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Cardiology (Fall 2023) > Ischemic heart disease part 1 > Flashcards

Ischemic heart disease part 1 Flashcards

1
Q

How common are heart attacks in US

A

someone has a heart attack every 40 seconds

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2
Q

how many heart attacks are silent

A

1 in 5

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3
Q

what are the MC risk factors for ischemic heart disease (IHD)

A
  • genetics
  • high fat and energy rich diet
  • smoking
  • sedentary lifestyle
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4
Q
A
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5
Q

what group is IHD growing among

A

low-income groups

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6
Q

what is the pathogenesis of IHD

A

the heart muscle is not perfused with blood leading to improper oxygenation and ischemic results.

(in notes)

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7
Q

what is the mechanism of myocaridal ischemia

A

very multifactoral but egnerally an imbalance between oxygen supply and demand.

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8
Q

what is oxygen supply determined by

A

blood flow which is regulated by pressure vs. resistance ratio

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9
Q

what is the most critical factor of blood flow and therefore oxygen supply

A

the radius of the blood vessel

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10
Q

what can influence the radius of the blood vessel

A

This is influenced by atherosclerosis hardening of vessels, vascular tone, and endothelial cell dysfunction in cardiac ischemia

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11
Q

what is the MCC of IHD

A

atherosclerosis (in notes slide 11)

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12
Q

what is considered a silent heart attack

A

found after the fact or incidentally due to symptoms not being indicative of myocardial infarction
(said in class)

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13
Q

what are the types of ischemic heart disease

A
  • prinzmetal angina
  • stbale angina
  • unstable angina
  • MI (stemi/nstemi)
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14
Q

what is included in acute coronary artery syndrome?

A
  • unstable angina
  • MI (stemi/nstemi)
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15
Q

flip to see a picture example of unstable, chronic stable and prinzmetal angina.

A
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16
Q

what is acute coronary syndrome

A

ACS results when there is plaque rupture and thrombus formation.

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17
Q

what determines the severity of ACS

A

the amount of coronary blood flow restriction

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18
Q

what are the three severity types of ACS

A
  • unstable angina - no occluded blood flow in coronary vessels but unstable plaque is still present leading to symptoms at rest
  • NSTEMI - partially impeded blood flow through the coronary vessels
  • STEMI - completely impeded blood flow through the coronary vessels
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19
Q

what is STABLE angina?

A
  • fixed stenosis!
  • occurs when the heart is under stress and needs more oxygen (exercise, cold, emotions)
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20
Q

how long does STABLE angina typically last

A
  • 1-15 minutes
  • goes away with rest and/or NTG
  • may continue without much change for years

(i assume this means it is intermittent!)

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21
Q

how does the pattern of unstable angina differ from stable angina

A
  • unstable angina is unexpected and a change in your usual pattern of stable angina
  • does NOT go away with nitroglycerin
  • considered an EMERGENCY. wanring that an MI is impending
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22
Q

what is prinzmetal angina

A

spasm of the vessel leading to reduced vessel diameter or decreased pressure, like in hypotension, that leads to poor perfusion

(said in class and at bottom of slide 11)

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23
Q
A
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24
Q

after occlusion of a coronary artery, the myocardium involves through various stages and degrees of severity of impact. what are these stages?

A
  • ischemia
  • injury
  • infarction
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25
Q

what is included in the ischemic phase of coronary artery occlusion

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 adequate blood flow / reoxygenation return, these cells usually return to a normal
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26
Q

what occurs during the injury phase of coronary artery occlusion

A
  • If ischemia is severe or prolonged, the anoxic cardiac cells sustain damage and stop functioning normally
  • Damage to the cells still remains reversible so that injured cells remain viable and salvageable for some time
  • Cells may return to normal or near normal after the return of adequate blood flow and reoxygenation
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27
Q

what is occuring in the infarction phase of coronary artery occlusion

A
  • Severe myocardial ischemia continues because of continued complete absence of blood supply
  • The anoxic cardiac cells will sustain irreversible injury and die.
  • DEAD MEAT DONT BEAT
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28
Q

once ischemia occurs what physiologically happens to the heart

A

The tissue will no longer contract and will not have normal function leading to ventricular arrhythmias, heart failure, and sudden death

(in notes on slide 16)

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29
Q

what is the definition of myocardial infarction

A

irreversible myocardial injury resulting in necrosis of a portion of the myocardium

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30
Q

ACUTE MI suggests the infarction is how old?

