Cardiology Test 5- Sprowls IHD

Death caused by IHD was ____ at the start of the 20th century because of lifestyle differences (now we are more sedentary, have a worse diet, etc.)

uncommon

does ischemic heart disease (IHD) affect men or women to a greater extent?

men

What has caused a reduction in IHD related deaths?

-reduced ___

-improved treatment of various CVDs

-better medical interventions

-early ___

smoking, detection

IHD encompasses heart related conditions such as:

-stable ___

-acute ___ syndrome

-____ myocardial ischemia

angina, coronary, silent

Angina = chest pain caused by temporary decrease in __ __ to the muscles of the heart, and includes symptoms like "crushing" or "squeezing" pain in the chest, pain radiating to the left arm, SOB, nausea and/or sweating

blood flow

Angina is a ____ of IHD (not the same thing)

symptom

Coronary arteries are the major blood vessels that supply ___ blood to the heart

oxygenated

Coronary arteries branch off from the ___

aorta

Important vessels regarding IHD:

1) right coronary artery (RCA)

2) posterior _____ artery (PDA)

3) left anterior ____ artery (LAD)

4) left _____ artery (LCX)

descending, descending, circumflex

right coronary artery (RCA) supplies blood to the right side of the heart including the:

-right ___ and ___

-__ and ___ nodes

atrium, ventricles, SA, AV

posterior descending artery (PDA) supplies blood to the:

-intraventricular ___

-__ node

-____ aspects of the right and left ventricles

septum, AV, posterior

left anterior descending artery (LAD) supplies blood to the:

-anterior portion of left ____

-intraventricular _____

-___ of heart

ventricle, septum, apex

left circumflex artery (LCX)

-supplies blood to left _____

-posterior-lateral wall of left ___

-intraventricular ___

atrium, ventricle, septum

What is the single most common cause of IHD?

atherosclerosis

IHD can also be caused by:

-coronary artery ____

-coronary ___ dysfunction

spasm, microvascular

atherosclerosis= the gradual, persistent buildup of ___ ___ within artery walls, specifically the ___ ___

fatty plaques, tunica intima

Plaque size can reduce the vessel lumen up to __% before symptoms of angina begin (but an MI can still occur at a lower degree of reduction)

70

The following worsen IHD (because they lead to development of atherosclerosis)

-smoking

-age

-diabetes

-increased ___

-hypertension

-family ___ of atherosclerotic vascular disease

cholesterol, history

Ischemia is ___ ___ ___ to an organ or part of the body that causes a mismatch between oxygen supply and oxygen demand

inadequate blood supply

is Ischemia reversible?

yes

Infarct is the localized area of ___ ___ that results from failure of blood supply

dead tissue

is Infarct reversible?

no

Lab Markers

prior to heart muscle contraction, calcium is released from the ER and binds to _____, causing a conformational change that allows for myosin binding and therefore muscle contraction

troponin

In a patient's lab results for any acute coronary issues, will increased troponins indicate ischemia or infarcts?

Infarct

Lab Markers

___ ___ ___ converts creatine into phosphocreatine which functions as mechanism to quickly regenerate ATP in energy demanding situations

creatine kinase MB

Types of IHD Overview

1) ____ angina

2) stable coronary artery disease (___)

3) acute coronary syndrome (____)

variant, CAD, ACS

Variant Angina

-also known as ___ angina

-NOT caused by atherosclerosis, occurs at rest caused by ___ ___

Prinzmetal, vessel spasms

Variant Angina Triggers

1) ____

2) ____

3) ____

4) "____" drugs used for migraine control

smoking, cocaine, alcohol, triptan

Variant Angina Treatment

- ___ ___ ___

-____

calcium channel blockers, nitroglycerin

Stable Coronary Artery Disease (CAD)

-caused by blockage of artery ___ by a stable atherosclerotic plaque

-this leads to myocardial ___ and symptoms of angina

lumen, ischemia

Stable Coronary Artery Disease (CAD)

-the greater the degree of ____, the greater the degree of angina

blockage

Stable Coronary Artery Disease (CAD)

-pain is normally caused by, and is reproducible with physical ___ or emotional ___

exertion, stress

Stable Coronary Artery Disease (CAD)

-pain is normally caused by, and is reproducible with physical exertion or emotional stress, but is relieved with ___ or by __ ___

rest, sublingual nitroglycerin

Stable Coronary Artery Disease (CAD)

