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Cardio Exam 2 > lecture 5a > Flashcards

lecture 5a Flashcards

1
Q

ischemia heart disease (IHD) definition

A

a condition in which there is an inadequate supply of blood & oxygen to a portion of the myocardium

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2
Q

IHD typically occurs when

A

there is an imbalance between myocardial oxygen supply ad demand

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3
Q

the most common cause of myocardial ischemia is

A

atherosclerotic disease of an epicardical coronary artery (90%) sufficient to cause a regional reduction in myocardial blood flow and inadequate perfusion of the myocardium supplied by the involved coronary artery

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4
Q

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

A

IHD

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5
Q

what are associated with IHD

A

genetic factors, high-fat & energy rich diet, smoking & a sedentary lifestyle

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6
Q

powerful risk factors for IHD

A

obesity, insulin resistance, & T2DM

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7
Q

MVO2 (myocardial oxygen demand)=

A

O2 delivery

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8
Q

hypoxia

A
  • lack of oxygen
  • exacerbates effects of atherosclerosis
  • anemia
  • cyanotic heart disease
  • advanced lung disease
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9
Q

ischemia

A

mainly lack of oxygen, but also nutrients

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10
Q

factors that effect MVO2 (myocardial oxygen demand)

A 
HR
myocardial contractility
myocardial wall tension (stress)
BP
ionotropic status
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11
Q

adequate oxygen-carrying capacity of blood is determined by

A
  • inspired level of oxygen
  • pulmonary function
  • hemoglobin concentration & function
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12
Q

blood flows through the coronary arteries in a phasic fashion, with majority occuring during

A

diastole

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13
Q

75% of the total coronary resistance to flow occurs across 3 sets of arteries

A
  1. Large epicardial arteries (R1)
  2. prearteriolar vessels (R2)
  3. arteriolar & intramyocardial capillary vessels (R3)
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14
Q

in the absense of significant flow-limiting atherosclerotic obstructions, R1 is tirvial:

A

the major determinant of coronary resistance is found in R2 and R3

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15
Q

coronary circulation is controlled by the heart’s requirements for oxygen

A

metabolic regulation

auto regulation

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16
Q

metabolic regulation

A

exercise, emotional stress (coronary vascular resistance)

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17
Q

auto regulation

A

the coronary blood flow is maintained on the same level, independently on physiological alterations in BP

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18
Q

large portion of the myocardium is effects if atheroscleosis occurs

A

in left coronary artery

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19
Q

rupture

A

fibrous cap is broke

- tissue factor is released & initiates coagulation

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20
Q

other causes of ischemia

A
  • spasms: prinzmetal’s angina
  • thrombi
  • emboli
  • BP decrease
  • ostial narrowing due to aortitis
  • congenital abnormalities
  • severe left ventricular hypetrophy due to aortic stenosis
  • severe anemia or the presence of carboxyhemoglobin
  • abnormal constriction or failure of normal dilation of the coronary resistance vessels
21
Q

where does atheroscleosis occur?

A
  • sites of increased turbulence in coronary flow

- brand points in the epicardial arteries

22
Q

risk factors for atherosclerosis & IHD

A 
high LDL
low HDL
smoking
HTN
DM
23
Q

severity of symptoms depends on

A

degree & location of stenosis & how fast it develops

24
Q

50% stenosis

A

limited ability to increase blood flow in the response to an increased demand

25
Q

80% stenosis

A

blood flow at rest may be reduced

26
Q

stenosis where are particularly hazardous?

A

of the left main coronary artery of the proximal left anterior descending coronary artery

27
Q

gradually developing stenosis causes formation of

A

collateral vessels

- these are good!

28
Q

stenosis of the epicardial artery leads to

A

the dilation of the distal resistance vessels

29
Q

effects of ischemia

A
  • inadequate perfusion
  • decreased myocardial O2 tension
  • mechanical, biochemial & electrical disturbances
  • regional disturbances of ventricular contractility
  • segmental hypokinesia
  • segmental akinesia
  • segmental dyskinesia
  • reduced myocardial pump function
30
Q

effects of acute ischemia

A

(failure of relaxation & contraction)

  • transient left ventricular failure
  • mitral regurgitation if the papillary muscle apparatus is involved
31
Q

left ventricular failure

A
  • worst scenario!
  • dramatic < BP
  • hypoperfusion to the brain
  • stroke
32
Q

mitral reguritation

A
  • blood flowing back

- problems in the pulmonary circulation

33
Q

transient ischemia

A

angina pectoris

34
Q

prolonged ischemia

A

actute MI

35
Q

infarction=

A

tissue necrosis

- irreversible tissue damage

36
Q

ECG effects of ischemia

A
  • nature of process (reversible vs irreversible
  • duration (acute vs chronic)
  • the extent (transmural vs subendocardial)
    localization (anterior vs inferioposterior)
  • presence of other underlying abnormalities (ventricular hypertrophy, conduction defects)
37
Q

ST depression

A

Partial thickness

possible ischemia

38
Q

ST elevation

A

total thickness

MI

39
Q

effects of ischemia: arrhythmias

A
  • electrical instability, which may lead to isolated ventricular premature beats or even ventricular tachycardia or ventricular fibrillation
  • most patients who die suddenly from IHD do so as a result of ischemia-induced ventricular tachyarrhythmias
40
Q

IHD can be classified as

A

chronic coronary artery disease or

acute coronary syndromes

41
Q

chronic coronary artery disease (CAD)

A

stable angina

42
Q

acute coronary syndromes (ACS)

A
  • STEMI
  • unstable angina
  • NSTEMI
  • sudden cardiac death
  • prinzmental’s variant angina
43
Q

CAD- stable angina pectoris clinical manifestations

A
  • male >50 or women >60
  • chest discomfort
  • crescendo-decresendo
  • can radiate down shoulder & to both arms
  • can arise or radiate to the back, interscapular region, root of neck, teeth & epigrastric
  • rarely localized below umilicus or above mandible
  • episodes typically caused by exertion or emotion, heavy meal or cold
  • symptoms releived by SL NTG***
44
Q

symptom of myocardial ischemia

A
  • angina
  • dyspnea
  • nausea
  • fatigue
  • faintness
45
Q

may indicate UA

A
  • angina occurring with less exertion than in the past, occurring at rest or awakening the patient from sleep
46
Q

patients should be questioned & examined for

A

claudication, stroke & transient ischemia attacks

47
Q

evidence of atherosclerotic disease at other sites

A
  • abdominal aortic aneurysm
  • carotid arterial bruits
  • diminished arterial pulses on lower extremities
48
Q

laboratory exam

A
  • check urine for evidence of DM & renal disease
  • cholesterol, glucose, Creatinine, Hct, thyroid function
  • X-ray- cardiac enlargement, aneurysms, signs of heart failure
  • C-reactive protein
  • ECG
  • stress testing
  • cardiac imaging
  • coronary arteriography

Cardio Exam 2 (12 decks)

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