Cardiovascular Diseases Flashcards
What is atherosclerosis?
Disease of lipid panel plaques affecting moderate and large size arteries
Thickening and narrowing of the intimal layer of the blood vessel wall from focal accumulation of lipids, platelets, monocytes, plaque and other debris
List 4 non-modifiable risk factors for cardiovascular disease.
- Age (Men > 45 and women > 55)
- Family history
- Race (African Americans have increased risk)
- Gender (Men > premenopausal women; risk equalized after menopause)
List 6 modifiable risk factors for cardiovascular disease.
- High cholesterol
- Diabetes
- Hypertension
- Obesity
- Physical inactivity
- Tobacco use
List the 3 conditions that make up coronary artery disease.
Angina pectoris
Myocardial infarction
Heart failure
What is angina pectoris? What sign may be part of its clinical presentation?
Chest pain or pressure due to ischemia and diminished myocardial perfusion due to narrowing of the coronary arteries
Levine’s sign: patient clenches fist over sternum
What symptoms are associated with angina pectoris?
Pressure, heaviness, burning or aching behind the sternum
Pain can also be felt in jaw, back, shoulders and arms
What are three types of angina?
Stable angina
Unstable angina
Prinzmetal (variant) angina
Describe stable angina. How are symptoms relieved?
Classic exertional angina occurring during exercise of activity; occurs at a predictable rate pressure product
Relieved with rest and/or nitroglycerin
Describe unstable angina.
Coronary insufficiency that occurs without cause and at any time.
Pain is difficult to control
Describe Prinzmetal’s angina (variant). How are symptoms treated?
Occurs secondary to coronary vasospasm
Responds well to nitroglycerin and calcium channel blocker long term
What is myocardial infarction?
Prolonged ischemia, injury and death of an area of the myocardium caused by occlusion of one or more of the coronary arteries
What is the zone of infarction? How does it appear on a ECG?
Consists of necrotic, noncontractile tissue; electrically inert
ECG: pathological Q wave
What is the zone of injury? How does it appear on a ECG?
Area immediately adjacent to the central zone, tissue is noncontractile; electrically unstable
ECG: elevated ST segment in leads over injured area
What is the zone of ischemia? How does it appear on a ECG?
Outer area; cells undergoing metabolic changes; electrically unstable
ECG: T wave inversion
What is the difference between transmural and non-transmural infarction sites?
Transmural: full thickness myocardium, which is often an ST elevated MI or Q wave MI
Non-transmural: subendocardial, subepicardial, intramural infarctions. Non-ST elevated MI or non-Q wave MI
Impaired ventricular function results in decrease ____, ____, and ____.
Stroke volume
Cardiac output
Ejection fraction
What is heart failure?
A clinical syndrome in which the heart is unable to maintain adequate circulation of the blood to meet the metabolic needs of the body.
Left sided heart failure is also known as _____.
Congestive heart failure
Describe left sided heart failure.
Characterized by pulmonary congestion, edema, and low cardiac output due to back flow of blood from the left ventricle to the left atrium and lungs.
Describe right sided heart failure.
Characterized by increased pressure load on the right ventricle with higher pulmonary vascular pressures (i.e. mitral valve disease, cor pulmonale)
What are 2 hallmark signs of right sided heart failure?
Jugular vein distension
Peripheral edema
What is compensated heart failure?
Heart returns to functional status with reduced cardiac output and exercise tolerance.
List 5 physiological compensatory mechanisms that are present with compensated heart failure.
SNS stimulation Left ventricular hypertrophy Anaerobic metabolism Cardiac dilation Arterial vasoconstriction
List 4 signs and symptoms of pulmonary congestion secondary to left ventricular failure.
- Dyspnea, dry cough
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Pulmonary rales, wheezing
List 4 signs and symptoms of pulmonary congestion secondary to right ventricular failure.
- Dependent edema
- Weight gain
- Ascites
- Liver engorgement (hepatomegaly)
Describe the activity restrictions following an acute MI.
- Activity can be increased once the acute MI has stopped (peak in cardiac troponin levels)
- Activity should be limited to 5 METS or 70% of age predicted HRmax for 4-6 weeks following MI.
