Ischemic Heart Disease Flashcards
acute coronary syndrome (ACS)
- umbrella term for symptoms associated with sudden, reduced blood flow to heart
What conditions are included in ACS diagnosis?
- MI
- unstable angina
- STEMI
- NSTEMI
ACS diagnosis is dependent on:
- patient hx of chest or left arm pain
- hx of CAD
- exam findings
ACS exam findings
- hypotension, diaphoresis
- pulmonary edema, rales
- ST seg deviation
- Elevated biomarkers
Ischemic heart disease includes
- heart attack
- stable or unstable angina
IHD causes
- atherosclerosis of coronary arteries
- coronary thrombus or emboli
- coronary spasm
- complications of conn tissue disorders
IHD risk factors
- age
- HTN
- DM
- Gender
- Smoking Hx
- Physical inactivity
- Obesity
- Hypercholestermia
- Hyperlipedemia
- High stress
- family hx
- poor diet
IHD common symptoms
- chest p! or discomfort
- p! or discomfort in one or both arms, jaw, neck, back, or stomach
- SOB
- dizziness/lightheaded
- nausea
- sweating (diaphoresis)
IHD blood testing
- cardiac enzymes
- c reactive protein
- homocysteine
- abdnormal lipid profile
- brain natriuretic peptide (BNP)
- prothrombin
Ischemic cardiomyopathy
- caused by narrowing of coronary arteries, diminished blood supply to heart.
- most common type of dilated cardiomyopathy
- caused by CAD
- constant cardiac ischemia = irreversible myocyte damage
Ischemic cardiomyopathy:
cardiac remodeling
- myocardial fibrosis
- possible cardiac conduction system impairment
- cell death
- LV enlargement and dilation
HF due to ischemic cardiomyopathy
- most common presentation for ischemic cardiomyopathy
2. prognosis determined by myocardial viability
Rheumatoid CA disease
patients with rheumatoid arhtritis have 2-3X more epicardial and small vessel CAD
Angina pectoris
stable and unstable
intermittent chest p! caused by transient, reversible myocardial ischemia
angina pectoris leads to
- MI
- Sudden cardiac death
- ischemic cardiomyopathy
stable angina
- caused by mismatch between O2 delivery and need
- brought on by exertion/stress
- predictable HR
- crushing or squeezing substernal sensation w/possible radiation down L arm
- reduction in stress reduces symptoms
treatment for stable angina
nitroglycerin
causes systemic vasodilation
unstable angina
- exertion/stress
- unpredictable onset
- crushing or squeezing substernal sensation w/possible radiation down L arm
- poor prognosis
IHD:
plaque rupture
- exposes thrombogenic lipids to blood
- stimulates localized thrombus formation with ischemic outcomes
IHD:
Occlusive event
damage dependent on CA involved and time before treatment
MI:
stages (0-7 days)
0-6 hrs: no change
6-24 hrs: early features coagulative necrosis
1-4 days: coagulative necrosis w/acute inflammatory response
5-7 days: macrophage activity
MI:
stages (7 days-3 mo)
7-10 days: developing peripheral rim of granulation tissue
1-6 weeks: progressive organization of infarct
1-3 months: progressive collagen deposition, mature replacement scar
MI:
area of injury becomes a scar, leading to:
- wall movement issues
- electrical propagation issues
Reperfusion injury
tissue damage when blood returns to tissue after a period of ischemia or lack of O2
associated with microvascular injury
Sudden cardiac death
- 50% of deaths from CAD
- V fib, asystole (flat line)
- acute coronary plaque rupture/thrombosis
- clinically quiet MI
- No acute lesion but >60% stenosis of a CA
