Cardiovascular Pathophysiology Flashcards
Risks factors of heart and cardiovascular disease
- Smoking
- Physical inactivity
- Obesity
- Suboptimal diet
- HTN
- Elevated serum total cholesterol: elevated low density lipoprotein or decreased high density lipoprotein
- Diabetes: family Hx (mother/father <60 years old with cardiovascular event)
- Age
- Gender: male risk is higher until females reach menopause then risk is equal
- Stress
- Anger and hostility
Describe the difference between the Framingham risk score and the Reynolds risk score
- Framingham: estimation of 10 year cardiovascular disease risk
- Reynolds: Healthy and without diabetes it is designed to predict your risk of having a future heart attack, stroke, or other major heart disease in the next 10 years
What are the major determinants of arterial blood pressure
- Cardiac output
- Total peripheral resistance
What are the consequences of HTN
- Cerebral aneurysm or Hemorrhagic CVA (stroke)
- Retinopathy: arteriolar damage with micro aneurysms & rupture
- Persistent BP elevation
- Atherosclerosis
- Congestive heart failure, atherosclerosis, angina, and/or MI
- Nephrosclerosis and/or chronic renal failure
Describe the relationship between stroke and atrial fibrillation
- A-fib remains a common & high risk condition for secondary ischemic stroke
- Clots often form in the L atrial appendage
- Anticoagulation is usually recommended if the patient has no contraindications
- Anticoagulation risk must be weighed with risk for hemorrhage and/or fall risk
- Heart rhythm monitoring for occult A-fib is usually recommended if no other cause of stroke is discovered
What is atherosclerosis
- Fatty deposits (plaque) accumulate inside the artery wall causing blockage of blood flow
- Plaques are composed of lipid and thrombus
- Leads to progressive hardening & narrowing or abnormal dilation of the coronary, cerebral, & peripheral arteries
- Can occur throughout the body in large or small arteries based on disease process
Possible consequences of atherosclerosis
- Partial occlusion of coronary arteries: angina pectoris (ischemic heart disease)
- Total occlusion of coronary arteries: MI
- Partial occlusion of carotid/cerebral arteries: transient ischemic attack
- Total occlusion of carotid/cerebral arteries: cerebrovascular accident (CVA/stroke)
- Occlusion in the aorta: aneurysm (occlusion, rupture and hemorrhage)
- Occlusion in the iliac arteries in the legs: peripheral vascular disease (gangrene and amputation)
Describe what printzmetal (vasospastic angina) angina is
- Sclerotic arteries are prone to spasm
- Vasospastic angina occurs at rest (typically early morning) and is not associated with any preceding increase in myocardial oxygen demand
- Episodes of chest pain are associated with either transient ST segment elevation of 0.1 mV or depression of 0.1 mV
- Pain is relieved with nitroglycerin & other vasodilators
What are the usual causes of death and immediate action necessary following a sudden cardiac arrest/death
- Ventricular tachycardia & ventricular fibrillation leading to cessation of cardiac output are usual causes of death
- Prompt delivery of bystander cardiopulmonary resuscitation with an automatic external defibrillator (AED) and entry into the emergency medical system is best chance of survival
What is commotio cordis
- Abnormal heart rhythm (ventricular fibrillation) & cardiac arrest right after getting hit in the chest
- Most cases is caused by a baseball, hockey puck, or lacrosse ball hitting the L side of your chest
- Immediate CPR provides best chance of survival (~59% survival rate)
Define angina
- Substernal pressure caused by an imbalance in the supply & demand of myocardial oxygen
- Can occur anywhere from the epigastric area to the jaw & is described as squeezing, tightness, or crushing
Symptoms of angina
- Pain is gradual and diffuse
- Pain accompanied by shortness of breath, nausea, & diaphoresis (sweating)
What is the primary physiologic difference between unstable and chronic stable angina
- Absence of an increase in myocardial oxygen demand to provoke the syndrome
What are the most common warning signs of heart attack
- Uncomfortable pressure, fullness, squeezing or pain in the center of the chest (prolonged)
- Pain that spreads to the throat, neck, back, jaw, shoulders, or arms
- Chest discomfort with lightheadedness, dizziness, sweating, pallor (unhealthy pale appearance), nausea, or shortness of breath
- Prolonged symptoms unrelieved by antacids, nitroglycerin, or rest
Describe chronic stable angina
- Well established level of onset & is the result of not enough blood supply to meet the metabolic demand
- Usually can alleviate symptoms by reducing the intensity slightly or by taking sublingual nitroglycerin
- Metabolic demand = rate pressure product = Heart rate x Systolic BP
Differentiate the different types/causes of chest pain
- Stable angina: tightness/pressure anywhere above the waist with exertion activity & diminishes with rest or nitroglycerin
- Unstable angina: chest discomfort that is accelerating in frequency or severity that may occur at rest but doesn’t result in myocardial necrosis
- Vasospastic angina (printzmetal): Chest discomfort with ST segment depression or elevation occurring at rest typically early morning
- Musculoskeletal chest wall pain: pain/discomfort that is increased with palpation over chest wall
- Pulmonary/Pleuritic: discomfort/pain sharp in nature that changes with breathing
- Bronchospasm: exertion ally related or induced by cold relieved by bronchodilator or stopping activity
- Vascular: sudden onset, constant, pleuritic pain with SOB
- Gastrointestinal: prolonged epigastric discomfort usually related to food intake; relieved by antacid
What does CHEST PAIN stand for to indicate an acute coronary syndrome
- Chest pain
- High sensitivity
- Early care
- Share
- Testing
- Pathways
- Accompanying
- Identify
- Noncardiac
- Structured
What is the preferred blood test for in evaluation of patients with chest pain
- Troponins
- Troponins may become elevated within 2-3 hours after myocardial injury
- High sensitivity cardiac Troponin reference range: women = <14; men = <22
Vital signs recommendations to stop PT for acute coronary syndrome/MI patients
- Unable to comfortably speak
- RR >40
- Onset of S3 heart sound
- HR decrease >10 bpm
- SBP decrease >10 mmHg
- MAP increase >10 mmHg
- SpO2 <90% or a decrease ≥4%
- New onset or worsening of cardiac dysrhythmia
- Return of pre-MI angina like pain
Vital signs for initiation of PT intervention for stable angina/ECG/down trending toponin
- RR <30 (able to speak comfortably)
- Resting HR <120 bpm
- MAP a minimum of 60 mmHg
- SpO2 >90%
- SBP <110 mmHg
Diagnosis criteria for a non-STEMI
- Signs and symptoms of cardiac ischemia (chest pain or equivalent) and positive myocardial biomarkers (troponin)
- New pathologic Q wave on the ECG often does not develop
Relationship between Q-wave and STEMI
- Patient with a STEMI develops a Q-wave on the ECG in the subsequent 24-48 hrs & previously was defined as Q-wave or transmural infarctions
What is a NSTEMI
- Type of MI that happens when a part of your heart is not getting enough oxygen
- Usually occurs due to partial coronary artery blockage or blockage in a branch off of your main coronary artery
- Some electrical pattern changes visible but often not distinctive