ischemic heart disease

Question 1

a. Risk factors modifiable for ischemic heart disease

Answer 1

i. Age: Men>45, Women>55 (non-modifiable)
ii. Family history: CAD or stroke (non-modifiable)
iii. Lipid abnormalities: (modifiable)
1. LDL>160 mg/dL
2. HDL<35 mg/dL
iv. Smoking tobacco (modifiable)
v. HTN (modifiable)
vi. DM (controllable)

Question 2

MCC of ischemic heart disease

Answer 2

atherosclerotic disease
 also arterial thrombi
 spasm
 and rarely coronary emboli
 myocardial oxygen demands are abnormally increased, as in severe ventricular hypertrophy due to hypertension or aortic stenosis

Question 3

i. Scarring specific to arteries

Answer 3

a. Arteriosclerosis

Question 4

i. Scarring of all vessels

Answer 4

b. Atherosclerosis

Question 5

LAD

Answer 5

i. LAD: left anterior descending = anterior interventricular artery

Question 6

Feeds the anterior portion of the left ventricle

Answer 6

LAD

Question 7

Feeds the posterior and inferior part of left ventricle

Answer 7

RCA

Question 8

Feeds the posterior third of the interventricular septum

Answer 8

b. RCA:

Question 9

iii. Feeds the right bundle branch

Answer 9

LAD

Question 10

iv. Feeds both SA and AV node

Answer 10

RCA

Question 11

iv. Feeds the anterior division of left bundle

Answer 11

LAD

Question 12

v. Feeds His bundle

Answer 12

rca

Question 13

vi. Feeds the posterior division of left bundle

Answer 13

rca

Question 14

coronary arteries fill during what portion of the cardiac cycle

Answer 14

a. Coronary vessels fill in diastole diastole b/c when the ventricle contracts the blood goes through the aortic valve to get to the aorta. Position of aortic valve during systole is open. The origin of the coronary artery is at the base of the aorta****

Question 15

when does tachycardia decrease filling itme of the coronary arteries?

Answer 15

b. HR>180 decreases filling time of coronary arteries –> leading to ischemia

Question 16

“causes of atherosclerosis”

Answer 16

1. Cholesterol/TG (?) (cannot truly call it causative, can call it contributory)
2. HTN
3. Smoking
4. Glycolated substances (byproduct of having high blood sugar is that they attach to everything and cause cardiovascular disease)í by product is ketones.

Question 17

why do we see arteriosclerosis in pts with DM

Answer 17

(byproduct of having high blood sugar is that they attach to everything and cause cardiovascular disease)í by product is ketones.

Question 18

lipid deposition in the wbc leads to

Answer 18

smooth muscle proliferation and fatty streaks that are asymptomatic and can be seen in early adolescence

Question 19

what are foam cells

Answer 19

macrophages that ingest fat

this happens in early formation of plauqe

Question 20

what is a fribromuscular plaque

Answer 20

muscle fibers and colesterol core this is seen in mature plaque formation

this occurs when proliferating smooth muscle cells and connective tissue become incorporated into plaQUE

“fibrous cap”

Question 21

Describe the formation of early plaque

Answer 21

LDL enters the endothelium in the fatty streak and is oxidized which attracts macrophages and smooth muscle cells to ingest harmful LDL –> become foam cells

the foam cells attract more macrophages fibroblasts and inflammatory cells

Question 22

why do you see most ischemic dz during exercise

Answer 22

because this leads to narrowing of the vessels and further occlusion of already occluded vessels

or increased demands where more blood is needed and the metabolic demands are not met

Question 23

all pts with CAS

Answer 23

d. All patients with coronary artery disease of any kind should receive drug therapy if their LDL >130 mg/dL with the goal of reducing it to <100mg/dL

Question 24

iv. ST segment depression indicates what

Answer 24

(subendocardial ischemia) w/ ischemia
1. ST segment elevation w/ infarction

nonSTEMI or stable angena

Question 25

i. Coronary artery spasm, typically with arterial stenosis

Answer 25

XVI. Prinzmetal variant angina (happens at rest)

Question 26

prinzmetal variant angina is typically seen in what population? at what time>

Answer 26

ii. Frequently occurs in women, and at night (12-8am)

Question 27

XVI. Prinzmetal variant angina is relieved with what tx

Answer 27

by nitroglycerin

Question 28

b. Lifestyle modification to lower risk factors for angina

Answer 28

i. Stop smoking
ii. Diet control
iii. Exercise as tolerated

Question 29

angina tx

Answer 29

: antiplatelets (ASA), B-blockers, CCB (vasodilator so help improve blood flow), nitrates (for symptomatic tx - nitroglycerin - short acting, potent vasodilator-SE -HYPOTENSION and HA), lipid control

Question 30

cause if unstable angina

Answer 30

i. Caused by nonocclusive thrombus in an area of coronary atherosclerosis
1. It is partially occlusive

Question 31

most common type of MI

what is the pathophysiology behind this

Answer 31

i. Transmural infarction (

Q wave infarction
1. Ischemic necrosis of >50% of myocardial wall

Question 32

what types of MI’s do we see

Answer 32

transmural and subednothelial

ii. Subendothelial infarction: non-Q wave infarction
1. Ischemic necrosis of <50% of myocardial wall

Question 33

how frequently do we see thrombosis in

LAD
RCA
LCA

Answer 33

a. LAD: 45%
b. RCA: 35%
c. LCA (left circumflex artery): 15%

Question 34

• present with GI sx when having a heart attack and less classic sx

Answer 34

MI in women

Question 35

if ventricular wall ruptures you get

Answer 35

a. If Ventricular wall ruptures then you have cardiac tamponade

Question 36

sudden cardiac death is defined as

Answer 36

death within 1 hour of the onset of symptoms

i. Fatal cardiac arrhythmia (usually, VF)

Question 37

MCC of sudden cardiac death

Answer 37

i. Coronary artery disease (80%)
ii. Hypertrophic cardiomyopathy
iii. Mitral valve prolapse
iv. Aortic stenosis
v. Congenital heart abnormalities
vi. Myocarditis