-____ troponin levels

normal

Stable Coronary Artery Disease (CAD)

-normal troponin levels because it is an ischemic event. Troponin levels are only increased for an ___ event

infarct

Stable Coronary Artery Disease (CAD)

-a stable, unruptured plaque can lead to sub-total occlusion and development of ___ vessels to supply oxygenated blood to the poorly perfused area

collateral

collateral vessels supply blood, but are not as ____ as normal vasculature and therefore do NOT prevent exercise induced angina

efficient

Acute Coronary Syndrome (ACS) 3 Types:

1) ___ ___

2) ___

3) ___

unstable angina, NSTEMI, STEMI

Acute Coronary Syndrome (ACS)

-refers to new-onset angina OR stable angina that becomes increasing in ___/duration, triggered by less exertion than normal, and occurs at ___

frequency, rest

Unstable Angina

-caused by __-__ occlusion (about 90%) of the artery lumen leading to ischemia but not tissue death

near-total

Unstable Angina

-ischemia impacts the ___ tissue, or the layer below the endothelial layer that lines the inside of the heart and is continuous with the underlying myocardium

subendocardial

Unstable Angina-ECG findings

-ST segment ____

-T wave ____

depression, inversion

Unstable Angina

-troponin and creatinine kinase MB levels are ___ because it is an ischemic event (no tissue death (infarct))

normal

Non-ST elevated myocardial infarction (NSTEMI)

-caused by __-__ occlusion (about 90%) of the artery lumen leading to an ____ of the subendocardial tissue

near-total, infarct

NSTEMI-ECG findings

-ST segment ___

-T wave ____

depression, inversion

ST elevated myocardial infarction (STEMI)

-caused by __ occlusion (100%) of the artery lumen leading to an ____ ____ of the entirety of the heart wall

total, transmural infarct

STEMI-ECG findings

-ST segment ___

elevation

NSTEMI AND STEMI-Lab findings

-___ in troponin and creatinine kinase MB levels (because infarct event)

increase

Complications of IHD

-_____: death to myocardial tissue can interrupt the conduction of electrical impulses across the heart and lead to both increased and decreased heart rate depending on which vessel is occluded

arrythmia

If right coronary artery (RCA) is occluded, this will damage to the ___ node, leading to an __ block

AV, AV

If left anterior descending artery (LAD) or left circumflux artery (LCX) is occluded, this will induce tissue ____ and spur __-__ circuit activity in left ventricles

heterogeneity, re-entrant

Complications of IHD

-Ventricular tachycardia and fibrillation can occur and are the most common cause of ___ cardiac death

sudden

Complications of IHD

-___ ___ ___ : death to myocardial tissue can lead to decreased contractility, leading to hypoperfusion and low BP

acute heart failure

Complications of IHD

-with acute HF, different complications can occur depending on if it is right HF or left HF, particularly ___ ___

-these complications are the most common cause of hospital death following an MI

cardiogenic shock

Complications of IHD

-_____: inflammation following a MI that spreads to the pericardium (sac that surrounds heart and great vessels)

pericarditis

Complications of IHD

-pericarditis can progress to __-___ related reaction against the pericardium

auto-immune

Complications of IHD

-___ syndromes (infarct of intraventricular septum, papillary muscle rupture, free wall rupture, psuedoaneurysm)

rupture

infarct of intraventricular septum

-caused by ___ occlusion leading to ventricular septal defect (a __ forms between left and right ventricles)

-patients will present with murmur and right HF that ultimately progresses to the left ventricle

LAD, hole

papillary muscle rupture

-occlusion leading to dissociation of cordae tendinae from papillary muscle leading to ____

-can be anterolateral or posteromedial

regurgitation

anterolateral papillary muscle is supplied by __ and __

LAD, LCX

posteromedial papillary muscle is supplied by __ and __

RCA, LCX

free wall rupture

-death of myocardial cells in ventricular wall ultimately leading to a hole in the __ wall of the left ventricle causing ____

-pushes patient into cardiac ___ (fluid accumulation in pericardium compressing heart)

outside, hemopericardium, tampenade

psuedoaneurysm

-occlusion of ___ causing incomplete rupture of left ventricular free wall contained by fibrous layer leading to accumulated blood that remains in ___

-can produce a ____ that can traverse into other organs leading to pathologies like stroke

LAD, stasis, thromboembolism