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28 Cards in this Set
- Front
- Back
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Chronic ischemic heart disease:
Arterial blood flow is pulsatile and depends on what 3 things? Oxygen supply depends on what 3 things? |
HR, myocardial contractility, myocardial wall tension
hemoglobin concentration, inspired level of O2, coronary blood flow |
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Chronic Ischemic Heart disease:
Arteriosclerosis of the heart occurs in the ... coronary arteries. ... points are common sites. Reduction of blood flow occurs at >...% blockage. critical blockage = when the lumen of the coronary arteries reaches ...% occlusion |
epicardial
Branching 50 70 |
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Chronic ischemic heart disease:
The basic pathophysiology is ... formation within the endothelial lining of the vessel. This plaque is made up of a large core of ..., surrounded by a thin ... cap. Rupture of this ... is the anatomical cause of the acute myocardial infarction. |
plaque
lipids fibrous plaque |
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Blockage of a proximal epicardial artery will have a ... infarct compared to a more distal epicardial artery.
Blockage of the ... would be really bad b/c it supplies 70% of the LV. The ... portion of the ... artery supplies about 40% of the LV. You can only lose about ...% of the left ventricle and survive. anything past this and the person goes into cardiogenic shock. |
larger
left main coronary artery proximal LAD 40 |
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Chronic ischemic heart disease:
Loss of blood circulation leads to myocardial damage. If blood loss is complete, tissue death ensues. The tissue damage is ... with variable response depending upon the ... involved. Multiple complications occur secondary to the myocardial ischemia and tissue damage. |
regional
area |
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Stable Angina Pectoris:
Stable angina is precipitated by ... and relieved by ... Rarely occurs ... alone Physical exam may be ... Most common abnormal physical finding is decreased .... S3 or S4 gallop may also be present. |
exertion
rest at rest perfectly normal arterial pulses |
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Pain is not all that they experience. Many will feel an intense ....
Can occur almost anywhere in the chest, but primarily in the center of the chest and can radiate. If a female over 45 or 50 w/ central chest discomfort, and they feel it in their throat (like someone is choking them), think .... ..., especially in older patients and diabetics, may be their only symptom. May hear S3 in children (normal), but no S3 gallop is normal in an adult. |
pressure
MI Dyspnea |
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Stable Angina Pectoris: Lab findings
Plasma lipids may be elevated HTN – BP may be elevated Cardiomegaly may be present on CXR - An enlarged heart is always ... b/c it is trying to compensate. It dilates first, then hypertrophies. If it tries to dilate again, it’s .... It means the heart is in congestive HF. Cardiac enzymes will be ... |
abnormal
remodeling normal |
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Stable angina pectoris:
The electrocardiogram is usually ... unless the heart is ... (ST segment and T wave changes). The most common diagnostic test for ischemic heart disease is either an exercise or chemical ... test. ... should be considered for each patient’s test. Consider age, PMH, medications, and typicality of chest pain. |
normal
enlarged stress Pretest probability |
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Stable Angina Pectoris:
What is considered the “gold standard” for determining plaque formation and occlusion of the arterial lumen? -it is >95% accurate |
Coronary arteriography
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Stable Angina Pectoris:
Indications for arteriography 1. Chest pain ... to maximal medication. 2. The absolute need to identify the coronary .... 3. Evaluate survivors of .... 4. To identify ... of obstructive plaques in patients with abnormal stress tests. 5. To evaluate patients considered to be at ... risk based on symptoms and prior non-invasive stress tests. |
unresponsive
lumen cardiac arrest location high |
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Stable Angina Pectoris:
Prognosis depends upon - patient’s ... - ... function -... of coronary artery narrowing -... of coronary narrowing The amount of myocardial damage determines the ventricular function. |
age
left ventricular severity location |
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Stable Angina Pectoris:
Obstructive lesions of which 2 coronary arteries are associated with the greatest risk? |
left main and proximal left anterior descending coronary arteries
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Stable angina pectoris:
