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DMST 367 Echo 3 > Ischemic Heart Disease (Coronary artery disease) > Flashcards

Ischemic Heart Disease (Coronary artery disease) Flashcards

1
Q

What is ischemic heart disease?

A

Narrowing or obstruction of the coronary arteries Sufficient to prevent adequate blood and oxygen supply to the myocardium (ischemia)

not getting enough blood

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2
Q

What may IHD lead to?

A

May progress to the point the myocardium is damaged (infarction)

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3
Q

What are two types of IHD etiology?

A
  1. Atherosclerotic
  2. Non-Athersclerotic
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4
Q

What is the most common IHD etiology?

A

Atherosclerotic

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5
Q

What are examples of non- Atherosclerosis causes of IHD? 3

A
  1. Embolus into coronary artery
  2. Trauma
  3. Coronary artery dissection
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6
Q

What does this image represent?

A

Plaque progression from a fatty streak on the intima to a superficial erosion of the endocardial layer

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7
Q

In terms of atherosclerotic plaque progression, when the thrombus forms, what does it occlude? and where does it usually occur?

A
  1. The lumen of the artery
  2. Distal to an arterial branching
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8
Q

What are some major risk factors for IHD? 5

A
  1. Age
  2. Smoking
  3. Diabetes mellitus
  4. Dyslipidemia
  5. Hypertension
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9
Q

What are some predisposing risk factors for IHD? 4

A
  1. Abdominal obesity
  2. Family history
  3. Obesity
  4. Physical inactivity
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10
Q

What is ischemia?

A

Decreased blood supply to the myocardium

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11
Q

What is an infarction?

A

Death or necrosis of tissue which results from prolonged ischemia

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12
Q

Can ischemia occur due to increased demand for blood?

A

Yes

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13
Q

Is ischemia reversible?

A

Yes

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14
Q

What is a total occlusion of blood flow to the tissue?

A

Infarction

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15
Q

Between ischemia and infarction which one is reversible?

A

Ischemia is reversible

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16
Q

What the most common causes of ischemia? 2

A
  1. Coronary artery disease
  2. Increased metabolic demand
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17
Q

What is coronary artery disease (CAD)?

A

Plaque in the vessel which impedes blood flow

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18
Q

How would someone have ischemia due to increased metabolic demand? 2

A
  1. Hypertrophy cardiomyopathy (more muscle)
  2. Aortic stenosis (more work or high afterload)
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19
Q

Everything downstream of the obstruction dies unless there is what?

A

Collateral circulation from another vessel

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20
Q

In terms of infarction, cell death starts to happen when? (Time frame)

A

Within 1 hour and is complete by 4

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21
Q

What are signs/ symptoms of ischemia/ Myocardial infarctions? 2, 8

A
  1. Angina Pectoris (chest pain)
  2. SOB
  3. Syncope
  4. Fatigue
  5. Can be silent (Asymptomatic)
  6. Sweating
  7. Nausea and vomiting
  8. Anxiety
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22
Q

What might a CXR show in terms of ischemic heart disease? 3

A

May show

  1. Pulmonary edema
  2. Cardiomegaly
  3. May appear normal
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23
Q

Where would we auscultate for ischemic heart disease?

A

S4, possible S3

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24
Q

What might we hear when we auscultate for ischemic heart disease?

A

Mitral regurgitation murmur (systolic murmur at apex)

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25
Q

How many patients have Mitral regurgitation after acute Mitral infarction?

A

Up to 60%

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26
Q

What is angina pectoris caused by?

A

Reduced O2 delivery to a section of the myocardium

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27
Q

What is angina pectoris felt as?

A

Heaviness, burning or aching pain in the chest +/- left arm

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28
Q

In terms of angina pectoris women have what kind of symptoms?

A

Generalized symptoms

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29
Q

What might angina pectoris possibly be caused by? (Besides O2 delivery)

A

Coronary spasm

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30
Q

What is stable angina a result of?

A

Stable plaque

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31
Q

What can stable angina be described as in terms of pain?

A

Predictable, regular chest pain

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32
Q

What the solution for stable angina?

A

Rest or nitroglycerine

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33
Q

How does unstable angina pain compare to stable angina? And how predictable is it?

A

More intense/ painful and not predictable

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34
Q

What is the solution for unstable angina?

A

May require immediate intervention

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35
Q

What does Myocardial infarctions lead to?

A

MI &raquo_space; Arrhythmias (VT, VF)&raquo_space; Asystole

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36
Q

When someone experiences MI what is immediately needed?

A

CPR and Defibrillation

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37
Q

In terms of Cardiac arrest survival rates drops by how much every minute without a pulse?

A

10%

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38
Q

During Myocardial infarction, once the pulse is back, what do we do?

A

Thrombolytics and PCI or emergency bypass

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39
Q

What are two types of Myocardial infarctions?

