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CV <3 > Lecture 9: Ischemic Heart Disease Part 1 > Flashcards

Lecture 9: Ischemic Heart Disease Part 1 Flashcards

1
Q

What are the MC risk factors for ischemic heart disease?

A
  • Genetic influences
  • High-fat and energy rich diets
  • Smoking
  • Sedentary lifestyles
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2
Q

What is the #1 cause of myocardial ischemia?

A

Atherosclerotic coronary artery disease

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3
Q

What is the most important part of a blood vessel when it comes to blood flow?

A

The radius of the vessel.

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4
Q

What can affect the radius of a blood vessel?

A
  • Atherosclerosis
  • Vascular tone
  • Endothelial cell dysfunction
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5
Q

What is the spectrum of IHD?

A
  • Prinzmetal angina
  • Stable angina
  • Unstable angina
  • MI

Prinzmetal is more unique

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6
Q

What IHD are considered ACS?

A
  • Unstable angina
  • MI

Needa treat asap!!!

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7
Q

Describe unstable angina, NSTEMI, and STEMI in terms of blood flow occlusion.

A
  • Unstable angina = no occluded CORONARY blood flow
  • NSTEMI = partially occluded coronary blood flow
  • STEMI = completely occluded coronary blood flow

Unstable angina still has occluded blood flow through OTHER vessels.

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8
Q

How can we tell the difference between stable and unstable angina?

A
  • No response to NTG = unstable
  • Change in normal pattern of angina = unstable.
  • Unstable = impending MI!!!!!!!!!!!!
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9
Q

At what point is damage irreversible to the myocardium?

A

Infarct stage.

Ischemia and injury are still reversible.

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10
Q

If we have an acute MI, how long has the infarct mostly likely been occurring?

A

< 3-5 days

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11
Q

What is a transmural infarct?

A

MI that extends through all 3 layers of the heart.

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12
Q

How does an NSTEMI typically appear on EKG?

A
  • ST depression
  • T-wave inversion

Generally subendocardial.

NSTEMIs are also known as subendocardial or non-q-wave MI.

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13
Q

Describe the 5 types of MIs.

A
  1. Primary coronary event (plaque)
  2. Secondary to ischemia (prinzmetal, embolism, HTN)
  3. Sudden unexpected cardiac death
  4. Coronary angioplasty or stent related (4a = PCI, 4b = stent thrombosis)
  5. CABG related

Just know type 4 means coronary intervention in general

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14
Q

What 3 demographics is silent ischemia most common in?

A
  • Diabetics
  • Elderly
  • Women
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15
Q

What is myocardial stunning?

A

Reversible dysfunction following reperfusion.

Your heart stops working to try to preserve itself, but if you intervene, it will recover.

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16
Q

What is myocardial hibernation?

A

Ventricular dysfunction that will recover once reperfused.

Seen in a MUGA scan :)

17
Q

What is the posterior descending artery typically a branch of?

A

The right coronary artery.

15% of the time, its left.

18
Q

What can the SA nodal branch sometimes come off of?

A

40% of the time, it can come off the left circ.

Normally off the right coronary.

19
Q

What is RaMP?

A
  • Right coronary
  • SA & AV nodes
  • Marginal
  • Posterior descending
20
Q

What is LoCA?

A
  • Left coronary
  • Circumflex
  • Anterior Descending (most often occluded)
21
Q

What is this

A

Levine’s sign, AKA chest discomfort/angina pectoris.

22
Q

Describe the typical clinical presentation of chest discomfort.

A
  • Males > 50 or female > 60
  • Episodic chest discomfort (2-5 mins)
  • Often described as heaviness or pressure, not PAIN.
  • Substernal/central (sometimes radiates)
  • Sudden and constant

Severity does not always correlate with the extent of the injury.

23
Q

What are the two primary alleviating factors of angina pectoris?

A
  • NTG
  • Rest
24
Q

Why does chest discomfort tend to occur in the morning?

A

Cortisol levels rising overnight.

25
Q

What is the concern with exercise stress tests in women?

A

It can be less accurate.

Women in general can have more vague symptoms.

26
Q

What abnormal PE findings can suggest MI?

A
  • HTN
  • Anxious & diaphoretic
  • New heart sounds/murmurs
  • Labored breathing
  • ALOC

It can also be perfectly normal :)

27
Q

How do we treat prinzmetal angina?

A
  • CCBs
  • Nitrates
28
Q

Who is prinzmetal angina MC in?

A

Middle-aged women

Mimics STEMI on EKG.

29
Q

What illegal drug can induce vasospasms?

A

Cocaine

30
Q

At minimum, if someone presents with possible ACS but nondiagnostic EKG, what must we do?

A

Obs for at least 12 hours!

31
Q

What are the 3 ranges of heart scores?

A
  1. 0-3 = discharge
  2. 4-6 = admit for obs
  3. 7-10 = admit w/ early intervention
32
Q

What are the 7 criteria for a TIMI score?

A
  1. Age >= 65
  2. > = 3 CAD risk factors
  3. Prior CAD (stenosis > 50%)
  4. ASA in last 7 days
  5. Severe angina (2+ episodes in past 24h)
  6. ST deviation on EKG (>= 0.5mm)
  7. Elevated cardiac biomarkers

Only used for unstable angina or NSTEMI.

0-2 = low
3-4 = intermediate
5-7 = high

33
Q

What are the 5 criteria for a HEART score?

A
  1. History
  2. EKG
  3. Age
  4. Risk factors
  5. Troponin

0-2 for all criteria = max of 10.

34
Q

What does a HEART score calculate?

A

Risk of major adverse cardiac event (MACE) in 6 weeks.

CV <3 (25 decks)

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