Week 2- Ischemic Heart Disease (IHD) Flashcards
PART 1
PART 1
What is ischemia?
A condition in which blood flow (and thus O2) is restricted or reduced in a part of the body.
What is hypoxemia?
Low O2 content in the blood = Low O2 Sats!!
What is hypoxia?
A condition in which the body or a region of the body is deprived of adequate O2 supply at the tissue level.
Does ischemia result in hypoxemia or hypoxia?
hypoxia
_____ ________ _________ is an umbrella term for a range of symptoms associated with sudden, reduced blood flow to the heart i.e. cardiac ischemia.
Acute Coronary Syndrome (ACS)
What will the patient history of someone with ACS be?
- chest pain or left arm pain
- Hx of CAD
What will be found when examining a patient with ACS?
- hypotension, diaphoresis
- pulmonary edema, rales
- ECG changes
- elevated cardiac biomarkers
Do Ischemic Heart Disease (IHD), Coronary Heart Disease (CHD), Coronary Artery Disease (CAD), and Atherosclerotic Heart Disease (ASHD) mean the same thing?
Yes
What is the most common specific diagnosis under the umbrella term of ACS that is the most common cause of death in the US and western EU?
IHD (Ischemic Heart Disease)
IHD includes what (3) things?
- heart attacks
- angina (stable and unstable)
- heart failure and arrhythmias
What are (4) causes of IHD? Which is the most common?
- Atherosclerosis of coronary arteries (most common)
- Coronary thrombus/emboli
- Coronary spasm
- Complications of CT disorders
IHD risk factors.
- Age/Gender
- HTN
- Diabetes
- Smoking Hx
- Physical Inactivity
- Obesity
- Hypercholestermia/hyperlidemia
- Stress
- Family Hx
- Poor diet
What are some common S/Sx of IHD? (6)
- Chest pain or discomfort, which may involve pressure, tightness or fullness
- Pain or discomfort in one or both arms, the jaw, neck, back or stomach
- Shortness of breath
- Feeling dizzy or lightheaded
- Nausea
- Sweating
What is the most common type of dilated cardiomyopathy?
Ischemic Cardiomyopathy
What is Ischemic Cardiomyopathy?
In Ischemic CM, the heart’s ability to pump blood is decreased because the heart’s main pumping chamber, the left ventricle, is enlarged, dilated and weak. This is caused by ischemia, which is a lack of blood supply to the heart muscle caused by coronary artery disease and heart attacks.
One can live with ischemic CM for a long time, but the constant cardiac ischemia results in what?
Irreversible myocyte damage that in turn results in cardiac REMODELING.
Worsening _____ is a precursor of ischemic cardiomyopathy.
CAD
___________ is often the most common form of presentation for ICM. The prognosis for ICM is largely determined by what?
- Heart Failure (HF)
- myocardial viability (# of functioning myocytes)
What scan allows for physicians to determine myocardial viability?
Cardiac PET Scan
PART 2
PART 2
Angina pectoris (stable or unstable) can lead to what? (3)
- MI
- Sudden cardiac death
- Ischemic cardiomyopathy
____________ is intermittent chest pain caused by transient BUT reversible myocardial ischemia.
-Stable Angina Pectoris
Stable Angina:
- Caused by a mismatch between O2 _________ and ______.
- Brought on by _______ or other form of stress.
- Occurs at a _________ heart rate.
- Crushing or squeezing substernal sensation with possible ________.
- Reduction in stress reduces symptoms.
- __________ used to treat.
- delivery and need
- exertion
- predictable
- radiation
- nitroglycerin
What are the functional classifications of angina?
Class I = occurs after prolonged exertion
Class II = walking >2 blocks or >1 flight of stairs
Class III = walking <2 blocks or <1 flight of stairs
Class IV = occurs at minimal exertion or rest
Unstable Angina:
- Brought on by _______ or other form of stress.
- Onset is _________.
- Crushing or squeezing substernal sensation with possible _________ to the arm.
- Harbinger of bad things to come-____ prognosis.
- exertion
- unpredictable
- radiation
- poor
- Is nitroglycerin of benefit for unstable angina?
- Why is unstable angina thought to occur?
- May be of benefit
- Acute plaque changes and/or coronary artery vasospasm.
Is ongoing unstable angina a contraindication to symptom-limited maximal exercise testing?
Yes
What are 2 ways MI’s occur?
- Plaque rupture which exposes thrombogenic lipids to the blood, stimulating localized thrombus formation with ischemic outcomes.
- Occlusive event- damage is dependent on coronary artery involved and time until treated.
If an ischemic insult is sufficiently long, _____ damage and death results.
tissue (TIME IS TISSUE)
Morphologic Stages of Myocardial Infarction:
- __-__ hrs. =No Change (Gross or Microscopic)
- __-__ hrs =Early features of Coagulative Necrosis
- __-__ days =Coagulative Necrosis with Acute Inflammatory Response
- __-__ days =Macrophage Activity (phagocytic removal of dead myocytes)
- __-__ days =Developing peripheral rim of Granulation Tissue
- __-__ weeks =Progressive Organization of infarct
- __-__ months =Progressive Collagen Deposition, Mature replacement scar
- 0-6 hours
- 6-24 hours
- 1-4 days
- 5-7 days
- 7-10 days
- 1-6 weeks
- 1-3 months
In MI, the area of injury becomes a scar resulting in what?
- Wall movement issues
- Electrical propogation
What is a reperfusion injury?
- Damage caused when the blood supply returns to tissue after a period of ischemia or lack of O2.
- Associated with microvascular injury, particularly due to increased permeability of capillaries and arterioles.
What is sudden cardiac death?
Natural unexpected death secondary to cardiac causes with rapid loss of consciousness.
__% of all deaths from CAD are SCD.
50%
