CARDIAC ISCHEMIA-PROGNOSIS & OUTCOMES

SUMMARY

1. The most important prognostic factor in patients with CAD is the degree of LV dysfunction.

2. The exercise tolerance test is good in determining severity & prognosis - patients who are able to go to stage 4 of Bruce protocol have a nearly 100% 5-year survival, while those who cannot get past stage 1 have only a 50% 5-year survival!

3. Spasms of the coronary arteries usually show up as transient ST-segment elevation if they occur during stress testing.

4. Hibernating myocardium is chronically underperfused myocardium. There is no irreversible myocyte injury. When perfusion is restored to normal, contractility should return to normal.

5. Reperfusion injury occurs when a severely ischemic myocardium is reperfused after 1 hour, causing further irreversible microvascular damage to the myocardial cells.

6. Stunned myocardium is also the result of acute ischemia. From the time perfusion is restored, it can take 7-10 days for the ventricular function to return to normal.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].