Ischemic Heart Disease & Cardiac Failure Flashcards Preview

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Flashcards in Ischemic Heart Disease & Cardiac Failure Deck (19):
1

IHD is most commonly due to ___________ of the _______________.

- atherosclerosis of the coronary arteries

2

What is the normal progression of IHD?

- stable angina --> unstable angina --> MI --> chronic IHD --> sudden cardiac death

3

T or F: stable angina is associated with reversible injury, while unstable angina and MI are associated with irreversible injury.

- false!
- both stable and unstable angina are signs of reversible injury
- MI is irreversible injury

4

How long can myocardium survive in ischemia before dying?

- 20 minutes
- (this is why angina pain lasts 20 min)

5

ST depression is the hallmark sign of:

- subendocardial ischemia
- (stable and unstable angina, NSTEMIs)

6

What is stable angina due to? What about unstable angina? MI?

- stable angina is due to an increased demand of oxygen (ex: during exertion) in the setting of a coronary artery that is at least 70% occluded (from atherosclerosis)
- unstable angina is usually due to the rupture of the atheroma with incomplete occlusion, or when the the artery is 90% occluded from atherosclerosis
- MI: rupture of the atheroma with complete occlusion

7

Prinzemetal Angina is due to the episodic COMPLETE occlusion of the vessel via vasospasms (the vessel wall clamps down); what type of ischemia will occur? What will we see on ECG?

- complete occlusion will result in transmural ischemia
- as a result, we would expect to see an ST elevation

8

Subendocardial vs. Transmural ischemia/damage/infarct

- subendocardial results from incomplete occlusion (the ischemia only hits the endocardium because it is the farthest layer); ST depression
- transmural results from complete occlusion (all layers of the heart are deprived of oxygen); ST elevation

9

Occlusion of the LAD will result in damage to the:

- LV anterior wall and the anterior portion of the interventricular septum

10

Occlusion of the RCA will result in damage to the:

- LV posterior wall and the posterior portion of the interventricular septum

11

Why do neutrophils and macrophages enter the ischemic site after an infarction?

- because the infarction leads to necrosis, and acute inflammation (which involves these cell types) always follows necrosis

12

Pathogenesis of an MI from onset to scarring:

- MI hits: no changes within the first 4 hours -->
- over the course of a day: coagulative necrosis (deep red/dark discoloration of the heart) -->
- over a week: inflammation; first neutrophils (day 1-3) and then macrophages (day 4-7); (yellow pallor from the WBCs in myocardium) -->
- over the first month: granulation tissue (red border around the dead tissue) -->
- 1 month and on: fibrosis (white scar)

13

IHD is basically synonymous with:

- CAD (coronary artery disease)

14

Acute Coronary Syndrome

- unstable angina, MI, SCD (sudden cardiac death)

15

Which coronary artery is most commonly affected in IHD?

- LAD (50% of cases), followed by RCA and then LCX

16

What will wee see on ECG with a transmural MI?

- STEMI
- ST-segment elevation, pathologic (negative) Q-waves, and decreased R-waves

17

Acute Heart Failure vs. Chronic Heart Failure

- acute: usually refers to LHF
- chronic: usually refers to L and R HF (AKA congestive heart failure)

18

Signs and Symptoms of LHF

- *pulmonary congestion/edema* leads to dyspnea, PND, pulmonary crackles

19

Signs and Symptoms of RHF

- *peripheral congestion/pitting edema*, elevated JVP, nutmeg liver, organomegaly of liver and spleen, ascites