Ischemic Heart Disease

Question 1

What are 3 etiologies of Ischemic heart disease?

Answer 1

• CAD -atherosclerosis
  -congenital coronary anomalies
  -coronary artery spasm

Question 2

The size of an aneurysm during systole?

Answer 2

Increases

Question 3

What’s the pathophysiology of ischemic heart disease?

Answer 3

• atherosclerotic plaque causes stenosis in coronary arteries
• this obstructs blood flow
• leads to deprivation of myocardial o2 = ischemia
• total blockage causes muscle death = ischemia

Question 4

What are risk factors for ischemic heart disease ?

Answer 4

• sex
  -age
  -diabetes
  -hyperlipidedma
• obesity
  -family history
  -smoking
  -HTN

Question 5

What are complications of ischemic heart disease?

Answer 5

• Aneurysm
  -arrhythmias
  -mural thrombus
  -pap muscle rupture
  -VSD
  -death
  -Pseudoaneurysm
• PE
  -pap muscle dysfunction

Question 6

How common are aneurysms with ischemic heart disease?

Answer 6

8-15%

Question 7

How common are arrhythmias with ischemic heart disease?

Answer 7

90%

Question 8

___ thrombus occurs with ____ MI ___ to ___ % of the time

Answer 8

Mural ; acute ; 20-40%

Question 9

Papillary muscle rupture occurs in __% of MI’s

Answer 9

1%

Question 10

Papillary muscle rupture causes death in __% of MI’s patient

Answer 10

5%

Question 11

Papillary muscle rupture occurs in 90% of ____ MI’s

Answer 11

Inferior

Question 12

___% of patients are dead in 8 weeks due to pap muscle rupture

Answer 12

98

Question 13

VSD’s occur in ___% of MI patients

Answer 13

2

Question 14

What is the most common mechanical complication of an MI?

Answer 14

Aneurysm

Question 15

What’s the difference between mural vs. transmural thrombus ?

Answer 15

Mural is attached partial section of wall
Transmural takes up entirely of wall

Question 16

What’s another name for mural thrombus?

Answer 16

Subendocardical

Question 17

A new murmur post MI can be due to what 4 things?

Answer 17

• MR
  -ischemic VSD
  -pap muscle rupture
  Pap muscle dysfunction

Question 18

A physical sign of ischemic heart disease is ___

Answer 18

Angina

Question 19

__% of MI’s are silent

Answer 19

25%

Question 20

Severe acute MR patients often present with?

Answer 20

Florid pulmonary edema

Question 21

What’s the difference between stable and unstable angina ?

Answer 21

Stable follows a pattern of excertion causing chest pain

Unstable doesn’t follow a pattern. Chest pain occurs without excertion and is more dangerous and indicative of a MI

Question 22

What’s a flail leaflet?

Answer 22

Abnormality of leaflet mobility. Due to chordal rupture or dissociation

Question 23

Flail leaflet is associated with what disease?

Answer 23

MVP

Question 24

What type of MI causes pap muscle rupture?

Answer 24

Inferior MI

Question 25

What are 7 echo signs of ischemic heart disease?

Answer 25

-RWMA -LV dilation with ischemic cardiomyopathy - Thrombus in akinetic or dyskinetic areas -pap muscle dysfunction -pap muscle Rupture ( VSD or pesudeoanureysm) - dresser syndrome with PE -ventricular aneurysm

Question 26

A true aneurysm has what 3 characteristics?

Answer 26

-wide base -low risk of free rupture - encases the myocardial layer ( or all 3 layers of the heart)

Question 27

A pseudoaneurysm has what 4 characteristics?

Answer 27

-narrow base -high risk of free rupture - walls composed of thrombus -has only 1-2 layers of the heart not all 3

Question 28

The most common location for a pseudorandom is?

Answer 28

Inferior basal

Question 29

What information do you need pre-op in a patient with a LV aneurysm? 1. Size 2. Location 3. Thrombus? 4. Movement of other walls

Answer 29

4

Question 30

Color Doppler in ischemic disease can be good for ? 1. MR 2. TR 3. AR 4. VSD 5. ASD

Answer 30

4.

Question 31

What may be seen secondary to a pap muscle dysfunction on echo?

Answer 31

MR

Question 32

If a ischemic VSD is present what direction will the shunt be?

Answer 32

L-R

Question 33

What is Kawasaki disease?

Answer 33

Inflammation of small to medium sized vessels

Question 34

What do you look for in a patient with Kawasaki disease?

Answer 34

Coronary artery aneurysms

Question 35

Who is most affected by Kawasaki disease?

Answer 35

Children usually 5 years and younger

Question 36

What are other symptoms of Kawasaki disease?

Answer 36

-fever -enlarged lymph nodes -a rash in genital area, lips, palms, soles of feet -red eyes

Question 37

Hypokinesiss means?

Answer 37

Less motion than normal

Question 38

Dyskinesiss means ?

Answer 38

Motion is opposite than normal direction

Question 39

How many segments of a wall need to be affected before calling it a RWMA?

Answer 39

1 segment

Question 40

What is the IVS motion in a patient with a a LBBB?

Answer 40

Dyskinetic or paradoxical

Question 41

Another word for dyskinetic is?

Answer 41

Paradoxical

Question 42

What type of aneurysm gives a fusiform shape?

Answer 42

True aneurysm

Question 43

What kind of aneurysm gives a saccular shape?

Answer 43

Pseudaneurysm

Question 44

What are two signs on Doppler of a ischemic heart disease?

Answer 44

- MR due to secondary pap muscle rupture -L-R VSD shunt

Question 45

Which coronary artery supplies, the atrial septum?

Answer 45

RCA

Question 46

Which coronary artery supplies, the SA and AV nodes?

Answer 46

RCA

Question 47

What is meant by right dominance?

Answer 47

When the right cornary artery gives rise to the posterior descending artery 85% of the time 

Question 48

What percentage of people are right dominant?

Answer 48

85%

Question 49

What is the medication used with a nuclear stress test?

Answer 49

Thallium