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Cardio Unit 2 > Cardio Week 5 - CAD & Ischemia, Atherosclerosis, Ischemic Vessel Disease > Flashcards

Cardio Week 5 - CAD & Ischemia, Atherosclerosis, Ischemic Vessel Disease Flashcards

1
Q

How do coronary arteries provide nutrients to the heart muscle tissue?

A

Via perfusion

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2
Q

Rules of fluid dynamics

A
  • Fluids flow from an area of high pressure to low pressure
  • Fluids follow the path of least resistance
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3
Q

Major determinants of myocardial blood flow

A
  • Diastolic blood pressure
  • Vasomotor tone
  • Resistance to flow
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4
Q

What is the primary driving force moving blood into myocardial tissue?

A

Diastolic blood pressure

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5
Q

What plays a role in determining volume of blood passed along to tissue?

A

Vasomotor tone

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6
Q

What is resistance to flow commonly caused by?

A

Atherosclerosis

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7
Q

What does elevations in diastolic pressure indicate?

A
  • More resistance to flow
  • The heart has to work harder to pump the blood through the vessels
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8
Q

What does increased resistance cause?

A
  • Increased work load, which increases oxygen demand of the heart
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9
Q

What’s important when talking about myocardial perfusion?

A

The balance of oxygen supply and demand

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10
Q

What happens when demand exceeds supply of oxygen?

A

Ischemia or tissue death

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11
Q

What is the outer layer of the arteries and what is its role?

A
  • Adventitia
  • The basic support structure or basement membrane
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12
Q

What is the middle layer of the artery and its function?

A
  • Media
  • Made up of multiple layers of smooth muscle
  • Function is to make adjustments to luminal diameter
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13
Q

What is the inner layer of the artery and its function?

A
  • Intima or endothelial layer
  • Arterial endothelium is designed to be selectively permeable to macromolecules of the size of low density lipoproteins
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14
Q

What is most likely to accumulate in the intima?

A
  • Lipoproteins
  • Fibrinogen
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15
Q

Atherosclerosis

A
  • Accumulation of material beneath the tunica intima or inner layer of the arterial wall
  • Develops in response to endothelial injury
  • Advanced plaques are composed of lipid and thrombus
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16
Q

What material does atherosclerosis mostly consist of?

A
  • Macrophage cells
  • Debris
  • Lipids
  • Cholesterol
  • Fatty acids
  • Calcium
  • Variable amount of fibrous connective tissue
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17
Q

What are the development phases of atherosclerosis?

A
  • Atherosis
  • Sclerosis
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18
Q

Atherosis

A
  • Fatty streak of lipid-laden macrophages and smooth muscle cells
  • Cholesterol permeates the endothelium and deposits between the layers
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19
Q

Sclerosis

A
  • Inability of the blood vessel to be compliant (reduces its compliance) or to adjust the lumen with
  • Organization of “fibrous cap” of thrombi
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20
Q

What organs/areas can also be damaged by atherosclerosis?

A
  • Brain (CVA)
  • Kidneys (Renal artery; stenosis or atherosclerotic renovacscular disease)
  • Lower Extremities (Peripheral vascular disease)
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21
Q

Why are coronary vessels so susceptible?

A
  • Coronary vessels have short branches under high pressure
  • Flow is more likely to become turbulent
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22
Q

Risk factors for atherosclerosis

A
  • Smoking
  • Poorly controlled diabetes mellitus
  • High velocity/turbulent flow
  • Hypertension
  • Hyperlipidemia
  • Systemic inflammation
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23
Q

Major non modifiable cardiovascular disease risk factors

A
  • Heredity
  • Increased age
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24
Q

Major modifiable cardiovascular disease risk factors

A
  • Cigarette/tobacco smoking
  • Physical inactivity
  • High blood pressure (over 140/90)
  • High blood cholesterol levels
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25
Q

What is the best predictor for high blood cholesterol levels?

A

Ratio of total cholesterol to HDL

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26
Q

Total cholesterol - normal, borderline and high

A
  • Normal = < 200 mg/dL
  • Borderline = 200 - 239 mg/dL
  • High = >/= 240 mg/dL
27
Q

LDL - normal, borderline, high levels

A
  • Normal = < 130 mg/dL
  • Borderline = 130-159 mg/dL
  • High = > 160 mg/dL
28
Q

HDL - Low and Cardioprotective levels

A
  • Low = < 40 mg/dL
  • Cardioprotective = > 60 mg/dL
29
Q

Negative effects of smoking

A
  • Enhances atherosclerosis
  • Increased LDL production
  • Increased work of the heart - partially by increasing BP
30
Q

Other risk factors for cardiovascular disease

A
  • Diabetes
  • Obesity = BMI >/= 30 kg/m2
  • Gender
  • Stress
  • Diet
31
Q

What is diabetes mellitus?

A
  • Metabolic disorder - Type 2 DM
  • Start with high blood glucose
  • Accelerated atherosclerosis
  • Inflammatory response
32
Q

Ischemic vessel disease in the heart

A
  • Angina
  • Myocardial infarction
33
Q

Ischemic vessel disease in the brain

A
  • TIA = Transient ischemic attack
  • CVA = Cerebrovascular accident
34
Q

Ischemic vessel disease in the lower extremities

A
  • Intermittent claudication
  • PAD
35
Q

Causes of vessel narrowing and decreased perfusion

A
  • Atherosclerosis
  • Thrombus
  • Vasospasm
36
Q

What is a thrombus?

