Ischemic Heart Disease I - Exam 2 Flashcards
In general, why does mycocardial ischemia occur? What is the most critical factor?
occurs when there is an imbalance between oxygen supply and demand
radius of the blood vessel
What are the 3 factors that influence the radius of the blood vessel?
atherosclerosis hardening of vessels
vascular tone
endothelial cell dysfunction in cardiac ischemia
What is the difference between stable and unstable angina?
stable: chest pain on exertion
unstable: constant chest pain even at rest
What conditions are included in Acute Coronary Syndrome (ACS)? What conditions are included in Ischemic Heart Disease?
unstable angina
MI: including STEMI and NSTEMI
What is Prinzmetal angina?
not scary spasms of the blood vessels
What is Acute Coronary Syndrome a result of? What determines the severity?
ACS results when there is plaque rupture and thrombus formation
the amount of coronary blood flow
What are the differences in blood flow between unstable angina, NSTEMI and STEMI?
What are the differences between stable and unstable angina?
When does ischemia present? Can cardiac cells tolerate mild-moderate anoxia?
Present as soon as there is a decrease or complete absence of blood supply to myocardial tissue
Cardiac cells can tolerate mild-moderate anoxia for a short time without greatly affecting their function. When oxygen is restored the cells usually return to normal
When does cardiac injury appear? Is it usually reversible?
If ischemia is severe or prolonged, the anoxic cardiac cells sustain damage and stop functioning normally
damage to cells still remains reversible and cell may return to normal or near normal after the return of adequate blood flow and reoxygenation
When does an infarct occur? Is it reversible?
Severe myocardial ischemia continues because of continued complete absence of blood supply
The anoxic cardiac cells will sustain IRREVERSIBLE injury and die
aka dead meat, don’t beat!!
What is a transmural infarct?
When the tissue dies through all the layers of the heart
aka VERY BAD
What areas are common for NSTEMI? What area is particularly susceptible to ischemia?
Involves small area in the subendocardial wall of the LV, ventricular septum, or papillary muscle
subendocardial area
What are the EKG changes associated with NSTEMI? Will there be an increase in cardiac enzymes?
ST depression or T-wave inversion (or no EKG changes)
will see an increase in cardiac enzymes
Will there be an increase in cardiac enzymes with unstable angina?
NO increase in cardiac enzymes
What is the cause of a STEMI?
infarct through the extend through the whole thickness of the heart muscle wall, that is caused by the complete occlusion of a coronary artery
What are EKG changes that will appear with a STEMI? ______ is the classic description of the wave
ST elevation!!! and SOMETIMES develop a Q wave (but not always)
“tombstone” appearance
What are the 5 different types of MI classifications? **Type 1 and 2 are the highlighted ones
**Type 1: primary coronary event
**Type 2: MI secondary to ischemia
What is silent ischemia? **What are the top 3 pt demographics?
Myocardial ischemia without discomfort or pain
**More common in diabetics, elderly patients, and women
What is myocardial stunning?
Reversible myocardial dysfunction following reperfusion of an ischemic insult
Usually following sudden episode of ischemia then quick reperfusion. Dysfunctional after reperfusion but then goes back to normal
What is hibernating myocardium a result of? What does it cause?
A result of prolonged reduction in blood flow from coronary artery disease over a longer period of time
Causes ventricular contractile dysfunction that will improve once blood flow improves
**What is the significance of an inferior wall MI? What artery is that associated with?
often accompanied by a ↓ HR because of involvement of the sinus node. Long term effects are usually less severe than those of an anterior wall MI.
RCA
**What is the significance of an anterior wall MI? **What artery?
**the anterior wall performs the main pump function and decay of the function of this wall will lead to ↓ BP, ↑ HR, shock and on a longer term, HF
** LAD
**Draw the chart Prof Long gave us about the artery, heart wall/ventricle and correlating EKG leads
Draw the chart that you created when studying for the first EKG test
Draw the lecture version of the same EKG/artery chart
______ is the term used to describe chest discomfort related to ischemic heart disease
Angina Pectoris
What is the “typical angina” presentation? What are words that are used to describe the quality?
Typically male >50 or female >60 who presents with EPISODIC chest discomfort
heaviness, pressure, squeezing, smothering, aching or choking
Where does typical angina usually radiate? How long does it last? What setting? What are some alleviating factors?
Radiation to the arms/shoulders (left), neck, jaw, teeth, back/scapula, epigastrium
2-5 minutes
typically with exertion
NTG, rest
What is the abnormal presentation of a women having a heart attack?
SOB, pressure or pain in the lower chest or upper abdomen, dizziness, extreme fatigue, lightheadedness, fainting, or upper back pressure
T/F: Exercise stress tests are more likely to be accurate in women than men.
FALSE!!
Exercise stress test may be less accurate in women
How does Prinzmetal angina typically present? What is the tx? Who is the MC pt demographic? What will it look like on EKG?
chest pain due to vasospasm
Treated with CCB and nitrates
Most common in middle-aged women
mimics a STEMI on EKG
What does every pt with chest pain need?
EVERY PATIENT WITH CHEST PAIN GETS AN EKG/CXR. Add cardiac enzymes if clinically suspicious for ACS!
**What is the TIMI risk score? When is it used? What is considered low/intermediate/high?
TIMI (Thrombolysis in MI) Used in unstable angina and NSTEMI
used to risk stratify patients to help determine who should undergo aggressive evaluation / treatment. Event rates increase significantly as the TIMI risk score
0-2: Low risk
3-4: Intermediate risk
5 or more: High risk
**What are the 7 parameters for the TIMI risk score? Where are they used?
used in unstable angina and NSTEMI
What is the heart score? When is it used? What are the ranges with interpretation?
should you admit the pt based on their probability of having a major adverse cardiac event
**What are the 5 categories that make up the components of the heart score?
What are the risk factors when talking about the heart score?
DM
smoking
HTN
hypercholesterolemia
obesity
family hx of CAD
What makes the history score change from 0-2?
What makes the EKG score change from 0-2?
What is considered “repolarization” abnormalities” on EKG for the heart score system?
**What is the entire expanded heart score chart from lecture?
