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PHM 521 > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

low density lipoproteins

A

bad cholesterol, atherogenic, carries lipids from liver to tissues

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2
Q

high density lipoproteins

A

good cholesterol, carries excess lipids to the liver for elimination

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3
Q

triglycerides

A

type of fat transported in bloodstream and stored in fat, some association with risk of cv disease

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4
Q

manifestations of atherosclerosis

A

ischemic stroke, coronary artery disease, carotid artery stenosis (stroke), renal artery stenosis, peripheral artery disease (PAD)

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5
Q

smoking effect on atherosclerosis

A

reduces hdl, impacts cholesterol retrieval, increases oxidation of lipoproteins, cytotoxic effects to endothelium, increases thrombogenesis

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6
Q

diabetes effect on atherosclerosis

A

major source of oxidative stress

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7
Q

htn effect on atherosclerosis

A

increases atherosclerotic cv disease

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8
Q

non-modifiable atherosclerotic risk factors

A

male >45, female >55
family history of CAD event: male> 55, female<65
history of family ischemic stroke or MI –> increased risk due to genetics

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9
Q

modifiable atherosclerotic risks

A

smoking (primary), htn dyslipidemia, diabetes, obesity, physical inactivity

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10
Q

ischemia

A

inadequate blood supply to an organ or tissue that leads to tissue damage and necrosis

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11
Q

arterial response to ischemia

A

arterial vasodilation to increase oxygen delivery

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12
Q

coronary arteries

A

starts just above the aortic root and supplies blood and oxygen to the myocardium

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13
Q

cardiac chest pain (angina)

A

described as a heavy weight or pressure on chest (not sharp pains) in substernal area (rarely radiates)
can be worsened by exercise, cold weather, postprandial and emotional stress

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14
Q

typical angina

A

occurs with characteristic quality, location, and duration, provoked by exertion or emotional stressm relieved by nitroglycerin or rest

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15
Q

atypical angina

A

meets only 2 or 3 typical angina criteria
women, older adults and individuals with diabetes may present with different symptoms including: anxiety, sob, weakness, fatigue, and indigestion, this often leads to misdiagnosis

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16
Q

non-cardiac chest pain

A

meets one or no criteria for typical angina

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17
Q

ischemic heart disease can be presented as

A

acute coronary symptoms (ACS) or chronic coronary disease (CCD)

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18
Q

chronic coronary disease (CCD) can present as

A

stable angina, patients discharged after ACS, patients diagnosed with CCD based on screening

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19
Q

acute coronary symptoms (ACS) presents as

A

ubstable angina, non-ST MI (NSTEM), ST MI (STEMI)

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20
Q

stable angina

A

chronic angina precipitated by activity or upset, relieved at rest
atherosclerotic plaque is reducing blood flow, there is no plaque rupture/hemostasis

21
Q

discharged after ACS

A

patients are considered to have CCD after they are discharged for an ACS event

22
Q

CCD diagnosed after screening

A

patients may have risk factors of or symptoms consistent with CCD for which a screening test is completed and CCD is identified

23
Q

unstable angina

A

increased frequency or duration of angina episodes produced at a lower level of exertion or at rest
acute change in level of what is causing patient to have chest pain

24
Q

non-ST elevation MI (NSTEMI)

A

myocardial necrosis resulting from prolonged interruption of the blood supply, generally results in acute thrombosis, but no ECG changes
partial occlusion
atherosclerotic plaque ruptures leading to primary and secondary hemostasis

25
Q

ST elevation MI (STEMI)

A

myocardial necrosis resulting from prolonged interruption of the blood supply generally results from an acute thrombus with ECG changes
complete occlusion
atherosclerotic plaque ruptures leading to primary and secondary hemostasis
diagnosed with positive troponins and a 1 mm elevation in at least 2 contiguous leads on ECG

26
Q

primary hemostasis

A

first step in plaque rupture- more relevant for arterial clots
forms a platelet plug in 3 steps
1. adhesion
2. activation
3. aggregation
first line of hemostatic defense, begins in seconds of vessel injury and is mediated by circulating agents

27
Q

secondary hemostasis

A

main driver of venous clots.
forms fibrin clots through clotting cascade
plasma coagulation cascade initiated by exposure of tissue factor from the vascular injury –> thrombin activation –> clot stabilizes and strengthens the platelet plug

28
Q

primary hemostasis adherence

A

adhere to collagen in the vascular sub endothelium, exposed collagen releases von Willebrand factor

29
Q

primary hemostasis activation

A

releases adp, ca, and thomboxane a2 to activate further platelets, GP IIb/IIIa receptors are exposed to platelets

30
Q

primary hemostasis activation

A

platelets aggregate through GP IIb/IIIa fibrinogen to form a platelet plug

31
Q

clotting cascade

A

surface activation –> XIIa __> XIa –> IXa –> factor XA –> converts prothrombin to thrombin –> converts fibrinogen to fibrin
vascular injury –> VIIa –> factor XA –> prothrombin to thrombin –> fibrinogen to fibrin

32
Q

left coronary artery

A

supplies left ventricle (major heart attack if occluded)

33
Q

right coronary artery

A

supplies the right side of the heart

34
Q

circumflex artery

A

supplies back side of left heart (minor heart attack if occluded)

35
Q

presence of cardiac enzymes in ACS

A

UA: no cardiac enzymes
NSTEMI: cardiac enzymes
STEMI: cardiac enzymes

36
Q

ECG ST elevation in ACS

A

UA: no st elevation
NSTEMI: no st elevation
STEMI: st elevation

37
Q

troponin

A

primary biomarker for ACS- takes 6 hrs to show up

38
Q

ST elevation on ECG

A

only present in STEMI (complete occlusion), take about 5 minutes to show up- needs to be tested in that window

39
Q

functional CAD testing

A

exercise stress tests, pharmacologic stress test

40
Q

anatomical CAD testing

A

coronary artery angiography, coronary artery ca scoring

41
Q

stress test

A

often initial recommended test, can be done with pharmacologic agents if patient is unable to exercise –> sent to angiogram if abnormal results

42
Q

coronary artery CT scqn

A

looking for calcification of the coronary arteries – abnormal results? –> coronary angiogram

43
Q

coronary artery calcium testing

A

used in asymptomatic patients, uses ct scan- no dye, calculates mass of Ca, score per age

44
Q

Peripheral artery disease

A

atherosclerosis that occurs in periphery, usually in lower extremities, can lead to pain on exertion, tissue damage, ulcers, and infection
most common in aortoiliac, femoral, popliteal, and tibeal

45
Q

intermittent claudication

A

Presentation of PAD pain when walking in the buttocks, thighs or calves, often relieved with rest, severe cases will have pain at rest

46
Q

chronic limb threatening disease

A

Presentation of PAD chronic decreased flow that can lead to ulcerations, gangrene, infections
patients with diabetes and smokers are at the highest risk

47
Q

acute limb threatening disease

A

presentation of PAD medical emergency, requires immediate revascularization to prevent limb loss

48
Q

Normal ABI levels

A

1-1.4 - no PAD

PHM 521 (11 decks)

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