Alt. Phys. Final Flashcards
What is an atherosclerotic plaque?
Hardening of the blood vessels caused by the plaque which is made up of lipids, cholesterol, calcium
Is atherosclerosis a chronic condition?
Yes
HDL vs LDL
HDL is good cholesterol and carries fats from periphery to the liver to be discarded. LDL contains less proteins and increases cholesterol in the blood
What is the proper order of development for atherosclerosis?
- endothelial damage and inflammation
- high levels of LDLs in the blood. Some enter the tunica intima
- LDL in the t.intima is oxidized into proinflammatory lipids. Attracts inflammatory cells+phagocytes into the endothelium
- LDLs will be engulfed by macrophages forming FOAM cells. FOAM cells collect to form fatty streak
- FOAM cells release cytokines and growth factors to stimulate proliferation and production of collagen
- formation of atherosclerotic plaque. Collagen fibers harden the blood vessel walls to form fibrous plaque
Arterial Disease is most commonly caused by______
Atherosclerosis
What is the most serious location for blockage in CAD?
left ventricle
CAD can lead to ______
LHF
PAD is especially present in___
smokers and those with diabetes
Stage 1 of CAD_______
absent, weak pulse in arteries supplying the legs and feet
stage 2 of CAD___-
intermittent claudication upon physical exertion
stage 3 of CAD_______
claudication without physical exertion. coldness in 1 leg//foot compared to the other
Primary Hypertension
most common; influenced by genetic and environmental factors
Secondary hypertension
Secondary hypertension: caused by a systemic disease process that raises peripheral vascular resistance or cardiac output. Often renal
Isolated systolic hypertension
Elevation of only systolic pressure
Primary hypertension is caused by
genetics +environment
Which type of hypertension can be caused by hormone imbalances
Secondary
Asymptomatic aneurysms can also be called
congenital
Which of the following is not a complication of an aneurysm?
Blood leaking
Hemorrhage
Ischemia
Infarction
infarction
Thrombus_____
blood clot that remains attached to vessel wall
What are the steps to hemostasis?
Vasoconstriction, platelet plug, coagulation
Thrombosis _______
intravascular activation of coagulation cascade with blood vessel wall damage
Thrombophlebitis_______
thrombosis and inflammation in the veins
Thromboembolus______
detached blood clot
Causes of arterial thrombosis include all except
Vasculitis
Shock
Blood thickening
endothelial wall infection
blood thickening
Which type of embolism can be caused by post-femoral (“hip”) fracture?
Fat-emoblism
Which two types of embolism can be caused by an IV?
Air embolism and foreign substance
Explain the sequences of events from atherosclerosis to thrombosis to myocardial infarction
atherosclerosis = most common cause of thrombus formation. Forces, inflammation, apoptosis or enzymes to the plaque will cause it to rupture leading to increased inflammation with release of multiple cytokines platelet activation, production of thrombin and vasoconstriction. This will cause decrease in lumen size, O2 which will lead to MI
Ischemia =
reduction of blood supply to tissues
Hypoxia =
low O2 in blood (inadequate supply to an area)
Hypoxemia =
low O2 in blood
Infarction=
tissue death due to lack of O2
Necrosis =
cell death due to pathophysiology changes in cells
Most common cause of transient myocardial ischemia is
atherosclerosis
cause of unstable angina (sudden onset) =
Reversible myocardial ischemia: presence of a complicated plaque, thrombus formation, vessel occlusion, vasoconstriction
Treatment for unstable angina (sudden onset) =
immediate: oxygen, aspirin, vasodilators, pain relief
intermediate: bypass, drugs, clot dissolving drugs
long term: cholesterol lowering agents, lifestyle changes
Modifiable risk factors for atherosclerosis include ALL except
age, hypertension, smoking, diabetes mellitus type 2, lack of physical activity
Temporary loss of contractile function lasting hours - days =
myocardial stunning
Tissue is persistently ischemic and metabolic adaptation which prolong myocyte survival until perfusion is restored
hibernating myocardium
leads to myocyte hypertrophy and loss of contractility distal to site
myocardial remodeling
Which one of the acute coronary syndromes can be caused by necrosis?
myocardial stunning
hibernating myocardium
myocardial remodeling
transient ischemia
myocardial remodeling
Which one of the following cardiac complications of MI is due to necrosis of the conducting system?
