Cardiovascular Flashcards
What are the 3 main cardiac biomarkers used by clinician to diagnose MI?
1) Creatine Kinase
2) Myoglobin
3) Troponin T and 1
Describe the difference between the following:
1) Automaticity
2) Excitability
3) Conductivity
1) Automaticity - The ability of specialized cardiac cells to spontaneously initiate an electrical pulse.
2) Excitability - The ability of cardiac cells to respond to an electrical impulse.
3) Conductivity - The ability of cardiac cells to propagate impulses from one cell to another.
Explain why and how Creatine Kinase can be used as a biomarkers to diagnose MI? What time frames does it rise, peak, and return to normal in the blood?
Creatine Kinase is released from damaged myocardium (as well as damaged skeletal muscle and brain tissue). It rises within 4 to 8 hours of myocardial injury peaks in 12 to 24 hours, and returns to normal within 3 to 4 days.
Explain why and how Myoglobin can be used as a biomarker to diagnose MI? What time frames does it rise, peak, and return to normal in the blood?
Myoglobin is a blood protein that transports oxygen. It is released when myocardial tissue becomes damaged.
Rise - 1 to 3 hours
Peak - 4 to 12 hours
Return to Normal - 24 hours
Explain why and how Troponin T and 1 can be used as a biomarkers to diagnose MI? What time frames does it rise, peak, and return to normal in the blood?
Troponin T and 1 are blood protein that regulate the contractile function of the myocardium and are released when the myocardium becomes injured.
Rise - 3 to 4 hours
Peak - 4 to 24 hours
Return to Normal - 1 to 3 weeks
Which biomarkers cannot be used alone to diagnose MI and why?
Myoglobin - because elevations can occur in patients with renal or musculoskeletal diseases.
Which biomarker make late diagnoses of MI possible in patients who delay seeking medical care for several days after the onset of acute MI symptoms?
Troponin T and 1 - because levels remain elevated for 1 to 3 weeks after injury of myocardium.
Briefly describe the following types of Angina:
1) Stable Angina
2) Unstable Angina
3) Intractable or Refractory Angina
4) Variant Angina
5) Silent Ischemia
1) Stable Angina - Predictable and consistent pain that occurs on exertion and is relieved by rest.
2) Unstable Angina - Aka preinfarction or crescendo angina; symptoms occur more frequently and lasts longer than in stable angina, and pain may occur at rest.
3) Intractable or Refractory Angina - Severe incapacitating chest pain.
4) Variant Angina - Aka Prinzmetal’s Angina; Includes pain at rest with reversible ST-segment elevation.
5) Silent Ischemia - Objective evidence of ischemia (such as ECG changes with a stress test), but patient reports no symptoms.
Describe the difference between the following terms:
1) Positive Chronotropic
2) Positive Dromotropic
3) Positive Inotropic
1) Positive Chronotropic - Increases Heart rate
2) Positive Dromotropic - Increases AV nodal conduction
3) Positive Inotropic - Increases contraction strength
Describe the S3 (the third heart sound).
S3 (aka ventricular gallop) - The rapid, forceful inrush of blood into a stiff, non-resilient, hypertrophied ventricle. Heard early diastole, after S2 and best heard in the mitral area. It is pathologic and usually seen in volume overload or cardiac failure.
Describe S4 (the forth heart sound).
S4 (aka atrial gallop) - Caused by forceful atrial contraction due to fluid overload. Heard just before S1 in late diastole. It is best head in the mitral area with patient either in the left side or setting up and leaning forward.
S4 is pathological and can sometimes be seen in patients with which types of conditions?
1) Heart Failure - fluid overload
2) Pulmonary hypertension
3) Pulmonary stenosis
4) Cardiac myopathies
5) Pregnant women
How are quality of murmurs charted?
1) By location (over aortic, mitral, etc.)
2) Intensity (i.e., 1/6 scale)
- 1/6 very faint
- 2/6 quiet but not difficult to hear
- 3/6 moderately loud
- 4/6 loud +/- thrills
- 5/6 very loud +/- thrills, may be heard with stethoscope entirely off chest.
- 6/6 may be heard with stethoscope off chest, +/- thrills.
3) Pitch - high, med, low
4) Timing in cardiac cycle - mid systolic, diastolic
5) Configuration/Shape - Crescendo(grows louder) or decrescendo
6) Radiation - i.e., murmur heard in back, neck, etc.
Are all systolic murmurs pathologic? diastolic murmurs?
1) Systolic Murmurs - Not all are pathologic
2) Diastolic Murmurs - All are pathologic
Label the following murmurs as Systolic or Diastolic:
1) Mitral Regurgitation
2) Aortic Stenosis
3) Mitral Stenosis
4) Aortic Regurgitation
1) Mitral Regurgitation - Systolic murmur
2) Aortic Stenosis - Systolic murmur
3) Mitral Stenosis - Diastolic Murmur
4) Aortic Regurgitation - Diastolic Murmur
What is a Pericardial Friction Rub and what are some of the causes of this condition?
Pericardial Friction Rub - A rubbing sound with every heart beat (at lower sternum) that indicates inflammation of the lining around the heart.
Caused by cardiac tamponade, viral pericarditis and post open heart surgery.
Describe which arteries branch from the left and right coronary artery and which parts of the the heart they supply blood to.
1) Left Coronary Artery - Arises from the aorta and divides into the left anterior descending and circumflex artery. These two supply the left atrium, left ventricle, intraventricular septum, lateral wall, posterior wall, and part of the right ventricle.
2) Right Coronary Artery - Arises from the aorta and supplies the right atrium (SA node and AV node - often goes bradycardic), right ventricle, a portion of the posterior wall of the left ventricle, and inferior wall.
How does coronary perfusion differ from that of the rest of the body?
1) Timing - Fills during diastole
2) Extraction - Maximal extraction of O2 from the blood at all times.
Which lipid levels represents a modifiable risk factor for CAD?
1) Cholesterol > 200 mg/dL
2) Triglycerides > 150 mg/dL
3) LDL > 160 mg/dL
4) HDL < 40 mg/dL
What is Metabolic Syndrome?
Metabolic Syndrome is a cluster of the most dangerous heart attack risk factors: diabetes, abdominal obesity, high cholesterol, and high BP.
What is Acute Coronary Syndrome (ACS)?
ACS - The clinical manifestation of CAD.
Physiologic Definition - Plaque rupture leading to thrombus formation, which leads partial or complete blocking of a coronary artery with or without mooch the death.
Spectrum of ACS includes unstable angina, NSTEMI, and STEMI
There is currently no screening tool for the existence of coronary artery disease. What is the exception t this rule?
Electron Beam CT - Used to detect calcification scoring in immediate risk patients.
Describe the difference between Stable and Unstable Angina.
1) Stable Angina - Intermittent transient pain lasting < 20 mins that worsen with exercise and resolves with rest or nitroglycerin.
2) Unstable Angina - Unpredictable pain at rest that does not resolve with nitroglycerin and lasts more than 2 mins. PT may have SOB.
