Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

My Assessment Cards > Ischemic Heart Disease (Exam IV) > Flashcards

Ischemic Heart Disease (Exam IV) Flashcards

1
Q

What chemical mediators are released from ischemia that activate cardiac nociceptors?

A

Adenosine and Bradykinin

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

What are the two main risk factors in the development of atherosclerosis?

A
  • Male
  • Older age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the first 3 manifestations of IHD?

A
  • Angina
  • Acute MI
  • Sudden death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the path for cardiac pain signals to reach the spinal cord?

A

Cardiac nociceptors → Afferent Neurons → T1 - T5 SNS ganglia.

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

What is the CNS response to cardiac ischemia?

A
  • ↓ AV conduction and thus ↓HR
  • ↓ Contractility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Angina is an imbalance between what two things?

A
  • Increased myocardial oxygen consumption
  • Decreased coronary blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Differentiate stable vs unstable angina.

A
  • Stable - No change in chest pain severity or frequency in 2-mo period.
  • Unstable - Increasing frequency and severity of chest pain without an increase in cardiac biomarkers.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Are cardiac biomarkers (troponin) present with unstable angina?

A

NO. If they were, that would be an MI.

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

What EKG abnormality is associated with old MI’s and/or current ischemia?

A

T-wave inversion

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

What is nuclear stress testing utilized for?

A

Coronary Perfusion assessment

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

What determines the significance of CAD during a nuclear stress test?

A

Size of the perfusion abnormality

Arrows point to arrows of lesser perfusion.

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

What test can differentiate a new vs and old perfusion abnormality?

A

Nuclear Stress Testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What nuclear stress test tracers are used with exercise?

A

Thallium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What nuclear stress test drugs are used without exercise?

A

Atropine
Dobutamine
Pacing

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

When are adenosine and dipyridamole used with nuclear stress testing? Why?

A

Used after test to dilate normal, non-ischemic areas of the heart.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What test would be useful for imaging wall motion abnormalities or valvular function?

A

Echocardiography

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

What is Prinzmetal Angina?

A

Coronary Spasm

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

What is the mechanism of action for aspirin?

A

COX-1 Inhibition → TXA2 inhibition → Plt aggregation inhibition.

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

How can aspirin be reversed?

A

Trick question. It can’t be, platelets are damaged until they die and are replaced.

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

What is the mechanism of action of abciximab, eptifibatide, and tirofiban?

A

Platelet glycoprotein IIb/IIIa receptor antagonists

Inhibit platelet activation, adhesion, and aggregation.

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

What drugs (discussed in lecture) are P2Y12 inhibitors?

A

Clopidogrel and Prasugrel

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

What common drug class will antagonize P2Y12 inhibitors?

A

PPIs

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

How does Prasugrel compare to Clopidogrel?

A

More predictable pharmacokinetics but greater bleeding risk.

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

How do P2Y12 inhibitors work?

A

Inhibit ADP receptor P2Y12 and thus inhibit platelet aggregation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What drug classes are synergistic with nitrates?

A
  • β-blockers
  • CCBs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When are nitrates contraindicated?

A
  • Aortic Stenosis
  • Hypertrophic Cardiomyopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What drug class is the only one proven to prolong life in CAD patients?

A

β-blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What properties do β-blockers have?

A
  • Anti-ischemia
  • Anti-HTN
  • Anti-dysrhythmic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which β blockers are cardioselective?

A
  • Atenolol
  • Metoprolol
  • Acebutolol
  • Bisoprolol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which β blockers are non-selective?

A
  • Propanolol
  • Nadolol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What risk is associated with non-selective β blockers in asthma patients?

A

↑ risk of bronchospasm in reactive airway disease patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What drug class is uniquely effective is decreasing the severity/frequency of coronary vasospasm?

33
Q

Angiotensin II will increase what four things?

A
  • Myocardial hypertrophy
  • Interstitial myocardial fibrosis
  • Coronary vasoconstriction
  • Inflammatory responses
34
Q

Is troponin or CK-MB more specific for myocardial injury?

35
Q

How soon with troponin start to increase after myocardial injury?

36
Q

How long will troponin stay elevated after a MI?

A

Up to 2 weeks

37
Q

What is ST segment depression characteristic of?

A

Subendocardial ischemia

38
Q

What diagnostic studies might indicate a myocardial infarction?

A
  • EKG: abnormality (ex. LBBB)
  • US: Regional wall motion abnormalities
39
Q

What are indications for PCI treatment of an MI?

A
  • Contraindicated tPa therapy
  • Severe HF and/or pulm edema
  • S/S for 2-3 hours
  • Mature clot
40
Q

When is CABG preferred over PCI?

