CARDIO-CAD Flashcards by JHope .

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

Heart dz, 2. Cancer 3. COPD 4. CVA

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What is true definition of Ischemia?

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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What is major difference with ishemcial vs. infart?

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

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When do coronary arteries fill w/ blood?

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

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When are coronary aa blocked?

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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How does HTN and AS affect CAD?

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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What is the widowmaker artery?

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

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

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What does the RCA supply in the heart?

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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What is essential regarding HTN?

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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What forms in due to endothelium injury?

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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When fibromuscular plaque ruptures?

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

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what inflammatory component affect atherosclerois?

CRP inc rupture risk- inducing MACs

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How does smoking inc risk?

Dec NO, INC inflammation, oxidation of LDL

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

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

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

Lifestyle diet and smoke talk

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

Statin

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When should TX start for LDL >100?

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

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

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

Chronic ischemic dz include:

Stable Angina, Silent MI, Variant Angina

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

Stable Angina-MC

What induce stable angina?

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

Is EKG indicative for stable angina?

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

How does silent Myocardial Ischemia occur?

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

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

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

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

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

What is transmural ischemia?

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

What are other DDX of substernal chest pain?

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

Do you ever place unstable angina stress test?

As a PA no, let Cardio determine. EST

When is angiogram important?

ED, new onset lasting CP, unstable angina

What is TX for Stable Agina?

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

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

Unstable Angina- clincal progression. HIGH risk for MI

What defines a true MI?

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

How is the area of infarction defined?

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

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

Acute STEMI

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

Troponin. In cardiac msk. TNL, TNT

How long do CK markers last?

decline 2-3d, rise 4-8hr

What are physiologic changes to heart after MI?

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

What is the concern post MI?

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

What are microscopic changes to heart after MI?

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)

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

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

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

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

Who can go into MI from a bee sting?

Analphalxis bc widespread vasodialtion, heart cannot keep up

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?

Sudden cardiac death