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SUMPHYS2 > CARDIO-CAD > Flashcards

CARDIO-CAD Flashcards

1
Q

As a HCP what are you primary goals to prevent d/t statistics in US?

A
  1. Heart dz, 2. Cancer 3. COPD 4. CVA
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2
Q

What is true definition of Ischemia?

A

insuffiencent coronary blood flow to heart d/t imbalance of supply vs demand. REVERSIBLE. 1. MC atheroscerlosis, aterioscleroiss 2. VTE, DVT, 3. spasm, 4. severe LVH via HTN or AS.

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3
Q

What is major difference with ishemcial vs. infart?

A

Infarct is tissue death. IRREVERSIBLE. Ischemia is not a Diagnosis

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4
Q

When do coronary arteries fill w/ blood?

A

Diastole, unlike other artieries. Location: Main aa. LAD- ant. Interventricular descending. Septum

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5
Q

When are coronary aa blocked?

A

During aortic valve opening/systole, due to involuted vavles in the way of coronary aa. During aortic valve closure/diastole leaflets fall back down and fill coronary aa

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6
Q

How does HTN and AS affect CAD?

A

Bc over time HR inc w/ HTN, diastole shorten, less filling of coronary aa.. HR <180= less diastole thus less leaflets closed, less coranory artery fill w/ blood

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7
Q

What is the widowmaker artery?

A

LAD- ant. Interventricular. Off of LCA. Supplies LV, 2/3 of IV septum, RBB, and LBB. Thus if block, heart will not perfuse or contract d/t block of purkinje and Branches

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8
Q

The heart requires relatively lots of Oxygenation, how is it supplied?

A

RCA,LCA resistance here determines myocardial blood flow. Myocardial tissue doesn’t fatigue

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9
Q

What does the RCA supply in the heart?

A

RV, Post and inf LV, Post 1/3 of septum, SA and RV node, His, post. LBB. Conduction blocks may mean coronary aa dysfx

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10
Q

What is essential regarding HTN?

A

AtHEROSCLEROSIS or arteriosclerois will requiring high pressure to perfuse the body’s essential need for O2. Coronary aa will require higher pressure if stiffened. Age- need high pressure to profose bc lose compliance/elasticy in vessels.

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11
Q

What forms in due to endothelium injury?

A

ALL Pressure cause damage. Loss of NO. Deposits in intima. If tears platelet adhere, monocyte recruited, foam cells, and fatty streak. FIBROMUSCULAR PLAGUE-MSK FIBERS +CHOLESTERAL CORE

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12
Q

When fibromuscular plaque ruptures?

A

Breaks off embolus travel to smaller vessels, occulde, CVA, or MI

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13
Q

what inflammatory component affect atherosclerois?

A

CRP inc rupture risk- inducing MACs

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14
Q

How does smoking inc risk?

A

Dec NO, INC inflammation, oxidation of LDL

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15
Q

Mr. KFC has low HDL, does he need Rx? What is TX fo him?

A

Not necessarily based solely on HDL. #1 Exercise to inc HDL

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16
Q

Ms. KFC has LDL 132, no risk factors except smoking?

A

Lifestyle diet and smoke talk

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17
Q

Mr. KFC had low HDL and LDL 192? TX?

A

Statin

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18
Q

When should TX start for LDL >100?

A

> 130 with cormorbities= diet talk. >160 RX talk

19
Q

What is paroxysmal chest pain, crushing pressure, transient cardiac ischemia w/o cell death?

A

Angina pectoris: substernal chest pain. VC sx assoc, w/CAD

20
Q

Chronic ischemic dz include:

A

Stable Angina, Silent MI, Variant Angina

21
Q

What is a fixed atherosclerois, narrow lumen >75% L/T subendothial ischemia when demand is high?

A

Stable Angina-MC

22
Q

What induce stable angina?

