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Cardiology > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

Has only a single blood supply

A

Posterior papillary muscle

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2
Q

Accounts for the majority of fluctuation in coronary O2 supply

A

Coronary Blood Flow

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3
Q

The diastolic pressure as the coronaries fill during diastole

A

Perfusion Pressure

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4
Q

The coronary arteries fill during

A

Diastole

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5
Q

Epicardial coronary vessels can be compressed in a condition where the coronary dives into the muscle. This is called

A

Myocardial bridging

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6
Q

The subendocardium is subject to LV wall pressure, which makes the subendocardiu more susceptible to

A

Ischemia

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7
Q

What are the 3 factors affecting intrinsic coronary tone?

A

Local metabolites, Endothelial Factors, and Neural innervation

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8
Q

Primarily adenosine, as well as lactate, hydrogen ions, and CO2

A

Local metabolites

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9
Q

What are the two endothelial factors

A

Vasodilator and vasoconstrictors

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10
Q

Hypoxemia inhibits aerobic metabolism and oxidative phosphorylation in mitochondria. This results in increased coronary flow via the vasodilator

A

Adenosine

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11
Q

Produced in response to Ach, histamine, and. Serotonin. Then converts GTP to cGMP and causes smooth muscle relaxation

A

Nitric Oxide

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12
Q

Released in response to hypoxia, shear stress, Ach and platelet factors

-functions through cAMP related mechanism

A

Prostacyclin

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13
Q

Released in response to Ach and pulsation blood flow

A

Endothelial derived hyperpolarizing factor (EDHF)

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14
Q

Vasoconstrictor released by thrombin, epinephrine, and angiotensin II

A

Endothelial-1

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15
Q

In atherosclerotic vessels, release of vasodilator may decrease, causing endothelial dysfunction by a shift in favor of

A

Vasoconstrictors

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16
Q

What are the three things that dictate myocardial oxygen demand?

A

Wall stress, HR, and contractility

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17
Q

Increased LVEDP, hypertension, and aortic stenosis, all increase

A

Wall stress

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18
Q

How do we find wall stress?

A

Wall stress = pressure/2 x radius/wall thickness

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19
Q

What has a bigger effect on increasing wall stress, increasing pressure? Or radius?

A

Increasing pressure

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20
Q

Decrease oxygen demand

A

Beta-blockers

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21
Q

With regards to neurostimulation of intrinsic coronary tone, which effects are greater, sympathetic or parasympathetic?

A

Sympathetic effects

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22
Q

NOT a component of myocardial oxygen demand

A

O2 content

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23
Q

Resistance is:

  1. ) Directly proportional to?
  2. ) Inversely proportional to?
A
  1. ) Length

2. ) r^4

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24
Q

So as the vessel narrows, the resistance is drastically increase by change in

A

Radius

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25
Q

Epicardial arteries are more susceptible to

A

Plaque

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26
Q

The smaller arterioles are free from plaque and have the ability to adjust their vasomotor tone to allow greater
blood flow as needed. This is called?

A

Compensatory Vasodilation

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27
Q

At greater than 70% stenosis, we may not have enough coronary flow for

28
Q

Resting coronary flow begins to fall at

A

90% stenosis

29
Q

What are the two types of endothelial dysfunction that can contribute to ischemia?

A
  1. ) Inappropriate vasoconstriction

2. ) Loss of antithrombotic properties

30
Q

In normal individuals, in response to physical activity, we see release of

A

Vasodilator

31
Q

However, in a diseased vessel, we see decreased release of

A

Vasodilators

32
Q

Not aproblems with regard to atherosclerotic plaque but rather a supply/demand mismatch

A

Non-CAD related ischemia

33
Q

Results in both decreased LV contractile function as well as relaxation, both of which are energy dependent processes

A

LV dysfunction

34
Q

Lactate, serotonin, and adenosine accumulate locally and activate pain receptors C7-T4 with

35
Q

Transient abnormalities of myocyte ion transport that can result in V-tach or V-fib

A

Arrhythmias

36
Q

Complete death of myocytes w/ no chance for recovery

A

Infarction

37
Q

Transient ischemia, which has recovery of blood flow, but still shows systolic dysfunction that slowly recovers

A

Stunned myocardium

38
Q

Chronically ischemic tissue from severe stenosis that shows viability

A

Hibernating Myocardium

39
Q

Exertion also chest pain which predictably comes on with exercise and goes away with rest

A

Stable Angina

40
Q

Clinically defined as new, or worsening, angina

-Part of spectrum of acute coronary syndrome

A

Unstable angina

41
Q

Severe variant angina that can cause ST Elevation MI (STEMI)

-Can be very difficult to diagnose

A

Variant (Prinzmetal’s) Angina

42
Q

Be careful not to use non-selective beta-blockers to treat

A

Variant (Prinzmetal’s) Angina

43
Q

Presence of myocardial infarction w/out clinical symptoms

-Higher frequency in diabetics and women

A

Silent ischemia

44
Q

Patients w/ typical angina symptoms and no significant stenosis of epicardial coronary arteries

A

Cardiac Syndrome X

45
Q

Thought to be due to endothelial dysfunction and inadequate vasodilator reserve of small arteries

A

Cardiac Syndrome X

46
Q

Retrosternal chest pain or pressure that is WORSE with exertion and improved w/ rest or nitro

A

Angina (CAD)

47
Q

Sudden onset tearing or ripping pain with radiation to the back

-Occurs at rest w/out relief

A

Aortic Dissection

48
Q

Pleuritic sharp pain that may be associated w/ fever or viral syndrome

A

Pericarditis

49
Q

ST depression and T-wave inversion are signs of

A

Subendocardial Ischemia

50
Q

Shows ST elevation on EKG

A

Transmural ischemia

51
Q

A positive stress test for ischemia is

A

1 mm of horizontal or downsloping ST-depression

52
Q

An esophageal spasm can be relieved by

53
Q

A fall in systolic BP, ventricular arrhythmias, and greater than 2 mm ST depression is

A

Markedly positive for ischemia

54
Q

Does not have the same resolution as angiography, but is a non-invasive method that can identify severe stenosis

A

Coronary CT angiography

55
Q

The gold standard to diagnose CAD

-Artery is accessed via femoral or radial artery

A

Coronary Angiography

56
Q

Fast acting vasodilator to decrease venous return to the heart

-Coronary vasodilator used to treat acute angina

A

Nitroglycerin

57
Q

Reduce myocardial demand by decreasing HR and contractility

-Shown to decrease mortality after MI

A

Beta-blockers

58
Q

Deep T-wave inversions in anterior leads

A

Wellen’s sign

59
Q

Long acting version of nitroglycerin

-Are vasodilators

A

Nitrates (isosorbide mononitrate and isosorbide dinitrate)

60
Q

Calcium channel blocker that is a potent vasodilator used to treat angina

A

Dihydropyridine (amlodipine and nifedipine)

61
Q

Nonhydropyridin’s are Ca2+ channel blockers with a more negative inotropic and chronotropic effect. Two examples are?

A

Diltiazem and verapamil

62
Q

Recommended in ALL CAD patients

63
Q

What are two types of revascularization used for treatment of CAD?

A

Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting

64
Q

Pass wire and then ballon to open up blockages and then place a stent

65
Q

Potent antiplatelet agents used in combination with aspirin in patients after an MI or who have coronary stents

A

Platelet P2Y12 ADP receptor antagonists

Cardiology (27 decks)

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