CAD and Ischemic Heart Conditions Flashcards by Alli Volkens

Does myocardial perfusion occur during diastole or systole?

diastole (relaxation phase)

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What is collateral circulation?

redundant circulation in an area of tissue that blood can reach by more than one pathway

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When does collateral circulation tend to occur in the heart?

with repeated episodes of myocardial ischemia

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Coronary Artery Disease (CAD) is manifested through 4 clinical syndromes, what are they?

1) Angina Pectoris
2) Myocardial Infarction
3) Heart Failure
4) Sudden Cardiac Death

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Define arteriosclerosis

the thickening and hardening of the walls of the arteries

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Arteries thicken and harden due to accumulation of what?

calcium in the media

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Arteriosclerosis can strat as early as the __ decade of life

second

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What are 3 arteriosclerotic diseases?

Atherosclerosis
Medial calcific sclerosis
Arteriolar stenosis

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Define atherosclerosis

a disease of the arteries characterized by a thickening of the intimal layer of the blood vessel wall by an accumulation of lipids

athero = glue

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Atherosclerosis occurs in what size of arteries?

large or medium

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What are the 3 steps that lead to an atherosclerotic lesion?

1) Fatty Streak
2) Raised Fibrous Plaque
3) Complicated Plaque

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Describe the fatty streak

A soft, yellow streak in the intima layer only (does not impinge on the lumen)

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Is a fatty streak reversible?

Yes, with diet, exercise, and pharmacology intervention

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Describe the raised fibrous plaque

A yellow/gray elevated lump that impinges on the lumen (does not occlude it)

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Is a fibrous plaque reversible?

No, but the progression can be slowed with lifestyle changes

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When does a fibrous plaque become complicated?

When it undergoes calcification, necrosis, internal hemorrhage, ruptures, or thrombus formation over plaque

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When plaques become complicated what is a person at risk for?

stroke

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The lumen is impinged with any kind of plaque, but flow is not impaired until stenosis exceeds __%

70%

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A complicated plaque changes the intima structurally which affects the muscle layer’s ability to do what?

distend and meet O2 demands of the cells

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High levels of _DL cause buildup on the arterial wall whereas high levels of _DL helps to reduce plaque formation by removing cholesterol

LDL

HDL

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What can be defined as a clot in a blood vessel?

thrombus

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What can be defined as a clot that dislodges and travels elsewhere in the body

embolus

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What can be defined as an abnormal connection between arteries and veins, in which the capillary system is bypassed and oftentimes leads to rupture

av malformation

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What is the most common site for sclerotic lesions to form? Where are 3 other common sites?

Proximal segment of the left anterior descending (LAD) artery (due to its location next to the L ventricle)

- aorta
- coronary arteries
- cervical, femoral, and other mid to large arteries

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True or False There is a hypothesis that states plaque formation begins in response to injury to the endothelial lining

True

What is the difference in symptoms between chronic and acute ischemia?

chronic = dull pain acute = intense sharp pain followed by numbness

The clinical presentation of a patient with CHD typically occurs in one of 4 ways, what are they?

- Sudden cardiac death - Chronic stable angina - Acute Coronary Syndrome - Cardiac Muscle Dysfunction

In 40% of patients with CHD what is the initial presenting symptom?

Sudden Cardiac Death

Sudden cardiac death results in death how long after symptoms begin?

1 hour Prompt deliver of CPR with AED and Emergency medical system within 10 minutes is their only chance of survival

What are the symptoms of angina described as?

substernal pressure that can occur anywhere from epigastric area to jaw and is described as squeezing, tightness, or crushing

Are men or women more likely to experience atypical symptoms of angina pain?

women

What are the 7 types of angina?

- Classic Stable Angina - Unstable Angina - Prinzmetal angina - Pericarditis - Chest Wall Pain - Pulmonary/Pleuritic - Brochospasm

What are the symptoms of class stable angina?

Tightness, pressure, indigestion, anywhere above the waist

What is the source of stable angina?

The heart is not receiving enough oxygen due to a narrowed coronary artery

What type of patients with stable angina complain of SOB?

those with diabetes mellitus

Symptoms of classic stable angina typically develop with what?

exertional activity, stress, cigarettes, and cold temps

What tends to resolve the symptoms of classic stable angina?

