Cardiovascular Flashcards
Approx how many people have MI each year
720,000
What is the leading cause of death for both men and women
Heart disease
What is the most common heart disease
coronary heart disease
What race is most likely to die of heart disease
African Americans
What are the modifiable risks for cardiovascular disease
PHYSICAL ACTIVITY, WEIGHT, Blood pressure, Diet/cholesterol, Stress, Glucose tolerance, Smoking
What are the non-modifiable risks for cardiovascular disease
Age, gender, race, hormonal status, family history
What are the risk factors for Coronary Artery Disease (CAD)
Hypertension, smoking, high cholesterol, elevated triglycerides, abnormal glucose tolerance, sedentary lifestyle, family history, age, male
What are the three main risk factors for Coronary Artery Disease (CAD)
Hypertension, smoking, high cholesterol
What does hypertension increase the risk of
heart disease and stroke
What percentage of people have high blood pressure
31%
What percent of people who have hypertension have it controlled
47%
What are the causes of HTN
At least 90% is “essential HTN”
other causes: kidney disease, narrowing of Aorta, narrowing of vasoconstriction of peripheral arterial system
What does HTN cause
- Mechanical damage to epithelial lining of arteries
- inflammatory response
- proliferation of smooth muscle in arterial wall
- Chronic Afterload on left ventricle
- Hypertrophy
- left ventricle failure
What are the risk factors of HTN
Inactivity, Obesity (BMI > 30), high salt diet (>2300 mg/day), heavy alcohol use, stress?, race (40% of african americans), genetics, age (women after menopause)
What is considered normal bloodpressure
Systolic <80
What is considered pre-hypertension
Systolic: 120-139
Diastolic: 80-89
What is considered stage I hypertension
systolic: 140-159
diastolic: 90-99
What is considered stage II hypertension
Systolic: >60
Diastolic: >100
Is cholesterol soluble or insoluble
Insoluble, so it binds with proteins
What is cholesterol needed for
for cell membranes, hormones
Where does LDL transport cholesterol
to cells
Where does HDL transport cholesterol
from body to liver
When a person has High LDL and Low HDL what do they have an increased risk of
Coronary Artery Disease (CAD)
What are triglycerides independent risk factors for
CAD
How many chemicals does tobacco contain
over 7,000
How many of the ingredients in cigarettes can cause cancer
70
What does smoking cessation lower the risk for
Lung cancer and other cancers
Coronary heart disease within 1-2 yrs of quitting
Respiratory symptoms
reductions in lung function
COPD
infertility and premature low birth weights
What can assist with the process of smoking cessation
Individual or group counseling/behavior modification
Over the counter medications (gum, patch, lozenge)
Prescription non-nicotine medications
Does second hand smoke contain the same cancer causing chemicals as cigarettes
Yes
Is there any risk-free level of exposure to secondhand smoke
no
What health problems can come with second hand smoke
more frequent and severe asthma attacks
increased prevalence and severity of respiratory and ear infections
increased risk of sudden infant death syndrome
increased risk of heart disease, lung cancer, stroke
What race smokes the most cigarettes
american indians/alaska natives
how does education level relate to smoking
people with a GED diploma are most likely to smoke
What happens in the body while someone smokes
Decreases the oxygen content of the blood
Damages epithelial lining which makes it more permeable to lipids
Increases the viscosity of blood; increases risk for clotting
Increased vasoconstriction in coronary arteries
What happens to the body when a person quits smoking
Within 2-3 months, lung function improves up to 30%
1 Year after cessation, heart disease risk drops 50%
5-15 years later risk of CVA is about the same as a non-smoker
What does the AHA consider adequate exercise
150 minutes of activity weekly (moderate instensity) or 75 minutes of vigorous activity
What does exercise do to the body
Modify BMI, lower blood pressure in those who have HTN, improve insulin sensitivity, increase HDL, decrease LDL, reduce stress, improve endothelial function, reduces inflammatory markers, reduce homocysteine levels
What is obesity strongly linked to
HTN and diabetes
What is a risk factor of diabetes
2-4x increase in risks of CAD
What are the implications of diabetes
higher circulating levels of fatty acid
higher active metabolic tissue-central obesity
chronic inflammation
What are the non-modifiable risk factors of diabetes
Family history, race, age, gender
When is family history a risk factor for diabetes
higher risk if a relative had their first coronary event <60 (female)
When is race a risk factor for diabetes
African-Americans: higher bp and hd risk vs caucasions
Mexican Americans, American Indians: higher rates of HD, obesity, diabetes
When are age and gender risk factors for diabetes
males:females 4:1
After 70 years old 1:1
Describe Pack year history
number of cigarettes per day X number of years smoked
