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28 Cards in this Set
- Front
- Back
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which stage of the heart cycle is affected first by ischemia?
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the relaxation phase or diastole
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How do we get manisfestations of ischemia in the heart?
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the heart is unable to relax due to the decrease in available ATP which then causes the heart to stiffen. Due to the walls of the ventricles being incredibly stiff, the pressure inside the heart increases causing the pressure in the lung to increase leading to manisfestations.
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what is the sequence of the ischemic cascade?
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decreased oxygen availability --> decreased ATAO --> decreased actin-myosin unbridging; diastolic stiffness --> increased end-diastolic filling pressure --> decreased contractility --> ECG changes --> pain
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What is the sequence of plaque morphology?
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endothelial injury --> monnocyte/macrophage infiltration --> LDL oxidation/ fixation --> endothelial/medial hyperplasia --> fibrous cap --> central degeneration
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when is a plaque rupture most likely to occur?
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when subcapsular material is heavily lipid laden and the fibrous cap is thin.
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what do old plaques look like?
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they are calcified, thick and leathery.
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what is a red clot? what is a white clot?
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RBC caught by a mesh of fibrin. White clots are platelet plugs (d/t the platelets being a beige color)
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after rupture, exposed _______ and _____ promote platelet adherence.
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collagen and substrate
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what are the five presentations associated with angina?
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1) substernal heavy or squeezing pain
2) radiation down left arm, to jaw, or neck 3) may occur in epigastrium 4) can present with dyspnea instead of pain 5) fatigue often follows |
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what is an angina equivalent?
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a pt who presents with a lot of dyspnea, but not much chest pain
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why do pts w/ angina experience SOB?
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This feeling is associated with the 3rd stage of the cascade (diastolic stiffness). Increasing filling pressure to fill the heart and those pressures are automatically reflected in the lungs. When the pressures go up in the lungs, you get an increase in venous pressure in the lung. When the pulmonary vascular bed gets backed up, you start to feel SOB.
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what is the most important indicator of stable angina?
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reproducibility and predictability.
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T/F
In stable angina, stability is correlated to severity. |
False
Stability is not correlated to severity. Severity is a different marker involved with simple movements that cause it to happen. |
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what is the definitive indicator for unstable angina?
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any CHANGE in pattern, frequency, severity or quality of angina.
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what is the main indicator of mixed angina?
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component of VARIABLE threshold angina, but not in progressive pattern.
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which type of angina is the worst of all?
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crescendo angina
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Describe crescendo angina?
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progressively severe symptoms over short period of time
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after how many minutes of angina do you start to consider MI?
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15 minutes
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what are the five consequences of coronary ischemia?
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MI, ischemic dilated cardiomyopathy, arrhythmias, CHF, ischemic papillary muscle dysfunction w/ mitral regurgitation.
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the highest morbidity and mortality associated with Coronary ischemia is seen in pts with ____ and _____
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diabetes; metabolic syndrome
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what is metabolic syndrome?
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a cluster of RF (HTN, frank diabetes or glucose intolerance, certain type of obesity, and a certain cluster of lipid abnormalities (low HDL and high Triglycerides)
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what type of fat deposit is the most adverse?
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belly distribution. You want your hips to be bigger than your waist.
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what does aggressive/ interventional tx involve?
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1) hospitalize in CCU
2) IV nitrates 3) B-blocker 4) antiplatelet therapy 5) anticoagulant 6) emergent coronary visualization w/ angioplasty if indicated |
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why do you need antiplatelet therapy for aggressive tx? why do you need anticoagulant?
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because the initiating step in the cascade is the production of a platelet plug.
You need an anticoagulant because once the plugs resolves you will have a red thrombus and you need to deal with that. |
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what is involved in conservative care for highest risk pts?
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1) IV heparin, NTG, and 2b3a inhibitor
2) aspirin, B-blocker c) NO THROMBOLYSIS |
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what is involved in conservative care for lower risk pts?
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1) may require only 24 hour inpatient observation, w/ o ICY
2) oral nitrates, B-blocker, aspirin 3) Heparin NOT NEEDED and NO THROMBOLYSIS |
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what are the 6 steps of outpatient management?
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1) aggressive control of glucose
2) aggressive control of BP 3) attain ideal body weight 4) aggressive lipid control 5) regular aerobic exercise 6) smoking cessation |
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what medications are involved in outpatient management?
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aspirin, B-blocker, statin, nitrates as needed, ACE inhibitor
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