CAD and MI Cardiology (Benzoni) Flashcards
1
Q
3 types of hypertension
A
1) essential
2) secondary
3) malignant
2
Q
essential HTN treatment
A
treat via lifestyle modification and meds
3
Q
secondary HTN treatment
A
treat the cause
4
Q
malignant HTN treatment
A
treat based on the involved organ system and the cause
5
Q
malignant HTN can cause
A
CVA, CHF, STEMI etcc
6
Q
goal BP of essential htn
A
<140/<90
7
Q
2 types of hypovolemic shock
A
absolute (volume loss) hypovolemia
relative hypovolemia
8
Q
absolute hypovolemia
A
decrease in volume due to blood or fluid loss
9
Q
relative hypovolemia
A
normal BV but size of container decreased
- neurologic, meds, cardiac, psychogenic
treatment aimed at the cause
10
Q
shock is defined as
A
inadequate end organ profusion
11
Q
Absolute hypovolemic shock
A
- extreme of orthostatic hypotension
- findings vary based on involved organ system: brain = altered mental status, tachycardia = heart (ischemia), no urine output = kidney
12
Q
which type of shock will have mottled cool skin
A
absolute hypolovemia
13
Q
solution for absolute hypovemic shock
A
fill the tank!
14
Q
is total blood volume preserved in relative hypovolemic shock?
A
yes
15
Q
what is the issue with relative hypovolemic shock?
A
distribution issue. the total blood volume is preserved but it is not being distrubuted
16
Q
types of hypovolemic shock
A
neurogenic, cardiogenic
17
Q
neurogenic shock
A
- total BV is preserved
- issue with distrubtion
- loss of sympathetic tone = loss of vasoconstrictor reflex
- occurs at specific spinal cord level and below
- hyperreflexia can later occur
18
Q
cardiogenic shock
A
- ischemic or hypertrophic heart
- ischemic: dilated and thin; issue with emptying blood
- hypertropic: thickened and cannot fill with blood
- result is the same from differnt causes
- decreased BF, decreased renal fxn
- decreased CO
19
Q
RF’s for cardiogenic shock
A
HTN, DM, cholesterol, ASCVD
20
Q
cardiogenic shock cont
A
- distal ischemia from lack of BF
- ischemia causes decreased muscle mass and strength
- cardioac output is already maxed out when the individual is at rest
21
Q
cardiogenic shock can progress into what disease
A
myocardial ischemic disease
22
Q
cause of myocardial ischemic disease
A
blood supply does not equal the demand
23
Q
Modifiable RF’s for heart disease
A
SMOKING, cholesterol, HTN, DM2
24
Q
non modifiable RFs for heart disease
A
age, family history, gender, race, DM1
25
Ischemic disease
- lumina narrows which restricts blood flow to myocardium
- fat is laid down
- heart atrophies over time due to decreased BF which can cause an MI or CVA
26
mechanism for ischemic disease
vascular hypertrophy! hypertrophy occurs because of HTN, ischemia present, leading to decreased brain fxn, heart failure, decreased kidney fxn
27
ischemic disease
BP is high, but thickened heart walls has decreased the blood supply in the heart and to the rest of the body
28
cardiac hypertrophy
can't fill due to large ventricle size, so it can't distrubte as much blood to the body
- EKG shows endocardial ischemia
- HR increases to maintain CO
- leads to diastolic failure
29
What is diastolic failure?
failure to fill the heart due to hypertrophy of the heart
30
treatment for diastolic failure
control HTN, decrease contractile force (workload of heart), decrease HR
31
most common type of cardiogenic shock
systolic
32
systolic cardiogenic shock
- most common type
- result of diminished blood supply
- leads to systolic failure
33
primary cause of systolic failure?
atherosclerosis
34
define atherosclerosis
- arterial narrowing and hardening
- lipids are deposited between vessel layers
- lumin narrows due to lipid deposition
35
longer definition of atherosclerosis
progressive, chronic inflammatory disease of large arteries that begins in childhood
involves formation of fatty plaques
36
what happens in atherosclerosis?
