Ischemic Heart Disease Flashcards by Chance Lee Cauble

ISCHEMIC HEART DISEASE: PART 1

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What is ischemia?

A condition in which blood flow (and thus O2) is restricted or reduced in a part of the body.

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What is hypoxemia?

Low O2 content in the blood = Low O2 Sats!!

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What is hypoxia?

A condition in which the body or a region of the body is deprived of adequate O2 supply at the tissue level

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Does ischemia result in hypoxemia or hypoxia?

Hypoxia

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_____ ________ _________ is an umbrella term for a range of symptoms associated with sudden, reduced blood flow to the heart i.e. cardiac ischemia.

Acute Coronary Syndrome (ACS)

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ACS is a ________ that includes things such as what?

Diagnosis including:

heart attack (MI)
unstable angina
ST segment elevation MI (STEMI)
Non-ST segment elevation myocardial infarction or heart attack (NSTEMI)

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What will the patient history of someone with ACS be?

chest pain or left arm pain

- Hx of CAD

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What will be found when examining a patient with ACS?

hypotension, diaphoresis
pulmonary edema, rales
ECG changes
elevated cardiac biomarkers

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Do Ischemic Heart Disease (IHD), Coronary Heart Disease (CHD), Coronary Artery Disease (CAD), and Atherosclerotic Heart Disease (ASHD) mean the same thing?

Yes

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IHD includes what 3 things?

heart attacks
angina (stable and unstable)
heart failure and arrhythmias

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What is angina?

Chest pain symptom caused by reduced blood flow to the heart.

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____ is the most common specific diagnosis under the umbrella term of ACS and is the ______ common cause of death in the US and western Europe.

- most

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What are the causes of IHD?

Atherosclerosis
Coronary thrombus or emboli
Coronary spasm
Complications of CT disorders

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What is atherosclerosis?

Progressive inflammatory disorder of the arterial wall characterized by localized lipid deposits.

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What are some risk factors for IHD?

Age
HTN
Diabetes
Gender
Smoking Hx
Physical Inactivity
Obesity
Hyperecholestermia/Hyperlidemia
High levels of stress
Family history
Poor diet

What are some common symptoms of IHD?

chest pain or discomfort (tightness or fullness)
pain or discomfort in one or both arms, the jaw, neck, back, or stomach
SOB
dizzy or lightheaded
nausea
sweating

How is IHD diagnosed?

Blood testing for:

cardiac enzymes (troponin and creatine kinase)
C-reactive protein
Homocysteine
Abnormal lipid profile
Brain natriuretic peptide (BNP)
prothrombin

OR ECG alterations

What is ischemic cardiomyopathy?

In Ischemic CM, the heart’s ability to pump blood is decreased because the heart’s main pumping chamber, the left ventricle, is enlarged, dilated and weak. This is caused by ischemia, which is a lack of blood supply to the heart muscle caused by coronary artery disease and heart attacks.

One can live with ischemic CM for a long time, but the constant cardiac ischemia results in what?

Irreversible myocyte damage that in turn results in cardiac remodeling

Worsening _____ is a precursor of ischemic cardiomyopathy.

CAD

___________ is often the most common form of presentation for ICM. The prognosis for ICM is largely determined by what?

Heart Failure (HF)

- myocardial viability

What scan allows for physicians to determine myocardial viability?

Cardiac PET scan

ISCHEMIC HEART DISEASE: PART 2

Angina pectoris (stable or unstable) can lead to what?

- MI - Sudden cardiac death - Ischemic cardiomyopathy

Angina Pectoris (stable) is intermittent chest pain caused by transient but ___________ myocardial ischemia.

reversible

Stable Angina: - Caused by a mismatch between O2 _________ and ______. - Brought on by _______ or other form of stress. - Occurs at a _________ heart rate. - Crushing or squeezing substernal sensation with possible ________. - Reduction in stress reduces symptoms. - __________ used to treat.

- delivery and need - exertion - predictable - radiation - nitroglycerin

What are the functional classifications of angina?

Class I = occurs after prolonged exertion Class II = walking >2 blocks or >1 flight of stairs Class III = walking <2 blocks or <1 flight of stairs Class IV = occurs at minimal exertion or rest

Unstable Angina: - Brought on by _______ or other form of stress. - Onset is _________. - Crushing or squeezing substernal sensation with possible _________ to the arm. - Harbinger of bad things to come-____ prognosis.

- exertion - unpredictable - radiation - poor

- Is nitroglycerin of benefit for unstable angina? | - Why is unstable angina thought to occur?

- May be of benefit | - Acute plaque changes and/or coronary artery vasospasm

What are 2 ways MI's occur?

- Plaque rupture which exposes thrombogenic lipids to the blood, stimulating localized thrombus formation with ischemic outcomes. - Occlusive event- damage is dependent on coronary artery involved and time until treated.

If an ischemic insult is sufficiently long, _____ damage and death results.

tissue (TIME IS TISSUE)

Morphologic Stages of Myocardial Infarction: - __-__ hrs. =No Change (Gross or Microscopic) - __-__ hrs =Early features of Coagulative Necrosis - __-__ days =Coagulative Necrosis with Acute Inflammatory Response - __-__ days =Macrophage Activity (phagocytic removal of dead myocytes) - __-__ days =Developing peripheral rim of Granulation Tissue - __-__ weeks =Progressive Organization of infarct -__-__ months =Progressive Collagen Deposition, Mature replacement scar

- 0-6 hours - 6-24 hours - 1-4 days - 5-7 days - 7-10 days - 1-6 weeks - 1-3 months

In MI, the area of injury becomes a scar resulting in what?

- wall movement issues | - electrical propogation

What is a reperfusion injury?

- Damage caused when the blood supply returns to tissue after a period of ischemia or lack of O2. - Associated with microvascular injury, particularly due to increased permeability of capillaries and arterioles.

What is sudden cardiac death?

Natural unexpected death secondary to cardiac causes with rapid loss of consciousness.

__% of all deaths from CAD are SCD.

50%