Cessation of activity & Nitrates

What can be defined as chest discomfort that is accelerating in frequency or severity and may occur while at rest but does not result in myocardial necrosis?

Unstable Angina

What can be defined as a coronary artery spasm that occurs at rest or in morning hours, due to arterial changes from CAD?

Prinzmetal Angina

Are males or females more affect by Prinzmetal Angina?

females

Other than associated chest pain what are a few symptoms of Prinzmetal Angina?

Pain, syncope, palpitations

In what type of patients is asymptomatic (silent) angina common? Explain why...

In diabetics, because their neuropathies interfere with pain perception

Describe pericarditis

Chest pain that occurs at rest and is not necessarily worsened with activity.

What is the major difference between pericarditis and angina?

Pericarditis is not relieved with rest of NTG, instead symptoms resolve with anti-inflammatory medication

What musculoskeletal condition can sometimes mimic angina?

chest wall pain

How do you know whether or not chest pain has a pulmonary source?

pain occurs with embolism

What are the 2 types of acute coronary syndrome?

- STEMI | - Non-STEMI

What is the difference between STEMI and Non-STEMI on an ECG?

STEMI develops a Q wave on ECG Non-STEMI Does not develop a Q wave on ECG

In what type of acute coronary syndrome is the lumen completely occluded resulting in transmural injury distal to the occlusion?

STEMI

What is the 2nd clinical manifestation of CAD and the single largest killer of both men and women in the US?

Myocardial Infarction (MI))

Infarction = cell _____

death/necrosis

__% of myocardial infarctions are asymptomatic or silent and result from decreased coronary artery blood flow vs O2 demand

30%

In addition to the previously mentioned symptoms of CAD what does patients who are having a MI also experience?

nausea and diaphoresis

What serial serum enzyme should be continually monitored following a MI?

troponin

Myocardial cells can withstand ischemia approximately __ minutes before necrosis

ECG reading: Enlarged and inverted T wave symmetrically What is the diagnosis?

Ischemia

ECG reading: Elevated ST segment What is the diagnosis?

myocardial cell injury

ECG reading: Q waves indicate absence of current flow What is the diagnosis?

infarction

What is essential in order to limit the size of an infarct?

early reperfusion

What is the 3rd clinical manifestation of CAD?

Heart failure

What can be defined as the inability of the heart to maintain cardiac output adequate to meet the demands of tissue due to abnormality in function of heart muscle

Heart Failure

What is the most frequent cause of heart failure?

Changes in myocardial contractility

What are some compensatory mechanisms that help restore balance with cardiac output decreases following heart failure?

- Increased SNS stimulation which leads to increased HR and contractility - ventricular hypertrophy - Increased kidney retention of Na & water

___ ventricular heart failure occurs after MI. What does this result in?

Left Blood backs up in the L ventricle and atrium, then the capillary beds of the lungs which affects the diffusion of gases (pulmonary edema)

What are the symptoms of LV heart failure?

- Dsypnea at rest and even in upright position - Cough with frothy pink sputum - Rales (crackles) audible during inspiration

What 3 things can cause RV failure?

- LV failure - congestive heart problems - COPD

How is RV failure oftentimes manifested?

Elevated central venous pressure (CVP) which is observed by neck vein distension

What is the 4th clinical manifestation of CAD?

Sudden Cardiac Death

Sudden cardiac death results in increased HR; first ventricular tachycardia followed by ventricular fibrillation. ``` V-Tach = __-__ bpm V-Fib = __ or more bpm ```

150-200 bpm 300 bpm

Hypertension = DBP > __ mm Hg and SBP > __ mm Hg

90 140

Initially normal LV systolic function is maintained by hypertrophied LV, but as HTN becomes more severe systolic dysfunction develops and ejection fraction lowers to __-__%

40-50%

Why is sodium restriction important in patients with HTN?

Sodium retains water which increases peripheral vascular resistance

Exercise can result in __ mm/Hg reduction in both SBP and DBP in those with HTN

PTs need physician clearance to workout a patient with their BP is above __/__

200/100

PTs must stop exercise if BP exceeds __/__

250/110