CAD, Angina, And Acute Coronary Syndromes

Question 1

Factors affecting stroke volume

Answer 1

Preload, after load, contractility

Question 2

CO

Answer 2

HR x SV

Question 3

Preload

Answer 3

Volume and pressure inside ventricle at end of diastole
Determined by amount of venous blood returning to ventricle during diastole and amount left in ventricle after systole

Question 4

After load

Answer 4

Resistance to ejection of blood from L ventricle
Affected by systemic vascular resistance

Question 5

Contractility

Answer 5

Degree of myocardial fiber shortening
Affected by preload, myocardial O2 supply, inotropic stimuli

Question 6

Arteriosclerosis

Answer 6

Thickening and hardening of the vessel wall

Question 7

Atherosclerosis

Answer 7

Accumulation of lipid-laden macrophages within the arterial wall
Lesions progress from endothelial injury and dysfunction to fibrotic plaque

Question 8

Desired lipid values

Answer 8

Cholesterol <200
LDL 100-129
Triglycerides <150
HDL > 40-60

Question 9

LDL

Answer 9

Cholesterol and protein
Delivers cholesterol to tissues
Contributes to inflammatory and immune response

Question 10

HDL

Answer 10

Phospholipids and protein
Reverse cholesterol transport brings to liver for bile elimination
Participated in endothelial repair and decreases thrombosis

Question 11

Cholesterol

Answer 11

Used for bile acids and steroids
Obtained from foods
Some made by body cells

Question 12

VLDL

Answer 12

Triglycerides

Question 13

Myocardial Ischemia

Answer 13

Coronary arteries dilate with inc O2 demand
Coronary blood flow or oxygen content cannot meet the metabolic demands of myocardial cells

Factors for meeting cellular demands:
1. Amount of coronary perfusion
2. Myocardial workload
- heart rate
- preload
- after load
- contractility

Question 14

Stable angina pectoris

Answer 14

Vessels cant dilate; generally predictable in frequency, intensity, and duration; elicited by similar stimuli each time and usually relieved by nitro and rest

S/S: discomfort heaviness, pressure, crushing on chest, may radiate down left shoulder or arm, or up to jaw, pallor, cyanosis, dyspnea, diaphoresis, tachycardia, high BP

ECG: ST depression, T wave inversion, ST elevation (STEMI)

Question 15

Unstable angina

Answer 15

Transient/reversible ischemia due to unstable plaque occluding vessel x 10-20 minutes
ECG: ST depression or T wave inversion
Treat same as NSTEMI

Question 16

Myocardial Infarction

Answer 16

Thrombus occludes vessel for prolonged period of time
Categorized as NSTEMI or STEMI
Can lead to heart attack
Necrosis of heart leads to troponin release
Can lead to Dec contractility, SV, CO and dysrythmias and cardiogenic shock

Question 17

NSTEMI

Answer 17

ST depression or T wave inversion
Damages partial thickness of myocardium

Question 18

STEMI

Answer 18

ST elevation
Damage to complete thickness of myocardium

Question 19

Cardiogenic shock

Answer 19

Life threatening emergency
Occurs if left ventricular myocardium is severely damaged
Decreased perfusion to brain, kidney and all organs
S/S: confusion, LOC, rapid HR, SOB, pale, weak pulse, Dec urine output, cool hands and feet

Question 20

Myocardial stunning

Answer 20

Temporary loss of contractile function that persists for hours to days after restoration of perfusion

Question 21

Hibernating myocardium

Answer 21

Tissue that is persistently ischemic and undergoes metabolic adaptation to pro-long myocyte survival until perfusion can be restored

Question 22

Myocardial remodeling

Answer 22

Myocyte hypertrophy and loss of contractility in the areas of the heart distant from the site of infarction

Question 23

MI treatment

Answer 23

M- Morphine
O- O2
N- Nitrite
A- Aspirin
B- Beta blockers