Ischemic Heart Disease I - Exam 2

Question 1

In general, why does mycocardial ischemia occur? What is the most critical factor?

Answer 1

occurs when there is an imbalance between oxygen supply and demand

radius of the blood vessel

Question 2

What are the 3 factors that influence the radius of the blood vessel?

Answer 2

atherosclerosis hardening of vessels

vascular tone

endothelial cell dysfunction in cardiac ischemia

Question 3

What is the difference between stable and unstable angina?

Answer 3

stable: chest pain on exertion

unstable: constant chest pain even at rest

Question 4

What conditions are included in Acute Coronary Syndrome (ACS)? What conditions are included in Ischemic Heart Disease?

Answer 4

unstable angina

MI: including STEMI and NSTEMI

Question 5

What is Prinzmetal angina?

Answer 5

not scary spasms of the blood vessels

Question 6

What is Acute Coronary Syndrome a result of? What determines the severity?

Answer 6

ACS results when there is plaque rupture and thrombus formation

the amount of coronary blood flow

Question 7

What are the differences in blood flow between unstable angina, NSTEMI and STEMI?

Answer 7

Question 8

What are the differences between stable and unstable angina?

Answer 8

Question 9

When does ischemia present? Can cardiac cells tolerate mild-moderate anoxia?

Answer 9

Present as soon as there is a decrease or complete absence of blood supply to myocardial tissue

Cardiac cells can tolerate mild-moderate anoxia for a short time without greatly affecting their function. When oxygen is restored the cells usually return to normal

Question 10

When does cardiac injury appear? Is it usually reversible?

Answer 10

If ischemia is severe or prolonged, the anoxic cardiac cells sustain damage and stop functioning normally

damage to cells still remains reversible and cell may return to normal or near normal after the return of adequate blood flow and reoxygenation

Question 11

When does an infarct occur? Is it reversible?

Answer 11

Severe myocardial ischemia continues because of continued complete absence of blood supply

The anoxic cardiac cells will sustain IRREVERSIBLE injury and die

aka dead meat, don’t beat!!

Question 12

What is a transmural infarct?

Answer 12

When the tissue dies through all the layers of the heart

aka VERY BAD

Question 12

What areas are common for NSTEMI? What area is particularly susceptible to ischemia?

Answer 12

Involves small area in the subendocardial wall of the LV, ventricular septum, or papillary muscle

subendocardial area

Question 13

What are the EKG changes associated with NSTEMI? Will there be an increase in cardiac enzymes?

Answer 13

ST depression or T-wave inversion (or no EKG changes)

will see an increase in cardiac enzymes

Question 14

Will there be an increase in cardiac enzymes with unstable angina?

Answer 14

NO increase in cardiac enzymes

Question 15

What is the cause of a STEMI?

Answer 15

infarct through the extend through the whole thickness of the heart muscle wall, that is caused by the complete occlusion of a coronary artery

Question 16

What are EKG changes that will appear with a STEMI? ______ is the classic description of the wave

Answer 16

ST elevation!!! and SOMETIMES develop a Q wave (but not always)

“tombstone” appearance

Question 17

What are the 5 different types of MI classifications? **Type 1 and 2 are the highlighted ones

Answer 17

**Type 1: primary coronary event

**Type 2: MI secondary to ischemia

Question 18

What is silent ischemia? **What are the top 3 pt demographics?

Answer 18

Myocardial ischemia without discomfort or pain

**More common in diabetics, elderly patients, and women

Question 19

What is myocardial stunning?

Answer 19

Reversible myocardial dysfunction following reperfusion of an ischemic insult

Usually following sudden episode of ischemia then quick reperfusion. Dysfunctional after reperfusion but then goes back to normal

Question 20

What is hibernating myocardium a result of? What does it cause?

Answer 20

A result of prolonged reduction in blood flow from coronary artery disease over a longer period of time

Causes ventricular contractile dysfunction that will improve once blood flow improves

Question 21

**What is the significance of an inferior wall MI? What artery is that associated with?

Answer 21

often accompanied by a ↓ HR because of involvement of the sinus node. Long term effects are usually less severe than those of an anterior wall MI.

RCA

Question 22

**What is the significance of an anterior wall MI? **What artery?

Answer 22

**the anterior wall performs the main pump function and decay of the function of this wall will lead to ↓ BP, ↑ HR, shock and on a longer term, HF

** LAD

Question 23

**Draw the chart Prof Long gave us about the artery, heart wall/ventricle and correlating EKG leads

Answer 23

Question 24

Draw the chart that you created when studying for the first EKG test

Answer 24

Question 25

Draw the lecture version of the same EKG/artery chart

Answer 25

Question 26

______ is the term used to describe chest discomfort related to ischemic heart disease

Answer 26

Angina Pectoris

Question 27

What is the "typical angina" presentation? What are words that are used to describe the quality?

Answer 27

Typically male >50 or female >60 who presents with EPISODIC chest discomfort heaviness, pressure, squeezing, smothering, aching or choking

Question 28

Where does typical angina usually radiate? How long does it last? What setting? What are some alleviating factors?

Answer 28

Radiation to the arms/shoulders (left), neck, jaw, teeth, back/scapula, epigastrium 2-5 minutes typically with exertion NTG, rest

Question 29

What is the abnormal presentation of a women having a heart attack?

Answer 29

SOB, pressure or pain in the lower chest or upper abdomen, dizziness, extreme fatigue, lightheadedness, fainting, or upper back pressure

Question 30

T/F: Exercise stress tests are more likely to be accurate in women than men.

Answer 30

FALSE!! Exercise stress test may be less accurate in women

Question 31

How does Prinzmetal angina typically present? What is the tx? Who is the MC pt demographic? What will it look like on EKG?

Answer 31

chest pain due to vasospasm Treated with CCB and nitrates Most common in middle-aged women mimics a STEMI on EKG

Question 32

What does every pt with chest pain need?

Answer 32

EVERY PATIENT WITH CHEST PAIN GETS AN EKG/CXR. Add cardiac enzymes if clinically suspicious for ACS!

Question 33

**What is the TIMI risk score? When is it used? What is considered low/intermediate/high?

Answer 33

TIMI (Thrombolysis in MI) Used in unstable angina and NSTEMI used to risk stratify patients to help determine who should undergo aggressive evaluation / treatment. Event rates increase significantly as the TIMI risk score 0-2: Low risk 3-4: Intermediate risk 5 or more: High risk

Question 34

**What are the 7 parameters for the TIMI risk score? Where are they used?

Answer 34

used in unstable angina and NSTEMI

Question 35

What is the heart score? When is it used? What are the ranges with interpretation?

Answer 35

should you admit the pt based on their probability of having a major adverse cardiac event

Question 36

**What are the 5 categories that make up the components of the heart score?

Answer 36

Question 37

What are the risk factors when talking about the heart score?

Answer 37

DM smoking HTN hypercholesterolemia obesity family hx of CAD

Question 38

What makes the history score change from 0-2?

Answer 38

Question 39

What makes the EKG score change from 0-2?

Answer 39

Question 40

What is considered "repolarization" abnormalities" on EKG for the heart score system?

Answer 40

Question 41

**What is the entire expanded heart score chart from lecture?

Answer 41