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Block 3 physiology > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

Results from an imbalance between the heart’s blood supply and its requirement for oxygen, i.e., inadequate perfusion

A

ischemic heart disease/coronary artery disease

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2
Q

compromises the ability to provide nutrients, remove waste products

A

ischemic heart disease/coronary artery disease

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3
Q

__% of ischemic heart disease cases is due to _______ coronary blood flow due to coronary artery _________ (with or without ________)

A

90% of ischemic heart disease cases is due to reduced coronary blood flow due to coronary artery atherosclerosis (with or without thrombosis)

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4
Q

what are some other causes of IHD

A
  • reduced blood supply
  • severe anemia
  • pulmonary disease
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5
Q

2 major epicardial coronary arteries

A
  • right coronary artery

- left common coronary artery

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6
Q

Supplies the right wall, posterior wall, posterior septum (80% people)

A

right coronary artery

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7
Q

Supplies the apex, left anterior wall, anterior septum

A

left anterior descending artery (LAD)

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8
Q

Supplies the lateral left (80% people)

A

left circumflex artery

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9
Q

What does the left common coronary artery branch into?

A
  • left anterior descending artery

- left circumflex artery

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10
Q

Smaller branches off of the coronary arteries perfuse the myocardium

A

intramural arteries

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11
Q

When the left ventricle contracts, the aortic valve _____. The valve cusps ______ filling of the coronary arteries.

A

When the left ventricle contracts, the aortic valve opens. The valve cusps prevent filling of the coronary arteries.

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12
Q

When the left ventricle relaxes, aortic pressure ____ the aortic valve, allowing the coronary arteries to ____.

A

When the left ventricle relaxes, aortic pressure closes the aortic valve, allowing the coronary arteries to fill.

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13
Q

Conditions that aggravate IHD include:

A
  • conditions that increase cardiac energy demand

- conditions that reduce availability of blood or oxygen to the myocytes

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14
Q

examples of conditions that increase cardiac energy demand

A
  • hypertrophy

- increased rate i.e. via epinephrine, activity, cold

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15
Q

examples of conditions that reduce availability of blood or oxygen to the myocytes

A
  • reduced blood pressure i.e. anemia, shock

- low oxygen tension

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16
Q

IHD is generally related to ________ chronic ________ of _______ arteries

A

IHD is generally related to atherosclerotic chronic inflammation of coronary arteries

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17
Q

What are results of atherosclerotic chronic inflammation of coronary arteries?

A
  • stenosis - narrowing of coronary arteries

- increases risk of thrombus formation and total vessel occlusion and/or embolus formation

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18
Q

What is increased risk of thrombus formation and total vessel occlusion and/or embolus formation associated with?

A
  • rupture of fibrous cap of unstable plaques
  • erosion through fibrous cap
  • hemorrhage into plaque
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19
Q

manifestations of IHD

A

acute coronary syndrome (ACS)

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20
Q

examples of acute coronary syndromes

A
  • Chronic ischemic heart disease
  • Angina pectoris
  • Acute coronary syndrome
  • Acute myocardial infarction (AMI) – myocardial death resulting from a period of ischemia
  • Sudden cardiac death
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21
Q

chronic restriction of blood flow to cardiac tissue resulting in ischemia

A

(chronic) ischemic heart disease/coronary artery disease

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22
Q

What is the most common cause of chronic ischemic heart disease?

A

result of atherosclerotic plaque formation in coronary arteries

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23
Q

most common symptom of acute ischemia

A

angina

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24
Q

What are some things IHD can result in?

A
  • myocardial cell death
  • dilated cardiomyopathy
  • myocardial infarction
  • arrhythmias
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25
Q

Weakening of cardiac muscle, resulting in stretch and reduced cardiac output

A

dilated cardiomyopathy

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26
Q

A collection of symptoms resulting from coronary blood flow that does not meet current oxygen demand of the heart tissue (i.e., chronic ischemic heart disease)

A

angina pectoris

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27
Q

symptoms of angina pectoris

A
  • paroxysmal (sudden onset)

- recurrent substernal or precordial/retrosternal discomfort

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28
Q

3 types of angina pectoris

A
  1. stable angina
  2. unstable angina
  3. prinzmetal angina
29
Q

Associated with reduction of coronary perfusion to a critical level by chronic stenosing coronary atherosclerosis

A

stable angina

30
Q

when oxygen demand exceeds available what is delivered by the blood supply, therefore myocardium becomes temporarily ischemic

A

stable angina

31
Q

Is angina pectoris associated with myocyte death?

