Ischemia/Infarction

Question 1

What is main cause of occlusion?

Answer 1

Thrombosis

Question 2

What is main cause of coronary artery spasm?

Answer 2

Smooth muscle constriction

Question 3

If patient complains of substernal chest pain with radiation of pain to jaw or left arm, nausea, diaphoresis, and shortness of breath, suspect:

Answer 3

MI

Question 4

Who is prone to silent MI?

Answer 4

women, diabetics

Question 5

What enzyme is particularly affected in event of MI?

Answer 5

Troponin I

Question 6

Effect of MI on troponin I levels

Answer 6

Rise early and stay elevated for days

Question 7

CK-MB during MI:

Answer 7

6 hours to rise and then normalize in 48 hours

Question 8

First change to EKG during MI:

Answer 8

Peak T-wave, then inversion

Question 9

ST segment elevation/depression: which is more common with MI?

Answer 9

Elevation

Question 10

Why are new Q waves diagnostic of MI?

Answer 10

They indicate irreversible myocardial cell death.

Question 11

Change to EKG within minutes during MI:

Answer 11

Peaked T wave

Question 12

Change to EKG within hours-minutes during MI:

Answer 12

Progression of ST segment elevation

Question 13

Change to EKG within hours-days during MI:

Answer 13

Loss of R wave, Q wave formation

Question 14

If ischemia is reversed, what happens to the EKG?

Answer 14

T-wave will return to normal.

Question 15

What is the only diagnostic EKG criteria in event of MI?

Answer 15

New Q-waves

Question 16

Is ST segment elevation repairable?

Answer 16

Yes

Question 17

What is J point elevation?

Answer 17

A type of ST segment elevation seen in normal hearts

Question 18

What is a J point?

Answer 18

Where the ST segment takes off from the QRS complex

Question 19

Appearance of new Q waves in EKG indicates:

Answer 19

Irreversible myocardial death

Question 20

At time of Q wave appearance, what happens to ST segment?

Answer 20

ST segment returns to normal

Question 21

In leads more distant from site of infarction, what will you see?

Answer 21

Tall R waves

ST segment depression when ST segment and T wave changes are present

Question 22

What does the region of the heart muscle that suffers from infarction depend on?

Answer 22

Which coronary artery becomes occluded and extent of collateral blood flow

Question 23

What is the pathway of the RCA?

Answer 23

Runs between the right atrium + right ventricle, swings to posterior surface of the heart

Question 24

LCA divides into?

Answer 24

LAD artery and left circumflex artery

Question 25

If you obstruct the LAD, where would we see acute changes in our twelve-lead?

Answer 25

V2, V3, V4

Question 26

What about obstruction to left circumflex?

Answer 26

V5, V6, aVL

Question 27

What does LAD supply?

Answer 27

Anterior portion of heart and most of interventricular septum

Question 28

What is the pathway of the left circumflex artery?

Answer 28

Goes between left atrium and left ventricle and supplies lateral wall of left ventricle

Question 29

What causes inferior infarcts?

Answer 29

Occlusion of RCA or descending branch or left coronary artery