What does CAD affect
Medium and large arteries (coronaries, aorta, carotids, popliteal)
What causes altered permeability
Chronic Mechanical Stress (HTN)
Carbon Monoxide (smoking)
Catecholamines (stress & smoking)
Hyperlipidemia (diet, family history, diabetes)
What is the first sign of plaque formation called
Fatty Streak
What does plaque consist of
lipids, connective tissue, smooth muscle cells, platelets
What are mechanisms of artherosclerosis
Increased LDL penetrates the arterial wall
Lipids build up in smooth ms
LDL causes smooth ms hyperplasia
Cells migrate into intima
Subendothelium is exposed to blood atsites of tears and platelets aggregate
What is myocardial ischemia
oxygen supply does not equal oxygen demand
What can decrease oxygen supply
plaque, vasospasm, decreased cardiac output, low oxygen levels (lung disease)
What can increase oxygen demands
Exercise activity, psychological stress
What affects does angina have on the body
70% or more of coronary artery occlusion
Myocardium stimulates free nerve endings near coronary arteries
impulse travels in unmyelenated sympathetic nerves to thoracic ganglia, through dorsal horn, to spinothalamic tract of thalamus and landing in cortex
Trace the path of pain fibers for angina
go through cardiac plexus–> sypmathetic chain –> spinal cord C7-T6
Afferent fibers from the heart travel the same path as what other fibers
Sympathetic fibers (C7-T5 with some convergence of lower cervical)
How long do angina attacks last
1-5 minutes normally but can be up to 20 min
What signs are atypical of angina
Dyspnea, chest pain, fatigue, lightheadedness, diaphoresis, pallor
What are causes of angina with/without an infarction
total occlusion of artery
high demand with limited flow
plaque rupture with occlusion
vasospasm in a diseased artery
What are the types or patterns of angina
Stable, unstable, prinzmental
How is a M.I. or coronary heart disease diagnosed
ECG, cardiac enzymes, patient interview, patient examination, echocardiography, cardiac catheterization, exercise stress test
What is a coronary angiography
A test that uses dye and special x rays to show the insides of your coronary arteries
What is stable angina
exertional angina because it occurs at a predictable level of activity or emotional level of activity or emotional stress
What is unstable angina
unpredictable, not related to usual demand for myocardial O2
What does prinzmetals angina result from
due to coronary artery spasm and is likely to occur in the first few hours of rising
what are the 3 zones of damage in an MI
1) zone of infarction
2) zone of hypoxic injury
3) zone of ischemia
What is zone of infarction
area of myocardium that was completely deprived of O2 resulting in cell death
What is the zone of hypoxic injury
immediately surrounding the area of infarction and will recover if blood flow is quickly restored
Which zone is usually reversible after an MI
zone of ischemia
What is an exercise stress test
graded exercise test with ECG and other monitoring
What can a exercise stress test detect
activity related ischemia, rhythm abnormalities
What can a exercise stress test determine
exercise capacity which is predictive for mortality and guides the MD with treatment
What are some treatments for MI
- Medical/pharmacological: agents to increase supply and decrease demand
- Surgical intervention: PTCA, Stent, Coronary Artery Bypass Graft
- Left Ventricle Assist Device
- Orthotopic Heart Transplantation
What is a LVAD
mechanical pump from left ventricle to aorta with external component (battery)
What is heart failure
Inability of the patient to maintain adequate cardiac output at rest
Describe left sided heart failure
- Pumping malfunction (systolic) or resting/filling malfunction (diastolic)
- Systolic dysfunction: decreased cardiac output and higher volume of blood left in left ventricle
- Diastolic dysfunction: decreased ability to fill resulting in lower cardiac output and higher pressure
What happens to the body during congestive heart failure
- pressure transmitted to atria causing dilation
- pressure transmitted to pulmonary veins: leak into interstitial space, leak into alveoli
What are symptoms of congestive heart failure (CHF)
orthopnea, dry cough, inability to take a deep breath, exertional dyspnea, weight gain (6-10 lbs in 1-2 days), left ventricle hypertrophy, pulmonary engorgement
Describe what happens to the body during right sided heart failure (HF)
-Mechanical dysfunction of RV: decreases emptying into pulmonary artery, increased right sided pressures, pressures transmitted into system
What can cause right sided heart failure
pulmonary artery HTN, lung disease, untreated or severe congestive heart failure
What are some compensatory mechanisms for heart failure
increase in sympathetic tone (increase heart rate and contractility)
increase preload to improve cardiac pump strength
Ventricular hypertrophy (strength training)
When someone with peripheral MS has heart failure, what happens
increased production of TNF, loss of type I fibers, decreased oxidative enzymes, decreased mitochondrial enzymes, more frequent use of glycolysis