A

not necessarily

32
Q

Is stable angina associated with plaque disruption?

A

NO

33
Q

What are typical symptoms for patients with stable angina?

A

REVERSIBLE with rest, oxygen, vasodilators

34
Q

A pattern of angina pain which changes progressively over a short period of time

A

unstable angina

35
Q

increased frequency, duration, pain level, precipitated by less effort or occurs at rest

A

unstable angina

36
Q

Is unstable angina associated with plaque disruption?

A

YES

37
Q

What are some subsequent conditions follow plaque disruption?

A
  • thrombosis
  • embolization
  • coronary vessel spasm
38
Q

What is often a program to MI?

A

unstable angina

39
Q

Caused by reduction of coronary perfusion due to coronary artery spasm

A

prinzmetal angina

40
Q

type of angina NOT associated with increased activity, heart rate, blood pressure

A

prinzmetal angina

41
Q

Can EKG changes associated with ischemia be seen with prinzmetal angina?

A

yes

42
Q

type of angina where Symptoms occur more commonly at rest and in younger patients

A

prinzmetal angina

43
Q

refers to the signs and symptoms associated with acute ischemia of the myocardium

A

acute coronary syndrome (ACS)

44
Q

What is the initial stage of acute myocardial infarction associated with?

A

acute thrombus formation

45
Q

What may result in minimal permanent cardiac damage? (e.g., angioplasty, thrombolytics)

A

rapid tissue reperfusion

46
Q

What may be associated with ACS?

A
  • EKG changes including ST elevation or depression
  • unstable angina
  • characteristic symptoms including chest pain/pressure, radiation to the left arm or jaw, diaphoresis, nausea
47
Q

Results from irreversible ischemia-related injury to myocardial tissue

A

acute myocardial infarction

48
Q

2 types of AMI

A
  1. subendocardial

2. trasmural

49
Q

involves the innermost 1/3 to 1/2 of the thickness of the heart wall at the affected area

A

subendocardial infarct

50
Q

Blood supply to subendocardial region is most limited due to what?

A

normal narrowing of intramural arteries

51
Q

What may result from subencocardial infarct?

A
  • reduced blood pressure

- severe anemia

52
Q

involves the full thickness of the heart wall at the affected area

A

transmural infarct

53
Q

What is transmural infarct associated with?

A

thrombus blocking blood flow

54
Q

Acute myocardial infarction progresses from ______ infarct to ______ infarct

A

Acute myocardial infarction progresses from subendocardial infarct to transmural infarct

55
Q

consequences of AMI

A
  • contractile dysfunction
  • conduction disturbances
  • myocardial remodeling
  • pericarditis
  • infarct expansion
  • mural thrombus formation
56
Q

related to loss of contractile myocardium and replacement with fibrotic tissue, resulting in weak and/or poorly coordinated contraction

A

contractile dysfunction

57
Q

due to infarction of conductive tissues resulting in arrhythmia or “myocardial instability”

A

conduction disturbances

58
Q

increased likelihood to change to uncoordinated rhythms such as fibrillation, bundle branch blocks

A

conduction disturbances

59
Q

remodeling with ventricular walls and septum thinning (aneurysm), and detachment of papillary muscles

A

myocardial remodeling

60
Q

associated with new post-AMI systolic murmur

A

detachment of papillary muscles

61
Q

causing inflammatory fluid accumulation in the pericardial space

A

pericarditis

62
Q

types of pericarditis

A
  • serous
  • fibrinous
  • fibrohemorrhagic
63
Q

stethoscope finding for pericarditis

A

friction rub

64
Q

expansion around an area of recent infarct due to further compromise of blood flow

A

infarct expansion

65
Q

Where does a mural thrombus form?

A

on wall of affected chamber

66
Q

What is the risk for mural thrombus formation?

A

thromboembolism - usually going to CNS

67
Q

unexpected death from cardiac causes early after symptom onset, or without onset symptoms

A

sudden cardiac death

68
Q

What is SCD usually related to?

A

lethal arrhythmia

69
Q

possible causes of SCD

A
  • Congenital structural or conduction abnormality
  • Aortic valve stenosis or mitral valve prolapse
  • Myocarditis
  • Dilated or hypertrophic cardiomyopathy
  • Pulmonary hypertension

Block 3 physiology (6 decks)

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