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Cardio > Ischemic Heart Disease I - Exam 2 > Flashcards

Ischemic Heart Disease I - Exam 2 Flashcards

1
Q

In general, why does mycocardial ischemia occur? What is the most critical factor?

A

occurs when there is an imbalance between oxygen supply and demand

radius of the blood vessel

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2
Q

What are the 3 factors that influence the radius of the blood vessel?

A

atherosclerosis hardening of vessels

vascular tone

endothelial cell dysfunction in cardiac ischemia

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3
Q

What is the difference between stable and unstable angina?

A

stable: chest pain on exertion

unstable: constant chest pain even at rest

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4
Q

What conditions are included in Acute Coronary Syndrome (ACS)? What conditions are included in Ischemic Heart Disease?

A

unstable angina

MI: including STEMI and NSTEMI

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5
Q

What is Prinzmetal angina?

A

not scary spasms of the blood vessels

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6
Q

What is Acute Coronary Syndrome a result of? What determines the severity?

A

ACS results when there is plaque rupture and thrombus formation

the amount of coronary blood flow

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7
Q

What are the differences in blood flow between unstable angina, NSTEMI and STEMI?

A
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8
Q

What are the differences between stable and unstable angina?

A
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9
Q

When does ischemia present? Can cardiac cells tolerate mild-moderate anoxia?

A

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

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10
Q

When does cardiac injury appear? Is it usually reversible?

A

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

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11
Q

When does an infarct occur? Is it reversible?

A

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!!

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12
Q

What is a transmural infarct?

A

When the tissue dies through all the layers of the heart

aka VERY BAD

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12
Q

What areas are common for NSTEMI? What area is particularly susceptible to ischemia?

A

Involves small area in the subendocardial wall of the LV, ventricular septum, or papillary muscle

subendocardial area

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13
Q

What are the EKG changes associated with NSTEMI? Will there be an increase in cardiac enzymes?

A

ST depression or T-wave inversion (or no EKG changes)

will see an increase in cardiac enzymes

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14
Q

Will there be an increase in cardiac enzymes with unstable angina?

A

NO increase in cardiac enzymes

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15
Q

What is the cause of a STEMI?

A

infarct through the extend through the whole thickness of the heart muscle wall, that is caused by the complete occlusion of a coronary artery

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16
Q

What are EKG changes that will appear with a STEMI? ______ is the classic description of the wave

A

ST elevation!!! and SOMETIMES develop a Q wave (but not always)

“tombstone” appearance

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17
Q

What are the 5 different types of MI classifications? **Type 1 and 2 are the highlighted ones

A

**Type 1: primary coronary event

**Type 2: MI secondary to ischemia

18
Q

What is silent ischemia? **What are the top 3 pt demographics?

A

Myocardial ischemia without discomfort or pain

**More common in diabetics, elderly patients, and women

19
Q

What is myocardial stunning?

A

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

20
Q

What is hibernating myocardium a result of? What does it cause?

A

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

21
Q

**What is the significance of an inferior wall MI? What artery is that associated with?

A

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

22
Q

**What is the significance of an anterior wall MI? **What artery?

A

**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

23
Q

**Draw the chart Prof Long gave us about the artery, heart wall/ventricle and correlating EKG leads

A
24
Q

Draw the chart that you created when studying for the first EKG test

A
25
Q

Draw the lecture version of the same EKG/artery chart

A
26
Q

______ is the term used to describe chest discomfort related to ischemic heart disease

A

Angina Pectoris

27
Q

What is the “typical angina” presentation? What are words that are used to describe the quality?

A

Typically male >50 or female >60 who presents with EPISODIC chest discomfort

heaviness, pressure, squeezing, smothering, aching or choking

28
Q

Where does typical angina usually radiate? How long does it last? What setting? What are some alleviating factors?

A

Radiation to the arms/shoulders (left), neck, jaw, teeth, back/scapula, epigastrium

2-5 minutes

typically with exertion

NTG, rest

29
Q

What is the abnormal presentation of a women having a heart attack?

A

SOB, pressure or pain in the lower chest or upper abdomen, dizziness, extreme fatigue, lightheadedness, fainting, or upper back pressure

30
Q

T/F: Exercise stress tests are more likely to be accurate in women than men.

A

FALSE!!

Exercise stress test may be less accurate in women

31
Q

How does Prinzmetal angina typically present? What is the tx? Who is the MC pt demographic? What will it look like on EKG?

A

chest pain due to vasospasm

Treated with CCB and nitrates

Most common in middle-aged women

mimics a STEMI on EKG

32
Q

What does every pt with chest pain need?

A

EVERY PATIENT WITH CHEST PAIN GETS AN EKG/CXR. Add cardiac enzymes if clinically suspicious for ACS!

33
Q

**What is the TIMI risk score? When is it used? What is considered low/intermediate/high?

A

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

34
Q

**What are the 7 parameters for the TIMI risk score? Where are they used?

A

used in unstable angina and NSTEMI

35
Q

What is the heart score? When is it used? What are the ranges with interpretation?

A

should you admit the pt based on their probability of having a major adverse cardiac event

36
Q

**What are the 5 categories that make up the components of the heart score?

A
37
Q

What are the risk factors when talking about the heart score?

A

DM
smoking
HTN
hypercholesterolemia
obesity
family hx of CAD

38
Q

What makes the history score change from 0-2?

A
39
Q

What makes the EKG score change from 0-2?

A
40
Q

What is considered “repolarization” abnormalities” on EKG for the heart score system?

A
41
Q

**What is the entire expanded heart score chart from lecture?

A
42
Q
A

Cardio (24 decks)

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