Ischemic Heart Disease

Question 1

Has only a single blood supply

Answer 1

Posterior papillary muscle

Question 2

Accounts for the majority of fluctuation in coronary O2 supply

Answer 2

Coronary Blood Flow

Question 3

The diastolic pressure as the coronaries fill during diastole

Answer 3

Perfusion Pressure

Question 4

The coronary arteries fill during

Answer 4

Diastole

Question 5

Epicardial coronary vessels can be compressed in a condition where the coronary dives into the muscle. This is called

Answer 5

Myocardial bridging

Question 6

The subendocardium is subject to LV wall pressure, which makes the subendocardiu more susceptible to

Answer 6

Ischemia

Question 7

What are the 3 factors affecting intrinsic coronary tone?

Answer 7

Local metabolites, Endothelial Factors, and Neural innervation

Question 8

Primarily adenosine, as well as lactate, hydrogen ions, and CO2

Answer 8

Local metabolites

Question 9

What are the two endothelial factors

Answer 9

Vasodilator and vasoconstrictors

Question 10

Hypoxemia inhibits aerobic metabolism and oxidative phosphorylation in mitochondria. This results in increased coronary flow via the vasodilator

Answer 10

Adenosine

Question 11

Produced in response to Ach, histamine, and. Serotonin. Then converts GTP to cGMP and causes smooth muscle relaxation

Answer 11

Nitric Oxide

Question 12

Released in response to hypoxia, shear stress, Ach and platelet factors

-functions through cAMP related mechanism

Answer 12

Prostacyclin

Question 13

Released in response to Ach and pulsation blood flow

Answer 13

Endothelial derived hyperpolarizing factor (EDHF)

Question 14

Vasoconstrictor released by thrombin, epinephrine, and angiotensin II

Answer 14

Endothelial-1

Question 15

In atherosclerotic vessels, release of vasodilator may decrease, causing endothelial dysfunction by a shift in favor of

Answer 15

Vasoconstrictors

Question 16

What are the three things that dictate myocardial oxygen demand?

Answer 16

Wall stress, HR, and contractility

Question 17

Increased LVEDP, hypertension, and aortic stenosis, all increase

Answer 17

Wall stress

Question 18

How do we find wall stress?

Answer 18

Wall stress = pressure/2 x radius/wall thickness

Question 19

What has a bigger effect on increasing wall stress, increasing pressure? Or radius?

Answer 19

Increasing pressure

Question 20

Decrease oxygen demand

Answer 20

Beta-blockers

Question 21

With regards to neurostimulation of intrinsic coronary tone, which effects are greater, sympathetic or parasympathetic?

Answer 21

Sympathetic effects

Question 22

NOT a component of myocardial oxygen demand

Answer 22

O2 content

Question 23

Resistance is:

1. ) Directly proportional to?
2. ) Inversely proportional to?

Answer 23

1. ) Length

2. ) r^4

Question 24

So as the vessel narrows, the resistance is drastically increase by change in

Answer 24

Radius

Question 25

Epicardial arteries are more susceptible to

Answer 25

Plaque

Question 26

The smaller arterioles are free from plaque and have the ability to adjust their vasomotor tone to allow greater blood flow as needed. This is called?

Answer 26

Compensatory Vasodilation

Question 27

At greater than 70% stenosis, we may not have enough coronary flow for

Answer 27

Exercise

Question 28

Resting coronary flow begins to fall at

Answer 28

90% stenosis

Question 29

What are the two types of endothelial dysfunction that can contribute to ischemia?

