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CVPR exam 2 > Ischemic Heart Disease I > Flashcards

Ischemic Heart Disease I Flashcards

1
Q

What are the untreatable risk factors for CAD?

A

male gender age genetics

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1
Q

What is the estimated lifetime risk of DM for persons in the US?

A

33%

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1
Q

Diabetes and insulin resistance are associated with inflammation, oxidative stress, and dyslipidemia that predispose to _______.

A

atherosclerosis

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2
Q

_____ are associated with inflammation, oxidative stress, and dyslipidemia that predispose to atherosclerosis.

A

Diabetes and insulin resistance

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2
Q

In the normal coronary circulation, autoregulation provides protection from _____.

A

moderate changes in perfusion pressure

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4
Q

What contributes to fibrous plaques and occlusive atherosclerotic plaques?

A

activated macs (foam cells) smooth muscle proliferation forms fibrous caps progressive lipid accumulation in core of plaque

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4
Q

When is the LV perfused?

A

diastole only

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5
Q

When oxidized, ____ becomes pro-inflammatory and athrogenic.

A

LDL cholesterol

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5
Q

Factors that increase myocardial O2 demand?

A
  1. HR 2. wall tension 3. inotropic state
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6
Q

An _____ causes a drop in perfusion pressure.

A

epicardial coronary stenosis

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7
Q

Tachycardia can compromise ______.

A

coronary flow

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8
Q

The dyslipidemic triad includes ____, ____, and ____.

A

high HDL low LDL high triglycerides

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8
Q

What are the beneficial effects of HDL?

A
  1. inhibits oxidation of LDLs 2. inhibits tissue factor 3. enhances reverse cholesterol transport 4. stimulates NO production 5. inhibits endothelial adhesion molecules *** all oppose atherosclerosis
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8
Q

Oxygen delivery (mol/min) = coronary flow rate (ml/min) x _______

A

arterial oxygen content (mol O2/ml blood)

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9
Q

What are the acute vascular events associated with plaque rupture/fissure and thrombosis?

A

unstable angina MI stroke critical leg ischemia

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9
Q

Oxygen delivery (mol/min) = ______ x arterial oxygen content (mol O2/ml blood)

A

coronary flow rate (ml/min)

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9
Q

What is a reperfusion injury?

A

early reperfusion that can provoke an additional injury

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10
Q

______ = coronary flow rate (ml/min) x arterial oxygen content (mol O2/ml blood)

A

Oxygen delivery (mol/min)

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11
Q

How is O2 supply increased in chronic stable angina treated?

A

prevent HTN, give beta blockers, vasodilators, coronary angioplasty or bypass surgery, treat anemia and hypoxemia

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13
Q

Smoking confers a 50% increase in ___ risk.

A

CAD

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14
Q

How is O2 demand reduced in chronic stable angina?

A

antihypertensive drugs, rate slowing drugs (beta-blockers, Ca++ channel blockers, limit preload (diuretics, nitrates), negative inotropes (beta blockers, Ca++ channel blockers)

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15
Q

______ limits coronary flow and cause myocardial ischemia (tissue blood flow insufficient to meet oxygen requirements), particularly when cardiac work and oxygen demand increase.

A

Obstructive coronary lesions

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15
Q

Oxygen supply may be compromised by ____ or ____.

A

anemia; hypoxemia

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16
Q

What is the cardinal symptom of an MI?

A

severe and unremitting chest discomfort at rest (although 30% of MI’s are “silent”)

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17
Q

In coronary heart disease, autoregulation may be exhausted when ______ across an epicardial coronary stenosis.

A

pressure drops

18
Q

When is troponin elevated?

A

in an acute MI

19
Q

What causes unstable angina?

A

Near-complete occlusion of vessel with thrombus

20
Q

What is different about the coronary circulation?

A
  1. the myocardium depends on aerobic metabolism for energy supply 2. Under resting conditions, a near-maximal amount of oxygen is extracted from coronary arterial blood; therefore, the only effective means of increasing myocardial O2 supply is to increase blood flow rate 3. the LV is perfused in diastole only
21
Q

What attributes to a fatty streak?

A

endothelial injury lipid deposition mac and T cell recruitment

23
Q

______ (dental, respiratory, immunologic diseases) may also increase the risk of atherosclerotic cardiovascular events.

A

Extravascular inflammation

24
Q

Autoregulation occurs at the level of _____.

