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ECHO 325 > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

What are the two main causes of ischemic heart disease?

A

Atherosclerotic and non-atherosclerotic

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2
Q

What are atherosclerotic causes of coronary heart disease?

A

Angina pectoris and acute coronary syndrome

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3
Q

What are the two branches of acute coronary syndrome?

A

STEMI (st-elevation MI) and NSTEMI (non-st elevated MI)

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4
Q

Explain ischemia:

A

Decreased blood supply to the myocardium or increased demand for blood

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5
Q

Explain infarction:

A

Death or necrosis of tissue with results from prolonged ischemia or total occlusion of blood flow to the tissue

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6
Q

What are the most common causes of ischemia?

A

Coronary arterial disease (plaque in the vessel which impedes blood flow), and increased metabolic demand:

  1. Hypertrophic cardiomyopathy
  2. Aortic stenosis
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7
Q

Describe stable angina:

A

Predictable, regular chest pain that is manageable

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8
Q

Describe unstable angina:

A

Non-predictable, intense, medication helps minimally

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9
Q

What are two other types of angina?

A

Variant angina and microvascular angina

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10
Q

What is variant angina also known as?

A

Prinzmetals Angina (caused by coronary artery spasm, occurs in between 1-6 am, unrelated to exercise)

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11
Q

What is microvascular angina due to?

A

Microvascular dysfunction

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12
Q

What is CABG?

A

Coronary Artery Bypass Graft

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13
Q

What happens in CABG?

A

GSV or internal mammary artery harvested, one end proximal and other distal to blockage

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14
Q

When is CABG performed?

A

When angioplasty (balloon and stent) cannot be done:

  1. When blockage is unreachable percutaneously
  2. Too many blockages to stent (>3-4)
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15
Q

What is the treatment for ischemia/angina/chest pain?

A

Nitroglycerine (nitrates) are given (pills/spray/aspirin) to lower cause vasodilation (reduces arterial resistance and causes veinous congestion reducing preload).

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16
Q

What is used to prevent thrombi?

A
  1. Antiplatelet drugs: ASA/Aspirin, plavix

2. Anticoagulants: Warfarin/coumadin, pradax

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17
Q

What are the downsides to CABG? (3)

A
  • Higher mortality rates than angioplasty
  • Longer recovery time
  • Cant be done on weak patients
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18
Q

What do beta blockers do?

A

Lower HR, BP, and afterload (lowers O2 demand)

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19
Q

What do calcium channel blockers do?

A

Lower muscle contraction lowering after load

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20
Q

What is the gold standard for IHD diagnosis?

A

Coronary angiogram

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21
Q

What is the treatment for MI?

A

MONA (done within 5 mins):

Morphine
Oxygen
Nitrates (NOT if low BP or viagra)
ASA/Aspirin
1. Heparin
2. Thrombolysis
3. Reperfusion (CABG/PCI)
22
Q

What is TPA?

A

Tissue plasminogen activator - most effective MI clot busting medications

23
Q

What are the types of TPA?

A
  1. Streptokinase

2. Urokinase (from human and pig urine)

24
Q

What do TPA (streptokinase and urokinase) do?

A

Cut the chains of plasminogen which prevents them from forming strands or fibrinogen that cause blood clots.

25
Q

What is STEMI? (4)

A
  • Transmural (occurring through whole thickness of the myocardium endo to epi)
  • Anterior MI (anterior leads)
  • ST segment is elevated
  • Big Q wave
26
Q

How will the ST segment appear with STEMI MI?

27
Q

What is NSTEMI? (4)

A
  • Small zone of ischemia/cell death
  • Subendocardial MI only
  • ST segment is depressed
  • no Q wave
28
Q

NSTEMI is what kind of MI only?

A

Subendocardial MI only

29
Q

How will the ST segment appear with NSTEMI MI?

30
Q

What does a big Q wave indicate?

A

A big heart attack (untreated ST elevation) lead to necrosis

31
Q

ECG change to peaked T waves indicates what?

32
Q

Symmetric flat or reversed T waves indicates what?

A

Chronic ischemia

33
Q

The left main coronary artery branches to what?

A

LAD, Cx, and RCA

34
Q

LAD supplies what walls?

A

Anterior and septal walls

35
Q

Cx gives rise to what in a left dominant system?

36
Q

RCA usually supplies what?

A

SA and AV nodes

37
Q

RCA gives rise to what in a right dominant system?

38
Q

Abnormal septal motion may be seen with what?

A

LBBB, WPW (Wolf-Parkinson white syndrome), or paced rhythms

39
Q

Define sygmoid septum:

A

Basal septal focal hypertrophy

40
Q

Describe the hemodynamic properties of a sygmoid septum:

A

Subaortic stenosis, LVOT acceleration

41
Q

Describe the wall motion of a sygmoid septum:

A

Hypokinetic

42
Q

IHD/CAD could result in what kind of dysfunction?

A

Papillary muscle dysfunction

43
Q

Thrombus formation in the LV is more common with MI’s located where?

44
Q

What are the applications for LV contract enhancement?

A
  1. Detect intracardiac shunts
  2. Enhance Doppler signals
  3. LV opacification
  4. Myocardial perfusion
45
Q

Describe a VSD or wall rupture post MI

A
  • MI damages the wall
  • Wall thins and becomes necrotic
  • Wall weakens
  • Wall ruptures
  • Shunt occurs
46
Q

What is Dressler’s syndrome?

A

Acute pericarditis post infarct

47
Q

What are the 3 main features of Dressler’s syndrome?

A
  1. Fever
  2. Pleuritic pain
  3. Pericardial effusion
  4. Tamponade: rare
48
Q

How quickly does the survival rate of MI drop with no pulse?

A

10% every min

Need CPR and defibrillation (AED)

49
Q

What does the elevation/depression of the ST segment indicate?

A

Elevation above TP segment = infarct

Depression lower than TP segment = ischemia

50
Q

List 2 enzymes released during myocardium injury?

A
  1. CKMB

2. Troponin C

51
Q

What direction would the MR jet aim if there was a large inferior MI. And why?

A

Anterior

Due to posteromedial papillary muscle dysfunction

ECHO 325 (19 decks)

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