Ischemic Heart Disease Flashcards
What are 3 etiologies of Ischemic heart disease?
- CAD -atherosclerosis
-congenital coronary anomalies
-coronary artery spasm
The size of an aneurysm during systole?
Increases
What’s the pathophysiology of ischemic heart disease?
- atherosclerotic plaque causes stenosis in coronary arteries
- this obstructs blood flow
- leads to deprivation of myocardial o2 = ischemia
- total blockage causes muscle death = ischemia
What are risk factors for ischemic heart disease ?
- sex
-age
-diabetes
-hyperlipidedma - obesity
-family history
-smoking
-HTN
What are complications of ischemic heart disease?
- Aneurysm
-arrhythmias
-mural thrombus
-pap muscle rupture
-VSD
-death
-Pseudoaneurysm - PE
-pap muscle dysfunction
How common are aneurysms with ischemic heart disease?
8-15%
How common are arrhythmias with ischemic heart disease?
90%
___ thrombus occurs with ____ MI ___ to ___ % of the time
Mural ; acute ; 20-40%
Papillary muscle rupture occurs in __% of MI’s
1%
Papillary muscle rupture causes death in __% of MI’s patient
5%
Papillary muscle rupture occurs in 90% of ____ MI’s
Inferior
___% of patients are dead in 8 weeks due to pap muscle rupture
98
VSD’s occur in ___% of MI patients
2
What is the most common mechanical complication of an MI?
Aneurysm
What’s the difference between mural vs. transmural thrombus ?
Mural is attached partial section of wall
Transmural takes up entirely of wall
What’s another name for mural thrombus?
Subendocardical
A new murmur post MI can be due to what 4 things?
- MR
-ischemic VSD
-pap muscle rupture
Pap muscle dysfunction
A physical sign of ischemic heart disease is ___
Angina
__% of MI’s are silent
25%
Severe acute MR patients often present with?
Florid pulmonary edema
What’s the difference between stable and unstable angina ?
Stable follows a pattern of excertion causing chest pain
Unstable doesn’t follow a pattern. Chest pain occurs without excertion and is more dangerous and indicative of a MI
What’s a flail leaflet?
Abnormality of leaflet mobility. Due to chordal rupture or dissociation
Flail leaflet is associated with what disease?
MVP
What type of MI causes pap muscle rupture?
Inferior MI
What are 7 echo signs of ischemic heart disease?
-RWMA
-LV dilation with ischemic cardiomyopathy
- Thrombus in akinetic or dyskinetic areas
-pap muscle dysfunction
-pap muscle Rupture ( VSD or pesudeoanureysm)
- dresser syndrome with PE
-ventricular aneurysm
A true aneurysm has what 3 characteristics?
-wide base
-low risk of free rupture
- encases the myocardial layer ( or all 3 layers of the heart)
A pseudoaneurysm has what 4 characteristics?
-narrow base
-high risk of free rupture
- walls composed of thrombus
-has only 1-2 layers of the heart not all 3
The most common location for a pseudorandom is?
Inferior basal
What information do you need pre-op in a patient with a LV aneurysm?
- Size
- Location
- Thrombus?
- Movement of other walls
4
Color Doppler in ischemic disease can be good for ?
- MR
- TR
- AR
- VSD
- ASD
4.
What may be seen secondary to a pap muscle dysfunction on echo?
MR
If a ischemic VSD is present what direction will the shunt be?
L-R
What is Kawasaki disease?
Inflammation of small to medium sized vessels
What do you look for in a patient with Kawasaki disease?
Coronary artery aneurysms
Who is most affected by Kawasaki disease?
Children usually 5 years and younger
What are other symptoms of Kawasaki disease?
-fever
-enlarged lymph nodes
-a rash in genital area, lips, palms, soles of feet
-red eyes
Hypokinesiss means?
Less motion than normal
Dyskinesiss means ?
Motion is opposite than normal direction
How many segments of a wall need to be affected before calling it a RWMA?
1 segment
What is the IVS motion in a patient with a a LBBB?
Dyskinetic or paradoxical
Another word for dyskinetic is?
Paradoxical
What type of aneurysm gives a fusiform
shape?
True aneurysm
What kind of aneurysm gives a saccular shape?
Pseudaneurysm
What are two signs on Doppler of a ischemic heart disease?
- MR due to secondary pap muscle rupture
-L-R VSD shunt
Which coronary artery supplies, the atrial septum?
RCA
Which coronary artery supplies, the SA and AV nodes?
RCA
What is meant by right dominance?
When the right cornary artery gives rise to the posterior descending artery 85% of the time 
What percentage of people are right dominant?
85%
What is the medication used with a nuclear stress test?
Thallium
