Cardio - Exam 1 Flashcards
atherosclerosis is defined as a ____ disease of med and large sized arteries fueled by ___
inflammatory disease of med and large sized arteries fueled by lipids
list some risk factors of atherosclerosis
- HTN
- smoking
- low HDL, high LDL
- DM
- autoimmune disease
- infarction
list the 5 steps of plaque development
- endothelial cell injury
- migration of circulating monocytes
- lipid accumulation
- smooth muscle cell proliferation
- platelet adhesion
monocytes attach to the endothelial cells via which 2 receptors
VCAM 1 and ICAM 1
during lipid accumulation macrophages become ___ and form a lipid pool
foam cells
platelets can form a ___ through the platelet cascade
thrombus
4 steps of platelet cascade
- adhesion
- activation
- aggregation
- thrombosis
list the three key mediators to plaque development
- endothelial dysfunction
- oxLDL
- inflammatory response
oxLDL is released by ___ and causes ____
macrophages and causes increased inflammation (more monocytes are attracted to the area)
characteristics of vulnerable plaque
- THIN fibrous cap
- LARGE, soft, lipid rich core
- LOW SMC
- inflammatory process still occurring
- can lead to rupture/thrombus
myocardial ischemia is
decreased blood flow to the heart that decreases O2 to myocytes
STABLE angina is AKA
classic/effort angina
stable angina pain
intermittent with predictable pattern
pain at rest is unusual with ___ angina
stable
pain increases with 02 demand with ____ angina
stable angina
ECG will show ___ with stable angina
st segment depression
nirtoglycerin relieves pain for ___ angina
stable
pain lasts ___ min with stable angina
5-15 min
stable angina plaque has a ___ lipid core and a ___ cap
small lipid core and thick cap
unstable angina is AKA
crescendo angina
with UA pain has no
predictable pattern
with UA pain is at
rest or exertion
with UA the ECG will show
ST seg depression and T wave inversion
pain with UA lasts
longer than 20-30 min
with UA the plaque has a ___ lipid core and a ___ cap
large lipid core, thing cap
prinzmetal angina is AKA
variant angina
prinzmetal angina is related to
coronary artery spasms due to calcium influx
with prinzmetal angina there can be pain at
rest
ECG for prinzmetal angina
ECG ST segment elevation
silent myocardial ischemia is AKA
angina equivalent
with silent myocardial ischemia there is ___ presentation
atypical (no CP)
silent myocardial ischemia occurs in these three pops commonly
elderly, women, diabetics
what s/sx is common in those that present atypically
confusion
3 terms under ACS (acute coronary syndrome umbrella)
UA, NSTEMI, STEMI
3 terms under chronic ischemic HD
VA, SA, silent myo. ischemia
with myocardial infarction the pain is described as
vice like (vs radiating pain in angina)
a ____ MI is transmural or full thickness
STEMI
NSTEMI damage is limited to the
subendocardial layer
with STEMI the ECG shows
ST seg elevation
ECG with NSTEMI shows
ST seg elevation, can be ST depression or T wave inversion
with MI you will have elevated ____
cardiac enzymes
NSTEMIS have ____ EF than STEMI
higher
ST segment elevation is a sign of ____ and an early sign of ____
sign of injury and an early sign of infarction
ST segment depression or T wave inversion are a sign of
ischemia
an abnormal q wave is a sign of
necrosis/infarction
list two cardiac enzymes
troponin 1 and CKMB
troponin is released___ hours post injury, and stays elevated for
3-6 hrs, stays elevated for 4-12 days
CKMB is released ___ post MI
4-12 hours
___ is an abnormality in cardiac function, an inability of the heart to pump at a rate commensurate with metabolic requirements
heart failure
frank starlings law: __ volume of blood in the heart —> ___ force of contraction
INC volume of blood in the heart —> INC force of contraction
la place’s law: ___ wall tension, ___ volume, ___ pressure, ___ wall thickness
INC wall tension, INC volume, INC pressure, DEC wall thickness
___ is when the LV is SQUEEZING and pressure is INC
systole
____ is when the LV is FILLINg and vol is INC
diastole
list some common causes of HF
- CAD w myocardial ischemia (most reversible)
- HTN
- idiopathic dilated cardiomyopathy
- valvular HD
- drugs
- post partum
2 changes with post MI remodeling
- myocyte/ventricular hypertrophy
2. ventricular dilation
EF (ejection fraction) is the
volumetric fraction of blood ejected from a ventricle of the heart with each beat
normal EF
60-70%
systolic ventricular dysfunction is AKA
HFrEF
HFrEF is
HF with reduced EF
with systolic ventricular dysfunction (HFrEF) EF is
less than 40%
with systolic ventricular dysfunction (HFrEF) the volume in the heart is ___ and the EF is ___
volume in the heart is maintained but the EF is reduced
with systolic ventricular dysfunction (HFrEF) the ventricle is not strong enough to _____ due to ____
pump out all the blood due to INC AFTERLOAD
diastolic ventricular dysfunction is AKA
HFpEF
HFpEF is
HF with preserved EF
with diastolic ventricular dysfunction (HFpEF) volume of blood in the heart is ___ but EF is ____
volume of blood in heart is reduced but EF is preserved
with diastolic ventricular dysfunction (HFpEF) there is DEC ventricular ___
compliance (dec preload)
diastolic ventricular dysfunction (HFpEF) is more common in __ _and __
women and elderly
____ is equal to EDV
preload = EDV
preload is the amount of
stretch in the cardiomycocytes before contraction
INC EDV –> ___ preload —> __ contraction
INC EDV –> INC preload (stretch) —>INC contraction
____ is the pressure against which the heart must work to eject blood during systole
afterload
INC after load leads to INC
pressure the heart must generate to eject blood
compliance is the ability of the heart to
stretch
DEC compliance –> ___ EDV –> __ SV
DEC compliance –> DEC EDV –> DEC SV
____ are diseases that affect the mycardium and lead to HF
cardiomyopathies
dilated cardiomyopathy has ____ cardiac chambers and ___ wall thickness
DILATED cardiac chambers and NML wall thickness
with dilated cardiomyopathy there is poor ___ fxn
systolic
with hypertrophic obstructive cardiomyopathy there is ___ wall thickness and ___ chamber size
INC wall thickness and DEC chamber size
with hypertrophic obstructive cardiomyopathy there is poor ___ fxn
diastolic
with restrictive cardiomyopathy there is ____ LV cavity dimensions and ___ wall thickness
normal LV cavity dimensions and INC wall thickness (filling of ventricles DEC and CO DEC)
cause of Takotsubo cardiomyopathy
unknown, possible catecholamine induced myocardial stunning following physiological/emotional stress
