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PATHO EXAM 2 > Cardiac Alterations-Up two Slide 43 > Flashcards

Cardiac Alterations-Up two Slide 43 Flashcards

1
Q

Also called ischemic heart disease and coronary artery disease (CAD)

A

Coronary heart disease (CHD)

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2
Q

Characterized by insufficient delivery of oxygenated blood to the myocardium due to atherosclerotic coronary arteries (CAD)

A

Coronary Heart disease

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3
Q

Name up to 5 sequelae of CHD

A 
Angina pectoris
Myocardial infarction
Dysrhythmias
Heart failure
Sudden cardiac death
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4
Q

A known risk factor for CHD is _______

A

atherosclerosis/microcirculation abnormalities

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5
Q

Atherosclerosis causes narrowing of the arterial lumen that can lead to cardiac ischemia through (3)_______

A

Thrombus formation
Coronary vasospasm
Endothelial cell dysfunction

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6
Q

In coronary atherosclerosis, lipids are transported via ________

A

apoproteins

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7
Q

_________associated with a greater risk of atherosclerosis

A

Lipoproteins

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8
Q

High-density lipoproteins transport cholesterol from _________ back to the ______ clearing atheromatous plaque

A

peripheral tissue; liver

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9
Q

Atherosclerotic plaque formation initiated by injury to coronary artery ________

A

endothelium

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10
Q

In coronary atherosclerosis, the_______ becomes permeable and recruits leukocytes

A

endothelium

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11
Q

_______ occurs with oxidation by endothelial cells and macrophages in coronary atherosclerosis

A

LDL insudation (accumulation)

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12
Q

________are damaging to endothelial and smooth muscle cells, and stimulate recruitment of ______ into the vessel in coronary atherosclerosis

A

oxidized lipids; macrophages

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13
Q

In coronary atherosclerosis, ______ engulf the lipids; ______ (lipid-filled macrophages) release inflammatory mediators and growth factors, attracting more leukocytes and stimulating _____proliferation

A

macrophages; foam cells; smooth muscle

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14
Q

Excess ____and _____ accumulate within vessel wall and coalesce into lipid core in coronary atherosclerosis

A

lipid, debris

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15
Q

Vulnerable plaques may rupture or become eroded, which stimulates clot formation on the plaque in ________

A

coronary atherosclerosis

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16
Q

Vulnerable plaques have (3)________

A

Large lipid core
Thin cap
High shear stress

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17
Q

Stable plaques have (2)______

A

More collagen and fibrin

Stable cap

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18
Q

There is increased plaque ________ in coronary atherosclerosis

A

vulnerability

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19
Q

Name 5 signs of plaque vulnerability in coronary atherosclerosis

A

Active inflammation within the plaque
Large lipid core with a thin cap
Endothelial denudation (erosion) with superficial platelet adherence
Fissured or ruptured cap
Severe stenosis predisposing to high shear stress

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20
Q

_________ mainstay of treatment and prevention for atherosclerosis; also, stabilize the plaques, making them less prone to rupture

A

Lipid lowering therapy

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21
Q

Which plaque is most prone to rupture?

Contains significant collagen and fibrin
Has a large lipid core with a thin cap
Contains high-density lipoproteins
Has areas of ischemia and necrosis

A

Has a large lipid core within a thin cap

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22
Q

oxygen supply insufficient to meet metabolic demands

A

ischemia

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23
Q

Critical factors in meeting cellular demands for oxygen include: (2)

A

Rate of coronary perfusion

Myocardial workload

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24
Q

Large, stable atherosclerotic plaque and acute platelet aggregation/thrombosis can alter _________

A

coronary perfusion

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25
Q

Vasospasm, failure of autoregulation by the microcirculation, and poor perfusion pressure can alter________

A

coronary perfusion

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26
Q

Chronic occlusion of a coronary vessel sign of ______

A

stable angina

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27
Q

Plaque disruption and thrombus formation and results in unstable angina or MI a sign of _______

A

acute occlusion

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28
Q

Myocardial ischemia may uncommonly be caused by (3)_______

A

Coronary vasospasm
Hypoxemia
Low perfusion pressure from volume depletion or shock

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29
Q

Chronic syndromes with slow progression due to chronic obstruction from ____________

A

from stable atherosclerotic plaques

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30
Q

Name 2 examples of chronic syndromes with slow progression

A

Stable angina pectoris

Ischemic cardiomyopathy

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31
Q

__________associated with acute changes in plaque morphology and thrombosis; abrupt and can be life-threatening

A

Acute coronary syndrome (ACS)

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32
Q

Unstable angina and myocardial infarction associated with _________

A

Acute coronary syndrome (ACS)

