Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Cardiology-Exam 2 > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

Heart disease that is due to coronary atherosclerosis

A

Ischemic Heart Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CVD is the most common cause of morbidity/mortality of (men/women) in the United States

A

Women

  • 10 times more women die from CVD than breast cancer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Women with a positive stress test are (more/less) likely to have further cardiac evaluation

A

less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Young women are more likely than men to have an AMI (with/without) chest pain and (specific/non-specific) symptoms

A

without; non-specific

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Black patients with ACS/MI are more likely to receive…

A

aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Black patients with ACS/MI are less likely to receive…

A 
follow-up tests (stress, echo, cath, stents)
advanced medication (clopidogrel, GIIb/IIIa inhibitors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Chest pain due to an inadequate supply of oxygen to the heart muscle

A

Angina pectoris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do ischemic cardiomyocytes cause pain?

A

They release metabolic byproducts (lactate, serotonin, adenosine) that activate local afferent pain fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Increased severity of angina either at exertion or rest; commonly due to rupture of plaque and subsequent thrombosis; can cause MI

A

UA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pattern of predictable, transient chest discomfort due to exertion; commonly caused by a fixed occluded lumen by plaque (but still some flow); not associated with infarction (myocyte death)

A

Stable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The pathophysiology of myocardial ischemia is due to the imbalance between

A

Supply and demand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why is the heart prone to ischemia (3 reasons)

A
  1. Intramural coronary arteries are compressed during systole (when demand is highest)
  2. Heart’s oxygen demand at rest is highest of any organ (high ATP requirement)
  3. Oxygen is nearly all extracted from blood at rest (no reserve)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

______ is the primary determinant of myocardial oxygen supply

A

Coronary blood flow

  • Vascular resistance is the primary determinant of coronary blood flow
  • Radius is the primary determinant of vascular resistance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Regulation of blood flow occurs mostly in the

A

smaller “resistance” vessels (arterioles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Coronary blood supply will increase with decreased _______ due to increased diastolic time

A

heart rate

  • increased diastolic time will increase coronary blood perfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Coronary Perfusion Pressure

A

the pressure needed to drive coronary blood perfusion

Aortic diastolic pressure - LVEDP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Major determinant of resistance in blood vessels

A

radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Blood flow through a vessel is inversely proportional to

A

length and viscosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Resistance is directly proportional to

A

length and viscosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Resistance is inversely proportional to

A

radius

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

_________ are capable of sufficient compensatory dilatation to prevent ischemia

A

Coronary arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Clinically, we consider _____% of lumen reduction to be “significant” stenosis

A

70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What metabolic factors decrease vascular resistance by increasing radius through vasodilation?

A

Acidosis
Hypoxia
Citrate/acetate
Adenosine

  • all above cause vasodilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Most potent endogenous vasodilator

