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Ischemic Dx Part 1 Flashcards

1
Q

Ischemia occurs when there is an imbalance between __________ & __________

A

Oxygen supply & Demand

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2
Q

Blood flow is regulated by what ratio?

A

Pressure vs resistance ratio

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3
Q

Oxygen supply is determined by

A

Blood flow

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4
Q

What pathologies can cause issues with blood vessel radius?

A

Atherosclerosis
Vascular tone
Endothelial cell dysfunction

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5
Q

Acute Coronary Syndrome includes what?

A

Unstable Angina
Myocardial Infarction (NSTEMI & STEMI)

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6
Q

Different kinds of Angina

A
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7
Q

ACS happens when?

A

Plaque rupture and thrombus formation

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8
Q

ACS severity is determined by what?

A

The amount of coronary blood flow restriction

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9
Q

Difference between stable vs unstable angina

A

Stable:
-Lasts 1-15 minutes & goes away with rest
-Occurs when heart is under stress
-Very predictable pattern

Unstable:
-Does NOT go away, is an EMERGENCY
-Occurs when blood flow is suddenly slowed
-Very unexpected

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10
Q

Explain development from ischemia to infarct

A

Ischemia:
-Occurs once there is a decrease in blood supply to myocardial tissue

Injury from severe/prolonged Ischemia:
-damage to myocardial tissue is still reversible if get proper reoxygenation- if not, it becomes…

Infarct: Complete absence of blood supply and now myocardial cells will die due to irreversible injury
(DEAD MEAT DONT BEAT)

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11
Q

Acute MI with necrosis of heart suggests it is how old?

A

<3-5 days old

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12
Q

NSTEMI aka what?

A

Subendocardial or non-Q wave MI

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13
Q

STEMI aka what?

A

Transmural/Q wave MI

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14
Q

NSTEMI- what part of the heart does it involve?

A

SMALL area of subendocardial wall
Can be found in:
LV
Ventricular septum
Papillary muscle

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15
Q

What causes NSTEMI?

A

LOCALIZED decrease in blood supply from narrowing of a coronary artery

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16
Q

NSTEMI- EKG looks like what?

A

ST depression +/- T-wave inversion
(It is possible to have no EKG changes)

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17
Q

STEMI- what part of the heart does it involve?

A

WHOLE THICKNESS of heart muscle wall, described by where it is:
Anterior
Inferior
Lateral
Septal

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18
Q

STEMI is associated with what pathology in a coronary artery?

A

Atheroscleric plaques which cause COMPLETE occlusion

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19
Q

STEMI- EKG looks like what?

A

ST elevation +/- Q waves
“Classic Tombstone” look

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20
Q

How are MI’s classified?

A

Type 1-5

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21
Q

Describe Type 1 MI

A

Cause: Primary Coronary event (Plaque erosion +/- rupture, fissuring, dissection)

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22
Q

Describe Type 2 MI

A

Cause: Secondary cause of ischemia (Increased oxygen demand, decreased supply due to coronary spasm, embolism, anemia, arrhythmia, HTN, HoTN)

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23
Q

Describe Type 3 MI

A

UNEXPECTED CARDIAC DEATH
(Cardiac arrest)

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24
Q

Describe Type 4 MI

A

Caused by coronary angioplasty or stents
4a) Associated with PCI
4b) Associated with stent thrombosis

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25
Describe Type 5 MI
Caused by Coronary Artery Bypass Graft
26
What is Silent Ischemia?
MI WITHOUT discomfort or pain
27
Silent Ischemia is MC in?
DM, Elderly, Women
28
What is Myocardial Stunning?
REVERSIBLE myocardial dysfunction after reperfusion of an ischemia injury Will go back to normal once successfully reperfused
29
What is Hibernating Myocardium?
Caused by prolonged blood flow reduction from Coronary Artery disease
30
Hibernating Myocardium can cause what?
Ventricular contractile dysfunction which will improve once blood flow improves
31
Where is Right Coronary Artery represented on EKG?
2, 3, avF
32
Inferior Wall LV has which Coronary artery?
Right
33
Right Ventricle has which Coronary artery?
Right
34
Posterior wall has which Coronary artery?
Posterior Descending
35
Septal wall has which Coronary artery?
Left Anterior Descending
36
Anterior Wall LV has which coronary artery?
Left Anterior Descending
37
Lateral Wall of LV has what Coronary artery?
Left Circumflex
38
Inferior Wall MI is often accompanied by what? Why?
Low HR Because Sinus Node is involved
39
Are long term effects typically worse in Inferior Wall MI or Anterior Wall MI?
Anterior Wall MI
40
Anterior Wall MI is associated with what sx?
Low BP High HR Shock
41
Long term of Anterior Wall MI is associated with?
Heart Failure
42
Where is Posterior Descending Artery represented on EKG?
V7-V9
43
Where is Left Anterior Descending Artery represented on EKG?
V1-V4
44
Where is Left Circumflex Artery represented on EKG?
1, avL, V5, V6
45
Which EKG leads are inferior?
2, 3, avF
46
Which EKG leads are Lateral?
1, avL, V5, V6
47
Which EKG are Anterior/Septal?
V1-V4
48
What is Angina Pectoris
General term to describe chest discomfort related to ischemic dx
49
Angina typically presents in what age for men and women?
Male > 50 Female >60 Presenting with EPISODIC (usually 2-5 min) chest discomfort
50
Exercise stress test may be less accurate in which sex?
Female
51
Which sex is more likely to die after first heart attack?
Female
52
Every patient with Chest Pain needs what diagnostic test?
CXR and EKG (add Cardiac enzymes if you are sus of ACS)
53
What are the diagnostic options?
Stress test Echo Coronary CTA Coronary Angiogram MUGA Scan Cardiac MRI scan
54
Which test is more invasive- Coronary CTA and Angiogram?
Angiogram- requires cardiac catheterization (Both use contrast)
55
What is a MUGA Scan?
Multigated Acquisition Scan It is non-invasive Uses radioactive material injection
56
How Cardiac MRI/Viability scan looks
57
What is the TIMI Risk Score?
Thrombolysis in MI Risk is used to determine how aggressive the treatment should be Low Risk= 1-2 Intermediate Risk= 3-4 HIGH Risk= 5+
58
What does the Heart Score assess?
Cardiac risk assessment for a Major Adverse Cardiac Event (MACE)
59
Describe how to interpret a Heart Score
Discharge pt= 0-3 Admit & Observe= 4-6 Admit & Treat Invasively= 7-10
60
Heart Score Specifics part 1
61
Heart Score Specifics Part 2

CV (6 decks)

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