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CV > Ischemia > Flashcards

Ischemia Flashcards

1
Q

Determinants of O2 supply

A

O2 content (hemoglobin level, O2 saturation)
O2 extraction
Coronary blood flow (perfusion pressure, resistance)

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2
Q

Determinants of O2 demand

A

Myocardial contractility
Heart rate
Wall stress (BP, ventricular radius, wall thickness)

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3
Q

Myocardial stunning

A
  • ventricular dysfunction that persists after reperfusion despite no irreversible damage and restoration of normal blood flow
  • myofilament alteration that involves impaired calcium responsiveness
  • repair in 7-14 days
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4
Q

Reperfusion injuries

A
  • stunning
  • no reflow
  • reperfusion arrhythmias
  • fatal reperfusion injury (myocyte cell death)
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5
Q

hibernation

A
  • chronic ischemic tissue can lead to myocytes that are alive but have reduced fxn
  • can by improved if blood flow improves
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6
Q

PET scan

A
  • Positron emission tomography

- used to identify conversion to anaerobic metabolism

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7
Q

Acute Coronary Syndrome risk factors

A

tobacco, DM, dyslipidemia, family hx of CAD, HTN, PAD, renal failure, inflammatory ds, obesity, sedentary lifestyle

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8
Q

Treat stable angina symptoms

A
  • nitrates, calcium channel blockers, B-blockers

- Revascularization-PCI, CABG

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9
Q

Stable angina-prevent adverse events

A
  • lifestyle changes
  • aspirin
  • statins
  • ACE-Is
  • Thioenopyridine
  • CABG if left main coronary artery ds or 3 vessel ds and decreased LV fxn
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10
Q

EKG

A
  • MI results in changes in the polarity, shape, and amplitude of T wave and ST displacement
  • during exercise stress test, may see ST depression or elevation
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11
Q

Exercise stress test

A
  • most common test to dx atherosclerotic coronary artery disease
  • horizontal or down sloping depression or elevation of ST segment -> significant, obstructive CAD
  • most useful if intermediate pre-test probability
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12
Q

Nuclear stress imaging

A
  • demonstrate regional myocardial blood flow

- intravenous injection of radionuclide tracer taken up by myocardium in proportion to blood flow

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13
Q

echocardiography

A

determine wall motion/contractility

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14
Q

Intravascular ultrasound

A
  • images arteries

- sensitive method to detect full extent of atherosclerosis

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15
Q

Fractional flow reserve

A
  • define functional significance of a lesion

- pressure transduced distal to lesion is divided by pressure proximal to lesion (healthy=1;

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16
Q

coronary CT angiography

A

-identifies obstructive plaques and non-obstructive calcifications

17
Q

invasive coronary angiography

A
  • gold standard for dx atherosclerotic CAD and assessing severity
  • inject radio-opaque contrast into arteries and record flow
  • demonstrates only lumen of artery and is not sensitive to early, preclinical athero
18
Q

TIMI variables

A
  • age >65
  • Presence of 3+ CAD risk factors
  • Prior coronary stenosis of >50%
  • ECG ST segment deviation
  • 2+ angina episodes in prior 24 hours
  • Elevated serum cardiac biomarkers
  • use of aspirin in prior 7 days
19
Q

0-2 TIMI variables

A
  • 4.7-8.3% risk

- stress test

20
Q

3+ TIMI variables

A
  • 13-41% risk

- invasive cardiac cath

21
Q

aspirin

A
  • anti-platelet therapy
  • irreversibly blocks COX-1 in platelets-can’t metabolize arachidonic acid to thromboxane A2 (promotes platelet aggregation)
22
Q

P2Y12 receptor blocker

A
  • irreversibly inhibits ADP receptor on platelets

- inhibits GpIIbIIIa complex activation

23
Q

GpIIb-IIIa inhibitor

A

-directly prevents fibrinogen cross linking

24
Q

Anti-thrombins

A
  • unfractionated and low molecular weight heparin, direct thrombin inhibitor, factor Xa inhibitor
  • final goal: block thrombin formation
25
Q

Treatment options UA/NSTEMI

A
  • anti-platelet therapy
  • anti-thrombin therapy
  • statins (HMGCoA reductase inhibitor)
  • B-blockers
  • ACE-I
  • revascularization
  • lifestyle

CV (4 decks)

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