Atherosclerosis Flashcards
What is atherosclerosis?
Build up and deposition of fatty plaques in the vessel’s inner walls.
Name 3 variations of Atherosclerotic disease that affect differing areas of the body?
Coronary Disease, Cerebrovascular Disease, Peripheral Arterial Disease
What is the number one cause of death worldwide?
Heart disease
Name some cardiovascular risk factors
Cigarette Smoking Abnormal Lipid Levels Hypertension Diabetes Obesity Stress
Name some cardioprotective factors
Fruit/Veggies
Exercise
Moderate Alchohol (Red Wine)
Physical measures of cardiovascular risk factors include 5 measures..
BMI, waist circum, BP, HR, Blood Test (Lipid Levels)
What contributes MOST to acute myocardial infarction?
Abnormal Lipid levels and smoking
What is the major difference between NSTEMI and STEMI
STEMI has full occlusion of an artery, while NSTEMI is a partial occlusion of an artery
Is artherosclerosis an acute or progressive disease?
What are the consequences of having it?
Progressive
Narrow diameter of vessel
Blockage
Stiffness (not as reactive)
Name 3 layers of the arterial walls ( Outside to inside order)
Tunica adventitia (collagen) –> Tunica Media (Smooth Muscle) –> Tunica Intima (Endothelium lining lumen)
Initial process of artherosclerosis has excess levels of what penetrate blood vessels, becoming trapped?
LDL
As LDL is trapped, what happens to it?
It oxidizes, releasing anions
Macrophages consume oxidized LDL, creating what kind of cell?
Foam Cell. Indicator of high cholesterol levels
Macrophages were previously what type of cell before chemical and adhesion factors attracted them?
Monocytes
Foam cells hold primarily what?
Free cholesterol
What does the smooth muscle do to foam cells and lipids?
Engulfs it, creating a fibrofatty atheroma in the vessel
What is the difference between a stable plaque and an unstable plaque?
Stable plaque has a thick cap and smaller fatty core. Is the primary cause of hardened and narrowed arteries.
Unstable plaque has thin cap with LARGE fat core, more likely to rupture –> heart attack or stroke possibility
When does myocardial perfusion occur?
During muscle relaxation (diastole)
What is ischemia?
Imbalance of supply and demand of O2
What results from increased myocardial demand?
Increase HR, Increased Contractile state, Increased systolic tension (HTN, Cold)
What are some gender specific symptoms of chest pain in males?
Crushing Pain, Elephant on Chest feeling, Nausea, Left arm pain, Jaw pain
What are some gender specific symptoms of chest pains in women?
Nausea/Vomiting, Fatigue, Anxiety, mid back tightness and discomfort
Stable angina is what?
Chest pain associated with increase in physical activity, relieved by rest.
Substernal chest pain radiating to elbow.
Crushing pain, or pressure feeling.
PREDICTABLE!
Define Rate Pressure Product
Myocardial oxygen consumption (O2 demand of heart)
What is the formula for Rate Pressure Product (RPP)?
HR x SBP
EX: 70 x 100 = 7000 RPP
Unstable Angina occurs when?
Randomly, without pattern.
@ rest
@ lower level of exercise than usual
@ varying patterns of activity
Blood pressure decreases with same amount of activity
What can happen to tissues if the supply of O2 does not meet the O2 demands?
Death of myocardial tissue
What is myocardial infarction and what does it result in?
Heart attack from prolonged period of ischemia, death of myocardial tissues
What are 2 common EKG changes during an MI?
ST elevation, and Q wave abnormality
When does an ST elevation occur?
During full occlusion of an artery in an instance of an acute MI. AN INJURY (EX: HEART ATTACK)
When does ST depression occur?
Due to ischemia
Q wave abnormality results from what?
Absence of electrical forces, an indicator of an MI or history of
Exercise testing for diagnosing CAD evaluates what?
HR/BP
EKG
Limiting symptoms and signs
Gas exchange or ventilatory response (VO2Max)
What is an indicator of myocardial ischemia?
ST depression
What is an indicator of an MI?
ST elevation with Q wave abnormality
What drop in blood pressure is indicative of exertional hypotension?
SBP drop of 10 mmhg
What happens in PCI (percutaneous coronary intervention)?
aka angioplasty, where a stent is placed in the affected artery and a balloon is then expanded. The plaque is then compressed and widened.
Another common procedure other than PCI for occluded arteries is what?
A CABG (coronary artery bypass graft) uses the saphenous vein.
An oral medication often used for angina , or CAD is what?
Nitroglycerin
Name 2 red flags as a PT for CAD/ischemia?
Angina, Nitroglycerin usage
Does chest pain need to be evaluated before physical therapy starts?
Duh.
What is peripheral artery disease?
Decreased blood flow to legs
What is a common symptom of PAD?
claudication pain (cramping angina in legs)
PAD does not increase risk of MI and stroke (TRUE OR FALSE)
False
PAD is increased by smoking and diabetes? ( Yes or no)
Yes. These are MAIN RISK FACTORS
What is the Ankle Brachial Index?
Checks risk for PAD, using brachial artery and the highest BP of either dorsalis pedis or posterior tibial artery
A low ABI indicates narrowing of the arteries in the legs.
ABI > 0.90 is normal
Formula is ankle systolic/arm systolic
Main 2 risk factors for PAD?
Smoking and diabetes
What are signs of intermittent claudication?
Achy, cramping legs
Pain during exercise
Decreases pain in rest
Onset of pain is PREDICTABLE
Patient needs to be in what position to compare blood pressure in legs/arms?
Supine
