Cardiac Function Flashcards
Structure contains oxygenated and deoxygenated blood?
- Aorta
Oxygenated
Structure contains oxygenated and deoxygenated blood?
- Inferior vena cava
Deoxygenated
Structure contains oxygenated and deoxygenated blood?
- Left atrium
Oxygenated
Structure contains oxygenated and deoxygenated blood?
- Left ventricle
Oxygenated
Structure contains oxygenated and deoxygenated blood?
- Mitral valve
Oxygenated
Structure contains oxygenated and deoxygenated blood?
- Pulmonary artery
Deoxygenated
Structure contains oxygenated and deoxygenated blood?
- Pulmonary vein
Oxygenated
Structure contains oxygenated and deoxygenated blood?
- Right atrium
Deoxygenated
Structure contains oxygenated and deoxygenated blood?
- Right ventricle
Deoxygenated
Structure contains oxygenated and deoxygenated blood?
- Superior vena cava
Deoxygenated
Structure contains oxygenated and deoxygenated blood?
- Tricuspid valve
Deoxygenated
Changes configuration; grabs actin to pull across fiber
Myosin
Regulatory proteins for actin filaments
Troponin complex
Helps contract muscle
Calcium ions
Interaction during cardiac muscle contraction
Troponin is regulatory for actin in the heart; energy in the form of ATP is required
(At least) five modifiable risk factors for cardiovascular disease
- Smoking
- High cholesterol
- High TGL
- High LDL
- Decreased HDL
- High blood pressure
- Physical inactivity
- Obesity
- Type 2 diabetes mellitus
(At least) two non-modifiable risk factors for cardiovascular disease
- Age
- Gender
- Family history
- Race
Medicare Defined Panel criteria for total cholesterol
< 200 mg/dL
Medicare Defined Panel criteria for HDL cholesterol
> 40 mg/dL
Medicare Defined Panel criteria for LDL cholesterol
< 100 mg/dL
Defined Panel criteria for TGL
< 150 mg/dL
Describe the sequence of events in the progression of atheroscloerosis, relating these changes to the development of biomarkers for the disease
- Traditional markers identify the patient’s response to the inflammatory process involved
- Developing biomarkers identifying the patien’ts response to damage to the endothelial cell lining initiation a hemosatic response w/ thrombosis and subsequent fibrinolysis
Five tests that may be used to assess risk for atherosclerosis development and subsequent cardiovascular disease
- High sensitivity CRP (HsCRP)
- Myeloperoxidase (MPO)
- Oxidized LDL
- Lipoprotein-associated phospholipase A2 (LpPLA2)
- Homocysteine
Five tests that are being developed to assess where a hemostatic response to endothelial cell injury has occurred
- Homocysteine
- tPA/PAI-1
- TAFI
- Fibrinogen
- D-dimer
Define unstable angina
Thoracic pain that may mark the onset of acute MI. It typically occurs at rest and has a sudden onset, sudden worsening, and stuttering recurrence over days and weeks. It carries a more severe short-term prognosis than stable chronic angina
Define stable angina
Thoracic pain that occurs w/ activity or stress
Briefly describe the sequence of changes in myocardial cells during an evolving acute myocardial infarction
- Complete or partial occlusion of coronary arteries
- Blood clot is a trigger for MI
- May result in: ischemia, infarction, anoxia
- Irreversible structural injury begins in less than 30 minutes after clot formation
What is occurring during the EKG?
- P wave
Activation of the atria
What is occurring during the EKG?
- QRS complex
Activation of the ventricles
What is occurring during the EKG?
- T wave
Recovery wave
Abnormal finding in the ST segment and T wave hours after MI
- Hours after infarction, ST segment becomes elevated
- Hours to days later, T wave inverts and Q wave becomes larger
2012 criteria for diagnosis of acute, evolving, or recent myocardial infarction
Detection of rise and fall of cardiac biomarker values and with at least one:
- symptoms of ischemia
- development of pathologic Q waves in ECG
- New ST-segment-Twave changes or new left bundle branch block
- identification of an intracoronary thrombus by angiography or autopsy
- Imaging evidence of new loos of viable myocardium or new regional wall motion abnormality
Appearance, peak, return to normal values in cardiac enzyme markers
- Total CK (CKMM, CKMB, CKBB)
Appearance: 3-8 hours
Peaks: 10-36 hours
Normal: 3-4 days
Appearance, peak, return to normal values in cardiac enzyme markers
- AST
Appearance: w/in 12 hours
Peaks: 18-24 hours
Normal: 4-5 days
Appearance, peak, return to normal values in cardiac enzyme markers
- LD
Appearance: 8-18 hours
Peaks: 48-72 hours
Normal: 6-10 days
Four current lab markers for acute MI
Myoglobin, CKMB, Troponin I, Troponin T
Principle O2 carrier protein in the cytoplasm of both skeletal and cardiac muscle cells
Myoglobin
Appearance, peak, return to normal values for…
- Myoglobin
Appearance: 0.5-2 hours
Peaks: 5-12 hours
Normal: 18-30 hours
Not often used due to non-specificity of the elevation to diagnose an AMI, clearance from the blood dependent on renal function so increases may not only be due to cardiac cell death
Myoglobin
Appearance, peak, and return to normal values for…
- CKMB
Appears: 1-4 hours
Peaks: 4-8 hours
Normal: 24-48 hours
B/c CKMB may be of myocardial or skeletal muscle origin, physicians prefer ____ ____
CK index = CKMB/Total CK
Regulates cardiac contraction via the ACTIN filaments
Troponin C, I, T
Ca-binding component
Troponin C
Inhibitory component; binds to actin to inhibit activity of actinomyosin APTase (breaks down ATP)
Troponin I
Tropomyosin-binding component
Troponin T
Appearance, peak, return to normal values for…
- Troponin I
Appears: 4-6 hours
Peaks: 24 hours
Normal: 5-15 days
Two physical changes to the heart in congestive heart failure
- Chambers enlarge to handle increased fluid
2. Walls may thicken to handle the increased strain
Four symptoms of congestive heart failure
- Dyspnea
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Exercise intolerance
- Fatigue
- Fluid retention
Contained in pressure-sensing cells in the left ventricle
BNP
Stimulus for BNP release
When pressure in the ventricle increases, BNP is released into the blood
Effect of BNP on ADH secretion from the hypothalamus
Decreased Na+ inhibits production of ADH by the pituitary gland; increased diuresis results in decreased blood volume, thereby trying to solve the problem
Effect of BNP on sodium excretion
In kidney, BNP stimulates natriuresis (Na+ excretion) by inhibiting Na+ reabsorption
Why BNP may be used in the diagnosis of congestive heart failure
Focuses on several goals:
- Determines the cause of diagnostic symptoms
- Estimate the degree of severity of CHF
- Estimate the risk of disease progression and risk
- Screen for a less symptomatic disease