A
  • Occludes vessel
  • Piece breaks off (embolus)
37
Q

What is a vasospasm?

A
  • Hyperplasia of smooth muscle cells - advanced atherosclerosis, prone to spasm
  • Can decrease size of the lumen vessel
38
Q

Prinzmetal angina

A

Variant angina associated with ST-segment elevation, at rest, and no associated with any preceding increase in myocardial oxygen demand

39
Q

Angina definition

A

Distress/pain of the chest

40
Q

What causes angina ?

A
  • Classic symptom of ischemic heart conditions
  • Secondary to imbalance of coronary oxygen delivery (usually due to decreased blood flow but not always)
  • May be due to increased demands of oxygen placed on the heart
  • Decreased blood flow
  • Anemia
41
Q

Stable (Typical) Angina

A
  • Caused by fixed atherosclerotic lesion
  • Reduces reserve for coronary blood flow
  • Not present at rest
  • Occurs when oxygen demand is increased
  • Reproducible in terms of exertion (intensity and length of time)
  • Relieved by rest and administration of nitrates
42
Q

Unstable Angina

A
  • Implies worsening of atherosclerotic process
  • Progressive in terms of - severity of pain, less exertion required to elicit it, may progress to pain at rest
  • Considered emergency
  • Requires intervention before myocardial infarction occurs
  • Typically caused by thrombosis of a coronary plaque
43
Q

Prinzmetal’s Angina aka Variant Angina

A
  • Caused by coronary vasospasm due to endothelial dysfunction
  • More difficult to diagnose due to its unpredictable onset, occurring even at rest (irrespective or cardiac demand)
44
Q

What is Ergonovine stimulation?

A
  • Used to diagnose suspected prinzmetal angina
  • Illicits coronary spasm and makes it occur predictably so they can image and locate it
45
Q

What is myocardial perfusion - ischemia?

A
  • Sudden cardiac death
  • Acute coronary syndrome
  • Chronic stable angina
46
Q

What is acute coronary syndrome (ACS)?

A
  • Unstable angina
  • Non ST-segment elevation
  • ST-segment elevation
47
Q

Unstable Angina - EKG, Cardiac Enzymes and Echo

A

EKG: Normal or ischemia
Cardiac Enzymes: Normal
Echo: Normal EF

48
Q

Non ST-segment Elevation, Myocardial infarction - EKG, Cardiac Enzymes, Echo

A

EKG: ST-segment depression
Cardiac Enzymes: Abnormal
Echo: May be abnormal

49
Q

ST-segment Elevation, Myocardial infarction - EKG, Cardiac Enzymes, Echo

A

EKG: ST-segment elevation
Cardiac Enzymes: Abnormal
Echo: Abnormal

50
Q

Right Coronary Artery - Location of Infarct, ECG changes, Common Complications

A

Location: Inferior
ECG changes: II, III, aVF
Complications: Risk of atrioventricular block and/or arrhythmias, 50% have right ventricular infarct

51
Q

Left Main - Location of infarct, ECG changes, Common Complications

A

Location: Anterior and lateral
ECG changes: V1-V6, I, aVL
Complications: Pump dysfunction or failure

52
Q

Left Anterior Descending (LAD) - Location of infarct, ECG Changes, Common Complications

A

Location: Anterior
ECG: V1-V4
Complication: Pump dysfunction or failure

53
Q

Circumflex - Location of Infarct, ECG Changes, Common Complications

A

Location: Lateral
ECG Changes: V5, V6, aVL, I
Complications: None specific

54
Q

Typical symptoms of acute coronary syndrome in men

A

“Elephant sitting on their chest”
- Pain in L side of upper back, neck and arm
- Men < 55 are 6x more likely than women to have MI

55
Q

Acute coronary syndrome in women

A
  • First sign is typically angina
  • Higher risk if had preeclampsia
  • Younger women < 55 have higher mortality rates
  • Pain low sternum - right below breast, upper middle back, R shoulder, pain mid sternum - right above breast, pain L side of chest
56
Q

What is the 2nd leading cause of death in women < 55 y/o?

A

Coronary artery disease

57
Q

Progression of myocardial necrosis

A
  • Necrosis begins in a small zone of the myocardium beneath the endocardial surface in the center of the ischemic zone
  • Area that depends on the occluded vessel for perfusion is the “at risk” myocardium
58
Q

Non-STEMI diagnosis

A
  • Rupture of coronary plaques —> partial occlusion of coronary artery —> subendocardial wall infarction
59
Q

Non - STEMI diagnosis - EKG

A
  • ST segment depression
  • T wave inversion
60
Q

Non-STEMI diagnosis - Cardiac enzymes

A
  • Positive
  • Troponin T and I
  • Creatine kinase - myocardial bound
61
Q

ST- elevation MI: diagnosis

A

Rupture of coronary plaques —> thrombus/clot —> total occlusion of a coronary artery —> transmural infarction

62
Q

ST-elevation MI: Diagnosis - EKG

A
  • ST segment elevation
63
Q

ST-elevation MI: Diagnosis - Cardiac enzymes

A
  • Elevated cardiac enzymes
  • Troponins
64
Q

Echocardiogram

A
  • Wall motion abnormalities
  • Detected in 90-95% of all transmural MIs
  • Detected in 80-90% of all subendocardial MIs
  • Specificity of 80-90%

Cardio Unit 2 (13 decks)

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