Lilly Chapter 6 Ischemic Heart Disease
Terms
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- What will be the effect on myocardial oxygen supply with decrease diastolic pressure?
- Drop in CA perfusion pressure may lead to impaired O2 supply.
- What region of the heart is the most vulnerable to ischemic damage?
- Subendocardium
- Name 2 effects on the LV which can decrease wall stress.
- Decreased filling (i.e. decreased chamer size = hypertrophy), decreased overall size (regression).
- True/False - Ischemia is always caused by either vasospasm (endothelial dysfunction) or atherosclerotic plaques.
- False - Can be a combination of both
- Where do CA's usually have overt stenotic plaques?
- CA's are usually larger and more susceptible to plaque in the proximal segments.
- What is the effect of 70% stenosis? 90%?
- Usually basal level flow is adequate at 70% but increased demand can not be met. At 90% basal levels may not be sufficently met.
- What determines fixed versus variable threshold in Stable Angina?
- The role of alteration in vascular tone in causing angina. Fixed has minimal role while variable has a prominent role.
- What is Syndrome X?
- Symptoms of Angina Pectoris with no evidence of stenoses on coronary angiograms.
- True/False - Large Meals and Cold Weather can induce anginal discomfort in CAD patients.
- True
- Describe possible EKG changes in myocardial ischemia.
- ST segment depressionn and T wave symmetric inversion often appear.
- What is the purpose of an exercise stress test?
- To determine diagnostically or prognostically the level of ischemia.
- What makes a Exercise Stress test positive?
-
1. ischemic EKG changes;
2. ST segment depression'
3. Systolic BP DECREASES;
4. Ventricular Arrhythmias present;
5. Patient unable to exercise more than 2 minutes - When is Radionucleid imaging used?
-
1. EKG abnormalities preclude stress test;
2. discordant results with previous testing modality - When is pharmacologic stress testing used? What drugs are often used?
- Indicated in the elderly, those on Beta blockers, and the physically impaired. Adenosine & Dipyrdimaole are vasodilators (steal) or Dobutamine, a Beta agonist, is used to increase demand.
- True/False - Thallium and Technetium are both used in NSPECT for perfusion studies.
- True
- True/False - Coronary Calcium CT Scoring is an independent predictor for incident premature Coronary HD.
- True
- TRUE/FALSE - Lifetime Anticoagulation is necessary for cardiac stents, which are thrombogenic.
- False - only required upto 4 weeks after stent placement.
- What is the main negative in CABG when veins (saphenous) are used instead of arteries (internal mammary)?
- Veins are vulnerable to increased atherosclerosis.
- What 3 factors must be considered when deciding between PCI and CABG?
- Type/Number of stenotic vessels with concomitant current LV contractile function or Diabetes