What is the goal of heart failure treatment
to maximize input and output
How is input and output of the heart maximized
preload: optimize the volume which returns to the LV to improve contractility
Contractility: inotropic medications, increase intracellular calcium
What is one way to treat HF
afterload reduction: reduce the pressure against which the LV has to pump
When does congenital heart disease occur
In-utero, normally 1st trimester
What are the 2 main types of congenital heart disease
Cyanotic defects, acyanotic defects
What is cyanotic defects
blood flow to the lungs may be impaired and/or there is mixing of oxygenated & deoxygenated blood
What is acyanotic defects
Shunting of blood from left side of heart to right side
What are the implications of cyanotic congenital heart disease
transposition of great vessels, tetrology of fallot, tricuspid atresia
What are implications of acyanotic congenital heart disease
ventricular spetal defect (VSD)
artial septal defect (ASD)
Coarctation of aorta
Patent ductus arteriosis (PDA)
What is the etiology of congenital heart disease
10% attributed to a genetic defect maternal alcohol consumption maternal diabetes viruses hypoxemia prematurity
What is the pathophysiology of congenital heart disease
heart forms from a tube that twists and turns to form the valves and chambers. In the fetus there is something called the ductus arteriosis which connects the pulmonary artery to the aorta (bypass lungs in utero) When this does not close off after birth it can cause acyanotic congenital heart disease
Explain the path of blood through the ductus arteriosis
blood travels from High Pressure in the aorta to low pressure in the pulmonary artery. Called left to right shunt.
What are signs and symptoms of congenital heart failure
respiratory distress cyanosis grunting/wheezing failure to thrive signs of heart failure SOB
How is congenital heart failure diagnosed
prenatal screening for genetic disorders
ultrasound diagnosis
echocardiogram
What other issues does congenital heart disease often occur with
neuromuscular, musclular, and organ related issuses
What is the implication of congenital heart disease for PTs
Need to assess activity tolerance, breathing patterns, HR response, posturing, developmental milestones
What is the etiology of valve dysfunction
congenital, infection, MI
what are the physiological consequences of valve dysfunction
increases demand on heart
What are the signs/symptoms of valve dysfunction
asymptomatic fatigue turbulent blood flow ventricular hypertrophy symptoms of Heart failure
What can happen within the heart if the valves are not functioning properly
stenosis
regurgitation
prolapse
What are some treatments for heart valve abnormalites
surgical repair (mechnical, bioprosthetic)
valvuloplasty
commissurotomy-incision to separate adherent leaflets
What is an aneurysm
localized dilation or outpocketing of the arterial wall
What is a true aneurysm
deterioration of media
what is a false aneurysm
accumulation of blood and disruption of three layers of vessel wall
How can the media become weakened
atherosclerosis, congenital malformations, turbulent blood flow
How does the outpocketing become larger
increased wall tension, development of thrombi
What are the most common sites of aneurysms
abdominal aorta, thoracic aorta
What are the main causes of aneurysms
atherosclerosis and trauma
Signs/symptoms of an aneurysm
usually asymptomatic
palpable turbulent outpocketing in lower extremities
severe abdominal back pain
rupture-poor prognosis
What are the treatments for aneurysm
monitor size and location
grafting (resection of aneurysm)
what does peripheral artery disease have the same pathology as
CAD
What does peripheral arterial disease (PAD) have the same risk factors as
CAD, CVA
What are the signs and symptoms of PAD
Many are asymptomatic
related to workload
pain with increasing distance
pain with increasing speed
What are the signs and symptoms of occlusive arterial disease
ache, discomfort, pain, paresthesia, cold, those with DM tend to present later due to poor perception of symptoms (neuropathy)
What is intermittent claudication and what does its location correlate with
muscle ischemia due to imbalance of supply and demand
location of pain correlates with lesion: lesion is slightly upstream to site of muscular pain
When a person has occlusive arterial disease, what happens when the limb is elevated and depressed
Elevated: pallor
depressed: rubor
What can occlusive disease cause
ulcerations, gangrene, pain, diminished functional capacity
What is used to determine the severity of PAD and what is the scale
Ankle brachial index 1-1.29 = normal .91-.99= borderline .41-.9 = mild-moderate PAD 0-.4 = severe PAD
What is the treatment for Occlusive disease
risk factor modification place leg in a dependent position when able analgesics for pain control progressive exercise foot care (skin checks, footwear) angioplasty bypass surgery (graft bypasses occlusion to return blood flow:great saphenous vein) amputation
