Ischemic Heart Disease Lecture

Front 1

What is Ischemic Heart Disease?

Back 1

Mismatch between O2 Supply and demand leading to anaerobic metabolites and hypoxia.

Front 2

What is Angina Pectoris?

Back 2

Uncomfortable sensation in the chest produced by myocardial ischemia

Front 3

Describe the clinical presentation of Stable Angina. (such as Time course? Etiology? Relief? EKG signs?)

Back 3

Chronic but transient Angina brought on by increased demand (exercise/stress) with stenosis preventing increased supply. Relieved by rest. There is no necrosis, but ST segment depression and T symmetric wave inversion are seen on EKG during attack.

Front 4

Describe the clinical presentation of Variant Angina. (such as Time course? Etiology? EKG signs?)

Back 4

Typical Angina while at rest brought on by CA vasospasm (not demand). ST elevation is often observed on EKG.

Front 5

Describe the clinical presentation of UNStable Angina. (such as Time course?Etiology? Specific Risk?)

Back 5

Angina of increasing frequency and duration at ever lower exercise tolerance and even can occur at rest. Usually the result of rupture of unstable plaque with subsequent thrombosis. There is High frequency of untreated progression to MI!

Front 6

What defines Silent Ischemia?

Back 6

Being Asymptomatic

Front 7

What is a MI?

Back 7

Myocardial necrosis due to prolonged cessation of blood supply.

Front 8

What are the classic HA symptoms?

Back 8

N/V; Sweating, pallor, Anxiety, Dyspnea, Crushing chest pain

Front 9

Describe the factors that determine O2 supply.

Back 9

1. Hemoglobin and HB saturation;
2. Blood Flow which is proportional to P/R

Front 10

True/False - The Heart is a unique organ that receives blood flow only in diastole and can only increase O2 supply via increased flow.

Back 10

True

Front 11

What is the effect of anaerobic metabolites on vascular smooth muscle?

Back 11

Vasodilation

Front 12

Endothelial factors effect dilatation and constriction. Name the effect for NO, Prostacyclin, EDHF, & Endothelin-1.

Back 12

NO, Prostacyclin, & EDHF are Vasodilators;
Endothelin-1 is a vasoconstrictor;

Front 13

What 3 factors control O2 demand?

Back 13

HR, CTY, Ventricular Wall Stress (~PxR /wall thickness).

Front 14

True/False - Resistance (and therefore flow) is primarily controlled by Resistance's inverse relationship to vessel radius to the fourth power.

Back 14

True

Front 15

What is the difference between Stunned and Hibernating Myocardium in Severe ischemia without necrosis?

Back 15

Stunned = eventually but not immediately will restore systolic f(x); Hibernating = f(x) will return once perfused;

Front 16

Describe normal Drug treatment for Angina Pectoris.

Back 16

Nitrates, Beta Blockers, CCBs (variant), ASA