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33
Q

Any of the coronary heart syndromes may precipitate (2)________

A

sudden cardiac death and associated dysrhythmias

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34
Q

Chest pain associated with intermittent myocardial ischemia

A

Angina Pectoris

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35
Q

Burning, crushing, squeezing, choking or referred pain

A

Angina Pectoris

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36
Q

No permanent _________ damage occurs in Angina Pectoris

A

myocardial

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37
Q

May result in inefficient cardiac pumping with resultant pulmonary congestion and shortness of breath

A

Angina Pectoris

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38
Q

What are the 3 patterns of Angina Pectoris

A

Stable/typical, unstable/crescendo, prinzmetal/variant

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39
Q

Angina pattern that is most common and also called classic

A

Stable/typical

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40
Q

Angina pattern that is characterized by stenotic atherosclerotic coronary vessels

A

Stable/typical Angina

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41
Q

Onset of anginal pain is generally predictable and elicited by similar stimuli each time….associated with what angina pattern?

A

Stable/typical Angina

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42
Q

Stable/typical angina relieved by ______ and _____

A

rest, nitroglycerin

43
Q

Angina pattern that may progress to acute ischemia

A

Unstable/crescendo angina

44
Q

Unpredictable attacks of anginal pain associated with what angina pattern?

A

Prinzmetal or variant angina

45
Q

Onset of symptoms is unrelated to physical or emotional exertion, heart rate, or other obvious causes of increased myocardial oxygen demand…associated with what angina pattern?

A

Prinzmetal or variant angina

46
Q

_________ angina characterized by ______, atherosclerosis-induced hypercontractility, abnormal secretion of vasospastic chemicals by local mast cells, and abnormal ______ across vascular smooth muscle

A

Prinzmetal/variant angina, vasospasms, calcium flux

47
Q

Responds well to treatment with calcium channel–blocking drugs

A

Prinzmetal/variant angina

48
Q

Chest pain usually more severe and lasts longer than typical angina

A

Acute Coronary Syndrome

49
Q

In Acute Coronary Syndrome, there is ________ rupture with acute thrombus development

A

plaque

50
Q

In acute coronary syndrome, occlusion is partial with ________

A

unstable angina

51
Q

In acute coronary syndrome, occlusion is complete with______

A

MI

52
Q

Name 2 tools used for diagnosis of acute coronary syndrome

A

ECG and biomarkers

53
Q

Patients with acute coronary syndrome that present with ST elevation and show positive biomarkers have
_________

A

STEMI

54
Q

Patients with acute coronary syndrome that present with No ST elevation and show negative biomarkers have
_________

A

unstable angina

55
Q

Patients with acute coronary syndrome that present with No ST elevation and show positive biomarkers have _________

A

NSTEMI

56
Q

Patients with chest pain and evidence of acute ischemia on the electrocardiogram (ECG) (ST-segment elevation; STEMI) are candidates for _______

A

acute reperfusion therapy

57
Q

Patients presenting with symptoms of unstable angina and no ST elevation on the ECG (non-STEMI, NSTEMI) are candidates for ______

A

anti platelet drugs

58
Q

Acute occlusion causes a range of cellular events, depending on (3)________

A

Availability and adequacy of collateral blood flow
Relative workload
Length of time that flow is interrupted

59
Q

Ultimate size of the infarcted tissue depends on the extent, duration, and severity of ______-

A

ischemia

60
Q

In acute coronary syndrome, after ___ to ___ hours: area of infarction becomes paler than surrounding tissues

A

18-24

61
Q

In acute coronary syndrome, ___ to ___days: turns yellowish and soft with a rim of red vascular connective tissue

A

5-7

62
Q

In acute coronary syndrome, at ___to ____ weeks: necrotic tissue progressively degraded and cleared away; infarcted myocardium weakened and susceptible to rupture

A

1-2

63
Q

In acute coronary syndrome, by _____ weeks necrotic tissue replaced by tough fibrous scar tissue

A

6

64
Q

Electrocardiographic changes
Elevations of specific marker proteins in the blood
used to diagnose ________

A

acute coronary syndrome

65
Q

Severe ______, excruciating ______ pain that may radiate to the arm, shoulder, jaw, or back associated with acute coronary syndrome

A

crushing, chest

66
Q

Accompanied by nausea, vomiting, diaphoresis (sweating), shortness of breath

A

acute coronary syndrome

67
Q

Acute coronary syndrome lasts more than _____ minutes and is not relieved by ___ or nitroglycerin

A

15; rest

68
Q

Those with acute coronary syndrome have clinical manifestations including _____ MI

A

asymptomatic/”silent”

69
Q

In those with acute coronary syndrome, ECG changes include _____ segment elevation, large _____ waves, and inverted _____ waves

