Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular > Ischemic Heart Disease Part 1 > Flashcards

Ischemic Heart Disease Part 1 Flashcards

1
Q

How many heart attcks are silent?

A

1 in 5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common serious chronic life-threatening illness in the US?

A

IHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the most common risk factors for IHD?

A
  • Genetic influences
  • high-fat and energy-rich diet
  • smoking
  • sedentary lifestyle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In the US, IHD is growing among which groups?

A

Low-income

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is myocardial ischemia a supply and demand problem?

A

Myocardial ischemia results from an increase in demand with not enough supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What generally causes myocardial ischemia?

A
  • Imbalance between oxygen supply and demand
  • Oxygen supply determined by blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is blood flow regulated?

A

Pressure vs resistance ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most critical factor in the pathogenesis of myocardial ischemia? What impacts this?

A
  • Radius of the blood vessel
  • Atherosclerosis
  • Vascular tone
  • Endothelial cell dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is prinzmetal angina?

A

Coronary vessels spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is stable angina?

A

Plaque is walled off and not causing full blockage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is unstable angina?

A

Haven’t completely clogged vessel, but have pain at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is a myocardial infarction?

A

Complete blockage of the coronary vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does acute coronary syndrome include?

A

Myocardial infarction and unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes ACS?

A

Plaque rupture and thrombus formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is an NSTEMI?

A

Partially impeded blood flow through coronary vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a STEMI?

A

Completely impeded blood flow through coronary vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are characteristics of stable angina?

A
  • Typical predictable pattern
  • Occurs when heart under stress with higher O2 demand
  • Typically lasts 15 mins
  • Goes away with rest and/or NTG
  • May continue without change for years
  • Fixed stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are characteristics of unstable angina?

A
  • Unexpected change in usual pattern of stable angina
  • Blood flow to heart suddenly slowed by narrowed vessels or thrombus in coronary arteries
  • May happen at rest and does not away
  • Warning sign that MI is impending (EMERGENCY!)
  • Due to formation and dissolution of thrombus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the 3 stages after occlusion of a coronary artery?

A
  • Ischemia
  • Injury
  • Infarct
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When happens with ischemia after occlusion of a coronary artery?

A
  • Cardiac cells can tolerate mild-moderate anoxia for short time without impact on function
  • Present as soon as decrease or absence of blood supply
  • Cells return to normal when blood flow returns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What happens with injury after occlusion of a coronary artery

A
  • Ischemia is severe or prolonged –> cardiac cells sustain damage and don’t function normally
  • Damage to cells is reversible for some time
  • Cells return to normal or near normal after return of blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What happens during infarction after occlusions of a coronary artery?

A

*Complete absence of blood supply
* Anoxic cardiac cells sustain irreversible injury and die

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does irreversible myocardial injury result in during myocardial infarction?

A

Necrosis of a portion of the myocardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does it mean when someone says they had a acute MI?

A

<3-5 days old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a subendocardial/NSTEMI/Non-Q wave MI?

A
  • Involves small area in subendocardial wall of LV, ventricular septum, or papillary muscle
  • Caused by local decrease in blood from narrowing of coronary artery
  • Subendocardial area particularly susceptible to ischemia
  • EKG –> ST depression or T wave inversion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a transmural/STEMI/Q wave MI?

A
  • Extends through whole thickness of heart muscle wall
  • Associated with atherosclerotic plaques in a coronary artery that cause complete occlusion
  • Labeled by wall involved (anterior, posterior, inferior, lateral, or septal)
  • EKG –> STEMI –> Q Waves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What type of MI is more severe and has a high risk of complications?

A

Transmural/STEMI/Q Wave MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is a type I MI?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is a type II MI?

A

MI secondary to ischemia due to either increased oxygen demand or decreased supply (ex coronary artery spasm, coronary embolism, anemia, arrhythmias, HTN, or hypotension)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is a Type III MI?

A

Sudden unexpected cardiac death, including cardiac arrest, often with symptoms suggestive of myocardial ischemia

Death before blood samples could be obtained or at a time before the appearance of cardiac biomarkers in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a Type 4 MI?

A

MI associated with coronary angioplasty or stents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a type 5 MI?

A

MI associated with CABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is silent ischemia?

A

Myocardial ischemia without discomfort or pain
Exact mechanism unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Who more commonly has silent ischemia?

A
  • Diabetics
  • Elderly patients
  • Women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is myocardial stunning?

A
  • Reversible myocardial dysfunction following reperfusion of an ischemic insult
  • Initially appears permanently damaged but following early reperfusion contractile function returns to normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is hibernating myocardium?

A
  • Prolonged reduction in blood flow from coronary artery disease
  • Causes ventricular contractile dysfunction that will improve once blood flow improves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the main artery that goes to the right side of the heart?

A

Right coronary artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Which artery feeds the left ventricle?