Valve dysfunction
Pericarditis
Aneurysms
Dysrhythmias
Dysrhythmias
The T wave on the ECG is_____
ventricular repolarization, ventricular relaxation
The P wave on the ECG is______
Atrial depolarization and atrial contraction
The QRS segment of the ECG is_____
atrial repolarization, atrial relaxation, ventricular depolarization, ventricular contraction
Subendocardial MI is____
in b/w the endocardium and myocardium non STEMI
Transmural MI________
STEMI. MI is across the wall of the heart
Preload _____
volume of blood at the end of diastole (filling stage)
Afterload____
resistance in the that the left ventricles must overcome to pump blood out of the aorta.
Preload is increased in all of the following conditions EXCEPT
hypervolemia
hypertension
heart failure
regurgitation of valves
hypertension
RHF is most commonly caused by____
lung disease
LHF is most commonly caused by_______
ischemic heart disease
Which is more common RHF or LHF
LHF
Primary pulmonary hypertension is caused by_____
Idiopathic: imbalance in production of vasocontrictors & vasodilators
Secondary pulmonary hypertension is caused by_____
scar tissue or emphysema (COPD)
The end result of RHF is
pulmonary hypertension
pulmonary edema
peripheral edema
pitting edema
peripheral edema
Which of the following complications in not seen with RHF
pulmonary edema
jugular vein distention
dependent edema
ascites
pulmonary edema
Jugular venous distention
accumulation of fluid in the jugular vein, which returns blood from the head to the heart
Edema
excessive accumulation of fluid within interstitial spaces between tissue cells
Dependent edema
occurs in the feet & legs while standing and in the sacral regions and buttocks when lying down (supine). Dependent on gravity
Ascites
accumulation of fluid in the peritoneal
cavity. body fluid is trapped in the peritoneal
space from which it cannot escape
Pitting edema
occurs when a “pit” or indentation
is seen when pressure is applied
Which of the following is NOT a functional
change expected from acute myocardial
infarction?
A. Decreased contractility
B. Decreased stroke volume
C. Increased ejection fraction
D. Disordered heart rhythms
C. Increased ejection fraction
What is a possible consequence of thrombosis that occurs within the myocardium?
A. Aneurysm
B. Atherosclerosis
C. Ischemia
D. Hypertension
A. Aneurysm
Pericardial disease can be caused by_______
infection, trauma or surgery, neoplasm; disorders such as
uremia, rheumatoid arthritis, systemic lupus
Clinical manifestations of pericardial disease mimic those of ______
RHF
Acute pericarditis is a common CV complication of which disease?
HIV
Acute pericarditis =
Roughening and/or inflammation of pericardial membranes
can lead to pericardial effusion/tamponade or constrictive pericarditis
constrictive (restrictive pericarditis)_
Fibrous tissue scarring with calcification
Pericardium becomes a hardened shell encasing the heart
Pericardial effusion=
Accumulation of fluid in the pericardial cavity; fluid is usually an exudate; develops suddenly
Can occur as a result of pericarditis and can lead to cardiac compression (called: tamponade)
Pericardial tamponade
Unable to accommodate more than a small volume of fluid
Accumulation of fluid in the pericardial cavity Restricts contractile ability of heart
Which cardiomyopathy can mimic restrictive pericarditis?
restrictive cardiomyopathy
In which cardiomyopathy is contractility normal?
hypertrophic cardiomyopathy
valvular dysfunction most commonly occurs in the ____
aortic and bicuspid/mitral valve
Rheumatic heart disease occurs from ___________infection
pharyngeal
Aschoff bodies are seen in ____
Rheumatic heart disease: myocarditis
Myocardium vibrating or twitching is seen with which dysrythmia
atrial or ventricular fibrillation
slowing of postural reflexes as part of the aging process; neurologic diseases such as Parkinson’s Disease are causes of which orthostatic hypotension?
primary/neurogenic orthostatic hypotension
Triad of Virchow
venous stasis, venous endothelial damage, hypercoaguable states
Delivers nutrient rich oxygenated blood from placenta to fetal heart with some of this blood going to the liver
umbilical vein
Delivers wastes and deoxygenated fetal blood to placenta
umbilical artery