Both the ... and ... of cardiac risk factors are impt determinants in influencing the patient’s prognosis. |
number
severity |
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Stable Angina Pectoris:
Severity of cardiac dysfunction is indicated by measurements of LV ejection fraction, LV volumes, and LV end diastolic pressures assessed via cardiac .... Patients with chest pain but who have normal LV ejection fraction and normal coronary arteries have essentially a ... percent chance for a heart attack. |
catheterization
zero |
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Tx of Ischemic heart disease:
Reduce general .... -Start a regular exercise program of walking ... miles per hour for a minimum of ... minutes for ... days a week. -Total discontinuation of ... use. -Follow a low ... diet which is also relatively low in saturated and unsaturated trans fatty acids. -control DM to a fasting blood sugar of ...-... mg% and ... mg% post prandial -weight control |
risk factors
2 30 5 tobacco carbohydrate 80-120 140 |
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Tx of ischemic heart disease:
Specific txs: -angina pectoris (acutely) - ... |
organic nitrates (NTG)
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Tx of Ischemic heart disease:
Dyslipidemia – one of the most important treatments for long term care. -Lowering ... cholesterol and raising ... absolutely reduces the incidence of death, angina pectoris, and myocardial infarction. -The ... can lower ... cholesterol by 50-60% and raise ... by 10%. They lower ... by 25%. |
LDL
HDL HmG-CoA reductase inhibitors (statins) LDL HDL triglycerides |
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Tx of ischemic heart disease:
... work against the sympathetic nervous system. They reduce BP, HR, and myocardial contractility, which reduces O2 demand and therefore myocardial ischemia. They reduce chest pain, myocardial infarction, and death. They are also good antihypertensive drugs. |
Beta adrenergic blockers
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Tx of ischemic heart disease:
... -These drugs cause moderate arterial vasodilatation, reduce myocardial contractility, and reduce blood pressure. -They work best when combined with beta-blockers and nitrates. (but be careful b/c they both reduce HR) -The ... class is the preferred class. -The ... are preferable to beta-blockers when the patient has asthma or heart block. |
Calcium Channel Blockers
dihydropyridine calcium channel blockers |
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Tx of ischemic heart disease:
Antiplatelet drugs -... reduces platelet activation thereby reducing the chance for thrombus formation within the coronary artery. -All patients who have sustained a prior myocardial infarction should take low dose ... if they are not allergic to it. |
Aspirin
aspirin |
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Tx of ischemic heart disease:
Antiplatelet Drugs -... is a stronger blocker of platelet aggregation and definitely should be used in all patients who have coronary artery stents (especially w/ a new drug eluding stent). |
Clopidrogrel (Plavix)
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Tx of ischemic heart disease:
May also be used in survivors of acute MI. The benefits of ... are greatest if the patient with ischemic heart disease has heart failure, hypertension, or diabetes. |
ACE inhibitors
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Coronary Revascularization:
... involves a balloon angioplasty dilatation of the stenotic atherosclerotic coronary artery. -This has become the most common form of coronary revascularization. However, left main disease and diffuse three vessel disease especially in the ... patient should receive .... |
PCI
diabetic CABG |
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Coronary revascularization:
What is the most common clinical condition for PCI? primary success w/ PCI in vascular dilation therapy is ~...% |
angina pectoris w/o an acute MI
95 |
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look at slide 36
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ok
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Coronary revascularization:
Coronary Artery Bypass Grafting -Native bypass arteries (radial or ..., primarily the left one but can use both) or segments of veins can be used for CABG. -The ... vein is most commonly used. -This is a safe procedure with an approximate 1% mortality rate. |
internal mammary
proximal saphenous |
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Coronary Revascularization:
-The ... is the best bypass vessel. -Angina is abolished in about 90% of all bypass grafts. -Survival is better with a stronger left ventricle. -The decision to perform CABG is dependent on the coronary anatomy, ventricular function, and patient age. The older the patient, generally the ... likely we are to do a bypass. |
internal mammary artery
less |
