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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
What is the best predictor for high blood cholesterol levels?
Ratio of total cholesterol to HDL
26
Total cholesterol - normal, borderline and high
- Normal = < 200 mg/dL - Borderline = 200 - 239 mg/dL - High = >/= 240 mg/dL
27
LDL - normal, borderline, high levels
- Normal = < 130 mg/dL - Borderline = 130-159 mg/dL - High = > 160 mg/dL
28
HDL - Low and Cardioprotective levels
- Low = < 40 mg/dL - Cardioprotective = > 60 mg/dL
29
Negative effects of smoking
- Enhances atherosclerosis - Increased LDL production - Increased work of the heart - partially by increasing BP
30
Other risk factors for cardiovascular disease
- Diabetes - Obesity = BMI >/= 30 kg/m2 - Gender - Stress - Diet
31
What is diabetes mellitus?
- Metabolic disorder - Type 2 DM - Start with high blood glucose - Accelerated atherosclerosis - Inflammatory response
32
Ischemic vessel disease in the heart
- Angina - Myocardial infarction
33
Ischemic vessel disease in the brain
- TIA = Transient ischemic attack - CVA = Cerebrovascular accident
34
Ischemic vessel disease in the lower extremities
- Intermittent claudication - PAD
35
Causes of vessel narrowing and decreased perfusion
- Atherosclerosis - Thrombus - Vasospasm
36
What is a thrombus?
- Occludes vessel - Piece breaks off (embolus)
37
What is a vasospasm?
- Hyperplasia of smooth muscle cells - advanced atherosclerosis, prone to spasm - Can decrease size of the lumen vessel
38
Prinzmetal angina
Variant angina associated with ST-segment elevation, at rest, and no associated with any preceding increase in myocardial oxygen demand
39
Angina definition
Distress/pain of the chest
40
What causes angina ?
- 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
Stable (Typical) Angina
- 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
Unstable Angina
- 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
Prinzmetal’s Angina aka Variant Angina
- 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
What is Ergonovine stimulation?
- Used to diagnose suspected prinzmetal angina - Illicits coronary spasm and makes it occur predictably so they can image and locate it
45
What is myocardial perfusion - ischemia?
- Sudden cardiac death - Acute coronary syndrome - Chronic stable angina
46
What is acute coronary syndrome (ACS)?
- Unstable angina - Non ST-segment elevation - ST-segment elevation
47
Unstable Angina - EKG, Cardiac Enzymes and Echo
EKG: Normal or ischemia Cardiac Enzymes: Normal Echo: Normal EF
48
Non ST-segment Elevation, Myocardial infarction - EKG, Cardiac Enzymes, Echo
EKG: ST-segment depression Cardiac Enzymes: Abnormal Echo: May be abnormal
49
ST-segment Elevation, Myocardial infarction - EKG, Cardiac Enzymes, Echo
EKG: ST-segment elevation Cardiac Enzymes: Abnormal Echo: Abnormal
50
Right Coronary Artery - Location of Infarct, ECG changes, Common Complications
Location: Inferior ECG changes: II, III, aVF Complications: Risk of atrioventricular block and/or arrhythmias, 50% have right ventricular infarct
51
Left Main - Location of infarct, ECG changes, Common Complications
Location: Anterior and lateral ECG changes: V1-V6, I, aVL Complications: Pump dysfunction or failure
52
Left Anterior Descending (LAD) - Location of infarct, ECG Changes, Common Complications
Location: Anterior ECG: V1-V4 Complication: Pump dysfunction or failure
53
Circumflex - Location of Infarct, ECG Changes, Common Complications
Location: Lateral ECG Changes: V5, V6, aVL, I Complications: None specific
54
Typical symptoms of acute coronary syndrome in men
“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
Acute coronary syndrome in women
- 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
What is the 2nd leading cause of death in women < 55 y/o?
Coronary artery disease
57
Progression of myocardial necrosis
- 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
Non-STEMI diagnosis
- Rupture of coronary plaques —> partial occlusion of coronary artery —> subendocardial wall infarction
59
Non - STEMI diagnosis - EKG
- ST segment depression - T wave inversion
60
Non-STEMI diagnosis - Cardiac enzymes
- Positive - Troponin T and I - Creatine kinase - myocardial bound
61
ST- elevation MI: diagnosis
Rupture of coronary plaques —> thrombus/clot —> total occlusion of a coronary artery —> transmural infarction
62
ST-elevation MI: Diagnosis - EKG
- ST segment elevation
63
ST-elevation MI: Diagnosis - Cardiac enzymes
- Elevated cardiac enzymes - Troponins
64
Echocardiogram
- 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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