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Flashcards in Ischemic Heart Disease Deck (34):
1

What is stable angina?

  • Chest pain that arises with exertion or emotional stress

2

What is the cause of stable angina?

  • Atherosclerosis of coronary arteries with > 70% stenosis 
  • Decreased blood flow does not meet metabolic demands of the myocardium during exertion

3

Is stable angina reversible or irrversible damage to the myocytes?

Reversible

4

S/S of stable angina?

  • Chest pain ( < 20 mins) that radiates to the left arm or jaw
  • Diaphoresis
  • SOB
  • ST Segment depression from subendothelial ischemia 

 

5

How do you treat stable angina?

Rest or nitroglycerin

6

What is unstable angina?

Chest pain at rest

7

What causes unstable angina?

Rupture of atherosclerosis with thrombosis and incomplete occlusion of coronary artery.

8

Is unstable angina reversible or irreversible damage to myocytes?

Reversible

9

S/S of unstable angina

  • Worsening chest pain at rest  or minimal exertion
  • ST segment depression
  • High risk of progression to MI

10

How to treat unstbale angina?

Nitroglycerin

11

What is Prinzmetal angina?

Periodic chest pain unrelated to exertion. Due to coronary artery vasospasm.

12

Is Prinzmetal angina reversible or irreversible damage to myocytes?

Reversible

13

EKG of Prinzmetal angina?

ST elevation due to transmural ischemia

14

How to relieve prinzmetal angina?

Nitroglycerin or Ca-channel blockers

15

What is sudden cardiac death?

Unexpected death due to cardiac disease. Occurs without symptoms or < 1 hr after symptoims arise

16

What is the most common cause of sudden cardiac death?

Ventricular arrhythmia

17

What is chronic ischemic heart disease?

  • Poor myocardial function due to chornic ischemic damage
  • Progresses to congestive heart failure 

18

What is myocardial infarction?

  • Necrosis of cardaic myocytes.
  • Aka heart attack. 

19

What are the major and minor causes of MI?

  • Major
    • Rupture of atherosclerotic plaque with thrombosis and complete occlusion of coronary artery
  • Minor
    • Coronary artery vasospasm
    • Emboli
    • Vasculitis 

20

S/S of MI

  • Crushing chest pain (> 20mins)
    • Radiates to left arm or jaw
  • Diaphoresis
  • Dyspnea
  • Symptoms not relieved by nitroglycerin

21

What areas of the heart are most commonly affected?

  • LV > RV
  • Atria tend to be spared

22

What is the order of coronary arteries invovled in MI?

LAD > RAC > L Circumflex 

23

What area of the heart is affected by an LAD occlusion?

  • Anterior wall of LV 
  • Anterior interventricular septum

24

What are of the heart is affected by an RCA occlusion?

  • Posterior wall of LV
  • Posterior interventricular septum
  •  

25

What area of hte heart is affected by a left circumflex occlusion?

Lateral wall of LV

26

What are the two types of infarcts?

  • Subendothelial necrosis
    • Involves < 50% of myocardial thickness
    • ST depression
    • Initial phase of MI
  • Transmural necrosis
    • Continued or severe ischemia 
    • Necrosis involves most of the wall
    • ST elevation
    • Pathologic Q waves

27

What are the different laboratory diagnosis of MI?

  • Gold standard within first 6 hours = ECG
  • Troponin I
    • Most sensitive and specific protein marker
    • Levels rise 2-4 hours after infarction
    • Level elevated for 7-10 days
  • CK-MB
    • Useful for diagnosing re-infarction because of reduced elevated length
    • Levels rise 4-6 hours after infarction
    • Levels return to normal after 72 hours 

28

What are the different stages of morphological change after MI?

  • < 4 hours
    • None
  • 4-24 hours
    • Coagulative necrosis
    • Dark discoloration
  • 1-3 days
    • Neutrophil infiltration
    • Yellow pallor
  • 4-7 days
    • Macrophase infiltration
    • Yellow pallor
  • 1-3 weeks
    • Granulation tissue with plump fibroblasts, collagen and blood vessels
    • Red border around tissue
  • Months
    • Fibrosis
    • White scar

29

What complications occur during the first 4 hours after MI?

  • Cardiogenic shock
  • Congestive heart failure
  • Arrhythmia 

30

What complication occurs 4-24 hours after MI?

Arrhythmia 

31

What complications occur 1-3 days after MI?

  • Fibrinous pericarditis
    • Presents as chest pain with friction rub

32

What complications occur 4-7 days after MI?

  • Rupture of ventricular free wall
    • Cardiac tamponade
  • Rupture of interventricular septum
    • Shunt
  • Rupture of papillary muscle
    • Mitral insufficiency

33

What complications occur 1-3 weeks after MI?

None

34

What complications occur months after MI?

  • Aneurysm
    • Occurs because scar tissue is weaker than muscle
  • Mural thrombus
  • Dressler syndrome
    • Occurs because Abs form against pericardium after MI healing