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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

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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
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3
Q

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

A

less

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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

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5
Q

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

A

aspirin

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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)
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7
Q

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

A

Angina pectoris

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8
Q

Why do ischemic cardiomyocytes cause pain?

A

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

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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

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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

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11
Q

The pathophysiology of myocardial ischemia is due to the imbalance between

A

Supply and demand

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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)
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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
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14
Q

Regulation of blood flow occurs mostly in the

A

smaller “resistance” vessels (arterioles)

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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
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16
Q

What is Coronary Perfusion Pressure

A

the pressure needed to drive coronary blood perfusion

Aortic diastolic pressure - LVEDP

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17
Q

Major determinant of resistance in blood vessels

A

radius

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18
Q

Blood flow through a vessel is inversely proportional to

A

length and viscosity

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19
Q

Resistance is directly proportional to

A

length and viscosity

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20
Q

Resistance is inversely proportional to

A

radius

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21
Q

_________ are capable of sufficient compensatory dilatation to prevent ischemia

A

Coronary arteries

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22
Q

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

A

70

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23
Q

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

A

Acidosis
Hypoxia
Citrate/acetate
Adenosine

  • all above cause vasodilation
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24
Q

Most potent endogenous vasodilator

A

NO (act in paracrine fashion)

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25
Q

Nitric oxide increases smooth muscle ______, causing relaxation

A

cGMP

*cGMP activates protein kinase G that increase uptake of calcium

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26
Q

Atherosclerosis causes ischemia/infarction mainly by what two mechanisms

A 
Obstruction of the lumen (stenosis)
Decreased vasodilation (endothelial dysfunction)
27
Q

What are the determinants of oxygen demand?

A
  1. Heart Rate
  2. Contractility
  3. Wall tension
28
Q

Why does increase in wall tension increase oxygen demand?

A

Increase in wall tension means myocytes need to work harder (require more ATP) and therefore require more oxygen

29
Q

Ventricular hypertrophy (increased wall thickness) can be seen as a compensatory mechanism to increased

A

wall tension/stress

30
Q

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)

A

Stress Tests

31
Q

Calculation for predicted maximal HR (for stress tests)

A

220-age

32
Q

When is the exercise treadmill stress test considered positive

A 
Chest discomfort is reproduced
ECG abnormalities (> 1mm ST depression)
33
Q

Nuclear imaging (perfusion scan) is added in patients undergoing a stress test when

A

Abnormal baseline ECG

High suspicion of ischemia

34
Q

Reversible defect (cold spots only after stress) on nuclear imaging is indicative of

A

inducible ischemia

35
Q

Fixed defect (cold spot both at rest and after stress) on nuclear imaging is indicative of

A

prior MI and fibrosis

36
Q

Gold standard for the diagnosis of coronary artery disease; imaging study for those with myocardial ischemia; visualize with injection of contrast via cath

A

Coronary angiography

37
Q

Treatment for chronic stable angina focuses mainly on reducing (supply/demand)

A

Demand

Beta blockers
Nitrates
Calcium Channel Blockers

38
Q

Beta-blockers both

  1. reduce demand by decreasing _____
  2. increase supply by increasing _____
A

HR and contractility

Diastolic time

39
Q

Cardioselective beta-blockers (target B1 receptors more than B2 receptors) are

A

Atenolol
Metoprolol

Anti-anginals (reduce demand problem)

40
Q

Non-selective beta-blockers are

A

Propranolol

Nadolol

41
Q

Contraindications of beta-blockers

A

Bronchospastic disease
Decompensated HF
Severe bradycardia
AV block

42
Q

Calcium channel blockers block what type of calcium channels

A

L type

43
Q

Class of calcium channel blockers that act only on vascular smooth muscle

A

Dihydropyridines (end in -pine)

44
Q

Class of calcium channel blockers that act on both vascular smooth muscle and the cardiac tissue

A

Nondihydropyridines (Verapamil, Diltiazem)

45
Q

Despite their great effects, calcium channel blockers remain second-line therapy because

A

Don’t reduce mortality whereas beta-blockers do

46
Q

Contraindications for calcium channel blockers

A 
Systolic Heart Failure
Bradycardia
Sinus node dysfunction
Hypotension
AV block
47
Q

Why are beta-blockers commonly given in conjunction to organic nitrates

A

Organic nitrates cause arteriodilation that can cause reflex tachycardia (which beta blockers blunt)

48
Q

Contraindications for organic nitrates

A

Sexual enhancement drugs (Viagra)

49
Q

First-line treatment for stable angina is

A

always medical (b-blockers and nitrates)

  • Asprin and statins also are given for prevention
50
Q

PCI for stable angina (does/ does not) change mortality

A

Does not (only improves quality of life)

51
Q

When is CABG preferred over PCI?

A 
>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
Q

Nitrates both:

  1. reduce oxygen demand by causing venodilation which ____ wall tension
  2. increase oxygen supply by causing arteriodilation that ______ coronary blood flow
A

decrease; increase

53
Q

Late sodium current can continue through plateau (phase 2) leading to calcium overload. The drug that blocks this lat sodium current is

A

Ranolazine

54
Q

Ranolazine only decreases ______ thus decreasing oxygen demand

A

wall tension

NO effect on HR, preload, afterload, or contractility

55
Q

When does coronary blood flow occur?

A

diastole

56
Q

How do you determine coronary perfusion pressure on cardiac cycle?

A

the point where aortic valve opens - the point where mitral valve closes

57
Q

Hypertension increases/decreases wall tension?

A

increases

58
Q

Treatment for ACS/atherosclerosis focuses mainly on (supply/demand)

A

restoring supply

59
Q

In atherosclerotic coronary arteries, physical activity can both ____ demand and ____ supply in myocytes

A

increase demand b/c physical activity causes sympathetic tone to increase HR and contractility

decrease supply b/c of stenosis

60
Q

How does DHP and Non-DHP calcium channel blockers increase supply?

A

Both types of CCBs cause vascular smooth muscle relaxation leading to vasodilation. This increases the coronary blood flow thus increase oxygen supply.

61
Q

How does non-DHP CCBs reduce demand?

A

Decrease HR and contractility by reducing intracellular calcium thus decreasing oxygen demand

62
Q

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?

A

Nifedipine

It increases HR and contractility as reflex mechanism

63
Q

What are the determinants of oxygen supply?

A
  1. Coronary blood flow (thus vascular resistance)

2. Oxygen carrying capacity

Cardiology-Exam 2 (23 decks)

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