A

<3-5 days

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31
Q

what is the most concerning type of infarct?

A

transmural infarcts due to the amount of cardiac dysfunciton that results

( in notes, slide 17)

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32
Q

what are the types of myocardial infarctions?

A
  • subendocardial/NSTEMI/Non-Q Wave MI
  • Transmural/STEMI/Q wave MI
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33
Q

what is involved in subendocardial/NSTEMI/ non Q wave MI

A

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

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34
Q

what causes subendocardial/NSTEMI/ non Q wave MI

A

Caused by a local decrease in blood supply from narrowing of a coronary artery. The subendocardial area is particularly susceptible to ischemia.

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35
Q

what would the EKG show for subendocardial/NSTEMI/ non Q wave MI

A

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

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36
Q

what is involved in transmural/STEMI/ Q wave MI

A

Extend through the whole thickness of the heart muscle wall

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37
Q

what is the cause of transmural/STEMI/ Q wave MI

A

Associated with atherosclerosic plaques in a coronary artery that cause complete occlusion

38
Q

how is a transmural/STEMI/ Q wave MI labeled

A

Labeled by the wall involved: anterior, posterior, inferior, lateral, or septal

39
Q

what would an EKG show for transmural/STEMI/ Q wave MI

A

EKG → STEMI → Q waves

Tombstoning = grave prognosis

40
Q

what is the calssification of a Type 1 MI

A

Spontaneous MI related to ischemia due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection

41
Q

what is the classification of Type 2 MI

A

MI secondary to ischemia due to either ↑ oxygen demand or ↓ decreased supply (e.g. coronary artery spasm, coronary embolism, anemia, arrhythmias, HTN, or hypotension)

42
Q

what is the classification of type 3 MI

A

Sudden unexpected cardiac death, including cardiac arrest, often with symptoms suggestive of myocardial ischemia, accompanied by new ST elevation, or new LBBB, or evidence of fresh thrombus in a coronary artery by angiography and/or at autopsy, but death occurring before blood samples could be obtained, or at a time before the appearance of cardiac biomarkers in the blood

43
Q

what is the classification of type 4 MI

A

MI associated with coronary angioplasty or stents

44
Q

what is the classification of type 5 MI

A

MI associated with CABG

45
Q

can you have atherosclerotic blockages with a type 2 MI

A

yes, but it is not typically the main tissue!

(in notes on slide 23)

46
Q

What is silent ischemia and who is it most common in?

A
  • Myocardial ischemia without discomfort or pain
  • More common in diabetics, elderly patients, and women
47
Q

what is myocardial stunning

A
  • Reversible myocardial dysfunction following reperfusion of an ischemic insult
  • Initially appears to be permanently damaged but following early reperfusion, contractile function returns to normal
48
Q

what is hibernating myocardium

A
  • A result of prolonged reduction in blood flow from coronary artery disease
  • Causes ventricular contractile dysfunction that will improve once blood flow improves¹
49
Q

how is hibernating myocardium typically discovered

A

Hibernating myocardium is typically discovered by Cardiology following a MUGA scan (Multigated Acquisition Scan), which is a nuclear imaging technique used to measure EF

(in notes bottom of slides 24)

50
Q

Label this, itll come in handy

A
51
Q

try to label this too

A
52
Q

label it gurrrrl

A
53
Q

labellll ittttt

A
54
Q

what the actual heck is going on rn

A

mellert said:

55
Q

what does the right coronary artery supply

A
  • inferior wall LV
  • Right ventricle
56
Q

what is the significance of the right coronary artery in reference to MIs

A

assesses for inferior wall MIs. 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.

57
Q

what leads assess the Right coronary artery

A

II, III and aVF

58
Q
A
59
Q

what does the left anterior descending artery supply blood to

A
  • septal wall
  • anterior wall LV
60
Q

what is the significance of the left anterior descending artery in reference to MIs

A

AWMI - 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

61
Q

what is the EKG leads assessing Left anterior descending artery

A

V1-V4

62
Q

what does the left circumflex artery supply

A

lateral wall LV

63
Q

what EKG leads assess the left circumflex artery

A

I, aVL, V5, and V6

64
Q

if your brain works like this it may be good to label this~!