A

Left anterior descending (anterior interventricular branch)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Which artery feeds the back side of the heart?

A

Posterior left ventricular branch and PDA

39
Q

Which artery feeds the SA node?

A

SA nodal branch from circumflex branch

40
Q

What vessels feed the right side of the heart?

A

Right coronary –> marginal and posterior descending

RaMP

41
Q

If the RCA is blocked which portions of the myocardium will be affected?

A

Inferior wall LV and Right ventricle

42
Q

What vessels feed the left side of the heart?

A

Left coronary –> circumflex and anterior descending

LoCA

43
Q

What is the clinical significance of a inferior wall MI?

A

Often accompanied by a decrease in HR because of involvement of the sinus node. Long term effects usually less severe than anterior wall MI

44
Q

What ECG leads correspond to a RCA block?

A

Goes to inferior wall and R ventricle so II, III, aVF (inferior leads)

45
Q

If the PDA is blocked, what area of the myocardium would be affected?

A

Posterior wall

45
Q

What leads would be impacted by a LAD block?

A

V1-V4

45
Q

If the LAD is blocked, what areas of the myocardium would be affected?

A

Septal wall and anterior wall LV

46
Q

What is the significance of a anterior wall LAD blockage impacting the anterior wall LV?

A

Anterior wall performs main pump function and decay of the function of this wall will lead to decreased BP, increased HR, shock, and HF long term

47
Q

What area of the myocardium would be impacted by a left circumflex blockage?

A

Lateral wall LV

48
Q

What ECG leads are impacted by a blockage in the left circumflex?

A

I, aVL, V5, V6

there is a chart on all of this if it is helpful

49
Q

What are two questions to consider in initial evaluation of ischemic heart disease?

A

1) How likely is ACS
2) What is the risk of adverse events

50
Q

What do we need to do when a patient presents with chest discomfort?

A
  • A detailed history
  • An appropriate, focused physical exam
  • Consideration of patient risk factors

–> estimate the probability of signficiant CAD (high, intermediate, or low)

51
Q

What term is used to describe chest discomfort related to IHD?

A

Angina pectoris

52
Q

What is the typical cause of angina pectoris? What else could cause it?

A
  • atherosclerosis
  • anxiety
  • PE
  • pericarditis
  • reflux
  • muscle strain/costochondritis
  • LVH
  • aortic stenosis or regurgitation
53
Q

What is the typical patient presentation of someone with a MI?

A
  • Male >50 or female >60
  • Episodic chest discomfort
54
Q

How might someone describe the quality of a MI?

A
  • Heavy
  • Pressure
  • Squeezing
  • Smothering
  • Aching
  • Choking
55
Q

Where is the pain due to an MI usually located?

A
  • Substernal, central chest
  • Radiation to arms/shoulders (left), neck, jaw, teeth, back/scapula, epigastrium
  • Unlikely to radiate above mandible or below epigastrium
56
Q

What is the timing usually for a MI?

A
  • Sudden constant pain
57
Q

What is the usual duration of chest discomfort with ischemic heart disease?

A
  • 2-5 minutes
  • Crescendo-decrescendo
58
Q

What setting does chest discomfort usually occur in due to IHD?

A

exertion

59
Q

What is the severity of chest discomfort with IHD?

A

varies and may not be correlated with extent of myocardial injury

60
Q

What aggravating or alleviating factors may be present with IHD?

A
  • Aggravating: activity/exercise, meals, stress/strong emotion, cold exposure, sexual activity, morning, supine position
  • Alleviating: NTG, rest
61
Q

What associated symptoms may be present in an MI patient?

A
  • SOB
  • N/V
  • Diaphoresis
  • Fatigue
  • Weakness
  • Feeling of impending doom
  • Paresthesias
  • Dizzy
  • Fever
62
Q

How might women experiencing an MI present?

A
  • SOB
  • Pressure or pain in the lower chest or upper abdomen
  • Dizziness
  • Extreme fatigue
  • Lightheadedness
  • Fainting
  • Upper back pressure
63
Q

What may be less accurate in women?

A

Exercise stress test

64
Q

which population is more likely to die after their first heart attack?

A

Women

65
Q

What will vital signs be like with an MI?

A
  • Hypotension or HTN, tachycardia or bradycardia, nonspecific fever

Can also be normal

66
Q

What general findings may be present in an MI PE?

A
  • Anxious
  • Restless
  • Diaphoretic
  • Pallor
  • Confusion
67
Q

What CV findings may be present during an MI PE?

A
  • Arrhythmia
  • Muffled heart sounds
  • S4 gallop
  • JVD
  • New heart sounds/murmurs
  • Diminished peripheral pulses
  • Pericardial rub
68
Q

What Pulm findings may be present during an MI PE?

