Ischemic Heart Disease

Question 1

define ischemia

Answer 1

a condition in which the blood flow (and thus oxygen) is restricted or reduced in a part of the body

Question 2

define hypoxemia

Answer 2

low oxygen content in the blood

low O2 saturation

Question 3

define hypoxia

Answer 3

a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level

Question 4

what is ACS (acute coronary syndrome)?

Answer 4

an umbrella term for a range of symptoms associated with sudden, reduced blood flow to the heart (i.e. cardiac ischemia)

Question 5

what conditions are included in ACS?

Answer 5

1. Heart attack (MI)
2. unstable angina
3. ST segment elevation MI (STEMI)
4. Non-ST segement elevation MI (NSTEMI)

Question 6

the diagnosis of ACS is based on what?

Answer 6

1. pt hx: chest or left arm pain, hx of CAD
2. examination:
   
   • hypotension, diaphoresis
   • pulmonary edema, rales
   • ECG changes: ST-segment deviation
   • elevated cardiac biomarkers

Question 7

Ischemic Heart Disease (IHD) if also referred to as what?

Answer 7

coronary heart disease (CHD)

coronary artery disease (CAD),

athersclerotic heart disease (ASHD)

Question 8

IHD includes what disorders/conditions?

Answer 8

1. heart attacks
2. angina: stable and unstable
3. heart failures and arrhythmias

Question 9

what are some causes of IHD

Answer 9

1. atherosclerosis of coronary arteries (most common)
2. coronary thombus or emboli
3. coronary spasm
4. complications of CT disorders

Question 10

risk factors for IHD include:

Answer 10

1. Age
2. Gender
3. Smoking Hx
4. physical inactivity
5. hypercholestermia
6. high levels of stress
7. family history
8. poor diet
9. HTN
10. diabetes
11. obesity

Question 11

list common symptoms of IHD

Answer 11

1. chest pain or discomfort, which may involve pressure, tightness or fullness
2. pain or discomfort in one or both arms, the jaw, neck, back, or stomach
3. SOB
4. feeling dizzy or lightheaded
5. nausea
6. sweating

Question 12

how is IHD diagnosed?

Answer 12

1. blood testing:
   
   • cardiac enzymes
   • CRP
   • homocysteine
   • abnormal lipid profile
   • BNP
   • prothrombin
2. ECG alteration

Question 13

what is ischemic cardiomyopathy?

Answer 13

most common cause of dilated cardiomyopathy

caused by CAD which causes an insufficient blood suppy to the heart resulting in myocyte ischemia

heart changes geometric shape in response to chronic shortage of O2

Question 14

T/F: ppl can live with CAD for a long time

Answer 14

TRUE

Question 15

Ischemic cardiomyopathy results in damage that can lead to ________

Answer 15

cardiac remodeling

Question 16

give an example of cardiac remodeling that can occur from Ischemic cardiomyopathy

Answer 16

1. myocardial fibrosis
2. arrthymias
3. possible cardiac conduction system impairments
4. cell death
5. left ventricular enlargement and dilation

Question 17

ultimately ischemic cardiomyopathy patients develop _____________

Answer 17

congestive heart failure

Question 18

what are the two types of angina pectoris?

Answer 18

stable and unstable

Question 19

IHD angina can lead to what?

Answer 19

1. Myocardial infarction
2. sudden cardiac death
3. ischemic cardiomyopathy

Question 20

define angina pectoris

Answer 20

intermittent chest pain caused by transient BUT reversible myocardial ischemia

Question 21

describe stable angina?

Answer 21

1. caused by a mismatch between O2 delivery and O2 need
2. brought on by exertion or other forms of stress
3. occurs at a predictable HR
4. crushing or squeezing substernal sensation w/possible radiation
5. reduction in stress reduces symptoms

Question 22

how is stable angina treated?

Answer 22

nitroglycerin

Question 23

describe unstable angina

Answer 23

• brought on by exertion or other form of stress
• onset is unpredictable
• crushing or squeezing substernal sensation with possible radiation to the arm

Question 24

what is the main difference between stable and unstable angina?

Answer 24

unstable has an unpredictable onset

Question 25

what is thought to be the cause of unstable angina?

Answer 25

thought to occur because of acute plaque changes, and/or coronary artery vasospasm

Question 26

how is an MI an ischemic heart disease?

Answer 26

if ischemic insult is sufficiently long, tissue damage and death results

Question 27

what is a reperfusion injury?

Answer 27

tissue damage caused when blood supply returns to tissue after a period of ischemia or lack of oxygen associated with microvascular injury, particularly due to increased permeability of capillaries and arterioles that lead to an increased diffusion and fluid filtration into the tissues

Question 28

what is sudden cardiac death?

Answer 28

natural unexpected death secondary to cardiac causes with rapid loss of consciousness

Question 29

\_\_\_\_% of CAD deaths are from sudden cardiac disease

Answer 29

50%

Question 30

list some anatomic findings in individuals who suffered sudden cardiac death

Answer 30

1. acute coronary plaque rupture or thrombosis 2. clinically quiet MI (minority of cases) 3. No acute lesion but \>60% stenosis of a coronary artery, often LAD