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Sharlene and MB's PT party > Cardiovascular Disease (not PVD) and the medical/surgical management of CVD > Flashcards

Cardiovascular Disease (not PVD) and the medical/surgical management of CVD Flashcards

1
Q

Characteristics of atherosclerosis

A
  • lipid-laden plaques (lesions) affecting mod-lg size arteries
  • thickening and narrowing of the intimal layer of blood vessels
  • focal accumulation of lipids, platelets, monocytes, plaque, and other debris
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2
Q

Cardiovascular Disease: Risk factors- list of non-modifiable risk factors

A

age
family history
race
gender

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3
Q

Cardiovascular Disease: Risk factors- specific info on age

A

men > 45

women > 55

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4
Q

Cardiovascular Disease: Risk factors- specific info on family history

A
  • cardiac event in 1st degree male relative < 55 or 1st degree female relative < 65
  • risk increases further w/ younger age of onset, number of events, and how close genealogically the relative is
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5
Q

Cardiovascular Disease: Risk factors- specific info on race

A

African American

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6
Q

Cardiovascular Disease: Risk factors- specific info on gender

A

men > risk than pre-menopausal woman

after menopause risk is =

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7
Q

Cardiovascular Disease: Risk factors- list of modifiable risk factors

A 
cholesterol
diabetes
diet
hypertension
obesity
physical inactivity
tobacco
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8
Q

Cardiovascular Disease: Risk factors- goals to reduce risk w/ cholesterol

A
  • Total cholesterol <200 mg/dL
  • LDL:<160mg/dL if at low risk for CVD, < 130 mg/dL if at mod risk for CVD, <100mg/dL if at high risk for CVD or have diabetes
  • HDL > 40 mg/dL for men, > 50 mg/dL for women
  • Triglycerides < 150 mg/dL
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9
Q

Cardiovascular Disease: Risk factors- goals to reduce risk w/ diabetes

A

HgA1C < 7%

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10
Q

Cardiovascular Disease: Risk factors- goals to reduce risk w/ hypertension

A

SBP <140 mmHg and DBP <90 mmHg

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11
Q

Cardiovascular Disease: Risk factors- goals to reduce risk w/ diet

A

low fat diet w/ balance of veggies, fruits, grains, and meats

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12
Q

Cardiovascular Disease: Risk factors- goals to reduce risk w/ obesity

A
  • BMI 18.5 - 24.9 kg/m2
  • waist for males < 40 in
  • waist for females <35 in
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13
Q

Cardiovascular Disease: Risk factors- goals to reduce risk w/ physical inactivity

A

at least 30 min of activity 5-7 days/wk

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14
Q

Cardiovascular Disease: Risk factors- goals to reduce risk w/ tobacco

A

smoking cessation, regardless of time smoked, reduces risk

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15
Q

3 types of Acute Coronary Disease (ACD)

A 
Angina pectoris
Myocardial Infarction (MI) 
Heart Failure (HF)
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16
Q

General characteristics of ACD

A
  • spectrum of clinical entities from angina to MI to sudden cardiac death
  • imbalance of myocardial O2 supply and demand, causing ischemic chest pain
  • may have no symptoms (more likely with diabetic) but present new pathologic Q wave on ECG
  • subacute occlusions may have no symptoms
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17
Q

Angina Pectoris: What is Levine’s sign

A

pt. clutches fist over sternum

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18
Q

Angina Pectoris: general

A
  • chest pain or pressure due to ischemia, may have levine’s sign
  • imbalance in myocardial O2
  • vasospasm (symptoms may be silent at rest)
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19
Q

Angina Pectoris: causes of myocardial O2 imbalances

A 
exertion
emotional stress
smoking
extremes of temp, especially cold
overeating
tachyarrhythmias
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20
Q

Angina Pectoris: 3 major types

A

stable angina
unstable angina
variant angina

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21
Q

Angina Pectoris: info about stable angina

A
  • classic exertional angina occurring during exercise or activity
  • occurs at predictable rate-pressure product (RPP = HRxBP)
  • relieved w/ rest and/or nitroglycerin
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22
Q

Angina Pectoris: info about unstable angina pre-infarction, crescendo angina)

A
  • coronary insufficiency w/out any precipitating factors or exertion
  • chest pain increases w/ severity, frequency, and duration; refractory to treatment
  • increased risk for MI or lethal arrhythmia
  • pain is difficult to control
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23
Q

Angina Pectoris: inf about variant angina (Prinzmetal’s angina)

A
  • caused by vasospasm of coronary arteries in the absence of occlusive disease
  • responds well to nitroglycerin or calcium channel blocker long term
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24
Q

