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732: Cardiopulmonary > CAD and Ischemic Heart Conditions > Flashcards

CAD and Ischemic Heart Conditions Flashcards

1
Q

Does myocardial perfusion occur during diastole or systole?

A

diastole (relaxation phase)

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2
Q

What is collateral circulation?

A

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

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3
Q

When does collateral circulation tend to occur in the heart?

A

with repeated episodes of myocardial ischemia

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4
Q

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

A

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

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5
Q

Define arteriosclerosis

A

the thickening and hardening of the walls of the arteries

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6
Q

Arteries thicken and harden due to accumulation of what?

A

calcium in the media

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7
Q

Arteriosclerosis can strat as early as the __ decade of life

A

second

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8
Q

What are 3 arteriosclerotic diseases?

A
  • Atherosclerosis
  • Medial calcific sclerosis
  • Arteriolar stenosis
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9
Q

Define atherosclerosis

A

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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10
Q

Atherosclerosis occurs in what size of arteries?

A

large or medium

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11
Q

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

A

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

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12
Q

Describe the fatty streak

A

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

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13
Q

Is a fatty streak reversible?

A

Yes, with diet, exercise, and pharmacology intervention

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14
Q

Describe the raised fibrous plaque

A

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

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15
Q

Is a fibrous plaque reversible?

A

No, but the progression can be slowed with lifestyle changes

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16
Q

When does a fibrous plaque become complicated?

A

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

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17
Q

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

A

stroke

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18
Q

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

A

70%

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19
Q

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

A

distend and meet O2 demands of the cells

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20
Q

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

A

LDL

HDL

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21
Q

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

A

thrombus

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22
Q

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

A

embolus

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23
Q

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

A

av malformation

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24
Q

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

A

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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25
Q

True or False

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

A

True

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26
Q

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

A

chronic = dull pain

acute = intense sharp pain followed by numbness

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27
Q

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

A
  • Sudden cardiac death
  • Chronic stable angina
  • Acute Coronary Syndrome
  • Cardiac Muscle Dysfunction
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28
Q

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

A

Sudden Cardiac Death

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29
Q

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

A

1 hour

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

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30
Q

What are the symptoms of angina described as?

A

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

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31
Q

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

A

women

32
Q

What are the 7 types of angina?

A
  • Classic Stable Angina
  • Unstable Angina
  • Prinzmetal angina
  • Pericarditis
  • Chest Wall Pain
  • Pulmonary/Pleuritic
  • Brochospasm
33
Q

What are the symptoms of class stable angina?

A

Tightness, pressure, indigestion, anywhere above the waist

34
Q

What is the source of stable angina?

A

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

35
Q

What type of patients with stable angina complain of SOB?

A

those with diabetes mellitus

36
Q

Symptoms of classic stable angina typically develop with what?

A

exertional activity, stress, cigarettes, and cold temps

37
Q

What tends to resolve the symptoms of classic stable angina?

A

Cessation of activity & Nitrates

38
Q

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?

A

Unstable Angina

39
Q

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

A

Prinzmetal Angina

40
Q

Are males or females more affect by Prinzmetal Angina?

A

females

41
Q

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

A

Pain, syncope, palpitations

42
Q

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

A

In diabetics, because their neuropathies interfere with pain perception

43
Q

Describe pericarditis

A

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

44
Q

What is the major difference between pericarditis and angina?

A

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

45
Q

What musculoskeletal condition can sometimes mimic angina?

A

chest wall pain

46
Q

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

A

pain occurs with embolism

47
Q

What are the 2 types of acute coronary syndrome?

A
  • STEMI

- Non-STEMI

48
Q

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

A

STEMI develops a Q wave on ECG

Non-STEMI Does not develop a Q wave on ECG

49
Q

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

A

STEMI

50
Q

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

A

Myocardial Infarction (MI))

51
Q

Infarction = cell _____

A

death/necrosis

52
Q

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

A

30%

53
Q

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

A

nausea and diaphoresis

54
Q

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

A

troponin

55
Q

Myocardial cells can withstand ischemia approximately __ minutes before necrosis

A

20

56
Q

ECG reading:

Enlarged and inverted T wave symmetrically

What is the diagnosis?

A

Ischemia

57
Q

ECG reading:

Elevated ST segment

What is the diagnosis?

A

myocardial cell injury

58
Q

ECG reading:

Q waves indicate absence of current flow

What is the diagnosis?

A

infarction

59
Q

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

A

early reperfusion

60
Q

What is the 3rd clinical manifestation of CAD?

A

Heart failure

61
Q

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

A

Heart Failure

62
Q

What is the most frequent cause of heart failure?

A

Changes in myocardial contractility

63
Q

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

A
  • Increased SNS stimulation which leads to increased HR and contractility
  • ventricular hypertrophy
  • Increased kidney retention of Na & water
64
Q

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

A

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)

65
Q

What are the symptoms of LV heart failure?

A
  • Dsypnea at rest and even in upright position
  • Cough with frothy pink sputum
  • Rales (crackles) audible during inspiration
66
Q

What 3 things can cause RV failure?

A
  • LV failure
  • congestive heart problems
  • COPD
67
Q

How is RV failure oftentimes manifested?

A

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

68
Q

What is the 4th clinical manifestation of CAD?

A

Sudden Cardiac Death

69
Q

Sudden cardiac death results in increased HR; first ventricular tachycardia followed by ventricular fibrillation.

V-Tach = \_\_-\_\_ bpm
V-Fib = \_\_ or more bpm
A

150-200 bpm

300 bpm

70
Q

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

A

90

140

71
Q

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

A

40-50%

72
Q

Why is sodium restriction important in patients with HTN?

A

Sodium retains water which increases peripheral vascular resistance

73
Q

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

A

10

74
Q

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

A

200/100

75
Q

PTs must stop exercise if BP exceeds __/__

A

250/110

732: Cardiopulmonary (5 decks)

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