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Patho Exam 3 > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

describe acute coronary syndrome (ACS)

A

an acute ischemic heart disease that takes into two forms:

  1. Unstable Angina (UA) or
  2. Myocardial Infarction (MI), divided into:
    - STEMI, and NSTEMI
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2
Q

main difference between STEMI and NSTEMI

A

STEMI is an emergency, NSTEMI’s intervention can wait until the next day

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3
Q

ACS is based on what

A

based on the presence or absence of ST- segment elevation or depression on the EKG
= ST elevation means MI
= ST depression means angina, non-emergent

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4
Q

Serum biomarkers, aka Cardiac panel includes what?

A
  1. troponin I (TnI)
  2. troponin T (TnT)
  3. creatinine kinase (CK- MB)
  4. myoglobin
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5
Q

Troponin I indicates what

A
  • highly specific for cardiac muscle necrosis
  • begin to rise 3 hours after the injury and remain elevated up to 7-10 days after the event
  • normal range: 0-0.05 ng/ml
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6
Q

Creatinine kinase indicates what

A
  • enzymes found in muscle cells
  • CK- MB = specific for injury to myocardial tissues
  • rises after 4-8 hours of myocardial injury and decline to normal within 2-3 days
  • if CK-MB is elevated but not TnI, then its rhabdomyolysis (just chest pain)
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7
Q

Myoglobin indicates what

A
  • not specific to cardiac injury

- present in both skeletal and cardiac muscles

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8
Q

risk factors for ischemic heart disease

A
  1. Atherosclerosis in the coronary arteries
    • Elevated cholesterol; DM
  2. HTN
  3. Smoking
  4. Family history
  5. Thrombus
    • disrupts coronary circulation
    • Endothelial lining injury + platelet aggregation
    • Calcified plaques that break off
  6. Coronary vasospasm
  7. Severe anemia
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9
Q

describe a thrombus in the RCA (coronary circulation)

A
  1. move along the RV
  2. branches into posterior descending artery
  3. travels around the back
  4. posterior portion of the heart
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10
Q

describe a thrombus in the LCA (coronary circulation)

A

a) Left anterior descending (LAD) - most commonly involved in the thrombus formation
= supplies the LV
b) circumflex artery

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11
Q

describe the pathway of diminished blood flow

A
  1. Diminished blood flow to coronary artery = decreased perfusion to heart muscles (ischemia)
  2. chest pain; chest heaviness -> relieved by rest and relieved with nitroglycerine
  3. diminished blood flow coupled with increased cardiac metabolic demand
  4. unable to meet oxygen need of the heart muscle
  5. If ischemia is prolonged = cell (death) infarction!
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12
Q

will exercise prevent contracting a heart attack?

A

being fit/healthy may not 100% prevent you from contracting a HA but will increase your chances of surviving b/c of collateral circulation

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13
Q

describe the pathway of total blockage (large thrombus has lodged)

A
  1. Total blockage = unable to perfuse cardiac cells
  2. Cells undergo anaerobic metabolism -> chest pain -> does not relieve by rest; does not relieve with nitroglycerine
  3. cell death (infarction!), depending on the location and size of infarction:
  4. it MAY have affectation of the conduction system of the heart
  5. (deadly) arrhythmias = decreased cardiac output
    = death
    OR
  6. it MAY have decreased contractility of the heart muscles = heart unable to pump blood properly
  7. s/s of CHF and cardiogenic shock
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14
Q

describe angina

A

chest pain that occurs when there is diminished blood flow or temporary lack of blood flow to the myocardium

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15
Q

describe stable angina

A

chronic chest pain that the individual has experienced in the past and feels similar to past episodes

  • the difference between this and unstable is a history of chest pain
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16
Q

describe unstable angina

A
  1. chest pain that occurs for the first time
  2. or a sudden chest pain caused by myocardial ischemia
  3. or a chest pain that is more severe that usual

= a medical emergency

17
Q

what are s/s of angina (5)

A
  1. Chest pain secondary to stress, exertion (exercise, etc.)
  2. Chest discomfort- pressure, choking, heaviness
  3. Anginal equivalents (often occur to women): dyspnea, dizziness, lightheadedness, jaw pain, epigastric pain, back pain
  4. Individuals may look pale, diaphoretic, dyspneic
  5. Heart rate may be normal, low, or high or irregular
18
Q

when does an acute myocardial infarction occur

A
  • occurs when heart muscles die from hypoxia (STEMI or NSTEMI)
  • prolonged ischemia greater than 30 minutes can cause irreversible damage and necrosis
19
Q

describe AMI STEMI vs NSTEMI

A
  • STEMI- indicates infarction that affects completely through the heart wall
  • NSTEMI- the infarct is subendocardial and NOT completely through the heart wall
20
Q

what is the normal HR range

A

60-100bpm (this comes from SA node)

  • if SA is injured and it has to use AV node
    = AV node only beats 40-60 this will NOT sustain life
21
Q

factors that affect the survival of heart muscles w/ AMI (3)

A
  1. Location or level of occlusion
  2. Length of time of occlusion
  3. Collateral circulation
22
Q

what are the clinical manifestations (s/s) of AMI

A
  1. Diaphoresis
  2. dyspnea
  3. anxiety (“feeling of impending doom”)
  4. chest pain
  5. pallor
  6. Levine’s sign (fist to the chest)
23
Q

treatment of AMI (2)

A
  1. PTCA/PCI
    - (percutaneous transluminal coronary angioplasty)
    - (percutaneous coronary intervention)
  2. CABG
24
Q

how is a PTCA/PCI done

A
  1. Catheter is inserted in the femoral or radial artery
  2. Threaded to coronary artery
  3. at point of obstruction a balloon is inflated
  4. stent may be placed
    = blood flow re-established
25
Q

what is a CABG

A

a surgery to create new routes around the blocked artery using great saphenous vein from the leg

(coronary artery bipass graph)

Patho Exam 3 (9 decks)

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