Angina Pectoris: symptoms in women

A
  • sensation of discomfort
  • crushing
  • pressing
  • bad ache
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25
Angina Pectoris: general symptoms
- SOB - fatigue - diaphoresis - weakness
26
Angina Pectoris: symptoms in older adults w/ atypical symptoms (absence of chest pain)
- dyspnea - diaphoresis - nausa and vomitting - syncope
27
MI: what is it
prolonged ischemia , injury, and death of an area of the myocardium caused by occlusion of one or more coronary arteries
28
MI: precipitating factors
- atheroscleroic heart disease w/ thrombs formation - coronary vasospasm - embolism - cocaine use
29
MI: 3 zones of infarction
- zone of infarction - zone of injury - zone of ischemia
30
MI: info about zone of infarction
consists of necrotic, non-contratcile tissue electrically inert on ECG- pathological Q waves
31
MI: info about zone of injury
area immediately adjacent to central zone tissue is non-contratcile cells undergoing metabolic changes electronically unstable on ECG- elevated ST segments over injured area
32
MI: info about zone of ischemia
outer area cells undergoing metabolic changes electronically unstable on ECG- inverted T waves
33
MI: Infarction sites
transmural | non-transmural
34
MI: Infarction sites- transmural
full thickness of myocardium | often a ST elevated (STEMI) or Q wave MI
35
MI: Infarction sites- non-transmural
sub-endocardial, sub-epicardial, intramural infarctions | Non-St elevated MI (NSTEMI) or non Q-wave MI
36
MI: sites of coronary occlusion
- Inferior MI, R ventricle infarction, disturbances in upper conduction system: R coronary artery - Lateral MI, ventricular ectopy: circumflex artery - Anterior MI, disturbances of lower conduction system: L anterior descending artery
37
MI: what happens w/ impaired ventricular function
- decreased stroke volume, cardiac output, and ejection fraction - increased end diastolic ventricular pressures
38
MI: What happens when there is electrical instability
arrhythmias, present in injured or ischemic areas
39
Heart Failure: general summary
clinical syndrome where heart is unable to maintain adequate circulation of blood to meet the metabolic needs of body
40
Heart Failure: 3 types
L sided heart failure (CHF) R sided HF Biventricular HF
41
Heart Failure: L sided heart failure (CHF)
characteriszed by: -pulmonary congestion, edema, and low cardiac output due to back up of blood from L ventricle to L atrium and lungs -due to insult to L ventricle from myocardial disease -excessive workload of heart ( HTN, valvular disease, and congenital defects) - cardiac arrhythmias or heart damage -
42
Heart Failure: R sided HF
characterized by: - increased pressure load on R ventricle - mitral valve disease - chronic lung disease (cor pulmonale) - hallmark signs are jugular vein distention and peripheral edema
43
Heart Failure: Biventricular HF
- severe LV pathology producing back up into the lungs - Increased PA pressures - RV signs of HF
44
Heart Failure: associated symptoms
muscle wasting myopathies osteoporosis
45
Heart Failure: s/s of pulmonary congestion - L ventricle failure
dyspnea, dry cough orthopnea paroxysmal nocturnal dyspnea (PND) pulmonary rales, wheezing
46
Heart Failure: s/s of pulmonary congestion - R ventricle failure
dependent edema weight gain ascites liver enlargement (hepatomegaly)
47
Heart Failure: s/s of low cardiac output - L ventricle failure
- hypotension - tachycardia - light headedness, dizziness - cerebral hypoxia- irritability, restlessness, confusion, impaired memory, sleep disturbances - fatigue, weakness - poor exercise tolerance - enlarged heart on x-ray - S3 heart sound, possibly S4 - murmers of bi and/or tricuspid valve regurgitation
48
Heart Failure: s/s of low cardiac output - R ventricle failure
-anorexia, nausea, bloating -cyanosis (nail beds) -R upper quadrant pain -jugular vein distention -R S3 heart sounds murmers of pulmonary or tricuspid insufficiency
49
Heart Failure: what is HF compensation and how is this done
- heart returns to functional status w/ reduced CO and exercise tolerance - Physiologic compensatory mechanisms are SNS stimulation, LV hypertrophy, anaerobic metabolism, cardiac dilation, arterial vasoconstriction - medical therapy used to assist compensation
50
Heart Failure: cause for sudden death
significant ischemia or ventricular arrhythmia
51
Medications: list of medications used for management of CVD
``` ACE inhibitors Angiotension II receptor blockers Nitrates Beta-adrenergic blocking agents Calcium channel blocking agents Antiarrhythmics Digitalis Diuretics Aspirin Tranquilizers Hypolipidemic agents ```
