Ischemic Heart Disease Flashcards
What is the main etiology of ischemic heart disease?
Coronary artery atherosclerosis
What is the most common type of heart disease in the US and other industrialized nations?
Ischemic heart disease?
What is the leading cause of death worldwide?
Ischemic heart disease
Heart muscle is dying in a patient with angina pectoris (TRUE/FALSE)?
FALSE
What is angina pectoris?
Pain of myocardial ischemia
Patient presents with crushing chest pain on the left side of his body lasting for the last two hours. The patient is also experiencing radiating pain to the medial aspect of his left forearm and achiness around the left side of his jaw. What is the diagnosis for this patient and how can his chest pain be classified?
Acute myocardial infarct with unstable angina
What is the most common symptom of ischemic heart disease?
Angina pectoris
When is angina pectoris symptomatic?
When the lumen of the affected vessel(s) is occluded more than 75%
What can bring on stable angina most commonly?
Exercise and emotional stress
What is the treatment for stable angina?
Rest and sublingual nitroglycerin
Patient presents with chest pain that increases while he is working out for around the last 15 minutes of his workout. The pain begins to subside when he is resting and driving home from the gym. What type of angina is he suffering from?
Stable angina
What is Prinzmetal angina also known as?
Variant angina
What is prinzmetal or variant angina?
Atypical form of angina that occurs at rest
What is the cause of prinzmetal angina?
Coronary artery spasm (vasoconstriction)
During prinzmetal angina the coronary artery (Vasoconstricts/Vasodilates)?
Vasoconstricts
Prinzmetal angina occurs at ____
Rest
What is the most common trigger for prinzmetal angina?
Emotional stress
What type of angina do cocaine drug users die from during an overdose?
Prinzmetal angina or variant angina
What is unstable angina also called?
Pre-infarction angina, accelerated angina, or crescendo angina
What is the occurrence pattern of unstable angina?
Episodes of chest pain becomes progressively more frequent and longer over a 3-4 day period
What type of angina is likely to progress to myocardial infarction?
Unstable angina (Crescendo, pre-infarction, accelerated)
What is myocardial infarct?
Death of myocardial tissue due to inadequate perfusion
What are the two types of myocardial infarcts?
Subendocardial and transmural
What is the main etiology of a subendocardial infarct?
Hypoperfusion
What part of the heart is affected by a subendocardial infarct?
Inner 1/3-1/2 of the left ventricle
What is a transmural infarct?
Infarct involving the full thickness of the left ventricle usually after the occlusion of a coronary artery
What is the main etiology of a transmural infarct?
Coronary artery occlusion via thromboembolism
What major coronary arteries are chiefly occluded in a transmural infarct?
Right coronary artery
Anterior interventricular artery
Left circumflex artery
What does a right coronary artery occlusion infarct?
Infarct of the posterior basal region of the left ventricle and the posterior third to half of the interventricular septum?
What artery is occluded in an inferior infarct?
Right coronary artery
What does an anterior interventricular artery occlusion infarct?
Infarct of the apical, anterior, and anteroseptal walls of the left ventricle
What does a left circumflex artery occlusion infarct?
Infarct of the lateral left ventricle wall
What is the least common artery occluded in a transmural infarct?
Left circumflex artery
What enzymes are increased in a patient experiencing a myocardial infarct?
Intracellular proteins such as: Troponin I or T, Creatine Kinase, myoglobin, and Lactate Dehydrogenase
What pattern of necrosis is evident in a patient suffering from a myocardial infarct?
Coagulative necrosis
What occurs 24 hours after a MI?
- Coagulative necrosis with clumping/loss of nuclei and organelles
- Eosinophilia
- Neutrophils migrate in
What occurs 2-3 days after a MI?
Neutrophils migrate to the periphery of an infarct
What occurs 5-7 days after a MI?
Neutrophils are replaced by macrophages
What occurs 1-3 weeks after a MI?
Progressive type III collagenization and pre-scar formation
What artery is occluded in a patient post MI who is experience arrhythmia or conduction anomalies? What side of the heart was infarcted?
Right coronary artery, right
What are complications post-MI?
Arrhythmia/conduction anomalies
Heart failure
Shock
Thromboembolism
Pericarditis
Aneurysm/rupture
What type of infarct commonly causes pericarditis?
Transmural infarct
What is the biggest concern for a patient recovering from a myocardial infarct one week post?
Cardiac tamponade or rupture
Hemopericardium indicates a (Small/Large) rupture?
Small
Cardiac tamponade indicates a (Small/Large) rupture?
Large
What murmur is seen in a patient with pericarditis?
Pericardial friction rub
What inflammatory exudate is present in pericarditis and surrounding areas of myocardial infarcts?
Fibrinous exudate
What is the presentation of a fibrinous exudate?
Shaggy, bread and butter, or mayonnaise appearance
When is a patient who has just suffered from a myocardial infarct most at risk for cardiac tamponade or rupture?
One week post MI
