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PHYSICAL THERAPY > Cardiovascular Pathophysiology > Flashcards

Cardiovascular Pathophysiology Flashcards

1
Q

Atherosclerosis

A

Hardening / lesions of arteries due to accumulation along intima in lumen of vessels of:

  • smooth muscle cells
  • connective tissue
  • macrophages
  • lipids
    • -> Calcification
      - -> Impairs blood flow

Stages:

  1. Initiation/Formation
  2. Adaptation
  3. Clinical
  • Could lead to:
    • MI
    • Cerebral infarct
    • Gangrene
    • Aneurysm
    • Occlusion / Ischemia
    • Thromboembolism
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2
Q

Lesion

A

Abnormality in tissue – Atherosclerotic:

- Plaque
- Atheromas
- Fibrous plaques
- Fibro-fatty lesions

Contributing factors:

- Cytokines
- T lymphocytes
- Endothelium
- Thrombosis
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3
Q

Atheroma

A

Arterial wall remodeling
–> area of thickened intima

*Can break off / rupture

Stages:

  1. Initiation/Formation
  2. Adaptation
  3. Clinical
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4
Q

Hyperplasia

A

Excessive cell growth

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5
Q

Regression

A

Body fixes itself

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6
Q

Infarct

A

Cell death caused by restricted blood supply to area

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7
Q

Angiogenesis

A

New vascular formation / regeneration

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8
Q

Risk Factors for Development of Atherosclerosis / CAD

A
  • Smoking
  • HTN
  • Family Hx
  • Sedentary lifestyle
  • Obesity
  • Diabetes
  • Dyslipidemia (high LDL, low HDL)
  • Age / Sex / Race
  • Hot reactor
  • High Homocysteine
  • High C-Reactive protein
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9
Q

CAD

A

(Coronary Artery Disease) - Ischemic Heart Disease
Deficit in O2 blood to myocardium

*Leading cause of death

Could lead to:

  • Angina
  • MI
  • CHF
  • Death
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10
Q

HTN

A

(Hypertension)
Persistent elevation of blood pressure
*Risk factor for CAD

Stage I:
Systolic BP > 140mmHg
Diastolic BP > 90mmHg

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11
Q

Obesity

A

BMI > 30kg/m2

*Risk factor for CAD

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12
Q

Diabetes

DM

A

Impaired fasting glucose > 100mg/dL

*Risk factor for CAD

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13
Q

Hypercholesterolemia

A

High blood cholesterol > 200mg/dL
LDL > 130mg/dL
HDL < 40mg/dL

*Risk factor for CAD

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14
Q

Lipid Metabolism

A

Cholesterol is insoluble, so must be transported in blood bound to lipoproteins

Normal < 200mg/dL

VLDL
LDL - target of therapeutic treatment
HDL

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15
Q

HDL

A

(High Density Lipoproteins) = Good cholesterol
Remove cholesterol from blood
–>liver for removal from body

Normal > 40mg/dL

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16
Q

LDL

A

(Low Density Lipoproteins) = Bad cholesterol
Oxidized and taken up by macrophages to lesions

Normal < 130mg/dL

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17
Q

Framingham Heart Study

A

Study to ID common factors contributing to CVD

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18
Q

Raynaud Phenomenon

A

Intermittent, bilateral attacks of ischemia caused by cold and emotions

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19
Q

Aneurysm

A

Weakening / bulge in wall of vessel

20
Q

DVT

A

(Deep Venous Thrombosis) *ACUTE
Blood clot formed in vessel of lower extremity
-Inflammatory response
-Constant pain

21
Q

PAD / PVD

A

(Peripheral Artery / Vascular Disease) *CHRONIC
Complication of atherosclerosis
-Pain with exertion, goes away with rest

22
Q

Coronary Arteries

A

Right: off anterior aorta
-In right AV sulcus

Left: off posterior aorta

  • LAD
  • Circumflex
23
Q

Angina

A
  • Most common symptom of CAD
    • Caused by ischemia (75-90% occlusion)

Symptoms:

  • Substernal pressure (feels like indigestion)
  • Pain in L arm, jaw (toothache), scapula
  • Ltd duration
  • Worse with exertion, better with rest
24
Q