52
Medications: ACE inhibitors
- inhibit conversion of Angiotension 1 to Angiotension 2 - decreases sodium retention and peripheral vasoconstriction in order to decrease BP EX: Captopril (Capoten), Enalopril (Vasotec), Lisinopril (Zestril)
53
Medications: Angiotension II receptor blockers
- blocks binder of angiotension 2 at the tissue/smooth muscle level, decreasing BP Ex: Losatan (Cozaar)
54
Medications: Nitrates
- decrease preload through peripheral vasodilation - reduce myocardial O2 demand - dilate coronary arteries & improve coronary blood flow Ex: Nitroglycerin
55
Medications: Beta-adrenergic blocking agents
- Reduce myocardial demand by reducing HR and contractility - control arrhythmias and chest pain - reduce BP Ex: Atenolol (Tenormin), Metoprolol (Lopressor), Propranolol (Inderal)
56
Medications: Calcium channel blocking agents
- inhibit flow of calcium ions - decrease HR - decrease contractility - dilate coronary arteries - reduce BP - control arrhythmias and chest pain Ex: Diltiazem ( Cardizem), Amlodipine (Norvasc)
57
Medications: Antiarrhythmics
- alter conductivity - restore normal heart rhythm - control arrhythmias - improve CO Ex: Quinidine, Procainamide
58
Medications: Digitalis
- increases contractility and decreases HR - mainstay in the treatment of CHF Ex: Digoxin
59
Medications: Diuretics
- decrease myocardial work (reduce preload and afterload) - control HTN Ex: Furosemide (Lasix), Hydrochlorothiazide (Esidrix)
60
Medications: Aspirin
- decreases platelet aggregation | - may prevent MI
61
Medications: Tranquilizers
decreases anxiety, sympathetic effects
62
Medications: Hypolipidemic agents
- reduce serum lipid levels when diet and weight reduction are not effective Ex: Cholestyramine (Questran), Covastatin ( Mevacor), Simvastin (Zocor)
63
Activity restrictions for acute MI
- Activity can be increased once acute MI has stopped (peak in cardiac troponin levels) - Activity should be limited to 5 METs or 70% of age predicted HR max for 4-6 weeks following MI
64
Activity restrictions for Acute HF
- O2 demand should not be increased in pt.s in acute or decompensated HF - Once medically managed and no longer display signs of acute decompensation, activity may be increased while monitoring hemodynamic response to activity.
65
List of surgeries for CVD
- Percutaneous Transluminal Coronary Angioplasty (PTCA) - Intravascular Stents - Coronary Artery Bypass Graft (CABG) - Transplantation - Ventricular Assist Device
66
What's up with the Percutaneous Transluminal Coronary Angioplasty (PTCA)
- Under fluoroscopy, surgical dilation of a blood vessel using a small balloon tipped catheter inflated inside the lumen - Relieves obstructed blood flow in acute angina or acute MI - Improves coronary blood flow, improves L ventricular function, and provide anginal relief
67
Tell me about Intravascular Stents
- an endoprosthesis (pliable wire mesh) implanted post-angioplasty to prevent re-stenosis and occlusion in coronary or peripheral arteries - often coated w/ medication to prevent thrombosis
68
The what and why of the Coronary Artery Bypass Graft (CABG)
- surgical circumvention of the obstruction in the coronary artery using an anastomosing graft (saphenous vein, intermal mammary artery) - multiple grafts may be necessary - Improves coronary blood flow, improves L ventricular function, and provide anginal relief
69
Why resort to using Transplantation
used in end-stage myocardial disease such as cardiomyopathy, ischemic heart disease, and valvular heart disease
70
3 types of transplantation
heteroptics orthotopic heart and lung transplantation
71
What is heteroptic transplantation
involves leaving the natural heart and piggy- backing the donor heart
72
What is orthotopic transplantation
involves removing the diseased heart and replacing it with a donor heart
73
What is the heart and lung transplantation
involves removing both organs and replacing them with donor organs
74
Major problems post-transplantation
rejection infection complications of immunosuppressive therapy
75
Ventricular Assist Device. Go!
- implanted device (accessory pump) that improves tissue perfusion and maintains cardiogenic circulation - used w/ severely involved patients such as cardiogenic shock unresponsive w/ meds, severe ventricular dysfunction
76
What is thrombolytic therapy
- given for acute MI - meds activate body's fibrinolytic system, disolve clot, and restore coronary blood flow Ex: streptokinase, TPA, urokinase

Sharlene and MB's PT party (35 decks)

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