Ischemic Heart Disease

Question 1

Major cause of sudden cardiac death

Answer 1

Arrhythmia –> most commonly ventricular

• • also major reason patients die in the hospital after infarction
• • frequently OLD MI that has caused arrhythmia

Question 2

When is treadmill testing used

Answer 2

First see patient
Stable Typical or Probably Angina
Changing symptoms

Question 3

Angina changes are usually precipitated by

Answer 3

Unstable, ruptured atherosclerotic plaque

Question 4

Ischemia means

Answer 4

oxygen demand exceeding oxygen supply

Question 5

Unstable Angina

Answer 5

New onset exertional angina

Exertional angina of increasing frequency or decreasing level of exertion

Occuring at rest/during sleep

Prolonged >20-30 minutes

Question 6

Determinants of myocardial oxygen demands

Answer 6

Blood pressure (afterload)
Ventricular volume (preload)
Heart rate
Contractility

Question 7

Diagnosis of MI requires

Answer 7

typical EKG finding (ST elevation/Q waves) or cardiac biomarkers rise/fall

Question 8

Pressure in coronary arteries is due to

Answer 8

Increased aortic diastolic pressure, decreased ventricular diastolic pressure

Question 9

Stable angina is

Answer 9

Predictable
Has history
Same HR/BP at onset
Provoked by exertion

Question 10

Stable angina classically lasts

Answer 10

3-5 minutes

Should go away as soon as precipitating problem is removed or with SL NTG

Question 11

Official Classification of Typical Angina Chest Pain

Answer 11

SUBSTERNAL
PROVOKED
RELIEVED

Question 12

Atypical angina

Answer 12

meets 2 of the 3 criteria of typical

Question 13

This meets 1 or none of the official criteria of typical angina

Answer 13

non-cardiac chest pain

Question 14

What are possible complications of MI?

Answer 14

Arrhythmia
Heart failure
Hypotension
++++

Question 15

Myocardial ischemia may manifest as

Answer 15

• Chest discomfort
• Shortness of breath
• Abnormal EKG
• Heart failure
• Arrhythmia with syncope or sudden cardiac death

Question 16

Oxygen supply is a matter of

Answer 16

How much flow for the whole body and the AV oxygen difference across the whole body

Question 17

Unstable ischemic pain, more severe, lasts 1/2 to several hours, associated with sweating, fever, nausea, vomiting or weakness

Answer 17

Myocardial Infarction

Question 18

Ischemic heart disease usually affects these structures

Answer 18

Coronary arteries

Question 19

Pathophysiology of MI

Answer 19

No Calcium in cells, actin-myosin units get ‘stuck’ –> systolic + diastolic problems

Question 20

Stable Angina can be more easily provoked by these types of exertion

Answer 20

Emotional
In cold environment
After heavy meal
Activity early in day
With isometric activity

Question 21

Levine’s signs

Answer 21

Substernal, clenched fist

Question 22

Describing stable angina

Answer 22

tightness, aching, sneezing, pressure/weight, burning, substernal, radiate to L>R shoulders/arms/neck/jaw/intrascapular, Levine’s

*occassionally angina is described as shortness of breath without chest discomfort

Question 23

Majority of MIs result in this gallop

Answer 23

S4 (atrial)

*rest have S3 (systolic dysfunction)

Question 24

Basic pathophysiology of acute coronary syndromes

Answer 24

unstable, ruptured atherosclerotic plaque

disease under endothelial cells –> dysfunction

Question 25

Angiogram tells us about

Answer 25

structural/anatomic changes

*Angina is a pathophysiologic/functional diagnosis

Question 26

What may occur 24 hours after infarction?

Answer 26

Pericardial rub

know it is this by radiation along trapezius

Question 27

How many acute MI patients die before hospitalization? survive the first year?

Answer 27

25%

50%