
T or F ?
F
Ischemia/infarction should be considered with a diastolic wall thickness of \< 7 mm or 30% less than adjacent myocardium.
132
List the factors that are considered the acute effects of Myocardial ischemia.
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
Anterior MI may reveal up to _____ ischemic LV myocardium and generally has worse LV systolic function than inferior MI.
40%
134
Old infarct may show as an area of thinning and
increased echogenicity due to scarred tissue and lack of blood supply.
T or F ?
T