Answer 29

1. ) Inappropriate vasoconstriction | 2. ) Loss of antithrombotic properties

Question 30

In normal individuals, in response to physical activity, we see release of

Answer 30

Vasodilator

Question 31

However, in a diseased vessel, we see decreased release of

Answer 31

Vasodilators

Question 32

Not aproblems with regard to atherosclerotic plaque but rather a supply/demand mismatch

Answer 32

Non-CAD related ischemia

Question 33

Results in both decreased LV contractile function as well as relaxation, both of which are energy dependent processes

Answer 33

LV dysfunction

Question 34

Lactate, serotonin, and adenosine accumulate locally and activate pain receptors C7-T4 with

Answer 34

Angina

Question 35

Transient abnormalities of myocyte ion transport that can result in V-tach or V-fib

Answer 35

Arrhythmias

Question 36

Complete death of myocytes w/ no chance for recovery

Answer 36

Infarction

Question 37

Transient ischemia, which has recovery of blood flow, but still shows systolic dysfunction that slowly recovers

Answer 37

Stunned myocardium

Question 38

Chronically ischemic tissue from severe stenosis that shows viability

Answer 38

Hibernating Myocardium

Question 39

Exertion also chest pain which predictably comes on with exercise and goes away with rest

Answer 39

Stable Angina

Question 40

Clinically defined as new, or worsening, angina -Part of spectrum of acute coronary syndrome

Answer 40

Unstable angina

Question 41

Severe variant angina that can cause ST Elevation MI (STEMI) -Can be very difficult to diagnose

Answer 41

Variant (Prinzmetal’s) Angina

Question 42

Be careful not to use non-selective beta-blockers to treat

Answer 42

Variant (Prinzmetal’s) Angina

Question 43

Presence of myocardial infarction w/out clinical symptoms -Higher frequency in diabetics and women

Answer 43

Silent ischemia

Question 44

Patients w/ typical angina symptoms and no significant stenosis of epicardial coronary arteries

Answer 44

Cardiac Syndrome X

Question 45

Thought to be due to endothelial dysfunction and inadequate vasodilator reserve of small arteries

Answer 45

Cardiac Syndrome X

Question 46

Retrosternal chest pain or pressure that is WORSE with exertion and improved w/ rest or nitro

Answer 46

Angina (CAD)

Question 47

Sudden onset tearing or ripping pain with radiation to the back -Occurs at rest w/out relief

Answer 47

Aortic Dissection

Question 48

Pleuritic sharp pain that may be associated w/ fever or viral syndrome

Answer 48

Pericarditis

Question 49

ST depression and T-wave inversion are signs of

Answer 49

Subendocardial Ischemia

Question 50

Shows ST elevation on EKG

Answer 50

Transmural ischemia

Question 51

A positive stress test for ischemia is

Answer 51

1 mm of horizontal or downsloping ST-depression

Question 52

An esophageal spasm can be relieved by

Answer 52

Nitro

Question 53

A fall in systolic BP, ventricular arrhythmias, and greater than 2 mm ST depression is

Answer 53

Markedly positive for ischemia

Question 54

Does not have the same resolution as angiography, but is a non-invasive method that can identify severe stenosis

Answer 54

Coronary CT angiography

Question 55

The gold standard to diagnose CAD -Artery is accessed via femoral or radial artery

Answer 55

Coronary Angiography

Question 56

Fast acting vasodilator to decrease venous return to the heart -Coronary vasodilator used to treat acute angina

Answer 56

Nitroglycerin

Question 57

Reduce myocardial demand by decreasing HR and contractility -Shown to decrease mortality after MI

Answer 57

Beta-blockers

Question 58

Deep T-wave inversions in anterior leads

Answer 58

Wellen’s sign

Question 59

Long acting version of nitroglycerin -Are vasodilators

Answer 59

Nitrates (isosorbide mononitrate and isosorbide dinitrate)

Question 60

Calcium channel blocker that is a potent vasodilator used to treat angina

Answer 60

Dihydropyridine (amlodipine and nifedipine)

Question 61

Nonhydropyridin’s are Ca2+ channel blockers with a more negative inotropic and chronotropic effect. Two examples are?

Answer 61

Diltiazem and verapamil

Question 62

Recommended in ALL CAD patients

Answer 62

Aspirin

Question 63

What are two types of revascularization used for treatment of CAD?

Answer 63

Percutaneous Coronary Intervention (PCI) and Coronary Artery Bypass Grafting

Question 64

Pass wire and then ballon to open up blockages and then place a stent

Answer 64

PCI

Question 65

Potent antiplatelet agents used in combination with aspirin in patients after an MI or who have coronary stents

Answer 65

Platelet P2Y12 ADP receptor antagonists