A

NO (act in paracrine fashion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Nitric oxide increases smooth muscle ______, causing relaxation
cGMP *cGMP activates protein kinase G that increase uptake of calcium
26
Atherosclerosis causes ischemia/infarction mainly by what two mechanisms
``` Obstruction of the lumen (stenosis) Decreased vasodilation (endothelial dysfunction) ```
27
What are the determinants of oxygen demand?
1. Heart Rate 2. Contractility 3. Wall tension
28
Why does increase in wall tension increase oxygen demand?
Increase in wall tension means myocytes need to work harder (require more ATP) and therefore require more oxygen
29
Ventricular hypertrophy (increased wall thickness) can be seen as a compensatory mechanism to increased
wall tension/stress
30
Tests that are designed to provoke and detect a mismatch in supply/demand which causes subendocardial ischemia; involves a stressor (exercise or drugs like dobutamine/adenosine) and detection (ECG, nuclear imaging, or echocardiography)
Stress Tests
31
Calculation for predicted maximal HR (for stress tests)
220-age
32
When is the exercise treadmill stress test considered positive
``` Chest discomfort is reproduced ECG abnormalities (> 1mm ST depression) ```
33
Nuclear imaging (perfusion scan) is added in patients undergoing a stress test when
Abnormal baseline ECG | High suspicion of ischemia
34
Reversible defect (cold spots only after stress) on nuclear imaging is indicative of
inducible ischemia
35
Fixed defect (cold spot both at rest and after stress) on nuclear imaging is indicative of
prior MI and fibrosis
36
Gold standard for the diagnosis of coronary artery disease; imaging study for those with myocardial ischemia; visualize with injection of contrast via cath
Coronary angiography
37
Treatment for chronic stable angina focuses mainly on reducing (supply/demand)
Demand Beta blockers Nitrates Calcium Channel Blockers
38
Beta-blockers both 1. reduce demand by decreasing _____ 2. increase supply by increasing _____
HR and contractility Diastolic time
39
Cardioselective beta-blockers (target B1 receptors more than B2 receptors) are
Atenolol Metoprolol Anti-anginals (reduce demand problem)
40
Non-selective beta-blockers are
Propranolol | Nadolol
41
Contraindications of beta-blockers
Bronchospastic disease Decompensated HF Severe bradycardia AV block
42
Calcium channel blockers block what type of calcium channels
L type
43
Class of calcium channel blockers that act only on vascular smooth muscle
Dihydropyridines (end in -pine)
44
Class of calcium channel blockers that act on both vascular smooth muscle and the cardiac tissue
Nondihydropyridines (Verapamil, Diltiazem)
45
Despite their great effects, calcium channel blockers remain second-line therapy because
Don't reduce mortality whereas beta-blockers do
46
Contraindications for calcium channel blockers
``` Systolic Heart Failure Bradycardia Sinus node dysfunction Hypotension AV block ```
47
Why are beta-blockers commonly given in conjunction to organic nitrates
Organic nitrates cause arteriodilation that can cause reflex tachycardia (which beta blockers blunt)
48
Contraindications for organic nitrates
Sexual enhancement drugs (Viagra)
49
First-line treatment for stable angina is
always medical (b-blockers and nitrates) * Asprin and statins also are given for prevention
50
PCI for stable angina (does/ does not) change mortality
Does not (only improves quality of life)
51
When is CABG preferred over PCI?
``` >50% stenosis in left coronary artery 3 vessel (LAD, LCx, RCA) 2 vessel (including LAD) with diabetes ``` * needs to meet one of the above
52
Nitrates both: 1. reduce oxygen demand by causing venodilation which ____ wall tension 2. increase oxygen supply by causing arteriodilation that ______ coronary blood flow
decrease; increase
53
Late sodium current can continue through plateau (phase 2) leading to calcium overload. The drug that blocks this lat sodium current is
Ranolazine
54
Ranolazine only decreases ______ thus decreasing oxygen demand
wall tension NO effect on HR, preload, afterload, or contractility
55
When does coronary blood flow occur?
diastole
56
How do you determine coronary perfusion pressure on cardiac cycle?
the point where aortic valve opens - the point where mitral valve closes
57
Hypertension increases/decreases wall tension?
increases
58
Treatment for ACS/atherosclerosis focuses mainly on (supply/demand)
restoring supply
59
In atherosclerotic coronary arteries, physical activity can both ____ demand and ____ supply in myocytes
increase demand b/c physical activity causes sympathetic tone to increase HR and contractility decrease supply b/c of stenosis
60
How does DHP and Non-DHP calcium channel blockers increase supply?
Both types of CCBs cause vascular smooth muscle relaxation leading to vasodilation. This increases the coronary blood flow thus increase oxygen supply.
61
How does non-DHP CCBs reduce demand?
Decrease HR and contractility by reducing intracellular calcium thus decreasing oxygen demand
62
What CCB is a short-acting preparation and should not be used alone without B blockers due to concerns for reflex sympathetic surge causing tachycardia?
Nifedipine It increases HR and contractility as reflex mechanism
63
What are the determinants of oxygen supply?
1. Coronary blood flow (thus vascular resistance) | 2. Oxygen carrying capacity

Cardiology-Exam 2 (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions