Podcast
Questions and Answers
Which of the following is an unalterable risk factor for ischemic heart disease?
Which of the following is an unalterable risk factor for ischemic heart disease?
- Family history or genetic composition (correct)
- Hypertension
- Obesity
- Smoking
What is the primary goal of short-term treatment for effort-induced angina?
What is the primary goal of short-term treatment for effort-induced angina?
- Prevent coronary heart disease events
- Lower blood pressure
- Reduce or prevent anginal symptoms (correct)
- Extend the patient’s life
Which of the following alterable risk factors can increase the likelihood of ischemic heart disease?
Which of the following alterable risk factors can increase the likelihood of ischemic heart disease?
- Age
- Hyperuricemia (correct)
- Environmental influences
- Gender
What is the long-term goal of treatment for effort-induced angina?
What is the long-term goal of treatment for effort-induced angina?
Which of the following is a secondary intervention for ischemic heart disease?
Which of the following is a secondary intervention for ischemic heart disease?
How do β-adrenergic blockers help in the treatment of effort-induced angina?
How do β-adrenergic blockers help in the treatment of effort-induced angina?
What is the relationship between myocardial blood flow and arteriolar resistance?
What is the relationship between myocardial blood flow and arteriolar resistance?
What is the significance of atherosclerotic lesions occluding R1?
What is the significance of atherosclerotic lesions occluding R1?
What is the clinical presentation of ischemic episodes?
What is the clinical presentation of ischemic episodes?
What is the relationship between the severity of stenosis and clinical events such as MI?
What is the relationship between the severity of stenosis and clinical events such as MI?
What are some precipitating factors for ischemic episodes?
What are some precipitating factors for ischemic episodes?
What is the role of R2 in maintaining coronary blood flow?
What is the role of R2 in maintaining coronary blood flow?
What is the primary determinant in the occurrence of ischemia in ischemic heart disease?
What is the primary determinant in the occurrence of ischemia in ischemic heart disease?
What does the double product (DP) serve as in the context of ischemic heart disease?
What does the double product (DP) serve as in the context of ischemic heart disease?
Which of the following is NOT a major determinant of myocardial oxygen demand?
Which of the following is NOT a major determinant of myocardial oxygen demand?
Which of the following is NOT a presentation of ischemic heart disease?
Which of the following is NOT a presentation of ischemic heart disease?
Which of the following best describes the relationship between large epicardial vessels and intramyocardial arteries and arterioles in normal circumstances?
Which of the following best describes the relationship between large epicardial vessels and intramyocardial arteries and arterioles in normal circumstances?
Which of the following is NOT a potential intervention to alleviate ischemia in ischemic heart disease?
Which of the following is NOT a potential intervention to alleviate ischemia in ischemic heart disease?
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Study Notes
Risk Factors for Coronary Heart Disease (CHD)
- Ask patients about personal risk factors for CHD, including smoking, hypertension, and diabetes mellitus
- Obtain family history, including premature CHD, hypertension, lipid disorders, and diabetes mellitus
Goals of Treatment
- Short-term goals: reduce or prevent anginal symptoms that limit exercise capability and impair quality of life
- Long-term goals: prevent CHD events such as myocardial infarction (MI), arrhythmias, and heart failure (HF), and extend the patient's life
Nonpharmacologic Therapy
- Primary prevention: modify risk factors to reduce prevalence of IHD
- Secondary intervention: reduce subsequent morbidity and mortality
- Risk factors for IHD are additive and can be classified as alterable or unalterable
Alterable and Unalterable Risk Factors
- Alterable risk factors: smoking, hypertension, hyperlipidemia, obesity, sedentary lifestyle, hyperuricemia, psychosocial factors, and use of detrimental drugs
- Unalterable risk factors: gender, age, family history or genetic composition, environmental influences, and diabetes mellitus
Pharmacologic Therapy
- β-Adrenergic blockers: decrease heart rate, contractility, and blood pressure, reducing MVo2 and oxygen demand in patients with effort-induced angina
- Myocardial blood flow is inversely related to arteriolar resistance and directly related to coronary driving pressure
Clinical Presentation
- Many ischemic episodes are asymptomatic (silent ischemia)
- Symptoms may include pressure or burning over the sternum, radiating to the left jaw, shoulder, and arm, and can be precipitated by exercise, cold environment, emotional upset, and other factors
- Symptoms usually last from 30 seconds to 30 minutes
Ischemic Heart Disease (IHD)
- Defined as lack of oxygen and decreased or no blood flow to the myocardium resulting from coronary artery narrowing or obstruction
- Can present as acute coronary syndrome (ACS), chronic stable exertional angina, ischemia without symptoms, or ischemia due to coronary artery vasospasm (variant or Prinzmetal angina)
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