Essentials Quiz 5

Cards (22)

  • Coronary perfusion from the aorta takes place during diastole
  • What are the various types of anginas?
    • Variant Angina
    • Stable Angina
    • Unstable Angina
  • Angina refers specifically to the uncomfortable sensation in the chest that arises from an imbalance between myocardial oxygen supply and demand
  • Cardiac Ischemia is when results form an imbalance between myocardial oxygen supply and demand. The most common symptom is “angina pectoris” (chest pain).
  • Angina Pectoris: Uncomfortable sensation in the chest and neighboring anatomic structures produced by myocardial ischemia
  • Stable Angina:
    • Chronic pattern of transient angina pectoris
    • Precipitated by physical activity or emotional upset
    • Relieved by rest within a few minutes
    • Episodes often associated with temporary depression of the ST segment, but permanent myocardial damage does not result
  • Myocardial Oxygen Demand is determined by:
    • Ventricular wall stress
    • Heart rate
    • Contractility
  • Ventricular wall stress:
    • Increase in wall tension
    • Increase in wall “thickness” decreases stress (hypertrophied heart)
    • Directly proportional to LV systolic pressure
  • Heart rate:
    • Increase in heart rate leads to an increase in oxygen consumption and oxygen demand
    • Medications can control heart rate, e.g., Ace inhibitors decrease HR
  • Contractility:
    • Refers to the force of contraction (inotropic + state)
  • Diagnostic studies of ischemia include:
    • Electrocardiogram
    • Stress testing
    • Coronary angiography
    • Noninvasive imaging of coronary arteries
  • Electrocardiogram Diagnostic Studies:
    • Subendocardial ischemia causes ST-segment depressions and/or T-wave flattening or inversions
    • Severe transient transmural ischemia can result in ST-segment elevations, similar to the early changes in acute myocardial infarction
    • When transient ischemia resolves, so do the electrocardiographic changes
  • Stress Testing Diagnostic Studies:
    • Standard Stress Testing
    • Nuclear Imaging Studies
    • Exercise Echocardiography
    • Pharmacologic Stress Tests (Nuclear and Echocardiographic)
    • Coronary Angiography (gold standard)
  • Subendocardial ischemia causes ST-segment depressions and/or T-wave flattening or inversions.
  • Severe transient transmural ischemia can result in ST-segment elevations, similar to the early changes in acute myocardial infarction. When transient ischemia resolves, so do the electrocardiographic changes.
    • Diagnostic Studies - Stress Testing
    • Standard Stress Testing (less useful w/baseline abnormalities)
    • Nuclear Imaging Studies
    • Exercise Echocardiography
    • Pharmacologic Stress Tests
    • Nuclear
    • Echocardiographic
    • Coronary Angiography (gold standard)
  • What are the diagnostic studies of ischemia? Electrocardiogram, stress testing, coronary angiography, and noninvasive imaging of coronary arteries
  • What are the O2 demand determinants? Organic Nitrates, Calcium Channel Blockers, and β-Blockers
  • What does PTCA stand for? percutaneous transluminal coronary angioplasty
  • What type of treatment is PTCA? A procedure to open blocked coronary arteries, being a revascularization treatment.
  • What are the drug types and their example medicine? 
    • Organic nitrates - Nitroglycerin
    • β-Blockers - Metoprolol
    • Calcium Channel Blockers - Amlodipine
    • Ranolazine - Ranexa
  • Variant Angina:
    • Typical anginal discomfort
    • usually at rest, which develops because of coronary artery spasm rather than an increase of myocardial oxygen demand
    • episodes often associated with transient shifts of the ST segment, usually ST elevation (also termed Prinzmetal angina)