Ch 24- Part 2 Alteration in Cardiovascular Function Flashcards
Coronary Artery Disease is usually caused by ________ (1) (plaque that build up diminishing blood supply to cardiac muscle cells)
It results in myocardial ______ (2) and infarction deprives heart muscle of blood-borne O2 (______ (3)) and nutrients and impair heart pumping ability.
- Atherosclerosis
- ischemia
- hypoxic
Persistent ischemia causes what syndrome which include myocardial infarction?
Acute Coronary Sydrome
T or F: Myocardial cells remain alive when the person has CAD and also functioning properly.
FALSE; Myocardial cells remain alive BUT are not FUNCTIONING PROPERLY.
Infarction potentially triggers ____ attack
heart
What is cardiac infarction?
obstruction of blood supply causing irreversible myocardial damage
What is the link between ab lipoproteins levels and CAD?
dyslipidemia
What are the 2 types of lipoproteins?
High density lipoproteins (HDL)
Low density lipoproteins (LDL)
LDL is responsible for DELIVERY of cholesterol to _____ (1) while HDL is responsible for delivery of excess cholesterol back to the ______ (2).
- tissues
- liver
T or F: High intake of cholesterol and saturated fats leads to decreased LDL.
FALSE; LEADS TO ELEVATED LDL
Excessive levels of LDL causes LDL migration into vessel wall which initiates _______ (reduced blood supply to myocardial cells)
atherosclerosis.
T or F: HDL plays a role in endothelial repair and increases thrombosis.
FALSE; DECREASES THROMBOSIS
T or F: Elevated levels of HDL has not proven to prevent cardiovascular diseases
TRUE
Hypertension is responsible for __-___ fold increase in CAD risk
2-3
What is the cause of hypertension that leads to CAD? (2 pts)
endothelial injury – atherosclerosis and myocardial hypertrophy (increase heart O2 demand)
What is myocardial hypertrophy?
increases heart O2 demand
Cigarette smoking is a ___ ____ generation
free radical
When we are smoking , what chemical stimulates catecholamines (epi/nor-epi)?
nicotine
Nicotine stimulates catecholamines which _____ (1) HR and vasoconstriction which increases _____ (2)
increases (1) & B.P (2)
CAD risk _____(1) with heavy smoking & _____(2) when smoking stopped.
Smoking is associated with _____ (3) LDL and ______(4) HDL
- increases
- decreases
- increased
- decreased
Abdominal obesity = strongest risk of CAD/ related to ____ (1) and decreased (LDL or HDL)_____ (2)
inflammation (1) & HDL (2)
T or F: Sedentary lifestyle not only increases risk of obesity but on its own increases risk of CAD
TRUE
What is atherogenic diet.
diet that promotes formation of fatty plagues in arteries
What type of diet is an atherogenic diet?
Western-style diet
What is the recommended diet?
Mediterranean diet
Which blood test can detect very low levels of C-reactive protein (CRP)?
hs-CRP test
T or F: Elevated serum hs-CRP is correlated to decreased CAD risk
FALSE; Correlated to increased CAD risk
What does hs-CRP test used for?
determine heart disease risk & stroke without know heart disease
What is CRP (C-reactive protein)?
protein sythesized in liver in response to increase in inflammation of body.
What is the hs-CRP value for high risk?
greater than 3 mg/L
What is the hs-CRP value for low risk?
less than 1 mg/L
What is the hs-CRP value for average risk?
1-3 mg/L
What are the 2 hormones produced from adipose cells?
leptin and adinopectin
What type of hormones are leptin and adinopectin?
Adipokines
Obesity = increased ____(1; hormone) & decreased _____ (2; hormone)
leptin (1) & adinopectin (2)
Adinopectin protects vascualr endothelium and is ____- ______
anti-inflammatory
How does myocardial ischemia develop?
blood-borne O2 is insufficient to meet myocardial metabolic demands.
