Ischemic Heart Disease

Question 1

Risk Factors for CAD

Answer 1

Smoking, Dyslipidemia, Hypertension, Diabetes, Obesity, Inflammation, Stress, Sedentary, Male, Age, Genetics

Question 2

Treatable Risk Factors Known to Reduce Events (3)

Answer 2

Smoking, Dyslipidemia, Hypertension

Question 3

Benefits of HDL (5)

Answer 3

Inhibits LDL Oxidation
Inhibits Tissue Factor
Stimulates NO Production
Enhances reverse cholesterol transport
Inhibits endothelial adhesion molecule expression

Question 4

Myocardial Ischemia

Answer 4

Mismatch of O2 supply and demand

Question 5

Key characteristics of coronary circulation (3)

Answer 5

Relies on aerobic metabolism
Extracts maximal O2 at rest (must increase flow)
LV is only perfused in diastole

Question 6

Determinants of Supply

Answer 6

Coronary Blood Flow Rate
- perfusion pressure, perfusion time (1/HR), vascular resistance
Blood Oxygen Content

Question 7

Perfusion pressure Autoregulation

Answer 7

Dilation/Constriction of small arterioles maintains pressure

Question 8

Determinants of Blood Oxygen Content

Answer 8

Anemia or hypoxemia

Question 9

Determinants of Demand (3)

Answer 9

Heart Rate
Wall Tension
Inotropic State

Question 10

Common Mechanism of Stroke

Answer 10

Atheroembolism from carotids or left atrial appendage

- Ophthalmic artery occlusion

Question 11

MI Common Mechanism

Answer 11

In-situ thrombosis from plaque rupture

Question 12

Angina Common Mechanism

Answer 12

stable plaque occlusion

Question 13

Claudication Common Mechanism

Answer 13

Stable plaque occlusion

Question 14

Acute Limb Syndrome Common Mechanism

Answer 14

Atheroembolism or thromboembolism

Question 15

Venous Thrombus Characteristics

Answer 15

Fibrin Rich, Includes RBCs, Areas of Stasis, Genetic Predisposition, Environmental Predisposition, Anticoagulation treatment

Question 16

Arterial Thrombus Characteristics

Answer 16

Platelet Rich, Plaque Rupture, Areas of high flow, Atherosclerosis/Trauma/APLA, Anti-platelet treatment

Question 17

Part of heart muscle most susceptible to ischemia?

Answer 17

Subendocardium: subjected to highest pressure from ventricle, deepest layer w/ little collateral flow

Question 18

Rise and Peak of Tropinin I testing

Answer 18

Rise at 3-4 hours

Peak at 18-36 hours

Question 19

Creatine Kinase Rise and Peak

Answer 19

Rise 3-8 hours

Peak at 24 hours

Question 20

Medications Given W/ ACS

Answer 20

Reduction of O2 demand

- Beta Blockers and Nitrates

Question 21

ACS includes…….

Answer 21

STEMI (complete occlusion); NSTEMI (partial occlusion w/ necrosis); Unstable Angina (partial occlusion w/o necrosis)