ACS

A

(Acute Coronary Syndrome)

Umbrella term for CAD symptoms

25
Q

MI

A 
(Myocardial Infarction)
Death of tissue due to prolonged ischemia, commonly from advanced atherosclerosis 
  --> Decreased effectiveness and efficiency of the pump
        -Dec ventricular function (EF)
        -Dec contractility
        -Abnormal wall motion
        -Inc ESV / EDV
        -Inc LV ED pressure

Symptoms:

  • Prolonged angina
  • Cyanosis
  • Dyspnea (SOB)
  • Nausea
  • Diaphoresis
  • EKG changes

*40% females - no angina

26
Q

Diaphoresis

A

Excessive sweating / perspiration

27
Q

MI: Immediate Mgmt

A

Dial 911, Chew aspirin

In ER:
   -EKG
   -Meds: 
        Nitrates
        Morphine
        Antiarrhythmics
        Anticoagulants = bleed
    -Thrombolytics
    -Blood Labs
    -O2
28
Q

Ischemic Heart Disease

A

Coronary Artery Disease (CAD)

29
Q

Alphabet Approach to Patient Management

A

A -antiplatelet

- anticoagulant
- ACE Inhibitor
- Angiotensin receptor blocker

B -beta blocker
-BP control

C -Cholesterol tx
-Cig smoking cessation

D -Diabetes mgmt
-Diet

E -Exercise

30
Q

ACE

A

(Angiotensin Converting Enzyme)

31
Q

Arrhythmia

A

Irregular heartbeat

32
Q

Physiological Controls of SV

A

(Stroke Volume)

  1. Preload
  2. Contractility
  3. Afterload
33
Q

mVO2

A

Myocardial oxygen uptake (WORKLOAD of heart)
= How much O2 needs to be delivered to myocardium for
adequate function at any given time

34
Q

Preload

A

Physiological control of SV
Degree of stretch of myocardial fibers prior to contraction
-Dependent on venous return

^preload = ^mVO2 = ^SV

35
Q

Contractility

A

Physiological control of SV
Increased interaxns of myofilaments at cross-bridges
Increased Ca
Increased SNS input

^Contractility = ^mVO2 = ^SV

36
Q

Afterload

A

Physiological control of SV
Amount of pressure ventricles must overcome during systole to open semilunar valves and eject blood
-If arterial pressure increases, so does afterload

^Afterload = ^mVO2 = Dec SV

37
Q

CHF

A

(Congestive Heart Failure)
Heart unable to maintain adequate output to meet metabolic needs
*Abnormally high atrial filling pressures

  • CO maintained by compensatory mech:
    • ^LV EDP
    • ^EDV
    • ^SNS stimulation
38
Q

Hypertensive Heart Disease

A

Cardiac hypertrophy secondary to prolonged systemic pressure overload

39
Q

Endocardial / Valvular Disease

A

Damage to valves, impairing their function
–> Regurgitation (retrograde blood flow)

Ex: MVP

40
Q

MVP

A

(Mitral Valve Prolapse)

Most common valvular disease

41
Q

Infective Endocarditis

A

Inflammation of the endocarditis with vegetations on valves
–> Erosion –> Valvular Impotence

*Bacterial or viral, IV drugs, catheters

42
Q

Cardiomyopathy

A

Primary noninflammatory myocardial disease
*NOT attributable to pressure or volume overload

  1. Dilated / Congestive –> CHF
  2. Hypertrophic / ASH / IHSS –> thickened myocardium
  3. Restrictive / Infiltrative –> ltd EDV –> CHF
43
Q

ASH

A

(Asymmetric Septal Hypertrophy)

44
Q

IHSS

A

(Idiopathic Hypertrophic Subaortic Stenosis)

45
Q

Congenital Heart Disease

A

Major heart disease within first decades

  1. Acyanotic Group (No sys/pulm mixing)
  2. Cyanotic Tardive Group (Sys/pulm shunt reversal
  3. Cyanotic Group (Mixing of sys/pulm)

PHYSICAL THERAPY (13 decks)

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