A
65
Q

what are the 2 questions to consider when initially evaluating a patient with suspected MI

A
  1. how likely is ACS?
  2. what is the risk of adverse events
66
Q

what is the term used to describe chest discomfort related to IHD

A

angina pectoris

67
Q

what is the typical patient presentation in MI

A
  • male>50 or female>60
  • episodic chest discomfort!
68
Q

what is the description of the chest pain that occurs with typical angina pectoris

A
  • quality - heavy, presssure, squeezing, smothering, aching, choking. rarely described as pain
  • location - substernal, central.
  • radiation to shoulder, jaw, shoulders/back
69
Q

what is the duration of episodic chest discomfort in a typical MI patient

A
  • Duration: 2-5 minutes, crescendo-decrescendo
  • Setting: typically with exertion
  • Severity: varies and may not correlated with extent of myocardial injury
70
Q

what are aggravating and alleviating factors for a typical mI patient

A
  • activity/exercise, meals, stress/strong emotion, cold, sex, morning time, supine position
  • Alleviating - NTG, rest
71
Q

what are associated S/Sx for MI patients

A
  • SOB
  • N/V
  • diaphoresis
  • fatigue
  • weakness
  • feeling of impending doom
  • paresthesias
  • dizziness
  • fever
72
Q

what are associated symptoms for women that are different from normal associated symptoms

A
  • pressure/pain in lower chest/upper abdomen
  • extreme fatigue
  • lightheadedness
  • fainting
  • upper back pressure
73
Q

what may be less accurate in women

A

exercise stress tests!

74
Q

why are MIs so important to catch in women

A

Women are are more likely to die after their first heart attack

75
Q

what are PE findings for MI

A
76
Q

what are 2 big differentials for chest pain ( i dont usually memorize these, but for some reason this slide looks important)

A
  • atheroscleosis (stenosis or plaque rupture)
  • variant (prinzmetal) angina
77
Q

what is the MC artery involved in variant (prinzmetal) angina

A

RCA

78
Q

what is prinzmetal angina treated with

A

CCB and nitrates

79
Q

who is prinzmetal angina MC in

A

middle aged women

80
Q

what does prinzmetal angina look like on an EKG

A

mimics STEMI on EKG

81
Q

what are diagnostic studies that could be done in a “chest pain” patient

A
  • EKG ALWAYS
  • cardiac biomarkers (almost always)
  • stress testing
  • coronary angiogram
  • imaging
82
Q

Prof mellert said this is super helpful becuase it contains everything from this lecture and the next lecture

A
82
Q

what is the TIMI risk score (not on test but will be on PANCE)

A

TIMI (Thrombolysis in MI) Risk Score is used to risk stratify patients to help determine who should undergo aggressive evaluation / treatment. Event rates increase significantly as the TIMI risk score increases.

83
Q

what is considered low, intermediate, and high risk TIMI score (not on test but will be on PANCE)

A
  • 0-2: Low risk
  • 3-4: Intermediate risk
  • 5 or more: High risk
84
Q

what are the 7 questions used in the TIMI risk score (not on test but will be on PANCE)

A
  1. Aged ≥ 65 years
  2. ≥3 CAD risk factors (HTN, DM, HLD, smoking, + FH early MI)
  3. Prior CAD (stenosis >50%)
  4. Aspirin in last 7 days
  5. Severe angina ( >2 anginal events within 24 hours)
  6. ST deviation on admission EKG ( >0.5mm)
  7. Elevated cardiac markers (CK-MB or troponin)

add 1 point for each of these

85
Q

what is heart score (WILL BE ON TEST)

A

A risk assessment for major adverse cardiac events that can help decide whether to discharge, admit for observation, or admit w/ early invasive strategies.

86
Q

what are the three categories of heart score and their interpretations.

A
  • 0-3 -> risk 2.5% -> discharge
  • 4-6 -> risk of 22.3% -> admit for obs
  • 7-10 -> risk of 72.7% -> admit w/early invasive strategies
87
Q

what are the 5 categories that determine heart score?

A
  • History
  • ECG
  • Age
  • Risk factors
  • Troponin

“HEART” score

88
Q

flip for another variation of heart score chart

A

she said this is breaking down what heart score stands for. HEART SCORE IS TESTABLE pleassssseeeee know this!

89
Q

FLIP FOR DOGGOOOOO!!!! congrats on finishing another lecture!

A

Cardiology (Fall 2023) (45 decks)

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