What is the common cause of myocardial ischemia?
atherosclerosis in coronary circulation
Atherosclerosis in coronary circulation = ____(1) ruptures = ____(2) formation = occlusion = myocardial _____ (3)
- plaque
- thrombus
- ischemia
How long do myocardial cells become ischemic when occlusion occurs?
within 10 sec
During myocardial ischemia, there is a shift toward anaerobic, thus there is accumulation of _____ (1) acid – there is then a decreased rate of ____ (2) re-phoshorylation.
- lactic
- ATP
If perfusion not restored, myocardial infarction occurs within _____ minutes.
20
What is angina?
chest pain caused by myocardial ischemia
Which type of myocardial ischemia occurs alone or with angina?
silent ischemia
What are some atypical symptoms of silent ischemia? (2 pts)
fatigue, dyspnea (bad/breathing)
T or F: Silent ischemia has an increased risk of cardiac event.
TRUE
T or F: Angina increases with rest and nitrates.
FALSE; Angina decreases with rest and nitrates
What type of myocardial ischemia is associated with gradual narrowing & hardening of arterial walls associated with inflammation and decreased endothelial vasodilators?
stable angina pectoris
What is the caused of prinzmetal angina?
VASOSPASM of coronary arteries
Which type of myocardial ischemia is associated with transient angina that occurs unpredictably and often at rest/sleep?
Prinzmetal’s angina
What are the tx for myocardial ischemia?
diet and exercise
Surgery: coronary vessels dilated and placement of coronary stent.
What are some evaluation for myocardial ischemia?
single-photon emission computed tomography or SPECT.
______ (1) congestion indicates impaired ____ (2) ventricular function for myocardial ischemia
- pulmonary
- left
When evaluating myocardial ischemia, the physical examination displays _____ (1) pulse and extra heart sounds.
rapid
In unstable angina, _____(1) (announces ‘the coming of something’) of impending infarction.
Harbinger
For unstable angina to occur, occlusion lasts no more than __-__ (1) minutes.
10-20
T or F: Unstable angina is consists of deep erosion of plague that leads to transient ep of thrombotic occlusion and vasoconstriction.
FALSE; superficial erosion of plague
What is the diagnosis for unstable angina?
ECG during attack & hs-cTnt
What is the tx for unstable angina?
immediate hospitalization
What to do look for ECG during unstable angina?
ST depression/ T wave inversion/ ST segment elevation
What is hs-cTnt when diagnosing unstable angina?
high sensitivity cardiac TROPONIN T can identify tiny amounts of enzymes released from damaged myocytes
Which acute coronary syndrome is categorized as non-STEMI or STEMI
Myocardial infarction
What does myocardial infarction non-STEMI mean?
persistent occlusion leads to infarction of myocardium closest to endocardium
What does myocardial infarction STEMI mean?
continued occlusion leads to infarction from endocardium to pericardium
How long does it take for myocardial infarction to occur?
O2 depletion in ___(1) seconds. After, the affected myocardium becomes ____ (2) and COOLER.
- 10
- cyanotic
The O2 deprivation during myocardial infarction is accompanied by?
- electrolyte disturbances (loss of K+)
- infiltration of immune cells
During myocardial infarction, what does infiltration of immune cells leads to?
further tissue damage
During the O2 deprivation that occurs during myocardial infarction, electrolyte disturbances leads to?
myocardial cells loss contractability.
With myocardial infarction, cardiac cells can withstand ischemic conditions for ___(1) minutes before _____(2) damage
20 (1) & irreversible (2)
What are the manifestations for myocardial infarction?
acute, sudden, severe chest pain
What is the diagnosis for myocardial infarction?
hs-cTnT
T or F: Most HF causes due to dysfunction of right ventricle.
FALSE; Due to dysfunction of left ventricle.
What is a heart failure?
heart unable to generate adequate cardiac output
What are the characteristics of heart failure?
inadequate perfusion of tissues (1), increased diastolic filling pressure of LV (2) or both (3) (if both, pulmonary capillary pressures are increased.)
How many individuals are affected by heart failure? What is the age range?
10% of individuals older than 65 yrs old.
T or F: Heart failure is the most common reason for hospital admission for people who are older than 65 yrs old.