A
  • Pulmonary rales or wheezing
  • Pulmonary edema
  • Labored breathing if in LV failure
69
Q

What should you look for on neuro exam of a suspected MI?

A
  • Signs of altered levels of consciousness
  • CVA
70
Q

What is variant (Prinzmetal) angina?

A
  • Results in vasospasm
  • May occur at site of atherosclerosis or in normal vessels
  • Often involves RCA
71
Q

How is variant (Prinzmetal) angina treated?

A
  • CCB and nitrates
72
Q

Who most commonly has prinzmetal angina?

A

Middle-aged women

73
Q

How will prinzmetal angina present on EKG?

A

mimics STEMI

74
Q

What are other coronary artery associated causes of chest pain?

A
  • Aortic dissection
  • Coronary embolism
  • Coronary arteritis
  • Congenital abnormalities/anomalies
  • Cocaine-induced vasospasm
75
Q

What are non-coronary causes of myocardial O2 supply-demand mismatch?

A
  • Hypotension
  • HTN
  • Hypertrophic CM
  • Severe myocardial hypertrophy
  • Severe AS/AR
  • Pericarditis
  • In response to increased metabolic demands (hyperthyroidism, anemia, paroxysmal tachyarrhythmias)
76
Q

what are non-ischemic myocardial injury causes of chest pain?

A
  • Myocarditis
  • Non-ischemic cardiomyopathy
  • Cardiac contusion
  • Cardiotoxic drugs
  • Multifactorial causes: Takotsubo, cardiomyopathy, PE, severe HF, sepsis
77
Q

What conditions related to the pulmonary system can cause chest pain?

A
  • Pulmonary embolus
  • Pneumothorax
  • Pneumonia
  • Pleuritis
  • Pulmonary HTN/cor pulmonale
78
Q

What conditions related to the chest wall can cause chest pain?

A
  • Costochondritis
  • Fibrositis
  • Rib fracture
  • Sternoclavicular arthritis
  • Herpes zoster
79
Q

What conditions related to the GI system can cause chest pain?

A
  • Esophageal: esophagitis, spasm, reflux, rupture
  • Other: peptic ulcer, pancreatitis
  • Biliary: colic, cholecystitis, choledocholithiasis, cholangitis
80
Q

What psych conditions can cause chest pain?

A
  • Anxiety disorders: hyperventilation, panic disorder, primary anxiety
  • Affective disorders: depression
  • Somatoform disorders
81
Q

What diagnostic testing can be performed for a chest pain patient?

A
  • Everyone gets EKG +/- cardiac biomarkers
  • Stress testing
  • Coronary angiogram
  • Imaging
82
Q

What sorts of stress tests can be performed?

A
  • Exercise stress test alone
  • Exercise stress test with nuclear imaging component
  • Pharmacologic stress test with nuclear imaging
  • Exercise stress test with imaging
83
Q

What imaging studies can be performed for a chest pain patient?

A
  • CT angiogram
  • Echocardiogram (transthoracic and transesophageal)
  • CT angiogram or V/Q scan to r/o PE
  • Electron beam CT scan (for coronary calcification)
84
Q

What is used to risk stratify patients to help determine who should undergo aggressive evaluation/treatment

A

TIMI (Thrombolysis in MI)

85
Q

What are 7 components of a TIMI score?

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 (>.5 mm)
  7. Elevated cardiac markers (CK-MB or troponin)
86
Q

How many points does a patient need to be low risk, intermediate risk, or high risk on TIMI score?

A

Low risk: 0-2
Intermediate risk: 3-4
High risk: 5+

87
Q

What are components of the HEART score?

A
  • History
  • EKG
  • Age
  • Risk factors
  • Troponin
88
Q

What HEART score indicates that a patient should be discharged? Admitted for observation? Admit with early invasive strategies?

A
  • 0-3 (risk of MACE - 2.5%)
  • 4-6 (risk of MACE - 22.3%)
  • 7-10 (risk of MACE - 72.7%)
89
Q

What age is considered a score of 1 on HEART score? 2?

A
  • between 45 and 64
  • 65 or older
90
Q

What is a score of 1 on the HEART score for risk factors? 2?

A

1 to 2 risk factors
3 or more risk factors

91
Q

What is considered elevated troponin for a score of 1 on HEART score? 2?

A
  • troponing <.04 is 0
  • elevated 1-3 times discriminative +/- .04-.12 ng/ml
  • elevated >3 times, discriminative, +/- accutroponin I >.12
92
Q

What are risk factors for HEART score?

A
  • BBB, LVH, digoxin effect, implanted right-ventricular pacemaker, past MI, +/- unchanged repolarization abnormalities
  • DM, tobacco smoker, HTN, hypercholesterolemia, obesity, +/- family history of CAD
  • Peripheral arterial disease, MI, past coronary revascularization procedure +/- stroke

Cardiovascular (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions