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Diagnostics (Final Exam) > Myocardial Ischemia/Infarction > Flashcards

Myocardial Ischemia/Infarction Flashcards

1
Q

Risk factors for myocardial infarction

A
  1. High cholesterol and triglycerides
  2. Hypertension
  3. Obesity
  4. Advancing age
  5. Smoking
  6. Diabetes
  7. Sedentary lifestyle
  8. Unhealthy diet
  9. Stress
  10. Family history
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2
Q

Temporary diminishes supply of blood (oxygen and nutrients) to the myocardium resulting inreversible effects?

A

myocardial ischemia

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3
Q

Name 3 causes of myocardial ischemia

A
  1. Coronary artery disease (CAD)
  2. Blood clot
  3. Coronary artery spasm
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4
Q

What is the most common cause of myocardial ischemia?

A

coronary artery disease

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5
Q

Which cholesterol is involved in atherosclerosis?

A

LDL

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6
Q

In atherosclerosis, what consume LDL and transform into foam cells which in turn release cytokines that encourage atheroscleorsis?

A

Macrophages

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7
Q

Name 3 patients that typically present atypically in myocardial ischemia?

A
  1. Elderly
  2. Female
  3. Diabetic
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8
Q

What is defined as myocardial cell death due to prolonged ischemia?

A

actue myocardial infarction

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9
Q

When doees cell death begin after the onset of myocardial ischemia?

A

as little as 20 mins

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10
Q

What is the time frame for complete necrosis of myocardial cells?

A

2-4 hours

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11
Q

What type of acute MI is classified as Type I?

A

spontaneous

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12
Q

ST depression > .5mm in 2 contiguous leads indicates what?

A

myocardial ischemia

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13
Q

ST depression of > 2mm in 3 leads or more is associated with a high probability of NSTEMI and predicts what?

A

significant mortality

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14
Q

Define ST elevation

A
  • at the J point
  • 2 contigous leads (or more) of .3mV in men or .15mV in women
  • Leads V2-V3
  • and/or-
  • .1 mV elevation in all other leads
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15
Q

ST elevation with convex or straight pattern is indicative of what?

A

STEMI

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16
Q

ST elevation with concave pattern is considered to be secondary to what?

A

non-ischemic etiologies

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17
Q

With ST elevation there is also ST depression is which leads?

A

electrically opposite leads

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18
Q

Which T wave changes are associated with myocardial ischemia?

A
  • tall
  • flattened
  • inverted
  • biphasic
19
Q

Tall T waves can be one early change in what?

A

acute myocardial infarction

most often seen in the anterior chest leads

20
Q

What could isolated tall T waves in leads V1 and V3 indicate?

A

ischemia of posterior wall of left ventricle

21
Q

In which leads are pathological Q waves seen?

A

V1-V3

22
Q

Name 3 characteristics of pathological Q waves

A
  1. > 40 ms (1 mm) wide
  2. 2 mm deep
  3. > 25% of depth of QRS complex
23
Q

Name the 4 cardiac enzyme labs

A
  1. Creatine Kinase (CK or Total CK)
  2. Creatine Kinase Myoglobin (CK-MB)
  3. Myoglobin (MB)
  4. Troponin
24
Q

What 3 isoenzymes make up Total CK?

A

Total CK=

  1. CK-MB (heart)
  2. CK-MM (muscle)
  3. CK-BB (brain)

*CK-MB may also be present in small quantities in small intestine, tongue, diaphragm, uterus, prostate

25
Q

When does CK-MB begin after myocardial injury?

A

4-6 hours

26
Q

When does CK-MB peak?

A

18-24 hours

27
Q

When does CK-MB normalize?

A

48-72 hours

28
Q

Where is myoglobin found?

A

cardiac muscle

skeletal muscle

29
Q

When does myoglobin begin after myocardial injury?

A

2-4 hours

30
Q

When does MB peak?

A

6-12 hours

31
Q

When does MB normalize?

A

24-36 hours

32
Q

Are troponin I and troponin T immunologically distinct in skeletal and cardiac muscle?

A

yes

33
Q

Is troponin C immunologically distinct in skeletal and cardiac muscle?

A

No, they are identical

34
Q

Which troponin has the greatest sensitivity for myocardial injury?

A

Troponin I

35
Q

When does troponin-I begin to increase after MI?

A

4-8 hours

36
Q

When does troponin-I peak?

A

18-24 hours

37
Q

When does troponin-I return to normal?

A

5-14 days

38
Q

What does the 99th percentile rule have to do in relation with troponin?

A

the 99th percentile rule is a guideline to help decide if troponin is positive

39
Q

How often are serial markers done for cardiac enzymes?

A

4-6 hour intervals, x3

40
Q

Which cardiac enzyme peaks first?

A

myoglobin (within 8 hours)

41
Q

Ischemic symptoms, new pathologic Q wave, new ST segment or twave change, identification of an intracoronary thrombus, imaging evidence are all evidence for MI. What other piece of evidence is needed to confirm MI?

A

Rise and fall of cardiac enzymes

42
Q

Which is more cardiac specific, troponin I or troponin T?

A

Troponin I

43
Q

Which biomarker (cardiac enzyme) persists the longest?

A

Troponins

Diagnostics (Final Exam) (2 decks)

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