Ischemic Heart Disease

Coronary artery disease

What is another name for ischemic heart disease?

Atherosclerosis

A disease process characterized by a buildup of lipids in the intimal layer of the coronary arteries, known as plaque.

HDL

Removes excess cholesterol in the blood.

Serves as a protector from atherosclerosis.

1. Increased LDL

2. Decreased HDL

What cholesterol factors will increase the risk of atherosclerosis?

Decreases O2 supply

The fibrous plaque narrows the lumen of the coronary artery, which ___.

Acute MI

What is triggered when O2 supply in the coronary arteries doesn’t meet demand?

Coronary artery disease

A narrowing of the coronary arteries sufficient to prevent adequate blood supply to the myocardium (ischemic).

This is a reversible condition.

Damaged (infarction); irreversible

The narrowing of the arteries can progress to the point that the heart muscle is ___ and ___.

Coronary artery disease

What is the most common type of heart disease?

1. High blood pressure

2. High cholesterol

3. Smoking

4. Diabetes

5. Obesity

6. Unhealthy diet

7. Physical inactivity

8. Alcohol use

What are some risk factors for heart disease (8)?

Myocardial ischemia

O2 to the myocardium is less than the demand.

Acute MI

Prolonged ischemia results in ___.

1. Exercise

2. Emotional stress

3. HTN

4. Tachycardia

5. LVOT obstructions

6. Aortic stenosis

Conditions which increase O2 demand include ___ (6).

1. Atherosclerosis (CAD)

2. Coronary artery spasm

3. Hypotension

4. Congenital defects

5. Anemia

6. Hypoxia

What conditions decrease the supply of O2 to the heart (6)?

Ischemia; CAD

Wall motion defects may develop during ____.

Ischemia may need to be induced through stress TTE to diagnose existing ___, which may have been missed at rest.

1. Decreased EF

2. Decreased dP/dT

3. RV systolic dysfunction

4. Elevated pulmonary pressure

5. LV dilatation and systolic dysfunction

6. Regional wall motion abnormality

7. Papillary muscle rupture or dysfunction

What are the significant findings of end-stage ischemic disease (CAD)?

1. Angina

2. Dyspnea

3. CHF

4. MI

5. Sudden death

Complications of CAD ___.

Angina

Chest pain associated with ischemia in CAD.

15 minutes

If chest pain lasts longer than or shorter than ___, then it is probably not angina.

Stable angina

What is the most common type of angina?

Stable angina

Usually occurs with activity (exertion).

Relieved within 2-5 minutes with rest and/or nitroglycerin (NTG).

Unstable angina

Angina that has changed in quality, frequency, timing, or duration.

Occurs at rest or with less physical effort.

Lasts longer; pain doesn’t go away with rest or medication.

Pt is at risk for MI or sudden death.

Nocturnal angina

Chest pain that occurs at night; pt wakes up.

Variant angina

Caused by coronary artery vasospasm (not CAD).

Typically occurs at rest.

Prinzmetal angina

What is another name for variant angina?

Acute myocardial infarction (MI)

The irreversible necrosis of heart muscle secondary to prolonged ischemia.

Typically not relieved by NTG.

1. Chest pain

2. Dyspnea

3. Diaphoresis (sweating)

4. Nausea and vomiting

5. Syncope

What are the signs and symptoms of acute MI?

1. LV systolic dysfunction

2. LV thrombus

3. Aneurysm formation

4. Acute MR

5. Flail mitral valve

6. VSD

7. LV rupture

8. Pericardial effusion

Acute MI complications include ___(8).

Electro-mechanical dissociation

Electrical activity without an associated pulse.

Occurs when the infarcted segment ruptures.

Pt develops tamponade.

Congestive heart failure

Develops with significant infarct.

May be secondary to systolic dysfunction, VSD, MR due to papillary muscle dysfunction, flail mitral valve.

VSD

Complication of septal infarctions.

LT to RT shunt causes RV volume overloads, resulting in pulmonary edema.

Flail mitral valve

Complications that is the result of damage to the papillary muscle arising from the infarcted segment.

Stress of the systolic contraction rips off the head of the papillary muscle attached to the MV leaflet.

Causes wide open MR resulting in pulmonary edema.

Sudden cardiac death

Complication of acute MI.

Most commonly due to lethal arrhythmias such as V-tach, v-fib, and bradycardia.

Diuretics

Reduce circulating blood volume.

Medical treatment for ischemic heart disease.

Ex: Lasix

Cholesterol drugs

Medical treatment for acute MI and ischemic heart disease.

Lowers bad cholesterol.

Reduces plaque buildup in the arteries.

Ex: statins, niacin

Blood thinners

Medical treatment for acute MI and ischemic heart disease.

Prevents blood clots from forming.

Low-dose aspirin is used in the prevention of heart attack or stroke.

Nitrates

Relaxes the smooth muscles.

Promotes venous and arterial dilation, resulting in decreased myocardial demand and increased myocardial perfusion.

Ex: nitroglycerin

Beta-blockers

Blocks the stimulatory effects of this receptor, slowing down the heart and dilating the vessels.

Slow down the heart rate, reduce BP, and reduce contractility.

Beta-1 adrenergic; epinephrine

Cardiac beta blockers are selective. They act on ___ receptors in the heart and block ___.

1. Acute MI

2. HTN

3. Angina

4. Some cardiomyopathy

Beta-blockers are used in ___.

Calcium channel blockers

Reduces vasoconstriction thus reducing LV afterload.

Lowers blood pressure.

Decreases contractility and heart rate.

Calcium

___ causes the heart and arteries to contract more strongly.

Calcium channel blockers

Allow blood vessels to relax and open by blocking calcium channel transport.

-ipine

Most calcium channel blockers end in ___.

1. Constipation

2. Headache

3. AV block

4. Edema

5. Flushing

What are some side effects of calcium channel blockers?

ACE inhibitors

Prevent the conversion of angiotensin I into angiotensin II.

Relaxes the veins and arteries, lowering blood pressure.

ACE inhibitors

Decreases the amount of sodium and water retained.

Drug of choice for heart failure.

Fetotoxic

Which ACE inhibitor shouldn’t be used by pregnant women?

CABG

Pts veins or arteries are used to bypass narrowed areas to restore blood flow.

Usually GSV; can use SSV, internal mammary artery, or radial artery.