A
  1. NSTEMI
  2. STEMI
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40
Q

What is NSTEMI?

A

Zone of ischemia with small zone of cell death

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41
Q

In terms if NSTEMI it usually affects which area?

A

Subendocardial

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42
Q

What does the ST segment look in terms of NSTEMI?

A

Depressed

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43
Q

What is STEMI in terms of Myocardial infarction?

A

Transmural, which means through the whole thickness of the myocardium

from Endo to epi

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44
Q

What does the ST segment look like in terms of STEMI?

A

Elevated

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45
Q

What does these images represent from top down?

A
  1. Normal
  2. ST depression
  3. Infarct
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46
Q

What does ST depression indicate?

A

Ischemia

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47
Q

What does ST elevation represent?

A

Infarction

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48
Q

During MI where does arrhythmias originate?

A

In the ventricle

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49
Q

In terms of MI, what kind of heart blocks will we see?

A

AV block

50
Q

If we see a new LBBB on an ECG what might this mean?

A

MI

51
Q

In terms of MI what does Q waves indicate on the ECG?

A

Old MI (necrotic tissue)

52
Q

In terms of MI, what does peaked T waves indicate?

A

Acute MI

53
Q

In terms of MI, what does reversed T waves indicate on a ECG?

A

Chronic ischemia

54
Q

What are some treatment options for ischemic heart disease? 6

A
  1. Smoking adjustment
  2. Diet
  3. Exercise
  4. Stress management
  5. Weight loss
  6. BP reduction
55
Q

What are some medications that can help assist with ischemic heart disease treatment? 4

A
  1. Pain relief meds
  2. Anticoagulation
  3. Beta blockers
  4. Calcium channel blockers
56
Q

What kind of pain relief meds does someone take for ischemic heart disease medication?

A

Nitroglycerine

57
Q

What kind of anticoagulation medication does someone take for ischemic heart medicine? 2

A
  1. Plavix
  2. Warfarin/ coumadin
58
Q

What are somethings we can look at to help diagnose ischemic heart disease? 6

A
  1. ECG
  2. Stress test
  3. Echo
  4. MIBI (Nuclear) stress test
  5. Cardiac CT or MRI
  6. Acute phase of MI requires blood work with enzymes
59
Q

What is the gold standard for diagnosis for IHD?

A

Coronary angiogram

60
Q

What is a stress test?

A

Exercise or pharmacological

61
Q

How can we detect ischemic heart disease with Cardiac CT or MRI?

A

Perfusion defects

62
Q

How can we diagnose Ischemic heart disease with the Acute phase of MI blood work and enzymes?

A

Certain blood and enzymes are released with myocardium injury occurs such as
1. Creatine kinase myocardial band
2. Troponin C (C- cardiac)

63
Q

What are four MI differential diagnosis tools? (Signs we see)

A
  1. Aortic dissection
  2. Tension pneumothorax
  3. Pericardial disease
  4. Pleural effusion
64
Q

What is the goal of Myocardial infarction management?

A

To restore normal coronary blood flow and save the myocardium

65
Q

What are somethings we can do for MI management? 3

A
  1. Cath lab - Angioplasty
  2. Surgical
  3. Lifestyle changes
66
Q

What are some surgical paths for MI management?

A
  1. Coronary artery bypass graft (CABG)
  2. Other
67
Q

What does this image demonstrate?

A

Coronary angiography

68
Q

What does this image demonstrate?

A

Coronary artery bypass graft

69
Q

What is the role of echo in terms of ischemic heart disease? 2

A
  1. Assess for Wall motion and thickening
  2. Assess for regional wall thinning of affected wall segments
70
Q

What is regional wall thinning of affected wall segments caused by?

A

Scarring and fibrosis over time

71
Q

What does regional wall thinning of affected wall segments look like sonographically?

A

Increased echogenicity

72
Q

Wall thickness with acute MI will look how?

A

Normal

73
Q

What is sigmoid septum?

A

Basal septal focal hypertrophy

74
Q

In terms of sigmoid septum, myocardial disarray may be related to what?

A

Reduced perfusion in that segment which caused it to thicken

75
Q

What is the prognosis for sigmoid septum?

A

Increased risk for adverse cardiac events

76
Q

What demographic is sigmoid septum more prominent in? 2

A
  1. Diabetics
  2. Elderly
77
Q

What are some post MI complications? 7

A
  1. Secondary MR
  2. Thrombus formation
  3. Aneurysms
  4. Dressler’s syndrome and post MI pericarditis
  5. Acquired VSD
  6. CHF
  7. Ventricular arrhythmia
78
Q

What is papillary muscle dysfunction?

A

Ischemia of papillary muscle segment

79
Q

What does papillary muscle dysfunction cause?

