Ischemic heart disease

Question 1

Inability of the coronary arteries to deliver oxygen to myocardium

Answer 1

Ischemic heart disease

Question 2

This is a risk/etiology for ischemic heart disease

Answer 2

Atherosclerosis

Question 3

3 other causes of ischemic heart disease

Answer 3

Thromboemboli
Coronary artery vasospasm
Increased cardiac workload and oxygen demand

Question 4

Number 1 cause of ischemic heart disease

Answer 4

Coronary artery disease

Question 5

3 clinical manifestations of coronary artery disease / ischemic heart disease

Answer 5

Angina pectoris
chronic ischemic heart disease
Myocardial infarction

Question 6

Most common clinical form of ischemic heart disease

Answer 6

Chronic ischemic heart disease

Question 7

Chronic ischemic heart disease leads to

Answer 7

left sided congestive heart failure
(Increase risk of other 2 clinical manifestations)

Question 8

Not constant = episode. Sudden onset from myocardial ischemia

Answer 8

Angina pectoris

Question 9

3 forms of angina pectoris

Answer 9

Stable angina
Unstable angina
Varient Angina

Question 10

Pain from exertion, predictable, relieved by rest or nitrates (nitroglyceran = vasodilation), 15-20 min duration

Answer 10

Stable angina (classic)

Question 11

What is the #1 cause of stable/classic angina

Answer 11

coronary artery disease

Question 12

More frequent and lasts longer, pain at rest or with minimal exertion

Answer 12

Unstable angina (pre-infarction)

Question 13

What needs to be ruled out with unstable angina

Answer 13

Non ST segment MI (NSTEMI)

Question 14

what 3 things define unstable angina

Answer 14

pain at rest for longer than 20min
Severe pain of NEW onset
crescendo pattern of pain

Question 15

No underlying coronary artery disease, CA vasospasm, occurs in younger ages, pain at rest and in the morning, resolves spontaneously

Answer 15

Varient (vasoplastic) angina

Question 16

What two things increase risk of varient angina

Answer 16

Heavy Cig smokers and cold weather

Question 17

Chest pain with an ST segment elevation

Answer 17

Varient angina

Question 18

What are more likely with varient angina

Answer 18

arrhythmias

Question 19

Insufficient supply of oxygenated blood to an area of the heart

Answer 19

Myocardial infarction

Question 20

Irreversible injury with prolonged ischemia causes an MI, what type of necrosis is present

Answer 20

coagulative

Question 21

MI’s are most frequently involving the

Answer 21

Left ventricle

Question 22

Leading cause of an MI

Answer 22

Coronary artery atherosclerosis

Question 23

3 ways to classify an MI

Answer 23

Degree of ventricular wall involvement
location of the infarct
presence or absence of an ST segment elevation on ECG

Question 24

Full thickness of ventricle

Answer 24

Transmural infarctions

Question 25

Inner 1/3 of the myocardium

Answer 25

Subendocardial infarctions

Question 26

Which type of infarction has an ST segment elevation

Answer 26

Transmural (subendocardial = no ST segment elevation, or pathologic Q waves)

Question 27

T/F: It is more common not to have an ST segment elevation

Answer 27

False! More common to have an MI with an ST segment elevation, Non-ST segment elevation MI is when the blockage is incomplete

Question 28

Similar to angina but more severe and prolonged, and unrelieved by nitroglycerin

Answer 28

Acute MI

Question 29

Is there an ST segment elevation in an AMI

Answer 29

Yes

Question 30

Most AMI's occur at __

Answer 30

rest

Question 31

30 minutes after occlusion of coronary artery, leads to scar formation

Answer 31

Myocardial necrosis

Question 32

Can be painless, and have non-characteristic chest pain

Answer 32

Atypical symptoms of an AMI

Question 33

What groups are more likely to have an atypical AMI

Answer 33

Elderly Female Diabetes

Question 34

Histological changes with an MI: 1. Earliest change within the first day 2. 1-2 days old 3. 2-3 days old 4. 3-4 days old 5. 1-2 weeks in age 6. 2-3 weeks 7. 2 months old

Answer 34

1. contraction band necrosis 2. dark contraction bands, no nuclei, begin acute inflammation 3. Neutrophils, coagulative necrosis, dissolution of nuclei. Extensive hemorrhage with fiber necrosis 4. acute inflammatory cell infiltration, necrotic fibers 5. macrophages 6. granulation tissue 7. collagenous scar

Question 35

3 ways to diagnose an MI

Answer 35

Ischemic type chest discomfort ECG abnormalities Elevated serum cardiac markers

Question 36

Number 1 way of diagnosing an MI

Answer 36

Elevated serum cardiac markers

Question 37

2 main cardiac markers

Answer 37

Cardiac-specific troponins T and I (cTnT, cTnI) Creatine kinase (ck) isoenzymes

Question 38

Which cardiac markers is more often used to diagnose and MI

Answer 38

Cardiac specific troponins T and I

Question 39

After how many hours to cardiac specific troponins T and I rise and then peak

Answer 39

4-6 hours = rised peak at 24 hours

Question 40

Creatine kinase isoenzymes (MB(ck2)) CK-MB occurs in __ and is an indicator for __

Answer 40

cardiac muscle myocardial necrosis

Question 41

After __ hours CK-MB levels are abnormal and peak at __ hours

Answer 41

6-12 18-24

Question 42

This is also elevated after an MI but is of low diagnostic value because it accumulates after any muscle damage

Answer 42

Myoglobin

Question 43

__ is much less specific for MI than cardiac specific troponins or even CK-MB and can be elevated due to other things

Answer 43

Lactic dehydrogenase (LD or LDH)

Question 44

3 major complications of an MI

Answer 44

Arrhythmias Progressive heart failure Ventricular aneurysm

Question 45

What arrhythmia is the most sudden cause of cardiac death in the 1st hour post MI

Answer 45

Ventricular fibrillation

Question 46

Progressive heart failure is when it involves __ of the left ventricle

Answer 46

20-25%

Question 47

Progressive heart failure results in congestive heart failure with __ of left ventricle is effected, and this is considered __

Answer 47

more than or equal to 40% cardiogenic shock (Most common IN HOSPITAL cause of death with AMI's)

Question 48

Late complication in 12-20% of MI patients

Answer 48

Ventricular aneurysm

Question 49

A ventricular aneurysm can result in a __ in 50% of cases because the heart cannot contract

Answer 49

Mural thrombi

Question 50

Most common 4-7 days post infarction, responsible for up to 20% of all fatal MI's

Answer 50

rupture of the myocardium

Question 51

Symptoms compatible with acute myocardial ischemia - unstable angina pectoris - non ST segment elevation myocardial infarction - ST segment myocardial infarction

Answer 51

Acute coronary syndrome

Question 52

Unexpected death due to cardiac causes

Answer 52

Sudden cardiac death