Ischemic Heart Disease Flashcards by Madeline Wing

O2 supply/demand mismatch for the whole body

shock

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O2 supply/demand mismatch for the heart

ischemic heart disease

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common symptom of ischemia

angina (chest pain)

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high-risk plaque; can rupture

vulnerable (unstable) plaque

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development of blood vessels

angiogenesis

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development of new blood vessels from a pre-existing vasculature

neoangiogenesis

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why does tachycardia produce ischemia (why intense workout can elicit MI)

diastole shortens

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ischemic heart disease (IHD) aka

coronary artery disease (CAD)

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3 main types of IHD/CAD

vasospastic
stable (chronic)
thromboembolic

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type of IHD/CAD very prone to rupture

thromboembolic

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type of IHD/CAD not likely to rupture

stable IHD (stable angina)

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another name for vasospastic IHD

Variant angina

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spastic coronary artery restricts flow and decreases O2 supply=

ischemia; Supply Angina

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during exercise, stenotic coronary artery can’t meet O2 demand=

ischemia; Demand Angina

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thrombus/thromboembolism occludes coronary flow=

ischemia; Acute Coronary Syndromes (ACS)

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thromboembolic occlusion of coronary flow can lead to what 4 things

unstable angina
NSTEMI
STEMI
sudden cardiac death

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type of angina due to vasoconstriction “Supply angina”

Prinzmetal (variant) angina

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type of angina due to increased cardiac workload “Demand angina”

stable angina

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leading cause of death nationally and internationally

Ischemic Heart Disease/Coronary Artery Disease

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most common etiology of IHD

atherosclerotic obstruction

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4 other non-atherosclerotc obstruction leading to IHD

myocardial bridging
microvascular angina
Prinzmetal
radiation-induced

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coronary artery prematurely enters myocardium

myocardial bridging

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total occlusion in the absence of collaterals </= 20 min

reversible damage

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total occlusion in the absence of collaterals > 20 min

permanent damage

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3 main ECG findings with ischemia

T inversion ST elevation ST depression

discomfort location of angina/MI patient

retrosternal pain

radiation of angina where

interscapular, arm

epigastric location of angina seen in

elderly and women

retrosternal _____ caused by myocardial ischemia due to stenosis or spasm of coronary arteries

discomfort

4 cardinal clinical features of angina discomfort

character site/radiation provocation factors duration

lasts b/t 2-5 min

angina

provoked by exertion/stress

angina

relieved by rest/nitroglycerin

angina

clenched fist over the sternum (sign of angina)

Levine's sign

does not radiate to trapezius m. unlike in pericarditis

angina

3 main provocation factors for angina

exertion emotion rest

2-3 min of discomfort

Prinzmetal angina

stable angina duration

2-5 min

unstable angina duration (thromboembolic)

5-10 min

chest discomfort for 20-29 min at rest or at night

NSTEMI

chest discomfort for >/=30 min at rest or night

STEMI

dyspnea, nausea, fatigue, and faintness

Anginal equivalents

symptoms of myocardial ischemia other than angina

Anginal equivalents

Angina or Not angina: sharp/fleeting pain/dull, prolonged ache in L submammary area

not angina

3 main labs that will show risk factors for CAD/IHD

dyslipidemia blood glucose CRP

vasoconstriction w/ dynamic coronary stenosis (Supply angina)

Prinzmetal (variant) anginawhat

transient ST elevation seen in what type of angina

Prinzmetal angina

patients experiencing prinzmetal angina may also have other vasospastic disorders such as

Migraine, Raynaud's

Prinzmetal angina

both vasoconstriction and increased cardiac workload lead to this angina (but mostly "demand" angina)

Stable angina

2-5 min discomfort; exertional, predictable timing

Stable angina

T inversion and ST depression seen with this angina

Stable Angina

ST depression is suggestive of what

Coronary Artery Disease

how does stress test help identify CAD

vascular (coronary) steal syndrome

explain vascular steal syndrome

artery w/ plaque is max dilated, on exertion, blood is stolen by other arteries; artery w/ plaque robbed of it's blood flow and O2

due to thromboembolic occlusion (2 names)

Acute Coronary Syndrome (ACS); unstable angina

rupture; unpredictable timing; 5-10 min discomfort

Unstable angina

this angina experiences ST depression

Unstable angina

unpredictable timing, plaque rupture; 20-29 min pain/discomfort; ST depression; necrosis

NSTEMI

severe angina, ST elevation; >/=30 min pain/discomfort; myocardial wall dies w/in 12-24 hrs

STEMI

heaviness of chest/pressure; 20-29 min or >/=30 min attack; unrelieved by rest or nitroglycerin

Myocardial Infarction

symptoms of this include: sob, sweating, weakness, nausea, vomiting, chest pressure

myocardial infarction

S wave in lead I, Q wave present and inverted T wave in lead III pattern sign of

pulmonary embolism

chest pain is often not present w/ what condition (99% not diagnosed)

pulmonary embolism

no Q wave seen most of the time in what

NSTEMI

exacerbated by vigorous exercise, experiences substernal chest PAIN

STEMI

presents w/ sweating, nausea, vomiting, sense of impending doom

STEMI

confusion, profound weakness, and hypotension

STEMI

anxious and restless; moving around; pain for >/=30 min + diaphoresis (sweating)

STEMI

what to order to diagnose STEMI

ECG and cardiac imaging

STEMI

ST elevation in leads II, III, aVF

acute inferior MI

ST elevation in leads (V1-V6)

acute anterior MI

ST elevation specifically seen in V4 and V5

Acute RV MI

preload dependent; so do NOT give nitroglycerin in this case b/c would precipitate hypotension

acute RV MI

ST elevation in V1-V3

acute posterior MI

cardiac biomarkers for cell death

Troponin I myoglobin CK-MB

cardiac biomarkers for inflammation

BNP CRP

risk factor cardiac biomarkers

LDL, HDL, TG's lipoprotein A

myoglobin elevated

cell death from MI within hours

troponin I elevated

cell death from MI within 1-2 days

CK-MB elevated

cell death from MI w/in a day

what biomarker to determine re-infarction

CK-MB

CK-MB is marker for what structure

myocardium

what can cardiac imaging show

perfusion defect

shows depolarization of interventricular septum; if present in V1-V3=

Q wave; injury to myocardium

autoimmune post-infarction syndrome that presents with fever and leukocytosis

Dressler Syndrome

Rx Dressler Syndrome

Aspirin

heart not responding after MI, but resolves within 24 hours

stunning

heart takes up to 7 days to recover from MI

hibernation

in obstruction, coronary channels open and develop into real arterioles due to blood flow creating pressure

arteriogenesis

body makes and degrades this through ubiquitin/proteosome degradation

HIFa

no oxygen w/ ischemia, HIF-1a will bind what and end up producing VEGF

HIF-1a binds HIF-1b

exercise does not improve _____ in humans

coronary collaterals