A

the small arterioles

25
Q

How does HTN contribute to CAD risk?

A

increased shear stress on arterial walls = - endothelial cell injury - initiates pathologic cell signaling program causing oxidant stress, cellular proliferation circulating hormones increased exert adverse affects on arterial wall (angiotensin, aldosterone, NE) LVH

27
Q

Myocardial ischemia = imbalance between _____ and ______

A

coronary oxygen delivery; myocardial oxygen demand

28
Q

How does smoking increase the risk of CAD?

A

thrombogenic tendencies platelet activation increased fibrinogen aryl hydrocarbons promote atherosclerosis endothelial dysfunction, vasospasms CO decreases myocardial O2 delivery decreased HDL

29
Q

Smoking confers a _____ in CAD risk.

A

50% increase

30
Q

In coronary heart disease, ______ may be exhausted when pressure drops across an epicardial coronary stenosis.

A

autoregulation

32
Q

Name the 4 steps of atherosclerosis, starting from normal.

A
  1. fatty streak 2. fibrous plaque 3. occlusive atherosclerotic plaque 4. plaque rupture/fissure and thrombosis
33
Q

What happens w/I 1 hour of acute coronary occlusion?

A

Myocardial necrosis and infarction

34
Q

What are the factors that are treatable, but whether the risk is reduced is unclear.

A
  1. diabetes/insulin resistance 2. obesity 3. inflammation 4. psychological stress 5. sedentary lifestyle
36
Q

Diabetes and insulin resistance are associated with _____, _____, and _____ that predispose to atherosclerosis.

A

inflammation, oxidative stress, and dyslipidemia

37
Q

What will the biomarkers be for unstable angina?

A

negative, including troponin

38
Q

Increased heart rate shortens the cardiac cycle, predominantly by ______.

A

shortening diastole

40
Q

_____ = imbalance between coronary oxygen delivery and myocardial oxygen demand

A

Myocardial ischemia

41
Q

What are some of the deleterious effects of LDL?

A
  • injures vascular epi and impairs epi function - deposits into arterial wall… taken up by macs, which increases plaque volume - activates inflammatory cells that play a role in progression and instability of lesions - activates platelets = pro-thrombotic
42
Q

_____ confers a 50% increase in CAD risk.

A

Smoking

43
Q

At which stage of atherosclerosis does effort angina and claudication appear?

A

occlusive atherosclerotic plaque

45
Q

What causes acute vascular events?

A

plaque rupture/fissure and thrombosis

46
Q

_____ can compromise coronary flow.

A

Tachycardia

47
Q

Lipid-laden macrophages in an arterial wall plaque are _____.

A

highly pro-inflammatory

49
Q

____ occurs at the level of the small arterioles.

A

Autoregulation

50
Q

An epicardial coronary stenosis causes _____.

A

a drop in perfusion pressure

51
Q

LV perfusion is predominantly diastolic because of ______.

A

compression of intramural coronary vessels in systole

52
Q

What happens w.i minutes of an acute coronary occlusion?

A
  1. Impaired calcium re-uptake into SR during diastole > diastolic dysfunction (filling impairment) > increased LV filling pressure > pulmonary congestion and edema 2. Depletion of high energy phosphates, intracellular acidosis > systolic dysfunction (contractile failure) 3. ECG signs of myocardial injury 4. Symptoms (chest pain, dyspnea, arrhythmias)
54
Q

What are 3 treatable factors with CAD that reduce risk?

A
  1. smoking 2. HTN 3. dyslipidemia
55
Q

When oxidized, LDL cholesterol becomes ____ and _____.

A

pro-inflammatory and athrogenic

56
Q

_____ in an arterial wall plaque are highly pro-inflammatory.

A

Lipid-laden macrophages

57
Q

In coronary heart disease, autoregulation may be exhausted when pressure drops across an _____.

A

epicardial coronary stenosis

58
Q

_____ shortens the cardiac cycle, predominantly by shortening diastole.

A

Increased heart rate

59
Q

Name one circulating marker of inflammation.

A

CRP

60
Q

Inflammation plays a key role in _____ and _____ of atherosclerosis.

A

initiation and progression

CVPR exam 2 (29 decks)

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