Cardiac Disease Flashcards
Arteriosclerosis
diseases of the arteries in which thickening and loss of elasticity occurs
Atherosclerosis
Atherosclerosis is the major type of arteriosclerosis:
- Involves the intima
- Is caused by cholesterol deposits and development of atheroma
Endothelium: Critical functions in regulating vascular homeostasis
Vascular permeability
Vascular tone
Thrombosis & thrombolysis
Regulates coagulation
Immune response
Angiogenesis
Lipid metabolism
Pathophysiology of CAD
Step 1: Endothelial Injury & Dysfunction
Step 2: Formation of a Fatty Streak (foam cells)
Step 3: Fibrous Plaque
Step 4: Complicated Lesions
Acute Coronary Syndrome (ACS)
ST-elevation myocardial infarction (STEMI)
Non-ST-elevation ACS (NSTE-ACS): Consists of NSTEMI and Unstable Angina (UA)
STEMI
Myocardial necrosis
Elevated troponin level
ECG shows: ST segment elevation or new left bundle branch block (LBBB)
STEMI management
“time to treatment”
reperfusion with primary percutaneous coronary intervention (PCI) or
fibrinolysis if at community hospital without immediate access to cardiac catheterization lab for PCI
NSTEMI
Presence of myocardial necrosis
Elevated troponin level
ECG shows: ST segment depression or T wave inversion
Unstable Angina (UA)
Transient episodes of thrombotic vessel occlusion and vasoconstriction occur at the site of plaque damage with a return of perfusion before significant myocardial necrosis occurs
ECG findings of new transient T wave inversion, ST segment depression or elevation; ECG can also be normal in UA
hs-troponin is negative (or slightly positive)
Myocardial Stunning
The temporary loss of contractile function that persists for hours to days after perfusion has been restored
Hibernating Myocardium
Tissue that is persistently ischemic undergoes metabolic adaptation to prolong myocyte survival
Myocardial Remodeling
Process that occurs in the myocardium after an MI
Repair after MI
Involves complex molecular mechanisms – inflammatory & immune response, macrophages remove necrotic tissue, replace collagen
Patients with ___ may present with “silent myocardial ischemia”
-
DM
Possibly due to autonomic neuropathy (injury to cardiac afferent nerves)
Non-modifiable Cardiac Risk Factors
Age: > 45 yrs. men; > 55 yrs. women
Gender: Men may develop CAD earlier
After age 65 yrs. risk for men/women similar
Family history of premature CVD
1st degree relative
M < 55 yrs.; W < 65 yrs.
Atable angina criteria (3)
Substernal chest discomfort with characteristic quality and duration
Provoked by physical exertion and emotional stress
Relieved promptly by rest or with the use of nitroglycerin spray
Atypical angina: 2 of the 3
how many CCS classification of angina
4 class
Class 1: ordinary physical activity does not cause angina
Class 2: slight limitation of ordinary physical activity
Class 3: marked limitation
Class 4: inability to carry out physical acitivity
Troponin is release into the blood after how long following MI?
3-4 hours after injury
troponin can be elevated in other diseases
Heart Failure
Sepsis
Renal Failure
PE
Myocarditis
labs for CAD
hs-troponin
CBC
Electrolytes
Creatinine
Coagulation studies: PT, INR
Lipid profile: TC, TG, LDL-C, HDL-C, TC/HDL ratio
Glucose (risk assessment): FPG, HbA1C
CRP: sensitive prognostic marker for CAD
the gold standard for diagnosing CAD is
coronary angiograph
