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CV > Ischemic Dx Part 1 > Flashcards

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
Q

Describe Type 5 MI

A

Caused by Coronary Artery Bypass Graft

26
Q

What is Silent Ischemia?

A

MI WITHOUT discomfort or pain

27
Q

Silent Ischemia is MC in?

A

DM, Elderly, Women

28
Q

What is Myocardial Stunning?

A

REVERSIBLE myocardial dysfunction after reperfusion of an ischemia injury

Will go back to normal once successfully reperfused

29
Q

What is Hibernating Myocardium?

A

Caused by prolonged blood flow reduction from Coronary Artery disease

30
Q

Hibernating Myocardium can cause what?

A

Ventricular contractile dysfunction which will improve once blood flow improves

31
Q

Where is Right Coronary Artery represented on EKG?

A

2, 3, avF

32
Q

Inferior Wall LV has which Coronary artery?

A

Right

33
Q

Right Ventricle has which Coronary artery?

A

Right

34
Q

Posterior wall has which Coronary artery?

A

Posterior Descending

35
Q

Septal wall has which Coronary artery?

A

Left Anterior Descending

36
Q

Anterior Wall LV has which coronary artery?

A

Left Anterior Descending

37
Q

Lateral Wall of LV has what Coronary artery?

A

Left Circumflex

38
Q

Inferior Wall MI is often accompanied by what? Why?

A

Low HR
Because Sinus Node is involved

39
Q

Are long term effects typically worse in Inferior Wall MI or Anterior Wall MI?

A

Anterior Wall MI

40
Q

Anterior Wall MI is associated with what sx?

A

Low BP
High HR
Shock

41
Q

Long term of Anterior Wall MI is associated with?

A

Heart Failure

42
Q

Where is Posterior Descending Artery represented on EKG?

A

V7-V9

43
Q

Where is Left Anterior Descending Artery represented on EKG?

A

V1-V4

44
Q

Where is Left Circumflex Artery represented on EKG?

A

1, avL, V5, V6

45
Q

Which EKG leads are inferior?

A

2, 3, avF

46
Q

Which EKG leads are Lateral?

A

1, avL, V5, V6

47
Q

Which EKG are Anterior/Septal?

A

V1-V4

48
Q

What is Angina Pectoris

A

General term to describe chest discomfort related to ischemic dx

49
Q

Angina typically presents in what age for men and women?

A

Male > 50
Female >60
Presenting with EPISODIC (usually 2-5 min) chest discomfort

50
Q

Exercise stress test may be less accurate in which sex?

A

Female

51
Q

Which sex is more likely to die after first heart attack?

A

Female

52
Q

Every patient with Chest Pain needs what diagnostic test?

A

CXR and EKG
(add Cardiac enzymes if you are sus of ACS)

53
Q

What are the diagnostic options?

A

Stress test
Echo
Coronary CTA
Coronary Angiogram
MUGA Scan
Cardiac MRI scan

54
Q

Which test is more invasive- Coronary CTA and Angiogram?

A

Angiogram- requires cardiac catheterization

(Both use contrast)

55
Q

What is a MUGA Scan?

A

Multigated Acquisition Scan

It is non-invasive
Uses radioactive material injection

56
Q

How Cardiac MRI/Viability scan looks

A
57
Q

What is the TIMI Risk Score?

A

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
Q

What does the Heart Score assess?

A

Cardiac risk assessment for a Major Adverse Cardiac Event (MACE)

59
Q

Describe how to interpret a Heart Score

A

Discharge pt= 0-3
Admit & Observe= 4-6
Admit & Treat Invasively= 7-10

60
Q

Heart Score Specifics part 1

A
61
Q

Heart Score Specifics Part 2

A

CV (6 decks)

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