Ischemic Heart Disease

These flashcards cover the causes, pathophysiology, categories, clinical features, complications, diagnosis, and treatment of Ischemic Heart Disease based on the provided lecture notes.

What is the underlying mechanism of Ischemic Heart Disease?

A reduction in coronary blood flow, which supplies oxygenated blood to the myocardium of the heart.

What is the most common cause of Ischemic Heart Disease?

Atherosclerosis.

What does the mnemonic BAD HEART stand for regarding risk factors for plaque formation?

BMI $\geq 30$, Age $\geq 65$, Hypertension, EtOH (alcohol abuse), increase in LDL and decrease in HDL, Relatives with CAD, and Tobacco use.

In the BAD HEART mnemonic, what constitutes the non-modifiable risk factor for age?

Age $\geq 65$.

What is the most common risk factor for plaque formation?

Hypertension.

How does tobacco use contribute to Ischemic Heart Disease?

It increases endothelial injury and plaque formation.

What are the three causes of decreased oxygen supply mentioned in the notes?

Embolus, Vasculitis, and Vasospasm.

What are three factors that cause increased oxygen demand?

Tachycardia, Left Ventricular Hypertrophy, and Exercise/Exertion.

What percentage of the lumen is occluded in stable angina?

$\geq 70\%$.

How is stable angina chest pain characterized and when does it occur?

Squeezing, tight choking pain that occurs with exertion and disappears with rest.

Why is the endocardium the most susceptible layer to ischemia?

It is the farthest layer from the coronary blood vessels.

What percentage of the lumen is occluded in unstable angina?

$\geq 90\%$ (near total occlusion).

What distinguishes the pathophysiology of unstable angina from stable angina regarding the plaque?

Unstable angina involves an unstable plaque with a weak fibrous cap that is prone to rupture and thrombus formation.

How long must ischemia remain unreversed to result in infarction?

At least $30\,\text{minutes}$.-

What characterizes the occlusion in a Transmural Infarct (STEMI)?

$100\%$ occlusion (total occlusion).

What three conditions are encompassed by the general term Acute Coronary Syndrome?

Unstable angina, Subendocardial infarction / NSTEMI, and Transmural infarct / STEMI.

Prinzmetal’s Angina is typically seen in which patient demographic?

Young females.

Which illicit drugs are associated with the history of patients with Prinzmetal's Angina?

Cocaine and methamphetamine.

What are the diagnostic features of Vasospastic Angina on an EKG and lab results?

ST elevation on EKG and negative troponins.

Why should beta blockers be avoided in treating Prinzmetal’s Angina?

Beta blockers inhibit dilation; blocking them allows only alpha receptor activity to register, worsening vasoconstriction.

What does the OPQRST approach help identify during history taking?

Onset, Provocation, Quality, Radiation, Severity, and Time.

In which three patient groups might atypical (silent) presentations of MI occur?

Diabetics, elderly, and post-heart transplant patients.

What clinical signs characterize a Right Ventricular MI?

JVD, Lower Extremities Edema, Hypotension with clear lungs, and Sinus Bradycardia or AV block.

Why does a Left Ventricular MI cause pulmonary edema?

Ischemia causes back flow into the pulmonary circulation, leaking into the pulmonary capillaries.

What heart sound is associated with infarcted, stiff ventricles?

S4 heart sound.

What complication can occur in the first 24 hours due to increased cell permeability and abnormal electrical potentials?

Sudden cardiac death (via PVC progressing to VT then VF).

What is Beck’s Triad and what condition does it indicate?

Hypotension, JVD, and muffled heart sounds; indicates Cardiac Tamponade.

A rupture of the papillary muscles in the left heart leads to which condition?

Mitral Valve Regurgitation.

When does pericarditis typically occur following an MI?

$3\,\text{days}$ to $14\,\text{days}$.

What causes Dressler’s Syndrome and when does it typically occur?

An immune reaction developing antibodies against the pericardium; occurs $14\,\text{days}$ to $1\,\text{month}$ post-MI.

Which biomarkers are negative in Stable Angina and Prinzmetal Angina?

Troponin and CK-MB.

Which specific biomarker is used to determine re-infarction?

CK-MB.

Which coronary artery supplies the anterior compartment of the heart and the septum?

Left Anterior Descending Artery (LAD).

Infarction in the inferior part of the heart involves which artery and which EKG leads?

Right Coronary Artery (RCA); leads II, III, and aVF.

Which leads are involved when there is an infarction in the lateral wall of the heart?

I, aVL, V5, and V6.

What is the most definitive test for myocardial infarction?

Cardiac Catheterization (Cath).

What does a TIMI score $\geq 2$ indicate for patients with NSTEMI or unstable angina?

Increased risk and consideration for catheterization.

What is the target heart rate for a patient undergoing a stress test?

$85\%$ of Max HR (where Max HR = $220 - \text{Age}$).

What three imaging modalities can be used to determine a 'positive' stress test?

EKG (ST depression or TWI), Echo (wall motion abnormality), and MPI (cold spots).

What two medications are used as vasodilators in pharmacologic MPI stress testing?

Adenosine and Diperidamole.

What is Coronary Steal Syndrome?

A phenomenon where vasodilators cause blood to be 'stolen' by healthy vessels, starving diseased vessels and inducing ischemia.

In Case 1: Anterior STEMI, which coronary artery is likely occluded?

LAD.

Which EKG leads show ST elevation in a Lateral STEMI?

I, aVL, V5, and V6.

What mechanism does Aspirin use to reduce the risk of thrombosis?

Irreversibly inhibits COX-1, inhibiting the production of Thromboxane A2 (TXA2), which inhibits platelet aggregation.

List three medications categorized as P2Y12 Receptor Inhibitors.

Clopidogrel (Plavix), Ticagrelor (Brilinta), and Prasugrel.

What is the mechanism of action for Heparin?

Binds to antithrombin III (AT-III) to enhance inhibition of Thrombin and factor X.

Why is Nitroglycerin contraindicated in Right Ventricular MI?

Right Ventricular MIs are preload dependent, and Nitroglycerin decreases preload.

What is the recommended 'door-to-balloon' time for Percutaneous Coronary Intervention (PCI)?

$\leq 90\,\text{mins}$.

What is the recommended 'door-to-needle' time for Thrombolysis?

$\leq 120\,\text{mins}$.

What does the mnemonic MONA BASH-C stand for in medical management of IHD?

Morphine, Oxygen, Nitroglycerin, Aspirin, Beta Blockers, ACE-I, Statin, Heparin, Clopidogrel.