```
lining of vessels erode (endothelial dysfxn)
lipids deposited (fatty streak) and layer of myocytes forms over it, making the new lumin mobile! This area is called an atheroma and is reversible! can decrease in size
```
37
modifiable RF of an atheroma
smoking, diabetes, dyslipidemia, HTN, lifestyle, obesity
38
non modifiable RF of an atheroma
family age of onset (male 55, female 65)
age of risk onset (male 45, female 55)
CKD (kidney disease)
genetics
39
what can occur at end stage of an atheroma?
- plaque rupture, leading to CVA, STEMI, NSTEMI, angina, or peripheral arterial occlusion
40
RF's of CVA/stroke
atherosclerosis, age, sex, family history, HTN, DM, smoking, cholesterol, a fib
41
why is afib a risk for a CVA
a fib increases the risk of having a clot form in the left atrium and travel to the carotids
42
ACS (acute coronary syndrome) - #1 risk?
- spectrum disorder
| - #1 risk is previous MI!! (ASCVD)
43
NSTEMI
- looks like an MI
- labs are positive
- EKG is negative (may show depression)
- high risk to prgoress to STEMI
- treat like a STEMI
- incomplete occlusion of lamina
44
STEMI
- complete occlusion of lamina (in watershed of carotid artery)
- abnormal EKG
45
inferior/posterior stemi = what artery
RCA
46
anterior stemi = what artery
LAD
47
lateral/posterior stemi = what artery
circumflex
48
classic MI presentation in elderly
weak and dizzy
49
STEMI ekg changes
1mm elevation in bipolar (limb leads)
| 2mm elevation in V (chest leads)
50
LCA: aspect of heart affected and leads
heart: lateral
leads: 1, avL, V5, V6
51
LAD: aspect of heart affected and leads
heart: anterior
leads: V3, V4
52
septal correlates with which leads
V1, V2
53
RCA: aspect of heart affected and leads
heart: inferior
| leads 2, 3, aVF
54
lateral MI = which leads
1, avl, v5, v6
55
inferior MI = which leads
2, 3, avf
56
anterior MI = which leads
V3, V4
57
septal MI = which leads
V1, V2
58
treatment of ACS
aspirin, nitro, oxygen, morphine
don't use NSAIDS (interfere with aspirin)
don't give O2 if oxygen sat is normal
59
RF for peripheral arterial thrombosis
smoking, cholesterol, HTN, family history, DM, age, sex, a fib!
60
Afib is a risk factor for what two pathologies
CVA and peripheral arterial thrombosis
61
RF for PAT are the same for what other condition
atherosclerosis
62
sudden onset limb arterial occlusion
- painful, cold, pale
| - don't really understand this ?
63
chronic occlusion, aka
intermittent claduication
leg pain with activity. can only go a certain distance before pain. muscle builds up an oxygen reserve, so pt is ok at rest but uses up the reserve with activity. once the oxygen is depleted with activity, the legs become painful
64
treatment for chronic occlusion
control RFs, encourage statins and exercise to increase collateral formation of vessels (BVs will form around occluded vessels), aspirin, PT!
65
T/F most causes of atherosclerosis are modifiable
true! smoking, cholersterol, HTN
66
define cardiac death
dead less than 1hr after symptom onset
| 50% of cardiac deaths
67
#1 cause of sudden cardiac death
```
heart disease (ASCVD) (acute ischemic event such as a STEMI)
second cause - channelopathy
```
68
Risks of sudden cardiac deaths
```
heart diease (ASCVD risks) such as smoking
drugs
time of day/season (morning, winter)
SDH: black race, poverty, stress
exercise
```
69
treatment of sudden cardiac death
defibrillate, CPR, drugs
70
people at risk of sudden cardiac death
- those with ASCVD (smokers or current/past heart damage)
- syncope in at risk pop
- family history