A

S-T, Q, T

70
Q

Acute coronary syndrome manifests as atypical symptoms like including fatigue, nausea, back pain, and abdominal discomfort among ______(3)

A

women/elderly/diabetic neuropathies

71
Q

Serum marker changes in acute coronary syndrome include increased ______(3)

A

CK-MB and troponin I and T

72
Q

Myoglobin, troponin, lactate dehydrogenase, and creatine kinase changes an indicator of _______

A

acute coronary syndrome

73
Q

In acute coronary syndrome, ____leads to drop in _____, triggering compensatory responses including sympathetic activation

A

MI; CO

74
Q

In acute coronary syndrome, Sympathetic nervous system activation leads to increased myocardial workload by increasing (3)_________

A

Heart rate
Contractility
Blood pressure

75
Q

In acute coronary syndrome, overall prognosis for acute MI difficult to determine because of (5)_______

A 
Of particular importance is how quickly treatment is sought
Extent and location of the infarct
Previous cardiovascular health
Age
Presence of other disease processes
76
Q

Treatment for acute coronary syndrome includes decreasing_______

A

myocardial oxygen demand

77
Q

Treatment for acute coronary syndrome includes increasing_______

A

myocardial oxygen supply

78
Q

Treatment for acute coronary syndrome includes managing and monitoring ______

A

complications

79
Q

Sympathetic antagonists, rest, heart rate control, pain relief, afterload reduction used to decrease ______in acute coronary syndrome

A

myocardial oxygen demand

80
Q

Thrombolysis, angioplasty, coronary bypass grafting

used to increase _________in acute coronary syndrome

A

myocardial oxygen supply

81
Q

Early detection and management of_______ and conduction disorders; continuous _____ monitoring treatment for acute coronary syndrome

A

dysrhythmias; ECG

82
Q

Reperfusion therapy is indicated for the patient with:

hypotension and dysrhythmias.
unstable angina and elevated serum markers.
chest pain and ST segment elevation.
stenosis and regurgitation.

A

chest pain and ST segment elevation.

83
Q

Unexpected death from cardiac causes within ____ hour/s of symptom onset

A

1

84
Q

Also called sudden cardiac death

A

sudden cardiac arrest

85
Q

Use of external defibrillators and CPR has increased survival of _______

A

sudden cardiac arrest

86
Q

____________ is usually the primary cause of sudden cardiac arrest

A

Lethal dysrhythmia (such as ventricular fibrillation)

87
Q

Heart failure develops insidiously due to progressive ischemic myocardial damage in ________

A

Chronic Ischemic Cardiomyopathy

88
Q

Those with history of Chronic Ischemic Cardiomyopathy

usually have history of ______ or _____

A

angina; MI

89
Q

Chronic Ischemic Cardiomyopathy IS MORE COMMON IN _____ and has _____ prognosis

A

adults; poor

90
Q

Appears to be a consequence of slow, progressive apoptotic death of myocytes from chronic ischemia

A

Chronic Ischemic Cardiomyopathy

91
Q

Apoptotic death of myocytes in Chronic Ischemic Cardiomyopathy scattered throughout ______

A

myocardium

92
Q

Endocardial and valvular structures may be damaged by (3)_______

A

Inflammation and scarring
Calcification
Congenital malformations

93
Q

Cause altered hemodynamics of the heart and increase myocardial workload

A

Endocardial and valvular disease

94
Q

failure of the valve to open completely results in extra pressure work for the heart

A

Stenosis

95
Q

inability of a valve to close completely results in extra volume work for the heart

A

Regurgitation (insufficiency)

96
Q

________ are common with valvular disorders

A

Murmurs

97
Q

Low-pitched, rumbling diastolic murmur; open snap; atrial dysrhythmias, atrial clots; exertional dyspnea associated with ________

A

Mitral Stenosis

98
Q

In Mitral stenosis, blood flow from left _____to left ______ impaired during ventricular _______

A

atrium; ventricle; diastole

99
Q

Increased pressure of the left atrium leads to atrial chamber enlargement and hypertrophy in ______

A

Mitral Stenosis

100
Q

Mitral Stenosis can lead to chronic pulmonary _______, right ventricular _______, and _____-sided heart failure

A

hypertension, hypertrophy, right

101
Q

In Mitral ________, there is a backflow of blood from the left ventricle to the left atrium during ventricular ____

A

Regurgitation; systole

102
Q

Mitral regurgitation may lead to ________heart failure

A

left sided

103
Q

High-pitched, pansystolic, blowing murmur; giant V waves; chronic weakness and fatigue associated with _______

A

mitral regurgitation

104
Q

Left atrium and ventricle dilate and hypertrophy due to extra volume in _________

A

mitral regurgitation

PATHO EXAM 2 (12 decks)

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