Ischemic Heart Disease Flashcards
A patient presents to you with chest pain only upon undue exertion. It is relived by rest. What would a treadmill test tell you?
does the chest pain come back and are there ECG changes (ST reversible changes)
What would a cardiac catheterization tell you?
a means of identifying the coronary arteries to ID coronary stenosis radiographically
How can we control the demand of the heart?
reduce exercise
What are some treatment options with multi-vessel coronary disease?
bypass (single would suggest a stent or medicine)
A patient present to the ED with severe chest pain. ECG reveals ST elevation in leads II, III, and avF. What do you do now?
cath lab and stent immediately because this patient has 100% occlusion of the lower part of the heart
What is acute coronary syndrome?
patient wakes up with massive pressure on their chest with or without ECG change
may last much longer than 30 minutes
What are the major determinants of myocardial oxygen demands?
HR and systolic BP
Keys to chronic stable angina.
- always lasts 5-30 minutes
- often associated with some type of sympathetic activity (sweating, etc.)
- cutaneous vasoconstriction (turned white as a ghost)
What causes the symptoms of acute coronary syndrome?
plaque rupture and thrombus formation, typically with dysfunctional endothelium
What is the composition of a vulnerable plaque?
mostly lipid core with a thin fibrous cap and high macrophage count vs
a smooth muscle core with a large cap and low macrophages being a stable plaque
What is the standard of care for acute coronary syndrome?
aspirin and heparin and other anti-platelet agents
What causes sudden death?
ventricular fibrillation
How to confirm CHF:
- S3 present
- apical impulse moved to the left
- jugular venous distention
What ECG findings would suggest anterior infarction?
leads I, aVL, V1-V6 (Q wave change, elevated ST)
What ECG findings would suggest posterior infarction?
V1-V3 (Tall R waves, ST depression)
What ECG findings would suggest inferior infarction?
Leads II, III, aVF (Q wave changes)
What ECG findings would suggest lateral infarction?
I, aVL, V4-V3 (Q wave changes)
What ECG findings would suggest septal infarction?
V1-V3 (Q wave changes)
What ECG findings would suggest right ventricular infarction?
V1R, V4R (ST elevation)
What is cariogenic shock?
Obstruction of a coronary artery leads to myocardial ischemia, leading to decreased ventricular contraction causing decreased AP which then causes decreased coronary perfusion and the cycle continues
characterized by someone with STEMI and hypotension (systolic 90 or less)
What is an intra-aortic balloon pump (IABP)?
treatment for cardiogenic shock that is threaded to the top of the defending aorta and inflates in diastole to reduce after load and increase perfusion to coronary arteries
diastolic pressure will be higher than systolic pressure
