Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
37 Cards in this Set
- Front
- Back
|
Formation of fibro-fatty lesions in the intimal lining of the large and medium sized arteries.
|
Atherosclerosis
|
|
|
Chronic IHD includes
|
Chronic stable angina
Variant angina Silent myocardial ischemia |
|
|
How does atherosclerosis Develop?
|
1.Fatty streak
2.Fibrous atheromatous plaque 3.complicated lesion |
|
|
What does fatty streak consist of?
|
macrophages and smooth muscle cells that become distended with lipid to form foam cells
|
|
|
What is the fibrous cap made of in Fibrous atheromatous plaque?
|
connective tissue and smooth muscle
|
|
|
What is happening when Fibrous Atheromatous Plaque is formed?
|
Accumulation of intracellular and extracellular lipids
Proliferation of vascular smooth muscle cells Formation of scar tissue Leads to elevated thickening of vessel intima |
|
|
Rupture/ulceration of plaque occurs that leads to Thrombus formation
|
complicated lesion
|
|
|
complicated lesion occurs only in ______?
|
ACS
|
|
|
What are the determinants of plaque vulnerability to rupture?
|
Eccentric shape inc. risk of rupture
Ongoing inflammation and repair within the cap Thickness of fibrous cap covering the core Size and consistency of lipid-rich atheromatous core |
|
|
What are the factors of plaque rupture?
|
blood pressure: shear force
force of cardiac contraction coronary blood flow |
|
|
White vs. Red Clot
|
White clot:Contains more platelets than fibrin(NSTE ACS)
Usually produces incomplete occlusion of coronary lumen Red clot: Contains more fibrin and red blood cells than platelets(STE ACS) Usually produces complete occlusion of coronary lumen |
|
|
Inadequate supply of O2 to meet myocardial O2 demand (MVO2)
|
Myocardial Ischemia
|
|
|
Results from persistent ischemia (not quickly reversed) or from complete occlusion of a coronary artery
|
Heart attack
|
|
|
What are the Major determinants of MVO2?
|
Heart rate
Myocardial contractility Intramyocardial wall tension |
|
|
Arteriolar resistance_______coronary blood flow
|
decreases
|
|
|
Increased coronary perfusion pressure__________coronary blood flow
|
Increases
|
|
|
List the Main coronary arteries
|
Left main (LM) coronary artery
Left anterior descending (LAD) artery Left circumflex (LCx) artery Right coronary artery (RCA) |
|
|
What are the nonmodifiable Risk Factors of ischemia?
|
Gender (male > female)
Age Men > 45 yrs Women > 55 yrs Family history of premature CAD |
|
|
What are the modifiable Risk Factors of ischemia?
|
Hypertension
Smoking Dyslipidemias Diabetes mellitus Obesity Sedentary lifestyle Inc C-reactive protein (CRP) Inc lipoprotein (a) Inc homocysteine Chronic kidney disease |
|
|
Ischemia is present, but anginal pain does NOT occur
|
Silent myocardial ischemia
|
|
|
What characteristics do patients typically have in silent myocardial Ischemia ? Who is affected?
|
Altered pain threshold
Autonomic neuropathy Can occur in: Elderly Diabetics |
|
|
Precipitating factors of angina pectoris?
|
Physical activity
Emotional distress Cold weather Smoking Large meals |
|
|
Relieving factors of angina pectoris?
|
Rest
Sublingual nitroglycerin (SL NTG) Within 30 seconds to 5 minutes |
|
|
Differential Diagnosis of angina pectoris?
|
Pericarditis
Esophageal reflux/peptic ulcer disease Aortic dissection Pulmonary embolus Biliary disease Musculoskeletal disease |
|
|
Which diagnostic tests would be performed to a patient presenting with angina pectoris?
|
Electrocardigram (ECG)
Stress testing Cardiac imaging Coronary angiography “Cardiac catheterization” |
|
|
What are the types of stress testing?
|
Exercise tolerance testing (ETT)
Pharmacologic |
|
|
What can stress tests help do? and what the cannot?
|
Can predict risk for future cardiac events and mortality
cannot predict location of obstruction |
|
|
Commonly used in conjunction with stress testing to help localize the area of ischemia?
|
nuclear imaging
|
|
|
What radionuclide tracers are used in nuclear imaging?
|
sestamibi or thallium
|
|
|
If cold spots appear after exercise and at rest then...
|
Irreversible ischemia
|
|
|
Difference between NSTE ACS & STE ACS?
|
Thrombus completely occludes coronary lumen in STE ACS but incomplete in NSTE ACS
|
|
|
Patients with UA present with?
|
Angina at rest
Severe, new-onset (<2 mo) angina Angina increasing in frequency, duration, or intensity |
|
|
Which Cardiac Biomarkers are released into bloodstream when myocardial necrosis occurs
|
Creatine kinase MB
Troponins |
|
|
When is MI diagnosed using CK-MB?
|
MI diagnosed if ≥2 CK-MB values
|
|
|
When is MI diagnosed using troponins?
|
MI diagnosed if ≥1 troponin value
|
|
|
When do Troponin T (TnT) and troponin I (TnI) return to baseline?
|
7 days (TnI)
10-14 days (TnT) |
|
|
What biomarker is prefered to detect early reinfarction?
|
CK-MB
|