TRUE
Left Ventricular Failure with Reduced Ejection Factor definition:
Left ventricle ejection fraction less than ___% (1) normal which results in inability of heart to ______ (2) tissue.
40% (1) & perfuse (2)
How to find CO? (hint: formula)
CO= SV x HR
What are the determinants of SV? (3pts)
contractility, preload and afterload.
What is ventricular remodelling?
disruption of normal myocardial function
What is the cause of ventricular remodelling?
progressive myocyte contractile dysfunction
In ventricular remodelling, the progressive myocyte contractile dysfunction leads to?
reduced SV & left ventricular end-diastolic volume (LVEDV) INCREASES
In ventricular remodelling, the disruption of normal myocardial function results in?
dilation of LEFT ventricle
What are the 3 main causes of myocardial dysfunction?
- Myocardial infarction
- Ischemic heart disease
- Hypertension
In left ventricular failure with REDUCED ejection factor, ____ (1) CO & ____(2) systemic BP = reduced PERFUSION of tissues.
Results:
increased ____(3) activity
increased secretion of _____(4)
increased _____(5)
- decreased
- decreased
- sympathetic
- catecholamines
- vasoconstriction
In left ventricular failure with REDUCED ejection factor, ______ (1) perfusion of kidneys
Result:
____-____(2) system activation = increased vasoconstriction and ____ ____ (3)
- decreased
2 Renin-angiontensin - blood volume
What are the 4 major results of left ventricular failure with reduced ejection factor?
- increased cardiac afterload
- increased b.p.
- increased HR
- ventricular remodelling
In left ventricular failure with reduced ejection factor, there is decreased _____(1) function which leads to decreased in contractility, resulting in increased _____(2)
- myocyte
- preload
What is the difference between effect of increased PRELOAD & AFTERLOAD? (2 pts each)
Increased Preload:
- stretching of myocardium –> further dysfunction of myocardial function
- sarcomere dysfunction
Increased Afterload:
-systemic HYPERTENSION
- myocardial HYPERTROPHY
T or F: Increased afterload is associated with myocardial hypertrophy.
TRUE
What is hypertrophy in regards to increased afterload?
increased myocardial O2 demand
What % of HF cases have previous hypertension?
75%
T or F: Hypertrophic/hypertrophy is the decrease in size of cells.
FALSE; Increase in size of cells
As CO decreases, ____(1) perfusion is reduced which result in further activation of ____(2) pathway - continue increase in vasoconstriction and blood vol. _______(3) continue to detect b.p which increased catecholamine release and increased _____(4).
Both results in continued increase in both ___(5) & ____(6)
renal (1)
RAAS (2)
Baroreceptors (3)
vasoconstriction (4)
preload (5)
afterload (6)
Pharmacology is the inhibition of various aspects of ____(1) & ____ (2)
RAAS (1) & SNS (2)
What manifestation of hear disease is defined as pulmonary congestion despite normal SV & CO?
Left ventricular failure with PRESERVED ejection factor
What is the prevalence of LVFpEF in population?
between 1-5%
What is the cause of LVFpEF?
- ab diastolic relaxation (normal left-ventricle volume)
- normal amount of blood returning to heart increased ventricle pressure
- the pressure is reflected back into pulmonary circulation – results in PULMONARY EDEMA & RIGHT ventricular hypertrophy
What are the diagnosis for LVFpEF? (3pts)
dyspnea on exertion, fatigue & evidence of pulmonary edema
Right ventricular failure is referred to as ___ Pulmonale
Cor
Right ventricular failure is the inability of right ventricle to provide inadequate blood flow into ______ circulation at a normal venous pressure.
pulmonary
What are the cause of right ventricular failure?
systemic hypertension leads to peripheral edema (1) & left ventricular failure – pressure reflected back into right ventricle (2)
Right ventricular failure serves a problem due to right ventricle POORLY PREPARED for increased afterload and will ___ (1) & fail. As a result, systemic hypertension = _____(2) edema.
dilate (1) & peripheral (2)
