Ischemic Heart Disease Flashcards
List the 5 main CV disease
- CAD
- Ischemia heart disease
- HTN
- Peripheral Vascular Disease
- Stroke
Condition: obstruction but doesn’t affect heart function
CAD
Describe the difference between CAD vs. IHD
CAD: blockage and the end of a vessel, low % blockage, pt. unaware
IHD: blockage midway down vessel, high % blockage, effects function
List the factors effecting the severity of CAD
- Degree of obstruction
- Number of vessels obstructed
- Location of blockage
List the 3 main coronary arteries
- R coronary
- LAD (branch of L coronary)
- L circumflex
List the determinants of myocardial blood flow
- DBP (driving force of blood to the heart, too high = limits BF)
- Resistance (too high = impairs BF, no signaling to release NO)
- Vasomotor tone (flexibility, shear releases NO, plaques block signal)
- LV end diastolic pressure (less pressure = less available for coronary circulation)
Condition: active process involving molecular signals that produce altered cellular behavior as well as endothelial dysfunction and a subsequent inflammatory response
Atherosclerosis
Describe the progression of atherosclerosis
- Fatty streaks develop due to the deposition of lipids
- Fibrous plaque forms due to increased collagen levels, destruction of elastin, and change in fibrous protein composition [can be stable or unstable]
Describe the atherogenesis chain of effect
- endothelais injury leads to increased infiltration of LDL
- sub endothelial retention and modification of LDL leads entry of monocytes
- monocytes > macrophages which internalize LDL creating foam cells
- the hemodynamic stress activates an inflammatory response activating PDGF
- foam cells die > necrotic core
- Rupture of fibrous cap can lead to arterial thrombosis
Describe the effect of exercise on atherosclerosis
Exercise promotes HDL
HDL removes LDL from being in vessel/prevents deposit
Condition: chornic elevation in BP
HTN
Describe how HTN is dx
3 HTN readings in 3 months
Describe the types of HTN
- Essential/primary [occurs in absense of disease]
- Non-essential/secondary [occurs in presence of disease]
- Labile [comes/goes w/o rhyme or reason]
Describe cut offs for montioring BP during exercise
Need medical clearnace: SBP > 200; DBP > 105
Terminate exercise: SBP > 250; DBP > 115
SE from BP required termination of exercise: SBP drops 20 OR SBP and DBP both drop 10
List the aerobic exercise recommendations for HTN
4-7x/wk, 30-45 min, 60-85% HR max; RPE 11-16 (not “very hard”
List the types of ischemic heart disease
- chronic stable angina
- unstable angina
- myocardial infarction
- silent ischemia
- arrhythmia
- sudden death
List the signs and symptoms of ischemic heart disease for men
- radiating pain (jaw, L side)
- crushing pain (elephant sitting on my chest)
- sweating
- skin color (pale, cyanosis)
List the signs and symptoms of ischemic heart disease in women
- more flu like sx
- heart burn
- feel off
- fatigued
List the atypical signs and symptoms of ischemic heart disease
- indigestion
- LV dysfunction
- Arrhythmia
- Syncope
- Silent
Condition: ST segment depression
Ischemia
List the key features of stable angina
- Well established onset (myocardial O2 demand, rate pressure product)
- Stable characteristics remain unchanged for 60 days
- Characterized by chest pain (transient hypoxia)
- Relieved with change in activity or sublingual nitroglycerin
List the key features of unstable angina
- presence of signs/sx of inadequate blood supply to myocardium in the absence of demand
- due to altered catecholamine levels, increased platelet activation
List the clinical clues of unstable angina
- angina at rest
- typical angina occurs at lower exertion
- deterioration of previously stable pattern
- physiological changes (drop in HR or BP w/exercise)
List the key features of prinzmetal angina
- unusual syndrome of cardiac pain secondary to myocardial ischemia
- cardiac pain exclusively at rest (sx NOT brought on by exercise)
- ST segment elevation
- secondary to increased coronary vasomotor tone/vasospasm
[tx w/nitrates and Ca blockers – beta blockers avoided]
List the types of acute MI
- Transmural
- Non-transmural (endocardium to myocardium)
EKG abnormality: cardiac cell death
ST segment elevation
Define ST elevation MI (STEMI)
- ST elevation in: 2 continuous leads, > 2 mm in V1, V2, V3, > 1 mm in other leads
- indicates occlusion in a large vessel (large area at risk)
- cardiac emergency
Define NSTEMI
- Findings of MI w/o ST elevation on EKG
- not always, but may represent smaller area or high grade lesion w/o total occlusion
Localization of Infraction: Inferior
- EKG
- Artery
- II, III, aVF
- R Coronary
Localization of Infraction: Anteroseptal
- EKG
- Artery
- V1-V3
- LAD
Localization of Infraction: Anterior
- EKG
- Artery
- V2-V4
- LAD
Localization of Infraction: Lateral
- EKG
- Artery
- I, aVL, V5, V6
- LAD or circumflex
Localization of Infraction: Posterior
- EKG
- Artery
- V1-V2, tall broad initial R wave, ST depression, tall upright T wave
- Posterior descending
Describe the Tx of Acute MI
MONA
- Morphine (pain, calming)
- Oxygen
- Nitrates (or beta blockers - vasodilate)
- Aspirin (so they don’t throw a clot)
{draw blood for cardiac markers]
List the Risk Factors for Ischemia Heart Disease
- Fam Hx
- Age
- Diabetes
- Hypercholesterolemia
- HTN
- Smoking
- Obesity
- Inactivity/Sedentary Lifestyle
Define the Fick Equation
VO2 = [SV x HR] x A-VO2
Describe the application of the Fick equation in those with compromised cardiac function
In those with compromise, A-VO2 allows for resting VO2 to be maintained
If Q can’t increase, O2 extraction can achieve a small increase in Vo2, but not enough to sustain exercise for an increased duration
**The heart is the limiting factor to exercise; but A-VO2 can improve with training
Describe the disease specific effects of ischemic heart disease on physiologic responses and fitness
- Decreased peak VO2 (
- reduced cardiac output
- chronotropic incompetence (HR/BP doesn’t met demand)
- abnormal HR recovery
- failure of SBP to rise in proportion to exercise intensity
Define chronotropic incompetence
- Failure to reach 85% of APMHR in the absence of beta blockers
- Abnormal HR recovery [dec in HR
List the surgical and pharmacological tx for ischemic heart disease
- oxygen
- nitroglycerin
- aspirin (anti-platelet)
- heparin (anti-coagulant)
- pain relief
- revascularization (catheterization)
- stent
- pharm: beta blockers, ca blocker, ACE inhibitors, statins
Describe the phases of cardiac rehab very briefly
phase 1 = inpatient rehab
phase 2 = outpatient, 12 wk
phase 3 = transition to community
