Cardiovascular Disease Flashcards
How many chambers are in the heart?
2 atria
2 ventricles
Right side of the heart is responsible for what?
Receiving oxygen-poor blood from the circulation
Pumping blood to the lungs
Left side of heart is responsible for what?
Receiving oxygen-rich blood from the lungs
Pumping blood to the body
Oxygen-poor blood is returned to the _____ atrium and pumped out the _____ventricle to the ________ arteries.
Right, Right, Pulmonary
Where is O2 and CO2 exchanged through diffusion?
At the capillaries and alveoli
What type of blood returns to the left atrium and pumps out the left ventricle through the aorta to the systemic circulation?
Oxygen-rich blood
“The presence of an obstruction that causes permanent damage to the heart muscle fibers downstream, thus inhibiting heart muscle function”
Coronary Artery Disease
What is the outer layer of the artery called?
Adventitia
What is the muscle layer of the artery called?
Tunica media
What is the inner layer of the artery called?
Tunica Intima
What is the most inner structure called of the tunica intima of the artery?
Endothelium
What are the key events in artherosclerosis?
- Fatty streaks
- Plaque Formation (Endothelium dysfunction)
- Formation of thrombus
- Vascular calcification (weakens wall, necrosis, thrombus -> embolus)
What is the underlying cause of Atherosclerosis?
Inflammation
What are examples of arterial endothelium inflammation initiating cytokines?
-Hyperglycemia
-bacteria
-toxins for smoking
-excessive lipids
Endothelium attracts _____ which kicks off an inflammatory response in the vessel wall.
Leukocytes
What happens to the vessel walls when leukocytes respond to the inflammation in the endothelium layer?
Leads to structural change in the vessel walls, leading to plaque
What is the order of atherosclerosis?
- fatty streaks
- Fibrous plaque
- Occlusion of the vessel lumen
Plaque may undergo calcification leading to what?
Ischemia, hypoxia or anoxia to the target organ
What are examples of health behavior modifications?
- Cease cigarette smoking
- Physical Activity
- Healthy diet
- Normal body weight
What are some examples of managing health factors?
- Blood pressure
- Cholesterol
- Fasting blood glucose
What are some risk factors for cardiovascular disease?
- GENETICS and environmental
- Cholesterol, hypertension, diabetes, obesity, smoking
- Age, gender, race, activity level
What is the clinical presentation of the patient with coronary heart disease typically occurs on one of the 4 ways……
- Sudden cardiac death
- Chronic stable angina
- Acute coronary syndrome
- Cardiac muscle dysfunction
What is the umbrella term used to define acute myocardial ischemia?
Acute coronary syndrome
Acute coronary syndrome is divided into 3 components, what are they?
- Unstable angina
- NSTEMI (non-ST-segment elevation myocardial infarction)
- STEMI (ST-elevation myocardial infarction)
Chest pain related to ischemia of the myocardium is defined as what?
Angina Pectoris
What causes angina pectoris?
There is an increased oxygen demand of the heart muscle that cannot be matched by increased perfusion through the coronary arteries.
What is caused by coronary artery disease?
-Valve disease
-hypertrophy of the heart
In angina pectoris, where may the pain be referred to?
The Left shoulder, neck, jaw, and between the shoulder blades
What are common symptoms in women that experience angina pectoris?
Fatigue, indigestion, sweating, and a sense of dread
Angina Pectoris can be presented how?
Stable, unstable, or variant
Angina Pectoris is associated with an increased risk of what?
Myocardial infarction
Myocardial Infarction is defined as what?
An interruption in blood supply to the area of myocardium.
Myocardial infarction depends on what?
The location and extent of occlusion
Diagnosis of MI is based upon…
-ECG
-Enzyme levels (troponin, creatine kinase)
-symptoms
What are the 4 stages of acute coronary syndrome?
- Stable Angina
- Unstable Angina
- NSTEMI
- STEMI
Angina pain develops when there is increased demand in the setting of a stable atherosclerotic plaque. The vessel is unable to dilate enough to allow adequate blood flow to meet the myocardial demand.
Stable Angina
Demand ischemia, no infarction is associated with what stage in ACS?
Stable Angina
What are stages have normal troponins levels?
Stable and unable angina
What level of ACS has a normal ECG?
Stable angina
The plaque ruptures and a thrombus forms around the ruptured plaque, causing partial occlusion of the vessel. Angina pain occurs at rest or progresses rapidly over a short period of time. What stage is this?
Unstable Angina
What does the ECG during an unstable angina and NSTEMI read?
Normal, Inverted T waves, or ST depression
What stage of ACS, where the plaque ruptures and thrombus formation causes partial occlusion to the vessel that results in injury and infarction to the subendocardial myocardium.
NSTEMI
Supply ischemia, no infarct is associated with what ACS?
Unstable angina
Subendocardial infarct occurs at what stage?
NSTEMI
What stages has elevated troponins?
NSTEMI and STEMI
What stage is characterized by complete occlusion of blood vessel lumen, resulting in transmural injury and infarct to the myocardium, which is reflected by ECG changes and a rise in troponins.
STEMI
Transmural infarct is associated with what stage?
STEMI
Transmural infarct is associated with what stage?
STEMI
During STEMI, what does the ECG read?
Hyperacute T waves or ST elevation
What are some complications of MI?
-Pumping ability of the heart
-Persistent angina and arrhythmias
-blood flow through the arteries
-exercise/activity tolerance
-functional/mobility limitations
-other systems affected by disease
What are some treatment to cardiovascular diseases/MI?
-prompt recognition
-Decrease myocardial work/O2 demands
-pharmacological
-surgical
-behavior modification (diet, exercise, smoking cessation, management of HTN)
What factors depend on the prognosis when treating cardiovascular diseases/MI?
- Size and location of infarct strongly influence the acute course
- Dependent upon L ventricular function
What are some PT implications when treating cardiovascular patients?
-once medically stable, progressive mobility
-evaluate tolerance to all activities
-Goal: return to PLOF
-General activity guidelines, role of exercise, and self monitoring techniques
-6 minute walk test (outcome measure)
-Asses ability to follow up with cardiac rehab