A
  1. Exerise 2. Stress 3 Cold. BUT last 1-5min, RELIEVED w/ rest and RX Nitroglycerin
23
Q

Is EKG indicative for stable angina?

A

Yes, ST depression impulse away from ventricle. Ventricle relax but subendothelium is ischemic <50% of wall

24
Q

How does silent Myocardial Ischemia occur?

A

Still agina, dec blood flow, but no pain. Theory- 1. Pt has defect in pain sensatin-DM. 2. Too small of ischemia. DM d/t neuropathy- Danger bc untreated

25
Q

What occurs in women during stress, exercise at 12am in morning?

A

Prinzmetal variant angina- coronary artery spasm, seen in aortic stenosis

26
Q

Mrs. KFC ECG shows transient ST elevation. What other finding on EKG?

A

Peak T-waves, transmural ischemia, inverted U wave. Hard to see w/o symptoms

27
Q

What is transmural ischemia?

A

Dec blood flow through >50% thickness of ventricle wall. MC. Q-wave infarct

28
Q

What are other DDX of substernal chest pain?

A

Think hollistic and anatomy. Esophagus, GERD, Ribs, Lung, Mediastinum

29
Q

Do you ever place unstable angina stress test?

A

As a PA no, let Cardio determine. EST

30
Q

When is angiogram important?

A

ED, new onset lasting CP, unstable angina

31
Q

What is TX for Stable Agina?

A

BB, CCB-ideal, anitplatelet. Nitrates acute, Lipid control, DM, Exercise, NO Smoke, GAD manage.

32
Q

What occurs with nonocculsive (FLAPlike) thrombus in area of atheroscleois. Pain last >20min, new onset, severe.

A

Unstable Angina- clincal progression. HIGH risk for MI

33
Q

What defines a true MI?

A

STEMI w/ cell death markers-troponin. NonSTEMI is not true MI bc no ST elevation. BUT may have markers

34
Q

How is the area of infarction defined?

A

Cornary artery that is affected and blood flow distribution. LAD 50%, RCA 40%, LCA- 20%

35
Q

This occurs when coronary artery plaque ruptures, thrombus forms, spasm, caused by vasuclitis, coacine, all emobize a plague?

A

Acute STEMI

36
Q

Which marker rises w/in 3 hrs and last 7-10d post MI?

A

Troponin. In cardiac msk. TNL, TNT

37
Q

How long do CK markers last?

A

decline 2-3d, rise 4-8hr

38
Q

What are physiologic changes to heart after MI?

A

18h-24h- pallor and soft. 2. 1 wk- yellow palor 3. month-central pallor red border (coagulation necrosis), tissue remodel

39
Q

What is the concern post MI?

A

Arrhymia w/in 24hr d/t conductioff from ischemia. RCA, nodes

40
Q

What are microscopic changes to heart after MI?

A

4-24h coagulation necrosis 2. 4d neutrophil, 3. 7d MAC which inc rupture risk d/t soft-HIGH ruptur risk 4. 28d, granulation fibers 5. Months scar, thick form, HIGH of aneurysm (Latin widen)

41
Q

What my happen if infart is in the following areas? Ventricular wall, Septum, Papillary msk?

A
  1. Ventricular wall- cardiac tamponade, heart fill w/ fluid 2. Septum- L-R shunt- weaken DEC output 3. Papillary msk- mitral valve insuffienct, regurg
42
Q

These people have common CP of MI. Elderly, DM, Women, S/Post op

A

Little to no angina. Denial. MC SX- N/V, sweating, anxiety, fear (SNS). Left ARM pain referral

43
Q

Who can go into MI from a bee sting?

A

Analphalxis bc widespread vasodialtion, heart cannot keep up

44
Q

This condtion is caused by the following where people die w/I 1hr of MC sx of MI. CAD, HOCM, Mitral prolapse, Aortic stenoiss, Congenital heart, Myocarditis?

A

Sudden cardiac death

SUMPHYS2 (27 decks)

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