cardiac ischemia

Question 1

what is hyperlipidemia

Answer 1

elevation of lipids

Question 2

What lipids make up hyperlipidemia

Answer 2

fat
triglycerides
cholesterol

Question 3

What is the job of total cholesterol

Answer 3

maintain cell membranes
building block for some nutritional absorption and hormone synthesis

Question 4

What is LDL and what does it do

Answer 4

low density lipo protein

atherosclerotic plaque formation

Question 5

What is HDL and what does it do

Answer 5

High density lipo-protein

bring cholesterol back to the liver

Question 6

What are triglycerides

Answer 6

stored energy

breaks down for cellular metabolism

Question 7

where are triglycerides stored

Answer 7

adipose and liver

Question 8

What is primary hyperlipidemia from

Answer 8

familial
polygenetic source
type 1-4

*can cause xanthomas, atherosclerosis, hepatosplenomegally

Question 9

What is secondary hyperlipidemia from

Answer 9

diet
medication
Dm
CKD
inflammatory states

Question 10

What structure is located in the tunica externa

Answer 10

vaso vasorum

Question 11

What is the vaso vasorum

Answer 11

vessels that feed the layers of thicker and larger vessels

Question 12

In diseased vessels, where does the smooth muscle end up

Answer 12

migrates from the tunica media to the intima

Question 13

Where does atherosclerosis occur in vessels

Answer 13

within the intima of the arteries

Question 14

What type of cells make up atherosclerosis

Answer 14

foam cells

Question 15

what are foam cells

Answer 15

main cellular component of an atheroma

Question 16

What is a fatty streak

Answer 16

first stage in development of atherosclerosis

Question 17

What is the process of atherosclerosis

Answer 17

muscle cells undergo apoptosis within fatty streak

monocytes will accumulate (which are engorged with cholesterol)

this makes foam cells and leads to plaque build up

Question 18

What occurs as foam cells increase the inflammatory response to the area

Answer 18

foam cells will die and a necrotic core will develop

Question 19

What leads to the rapid progression of atherosclerosis and eventually CAD

Answer 19

Thinner vessels that are created from the disease process rupture

Question 20

What is a calcified atherosclerotic plaque called

Answer 20

atheroma

Question 21

What causes unstable angina

Answer 21

atheroma cause remodeling with vascular expansion so the lumen size stays intact… leads to unstable plaques

Question 22

What causes stable angina

Answer 22

no remodeling from the atheroma leading to closure of the lumen

Question 23

What is anoxia

Answer 23

acute loss of O2

Question 24

What is ischemia

Answer 24

decreased blood flow to tissue causing hypoxia

Question 25

what is hypoxia

Answer 25

lack of oxygen in the tissue

Question 26

What is infarction

Answer 26

complete block of blood flow to tissue

Question 27

when do coronary vessels fill

Answer 27

diastolic relaxation

Question 28

What is the progression in acute coronary syndrome

Answer 28

stable angina unstable angina NSTEMI STEMI

Question 29

What are the symptoms of ischemia

Answer 29

chest pain +/- radiation

Question 30

Where are the classic places chest pain radiates

Answer 30

both arms jaw

Question 31

What should be in question if chest pain radiates into the patients back

Answer 31

dissection

Question 32

What are symptoms of angina

Answer 32

dyspnea nausea diaphoresis fatigue

Question 33

What is angina

Answer 33

chest discomfort (pressure / heavy / tight) Generally sub sternal and to the left

Question 34

What does the oxygen demand of the cardiac muscle outweighing the oxygen being delivered lead to

Answer 34

myocardial ischemia

Question 35

When does stable angina occur

Answer 35

chronic ischemic heart disease

Question 36

What sign shows that someone has chronic ischemic heart disease

Answer 36

if they have reproducible angina -discomfort comes on routine -pain stops as activity stops

Question 37

What are symptoms of stable angina

Answer 37

dyspnea pain away from substernal area nausea fatigue daiphoresis *occurs with increased cardiac demand

