Ischemic Heart Disease

Question 1

low density lipoproteins

Answer 1

bad cholesterol, atherogenic, carries lipids from liver to tissues

Question 2

high density lipoproteins

Answer 2

good cholesterol, carries excess lipids to the liver for elimination

Question 3

triglycerides

Answer 3

type of fat transported in bloodstream and stored in fat, some association with risk of cv disease

Question 4

manifestations of atherosclerosis

Answer 4

ischemic stroke, coronary artery disease, carotid artery stenosis (stroke), renal artery stenosis, peripheral artery disease (PAD)

Question 5

smoking effect on atherosclerosis

Answer 5

reduces hdl, impacts cholesterol retrieval, increases oxidation of lipoproteins, cytotoxic effects to endothelium, increases thrombogenesis

Question 6

diabetes effect on atherosclerosis

Answer 6

major source of oxidative stress

Question 7

htn effect on atherosclerosis

Answer 7

increases atherosclerotic cv disease

Question 8

non-modifiable atherosclerotic risk factors

Answer 8

male >45, female >55
family history of CAD event: male> 55, female<65
history of family ischemic stroke or MI –> increased risk due to genetics

Question 9

modifiable atherosclerotic risks

Answer 9

smoking (primary), htn dyslipidemia, diabetes, obesity, physical inactivity

Question 10

ischemia

Answer 10

inadequate blood supply to an organ or tissue that leads to tissue damage and necrosis

Question 11

arterial response to ischemia

Answer 11

arterial vasodilation to increase oxygen delivery

Question 12

coronary arteries

Answer 12

starts just above the aortic root and supplies blood and oxygen to the myocardium

Question 13

cardiac chest pain (angina)

Answer 13

described as a heavy weight or pressure on chest (not sharp pains) in substernal area (rarely radiates)
can be worsened by exercise, cold weather, postprandial and emotional stress

Question 14

typical angina

Answer 14

occurs with characteristic quality, location, and duration, provoked by exertion or emotional stressm relieved by nitroglycerin or rest

Question 15

atypical angina

Answer 15

meets only 2 or 3 typical angina criteria
women, older adults and individuals with diabetes may present with different symptoms including: anxiety, sob, weakness, fatigue, and indigestion, this often leads to misdiagnosis

Question 16

non-cardiac chest pain

Answer 16

meets one or no criteria for typical angina

Question 17

ischemic heart disease can be presented as

Answer 17

acute coronary symptoms (ACS) or chronic coronary disease (CCD)

Question 18

chronic coronary disease (CCD) can present as

Answer 18

stable angina, patients discharged after ACS, patients diagnosed with CCD based on screening

Question 19

acute coronary symptoms (ACS) presents as

Answer 19

ubstable angina, non-ST MI (NSTEM), ST MI (STEMI)

Question 20

stable angina

Answer 20

chronic angina precipitated by activity or upset, relieved at rest
atherosclerotic plaque is reducing blood flow, there is no plaque rupture/hemostasis

Question 21

discharged after ACS

Answer 21

patients are considered to have CCD after they are discharged for an ACS event

Question 22

CCD diagnosed after screening

Answer 22

patients may have risk factors of or symptoms consistent with CCD for which a screening test is completed and CCD is identified

Question 23

unstable angina

Answer 23

increased frequency or duration of angina episodes produced at a lower level of exertion or at rest
acute change in level of what is causing patient to have chest pain

Question 24

non-ST elevation MI (NSTEMI)

Answer 24

myocardial necrosis resulting from prolonged interruption of the blood supply, generally results in acute thrombosis, but no ECG changes
partial occlusion
atherosclerotic plaque ruptures leading to primary and secondary hemostasis

Question 25

ST elevation MI (STEMI)

Answer 25

myocardial necrosis resulting from prolonged interruption of the blood supply generally results from an acute thrombus with ECG changes complete occlusion atherosclerotic plaque ruptures leading to primary and secondary hemostasis diagnosed with positive troponins and a 1 mm elevation in at least 2 contiguous leads on ECG

Question 26

primary hemostasis

Answer 26

first step in plaque rupture- more relevant for arterial clots forms a platelet plug in 3 steps 1. adhesion 2. activation 3. aggregation first line of hemostatic defense, begins in seconds of vessel injury and is mediated by circulating agents

Question 27

secondary hemostasis

Answer 27

main driver of venous clots. forms fibrin clots through clotting cascade plasma coagulation cascade initiated by exposure of tissue factor from the vascular injury --> thrombin activation --> clot stabilizes and strengthens the platelet plug

Question 28

primary hemostasis adherence

Answer 28

adhere to collagen in the vascular sub endothelium, exposed collagen releases von Willebrand factor

Question 29

primary hemostasis activation

Answer 29

releases adp, ca, and thomboxane a2 to activate further platelets, GP IIb/IIIa receptors are exposed to platelets

Question 30

primary hemostasis activation

Answer 30

platelets aggregate through GP IIb/IIIa fibrinogen to form a platelet plug

Question 31

clotting cascade

Answer 31

surface activation --> XIIa __> XIa --> IXa --> factor XA --> converts prothrombin to thrombin --> converts fibrinogen to fibrin vascular injury --> VIIa --> factor XA --> prothrombin to thrombin --> fibrinogen to fibrin

Question 32

left coronary artery

Answer 32

supplies left ventricle (major heart attack if occluded)

Question 33

right coronary artery

Answer 33

supplies the right side of the heart

Question 34

circumflex artery

Answer 34

supplies back side of left heart (minor heart attack if occluded)

Question 35

presence of cardiac enzymes in ACS

Answer 35

UA: no cardiac enzymes NSTEMI: cardiac enzymes STEMI: cardiac enzymes

Question 36

ECG ST elevation in ACS

Answer 36

UA: no st elevation NSTEMI: no st elevation STEMI: st elevation

Question 37

troponin

Answer 37

primary biomarker for ACS- takes 6 hrs to show up

Question 38

ST elevation on ECG

Answer 38

only present in STEMI (complete occlusion), take about 5 minutes to show up- needs to be tested in that window

Question 39

functional CAD testing

Answer 39

exercise stress tests, pharmacologic stress test

Question 40

anatomical CAD testing

Answer 40

coronary artery angiography, coronary artery ca scoring

Question 41

stress test

Answer 41

often initial recommended test, can be done with pharmacologic agents if patient is unable to exercise --> sent to angiogram if abnormal results

Question 42

coronary artery CT scqn

Answer 42

looking for calcification of the coronary arteries -- abnormal results? --> coronary angiogram

Question 43

coronary artery calcium testing

Answer 43

used in asymptomatic patients, uses ct scan- no dye, calculates mass of Ca, score per age

Question 44

Peripheral artery disease

Answer 44

atherosclerosis that occurs in periphery, usually in lower extremities, can lead to pain on exertion, tissue damage, ulcers, and infection most common in aortoiliac, femoral, popliteal, and tibeal

Question 45

intermittent claudication

Answer 45

Presentation of PAD pain when walking in the buttocks, thighs or calves, often relieved with rest, severe cases will have pain at rest

Question 46

chronic limb threatening disease

Answer 46

Presentation of PAD chronic decreased flow that can lead to ulcerations, gangrene, infections patients with diabetes and smokers are at the highest risk

Question 47

acute limb threatening disease

Answer 47

presentation of PAD medical emergency, requires immediate revascularization to prevent limb loss

Question 48

Normal ABI levels

Answer 48

1-1.4 - no PAD