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Cardio MT2 > MT2_5_Ischemic Heart Disease > Flashcards

MT2_5_Ischemic Heart Disease Flashcards

1
Q

what falls under stable coronary disease?

A
  • chronic stable angina
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2
Q

what falls under acute coronary syndromes?

A
  • unstable angina
  • non-st elevation MI
  • st elevation MI
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3
Q

What is the most common cause of MI?

A
  • coronary artery disease (atherosclerosis)..can be stable or unstable
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4
Q

where are the arteries located, and why is diastole important?

A

arteries are on the epicardial surface, and diastole is important bc that is when coronary artery perfusion occurs.

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5
Q

why does ischemia occur?

A
  • when supply does not equal demand…for O2
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6
Q

What are the three things that affect coronary blood flow, and O2 SUPPLY?

A
  1. Coronary blood flow
    • vessel potency–obstruction
    • vasc. resistance of coronary arteries (dilatation)
    • heart rate (since arteries are perfused during diastole)
  2. O2 carrying capacity
  3. Collaterals (development of new blood vessels)
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7
Q

What are the three things that affect myocardial oxygen DEMAND (MVO2)?

A
  1. heart rate (need more atp)
  2. contractility (contractile myocytes require atp)
  3. wall tension/wall stress (preload and after load)
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8
Q

How do we estimate MVO2?

A
  • SBP times HR = rate pressure product
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9
Q

What are the most common causes of diminished coronary artery blood flow?

A
  1. **stable CAD +/- plaque rupture and atherothrombosis

2. coronary artery spasm (can occur w/o plaques)

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10
Q

define artheroclerosis

A
  • disease affecting arterial blood vessels, due to deposition and invasion of macrophages into arterial walls
  • this results in narrowing of artery lumen
  • reduced vascular reactivity (so stiffening and endothelial dysfunction)
  • unstable plaques can rupture
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11
Q

Define stable angina

A
  • atherosclerosis leads to……
  • diminished coronary artery lumen
  • endothelial dysfunction
  • reduced vessel compliance

resulting in a gradual reduction of coronary blood/O2 supply
= stable symptoms

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12
Q

Define acute coronary syndrome

A
  • the plaques rupture, leading to atherothrombosis, and a rapid loss of coronary blood/O2 supply
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13
Q

Summarize the sequence of events of an atherosclerotic event

A
  • plaque formation..chornic, leading to ischemia if MVO2 is INcreased
  • plaque disruption (or vas-spasmes) due to a sudden change in pressure
  • thrombus formation ( resulting in acute partial or complete obstruction of the artery)
  • ischemia (which can occur even without an increase in MVO2 due to the decrease in supply) –> angina
  • tissue necrosis (infarction) in a wavefront matter from the subendocardium to the epicardium
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14
Q

What does ACS severity depend on?

A
  • degree
  • duration
  • location
  • collateral circualtion
  • time to revascularization
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15
Q

What system is activated during an acute infarction phase?

A
  • neurohormonal systems (adrenenergic) which then worsen ischemia, expand infarct, and increase arrhythmic risk
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16
Q

What are the initial assessment tools?

A
  • Hx/chest pain differential (due to ischemia or stable/unstable?)
  • ECG
  • Cardiac Biomarkers (troponin I or T)
17
Q

How can we determine if it is angina?

A
  1. Description of pain
    - Quality
    - Duration
    - Location
    - Radiation
  2. Precipitating Factors?
    - exertion or stress (physical/emotional)
  3. Relieving Factors
    - rest, NTG,
  • pain scale, diaphoresis, dyspnea, weakness, nausea, fever
18
Q

What are the 3 main criteria for a typical angina? Atypical, and non-anginal chest pain?

A
  1. substernal chest discomfort with quality and duration that is
  2. provided by exertion or emotional stress
  3. and relieved by rest or NTG

Atypical: 2/3
Non-anginal: 0-1 of criteria

19
Q

What is the difference between stable and unstable angina?

A
  • stable is predictable and does not change in frequency, intensity, and duration
  • unstable can be 1. at rest, 2. new onset w severe pain, and 3. pain that is more frequent, longer in duration, and pt has a lower threshold
20
Q

What does T wave inversion represent?

A
  • myocardial ISCHEMIA
21
Q

What does ST segment depression represent?

A
  • active myocardial ISCHEMIA, more sensitive to T wave inversion
22
Q

ST segment elevation represent?

A
  • ACUTE INFARCT thus causing injury

- must be more than 1mm in 2 contiguous leads

23
Q

What does a Q wave represent?

A
  • transmural infarct, can be old OR new…not diagnostic for an acute infarct
24
Q

Troponin T/I is a regulatory protein that is very specific to cardiac tissue, and is proportional to amount of damage. The peak sensitivity is ____ therefore absence does not rule out damage

What are the troponin levels?

A
  • 8-12 hours
  • less than 0.01 is normal
  • 0.01-0.12 is “leak)
  • more than .12 is positive for MI
25
Q

When is CK a diagnostic of an MI?

A
  • CKMB fraction greater than 5% (with elevated CK) is a diagnostic for MI at 8-12 hours
26
Q

What are the 3 main things used to diagnose an acuity of an ischemia?

A
  • CP history
  • ECG
  • Biomarkers
27
Q

For stable angina,
CP History
ECG
Biomarkers

A
  • CP: typical or atypical angina, does not meet criteria for unstable symptoms

ECG: no change

Biomarkers: no change

28
Q

Non-STE ACS

CP
eCG
Biomarkers

A

CP: typical or atypical angina, meets criteria for unstable symptoms history

ECG: may have acute T wave inversion, or ST depression

Biomarkers: no change is UNSTABLE ANGINA

acute rise is NSTEMI

29
Q

STEMI
CP
ECG
Biomarkers

A

CP: typical or atypical, can be unstable

ECG: ST elevation

Biomarkers: acute rise, but can be normal in early stages of an MI

30
Q

What is considered an unstable angina?

A
  • patients presenting with worsening angina, w/o evidence of ST elevation on ECG or elevated cardiac biomarkers
31
Q

STABLE angina is a ___state caused by ____ narrowing of the coronary arteries. Under normal conditions, patients will not experience symptoms, but when ___is increased, the symptoms of ischemia are present. So the goal is to ____and____O2 supply

A

chronic

artherosclerotic

MVO2

stabilize, balance

32
Q

In ACS, an atherosclerotic plaque has been compromised, leading to ___and ___ process. If left unchecked, a complete ___of the artery will result. Therefore, therapy must be more ___and agents are added to combat the thrombotic and inflammatory process to restore normal blood flow.

How aggressively you manage the thrombotic aspect depends on the risk of further _____

Minority of the cases are due to ____

Symptoms can develop ___ of MVO2

A

prothormbotic and inflammatory

occlusion

aggressive

myocardial damage

vasospasms

independent

Cardio MT2 (12 decks)

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