Question 38

When do symptoms of stable angina occur

Answer 38

when the heart rate and o2 demand increase beyond the supply ability -exertion -anxiety -HTN -LV / RV hypertrophy

Question 39

What are the typical ACS descriptors

Answer 39

Onset: gradual / variable Provocation: exertion increases sx Quality:pressure / achey/ tightness Radiation: arms / neck Site: can be diffuse Time: <30min

Question 40

What is a type 1 MI

Answer 40

from a coronary atherothrombosis

Question 41

What is a type 2 MI

Answer 41

supply demand mismatch

Question 42

what is a type 3 MI

Answer 42

leads to sudden death, no confirmation on labs/ECG

Question 43

What is a type 4 MI

Answer 43

post PCI infarct

Question 44

What is a type 5 MI

Answer 44

post CABG infarct

Question 45

What does one minute without blood supply do to the cardiac tissue

Answer 45

pallor which leads to decreased contractility

Question 46

If ischemia persists and there is no cardiac contraction for 3-5 minutes, what happens

Answer 46

ATP depletes glycogen stores are used up lactate accumulates

Question 47

What are types of acute coronary syndromes

Answer 47

unstable angina NSTEMI

Question 48

When is ACS typically noticed

Answer 48

new/acute onset when patient has minimal exertion or at rest

Question 49

What causes ACS

Answer 49

atherosclerotic plaque rupture of the coronary artery

Question 50

When does someone have unstable angina

Answer 50

when it takes less exertion or stress than before to induce sx sx last longer severity of discomfort is increased

Question 51

What differentiates unstable angina with an acute MI

Answer 51

unstable angina has no signs of necrosis

Question 52

What occurs within the heart during an NSTEMI

Answer 52

disruption of plaque which leads to partial / intermittent blockage ischemic disease apoptosis/ necrosis of myocytes troponin is released

Question 53

What signs will be seen on an EKG for an NSTEMI

Answer 53

T wave inversion or ST depression

Question 54

What occurs in the heart during a STEMI

Answer 54

plaque ruptures which causes thrombosis of coronary artery causing an acute vessel occlusion leads to transmural myocardial ischemia and ST elevation of ECK

Question 55

What is transmural myocardial ischemia

Answer 55

complete obstruction of blood flow

Question 56

What is J point elevation

Answer 56

>1mm in in 2+ consecutive leads showing that ST elevation

Question 57

What is RV infarction associated with

Answer 57

RCA occlusion

Question 58

What signs will a patient have that has RV infarction

Answer 58

increased JVP Decreased CO hypotension

Question 59

What disease processes mimic a STEMI

Answer 59

acute pericarditis myopericarditis LVH aortic dissection severe hypercalcemia

Question 60

What causes prinzmetal angina

Answer 60

coronary vasospasm

Question 61

How is coronary vasospasm defined

Answer 61

nitrate responsive angina with transient EKG findings

Question 62

What causes coronary vasospasm

Answer 62

Hyperactivity of smooth muscle increased vagal tone can cause an endogenous release of vasoconstrictors

Question 63

What are triggers for coronary vasospasm

Answer 63

cocaine smoking botulism Kounis syndrome

Question 64

What is kounis syndrome

Answer 64

chest pain post allergic reaction

Question 65

What are some complications of ischemia

Answer 65

Arrhythmias (usually afib) Blocks Cardiogenic shock ventricular free wall rupture VSD acute mitral regurge increased pulm pressure -> pulm edema

Question 66

Where is papillary muscle dysfunction most common

Answer 66

posteriomedial papillary muscle

Question 67

What may cause a rupture of a papillary muscle

Answer 67

STEMI or NSTEMI

Question 68

When are ventricular wall ruptures most common

Answer 68

elderly female first MI *rare if ventricular hypertrophy is present at baseline

Question 69

Where are ventricular wall ruptures most common

Answer 69

anterior infarcted areas of the heart

Question 70

What is the main cause of a mural thrombi

Answer 70

STEMI

Question 71

Who is at risk for a mural thrombi

Answer 71

Patients who have had an apical aneurysm