A
  • Significant left main coronary artery disease
  • Three-vessel coronary artery disease
  • DM and two/three-vessel coronary artery disease
41
Q

What are 3 cases when revascularization is indicated?

A
  • > 50% left main coronary artery occlusion
  • > 70% epicardial coronary artery occlusion
  • EF <40% (impaired LV contractility)
42
Q

What risks are associated with PCI (percutaneous coronary intervention) ?

A
  • Endothelial destruction
  • Bleeding
  • Thrombosis
43
Q

What is Dual Antiplatelet Therapy (DAPT) ?

A
  • ASA w/ P2Y12
44
Q

Why is dual anti-platelet therapy used?

A

To prevent thrombus after stent placement

45
Q

What are the 4 steps of acute coronary syndrome?

A
  • Disruption of atheromatous clot
  • Coagulation cascade activation
  • Thrombin generation
  • Arterial occlusion by thrombus
46
Q

What 4 chemical mediators stimulate PLT aggregation?

A
  • Collagen
  • ADP
  • Epinephrine
  • Serotonin
47
Q

What are the effects of TXA2?

A

Vasoconstriction

48
Q

What diagnostic data indicates MI?

A
  • Elevated troponin (cardiac biomarkers)
  • Ischemia
  • ST changes, new LBBB, Q waves present
  • Regional wall motion abnormality
49
Q

What drug should be given with an aspirin allergy?

A

P2Y12 inhibitor

50
Q

Who are beta blockers not given to?

A

Those with a heart block

51
Q

What two drugs should be avoided with a STEMI?

A
  • Glucocorticoids
  • NSAIDs
52
Q

When should tPA be initiated?

A

Within 30-60 mins of arrival to the hospital and within 12 hours of onset of symptoms

53
Q

When should angioplasty be performed?
(Timeframe)

A

Within 90 mins upon arrival to the hospital and within 12 hours of symptom onset

54
Q

What are the causes of unstable angina/NSTEMI?

A
  • Ruptured coronary plaque
  • Obstruction due to vasoconstriction
  • Worsening coronary luminal narrowing
  • Inflammation
  • Myocardial ischemia
55
Q

How long until a vessel reendothelializes after a balloon angioplasty?

56
Q

How long will reendothelialization occur after a bare-metal stent placement?

A

Up to 12 weeks

57
Q

When will a drug-eluting stent reendothelialize?

A

After a year

58
Q

How long is DAPT required after balloon angioplasty without stent?

A

At least 2 weeks

59
Q

How long is DAPT required after a bare-metal stent placement?

A

At least 6 weeks

60
Q

How long is DAPT needed after a drug-eluting stent placement?

A

At least a year

61
Q

How long would one want to wait for elective surgery post angioplasty with no stenting?

A

2 - 4 weeks

62
Q

How long would one want to wait for elective surgery post angioplasty with bare-metal stent placement?

A

At least 30 days (12 weeks preferable)

63
Q

How long would one want to wait for elective surgery post angioplasty with drug-eluting stent placement?

A

At least 6 months (12 months if post ACS)

64
Q

How long would one want to wait for elective surgery post-CABG?

A

At least 6 weeks (12 weeks preferable)

65
Q

Is glycopyrrolate or atropine preferred for treatment of bradycardia?

A

Glycopyrrolate

66
Q

Are β blockers or ACE-inhibitors continued peri-operatively?

A

β-blockers

67
Q

Are β blockers or ACE-inhibitors discontinued 24 hours prior to surgery?

A

ACE inhibitors

68
Q

What components are worth 1 point on the Revised Cardiac Risk Index (RCRI) ?

69
Q

What % risk of major cardiac events would be conferred by a RCRI score of 0 ?

70
Q

What % risk of major cardiac events would be conferred by a RCRI score of 1 ?

71
Q

What % risk of major cardiac events would be conferred by a RCRI score of 2 ?

72
Q

What % risk of major cardiac events would be conferred by a RCRI score of ≥3 ?

73
Q

What does 1 MET equal?

A

3.5mLO₂/kg/min

74
Q

What drug is the preferred treatment for tachycardia?

75
Q

What anticholinergic is the better option for treatment of bradycardia in CAD patients?

A

Glycopyrrolate > Atropine

76
Q

What coronary artery would you expect to be effected from abnormalities noted on II, III, and aVF?

77
Q

What coronary artery would you expect to be effected from abnormalities noted on I and aVL?

A

Circumflex artery

78
Q

What coronary artery would you expect to be effected from abnormalities noted on V3 - V5?

My Assessment Cards (27 decks)

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