Ischemic or CHD Pt 1 Flashcards
An insufficient supply of oxygenated blood results in what?
Ischemia
Blockage of coronary artery(s) results in damage/injury
What is ischemia seen on an EKG as?
ST depression
Cell death or necrosis is a result of ______
MI (myocardial infarction)
MI is seen on an EKG as an ________
ST elevation
What is the leading cause of death in the US?
MI
What does a ST segment greater than 1mm indicative of?
That there is an acute evolving MI
Ischemia may involve an inverted what on EKG?
T wave
What is a visible Q on EKG indicative of?
A previous infarction
The Q wave remains abnormal due to scar formation
What are the non-modifiable risks?
Advancing Age
Gender- especially men and post menopausal women
Family History
What are the modifiable risk factors?
Diabetes Smoking HTN High Cholesterol Obesity Sedentary Lifestyle Stress Over Consumption of Alcohol
What are causes of Ischemic Heart Disease?
Atherosclerosis Thrombosis Coronary Spasm Decreased Coronary Flow Abnormal Coronary Artery Development
What is the inflammatory process?
Gradual build up of atherosclerotic material
damages arterial walls.
-WBCs respond- inflammatory response further damages walls allowing LDL molecules to infiltrate.
-Fatty (lipid) streak develops. May harden and narrow vessel or may rupture.
-Response to rupture is blood clot formation, may further obstruct artery OR plaque may embolize & block smaller arterial branch.
Ischemia or MI
What is angina pectoris?
Chest pain due to myocardial ischemia
Stable angina pectoris?
effort induced
short lasting
relieved by rest or NTG
Unstable Angina (USA) pectoris tends to?
Lasts longer
More often
Not always related to exertion
NTG temporarily relieves
Variant Angina is also known as
Prinzmetal’s Angina
Variant Angina occurs?
At rest
Early in the Morning
Thought to be a coronary artery spasm
What is Variant Angina often associated with on EKG?
ST segment elevation
Besides angina, what are other symptoms associated with IHD?
Fatigue
Silent MI, an MI can be silent ( mild/non-existent symptoms)
Detection of a new murmur post MI
Sudden Death
Detection of a new murmur post MI may be due to what?
MR due to pap muscle dysfx/rupture, VSD, LV dilation
With sudden death up to what % is due to MI’s
35%
What percentage have no symptoms prior to MI?
Up to 50%
Men v Women
Symptoms for Men
Typical Chest pressure
pain radiating to neck, jaw, and left arm
nausea
sweating
Men v Women
Symptoms for Women
Chest pain Profound fatigue Chest- area pressure, constant/intermittent SOA Fast, weak pulse Dizziness, fainting Nausea Sweating
-Relevant Facts for Women- Kills more women annually than \_\_\_\_\_\_ More prevalent after \_\_\_\_\_\_\_ More likely than men to \_\_\_\_\_\_ More \_\_\_\_\_\_ than men's MI's
Breast CA+accidents+diabetes
Menopause
Die within one year of first MI
Damaging
What are the Diagnostic tests for IHD/CAD
Cardiac Cath Echo Stress Echo Nuclear Stress Testing EKG Blood Tests: enzymes, or other markers
Which diagnostic test is the Gold Standard for IHD/CAD?
Cardiac Cath
Stress Echo
Evaluates functional response of heart by detecting WMA’s
Nuclear Stress Test
Detects perfusion abnormalities
Relevant Blood Tests
What cardiac enzymes increase with MI?
Troponin Creatinine Kinase (CK) -CK-MB Creatinine phosphokinase (CPK)
What is bad cholesterol?
LDL
What is good cholesterol?
HDL
Relevant Blood Tests Clotting Factors (Blood Clotting Time)
Prothrombin time (pro time, PT time, PTT, INR)
Relevant Blood Tests
C-reactive protein (CRP)
An indicator/marker of inflammation in the body
Clot Busters (thrombolysis)
Within 3 hours of onset of symptoms
- Streptokinase
- Urokinase
- tPA (tissue plasminogen activator)
Statins
Reduce cholesterol, triglycerides
Nitrates
Vasodilators, CP relief
Antiplatelets
Reduce clot formation
Beta Blockers and Calcium Channel Blockers
Reduce workload of the heart
