Ischemic Heart Disease

Question 1

What is an inadequate supply of blood to the heart, caused by a partial or total bloackage of a coronary artery.

Answer 1

Ischemia

Question 2

What are the three stages that the myocardium undergoes when a coronary artery becomes occluded?

Answer 2

Ischemia, Injury, and Infarction

Question 3

Myocardial cell injury (damage) occurs when the ischemic process is ______

Answer 3

More severe

Question 4

What is necrosis or death of myocardial cells known as?

Answer 4

Infarction

Question 5

What is the leading cause of death in the US?

Answer 5

MI

Question 6

What begins as a fatty streak, builds fibrous plaque, and then becomes a complicated lesion that can completely block off an artery?

Answer 6

Atherosclerosis

Question 7

What is due to a spasm that causes a temporary obstruction to coronary artery blood flow? Causes include cocaine use.

Answer 7

Coronary Artery Spasm

Question 8

What is typically the result of the sudden formation of a clot or a piece of plaque that breaks off and blocks a coronary artery?

Answer 8

Coronary Artery Thrombosis

Question 9

What are the causes of ischemic heart disease?

Answer 9

Atherosclerosis, coronary artery spasm, coronary artery thrombosis, decreased coronary blood flow, increased myocardial workload, or congenital anamolies.

Question 10

What are some causes of decreased coronary blood flow?

Answer 10

Arrythmias, pulmonary embolism, hypotension, or shock.

Question 11

What is chest pain due to myocardial ischemia?

Answer 11

Angina Pectoris

Question 12

Which type of angina is effort-induced chest pain,lasts seconds to minutes, and is relieved by rest or nitroglycerin (NTG).

Answer 12

Stable angina pectoris

Question 13

Which type of angina tends to last longer, occurs more frequently, is not necessarily due to effort, and may be relieved temporarily by NTG?

Answer 13

Unstable angina pectoris

Question 14

Which type of angina occurs at rest, early hours of the morning, is often associated with ST segment elevation on the EKG, and is thought to be due to coronary artery spasm?

Answer 14

Variant Angina

Question 15

What type of angina is also known as Prinzmetal’s angina?

Answer 15

Variant Angina

Question 16

What may cause detection of a new murmur post MI?

Answer 16

Ischemic mitral regurgitation due to LVD, arrythmias, or papillary muscle ischemia/infarct/rupture.

Question 17

What does the acronym MONA stand for?

Answer 17

morphine, oxygen, nitroglycerin, and aspirin.

Question 18

What does coronary artery bypass graft surgery do?

Answer 18

CABG creates new routes around narrowed and blocked arteries.

Question 19

According the WHO what are the 3 criteria for an MI?

Answer 19

• History of severe, prolonged chest pain.
• Unequivocal EKG changes to incude abnormal persistent Q waves.
• Changes in serial cardiac biomarker levels that indicate myocardial injury and infarction.

Question 20

Which serum cardiac biomarker rises 3-5 hours after an MI and remains elevated up to 21 days?

Answer 20

Troponin T

Question 21

Creatine kinase (CK), phosphokinase (CPK), and CK-MB ( the muscle type) are all enzymes that are released with ______

Answer 21

tissue necrosis

Question 22

What is an inflammatory process involving the parietal and visceral layers of the pericardium that may lead to a pericardial effusion?

Answer 22

Pericarditis

Question 23

What is a collection of fluid within the pericardial space?

Answer 23

Pericardial effusion

Question 24

Between what two layers does a pericardial effusion occur?

Answer 24

The parietal and visceral layers of the pericardium

Question 25

What is a common response to an acute MI?

Answer 25

pericardial effusion

Question 26

What is a post MI illness that presents with fever, pericarditis, pericardial effusion, and pleuritis?

Answer 26

Dressler’s Syndrome

may present weeks to months after an MI

Question 27

What would cause a bulge in the left ventricular wall that persists during diastole and systole with akinesis ir dyskinesis?

Answer 27

LV true aneurysm

A “hinge point” where good myocardium meets bad myocardium usually persists.

Question 28

What is a narrow perforation of the left ventricular free wall with a false chamber?

Answer 28

A left ventricular pseudo-aneurysm

Usually has a saccular or globular contour.

Question 29

Where is a left ventricular thrombus most commonly located?

Answer 29

At the apex

Question 30

What is a rupture of the interventricular septum that creates a shunt between the ventricles?

Answer 30

VSD

Question 31

What type of infarction is papillary muscle dysfunction most often associated with?

Answer 31

Inferior MI

Question 32

Isolated right ventricular infarction is ______

Answer 32

Rare

Question 33

Right ventricular infarction is most often associated with an ______

Answer 33

Inferior MI

Question 34

On 2-D echo what is seen in areas of ischemia or infarct?

Answer 34

WMA

Question 35

Why do resting echos tend to miss ischemic heart disease?

Answer 35

At rest the heart may prefuse adequately; therefore a stress echo should be performed.

Question 36

What are the risk factors for ischemic heart disease?

Answer 36

Advancing age, family hx, diabetes, smoking, HTN, high cholesterol, obesity, sedentary lifestyle, stress, and over consumption of alcohol.

Question 37

In regards to advancing age what groups are especially high risk for developing ischemic heart disease?

Answer 37

Males and post-menopausal women

Question 38

What are the diagnostic test used for ischemic heart disease?

Answer 38

Cariac cath, stress echo, nuclear stress, and 12 lead EKG