A

Improper contraction of the segment and the pap muscle

80
Q

What does papillary muscle dysfunction affect? and what does it lead too?

A

MV function leading to eccentric regurgitation

81
Q

In terms of Papillary muscle dysfunction, ruptures are more common with what?

A

Inferior MI

82
Q

Papillary muscle dysfunction may also occur where?

A

In right heart and TV

83
Q

LV thrombus is what? Where is it usually located?

A

Echodense mass usually in apex

84
Q

How does LV thrombus present? 2

A
  1. Protruding vs mural
  2. Mobile vs. Sessile
85
Q

What kind of view visualization is required for LV thrombus?

A

2 view visualization

86
Q

How are aneurysms grouped?

A

Either true or pseudo aneurysms

87
Q

How common are Aneurysms?

A

Rare

88
Q

What may line aneurysm?

A

Thrombus

89
Q

Thrombus that lines aneurysm may cause what?

A

Systemic emboli

90
Q

In terms of aneurysms, patients may present with what?

A

Continuing angina

91
Q

What does these images represent?

A

True aneurysm vs Pseudo aneurysm

92
Q

What does a pseudo aneurysm look like? 3

A
  1. Narrow neck
  2. Wall rupture
  3. Filled with thrombus
93
Q

What does a true Aneurysm look like? 5

A
  1. Thin walls (<5mm)
  2. 80% at apex
  3. Wide neck
  4. All 3 wall layers present
  5. May leak into pericardium
94
Q
A
95
Q

When does Acute pericarditis POST MI occur?

A

1-4 days post MI

96
Q

How many people are affected by acute pericarditis post MI?

A

25% of patients

97
Q

What are 3 main features of acute pericarditis?

A
  1. Fever
  2. Pleuritic pain
  3. Pericardial effusion
98
Q

In terms of acute pericarditis post MI, how often do we see Tamponade?

A

Rare

99
Q

How does the pericardium look like during acute pericarditis post MI?

A

Pericardium may look bright over ABD wall motion area

100
Q

What is pericarditis post MI related to?

A

Related to autoimmune response to necrosis

101
Q

What is Dressler’s syndrome?

A

Delayed pericarditis

102
Q

When does Dressler’s syndrome occur?

A

1-8 weeks post MI

103
Q

How many people are affected by Dressler’s syndrome?

A

1-3% of patients (rare)

104
Q

What is Dressler’s syndrome related to?

A

Autoimmune response to necrosis

105
Q

What are some of the signs and symptoms of Dressler’s syndrome?

A

Same as pericarditis

106
Q

What is VSD or Wall rupture due to in terms of MI?

A

Rupture of interventricular septum

107
Q

What does VSD or Wall rupture due to MI sound like?2

A
  1. Loud systolic murmur, left sternal border
  2. Thrill
108
Q

How does VSD or wall rupture due to MI move in the heart?

A
  1. High velocity flow across septum
  2. Flow into pericardium for wall rupture
109
Q

What is the pathophysiology of VSD/ Wall rupture: post MI? 3

A
  1. MI damages the wall
  2. Shunt occurs
  3. Can leak into pericardium
110
Q

What are some non IHD chest pain causes? 2

A
  1. Myocarditis
  2. Takotsubo cardiomyopathy (TTC)
111
Q

What is myocarditis?

A

Inflammation of the myocardium resulting in myocardial damage

112
Q

What is the pathophysiology of myocarditis? 4

A
  1. Myocardial infiltration produces toxin
  2. Autoimmune response
  3. Myocardial degeneration/ necrosis
  4. May cause heart failure
113
Q

What are some signs and symptoms of myocarditis? 1, 6

A
  1. Infection symptoms
  2. Chest pain
  3. SOB
  4. Fatigue
  5. Arrthymia
  6. Asymptomatic
114
Q

What are some echo findings for myocarditis? 3,5

A
  1. Dilated or hypertrophied ventricles
  2. LV dysnfunction
  3. RWMA
  4. Possible valvular issues
  5. Possible diastolic dysfunction
115
Q

What are the criteria for TTC? 6

A
116
Q

What is Takotsubo cardiomyopathy (TTC)?

A

Acute, transient or reversible LV dysfunction in the absence of obstructive CAD

117
Q

What is TTC named after?

A

Japanese octopus trap

118
Q

What does TTC mimic?

A

ACS

119
Q

What is TTC triggered by?

A

Stress

120
Q

Which demographic of people are affected by TTC?

A

Post menopausal women

121
Q

How does TTC appear?

A

Transient, normal on F/U

122
Q

What are four tips for IHD scans?

A
  1. Make sure you are on axis to see the RWMA
  2. Sweep
  3. Focus set
  4. Step out of the box (sometimes a new window is needed, or maybe a colour map)

DMST 367 Echo 3 (27 decks)

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