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CV Unit II > Ischemic Heart Disease I > Flashcards

Ischemic Heart Disease I Flashcards

1
Q

What are the risk factors for development of coronary atherosclerosis?

A

Treatable => reduced risk:

  • Smoking
  • HTN
  • Dyslipidemia

Treatable, no clear risk reduction w/ tx

  • Diabetes/insulin resistance
  • Obesity
  • Inflammation
  • Psych stress
  • Sedentary lifestyle

Not treatable

  • Males
  • Age
  • Most genetic factors
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2
Q

Which body response exacerbates almost all of the risk factors? He addressed this a bunch in his lecture

A

Inflammation!!!

However steroids have not been shown to reduce CHD (lots of trials going on now to see if/which specific ones will work)

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3
Q

What are the distinguishing features of the coronary circulation, including principle determinants of myocardial oxygen supply and demand?

A

1) Myocardium depends on aerobic metabolism for energy supply
2) Resting => near-maximal amount of O2 is extracted from coronary arterial blood (only way to ^ O2 supply is to ^ flow rate)
3) LV is perfused in diastole only

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4
Q

What are the key elements of pathophysiology stable coronary heart disease that decrease the O2 supply?

A

1) Perfusion pressure
2) Diastolic time
3) Coronary resistance
4) O2 content

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5
Q

Describe perfusion pressure as a key element of pathophysiology stable coronary heart disease.

A

a

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6
Q

Describe diastolic time as a key element of pathophysiology stable coronary heart disease.

A
  • LV perfusion is diastolic b/c of compression of intramural coronary vessels in systole
  • ^ HR shortens cardiac cycle (mostly shortens diastole)
  • THEREFORE => tachy can compromise coronary flow
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7
Q

Describe coronary resistance as a key element of pathophysiology stable coronary heart disease.

A

a

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8
Q

Describe decreased O2 content as a key element of pathophysiology stable coronary heart disease.

A

a

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9
Q

What is the tx of perfusion pressure?

A

Prevent hypotension

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10
Q

What is the tx of impaired diastolic time?

A

Rate-slowing drugs (e.g. beta blockers)

This is increases diastolic filling time

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11
Q

What is the tx of coronary resistance?

A

Vasodilators

  • Nitrates
  • CCBs
  • Coronary angioplasty
  • Bypass surgery
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12
Q

What is the tx of decreased O2 content?

A

Treat anemia and hypoxemia

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13
Q

What are the key elements of pathophysiology stable coronary heart disease that increase the O2 demand?

A

1) Increased HR
2) Wall tension (think Law of LaPlace)
3) Inotropic state

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14
Q

What is the tx of increased HR?

A

Rate slowing drugs

  • Beta-blockers
  • CCBs
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15
Q

What is the tx of increased wall tension?

A

Limit LV cavity size by limiting excessive preload

  • Diuretics
  • Nitrates
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16
Q

What is the tx of increased inotropic state (contractility)

A

Negative inotropes

  • Beta-blockers
  • CCBs
17
Q

Describe pathophysiology unstable coronary heart disease.

A
  • Inflammation in arterial wall
  • Weakening of fibromuscular cap
  • Abrupt plague fissure/rupture
  • Thrombogenic components in blood (lipids, TF)
  • Thrombosis w/ partial or complete occlusion
  • Myocardial injury and/or necrosis
  • Cardiac dysfunction, risk of arrhythmias, death
18
Q

Describe the pathophysiology of unstable angina

A
  • Near/complete vessel occlusion w/ thrombus
  • “threatened” heart attach
  • Biomarkers (troponin) are NEGATIVE
  • May not cause myocardial damage if tx is successful
  • ^ risk of recurrent events in 1st yr
19
Q

Describe the pathophysiology of MI

A
  • Persistent/severe coronary flow reduction
  • Thrombus => complete vessel occlusion
  • Wavefron of necrosis
  • Biomarkers are elevated
  • Cardinal symptoms (but 30% of symptoms are silent)
  • Early reperfusion is key tx
  • ^ early mortality if you don’t go to the hospital
  • Late mortality related to extent of LV dysfunction
20
Q

What is the timeline of acute coronary occlusion?

A

W/in minutes:

  • diastolic dysfunction
  • Systolic dysfunction
  • ECG signs of MI
  • Symptoms (chest pain, dyspnea, arrhythmias)

W/in an hour
- necrosis and infarction

Go look at the slide for this one (has more details)

CV Unit II (12 decks)

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