Chapter 33 Flashcards
Coronary Artery Disease
any vascular disorder that narrows or occludes the coronary arteries
results in in imbalance between coronary supply of blood and myocardial demand for oxygen and nutrients
nonmodifiable risk factors:
- _________, _______
- ______ gender or women after __________
modifiable risk factors:
-__________
-_________
_________ injury, increase in __________
-_________ smoking
_______ and increase in ____, decrease in ______
-_________ and _______ resistance
-risk of developing coronary artery disease is inceased up to _____ by which factor
_______ damage, _______ of the vessel wall
-_______ and ______ lifestyle
________ diet
advanced age
family history
male gender
menopause
dyslipidemia hypertension endothelial myocardial cigarette vasoconstriction LDL HDL diabetes mellitus insulin endothelial thickening obesity sedentary atherogenic diet
Modifiable risk factors
why are they risk factors for CAD?
__________ is associated w CAD because of the resulting alteration of ______________ synthesis; it increases ______ levels and is involved in ___ oxidation
_________ is the only factor responsible for a _____ to ______ increased risk of ________ cardiovascular disease
__________: nicotine stimulates the release of ___________ (eg the neurotransmitters: _________, ______) which increase the heart rate, and causes ___________ vascular _______
as a result, _________ increases, as do both cardiac workload and ______ demand
diabetes mellitus hepatic lipoprotein triglyceride LDL hypertension twofold, threefold atherosclerotic cigaratte smoking catecholamines epinephrine, norepinephrine periperal, constriction blood pressure oxygen
why are they risk factors for CAD?
high levels of HDL
high levels of HDL may be more ______ for the development of _________ that low levels of ____
low levels of HDL
low levels of HDL cholesterol are also a strong indicator of ______ risk
protective
atherosclerosis
LDLs
coronary
coronary artery disease
nontraditional risk factors: markers of inflammation and thrombosis -\_\_\_\_\_\_\_ protein is a lab test and indirect measure of \_\_\_\_\_\_\_\_\_ -\_\_\_\_\_\_\_ I -\_\_\_\_\_\_\_\_\_\_ -\_\_\_\_\_\_\_\_ -adiponectin and leptin -\_\_\_\_\_ -microorganisms and \_\_\_\_\_\_ disease -\_\_\_\_\_ pollution -coronary artery \_\_\_\_\_\_\_\_ and \_\_\_\_\_ wall thickness
c-reactive atherosclerosis troponin hyperhomocysteinemia adipokines infection periodontal air calcification carotid
coronary artery disease
myocardial ischemia
-develops if the supply of coronary ______ cannot meet the demand of the myocardium for _______ and ________
-stable angina: causes _______ chest pain.
-_________ (variant): causes ________ chest pain
-silent ischemia: causes ________ symptoms
-angina pectoris: causes _________ ______ chest discomfort
-_________ is triggered by myocardial ischemia!!!!
blood oxygen nutrients predictable prinzmetal unpredictable no detectable transient substernal angina pectoris
coronary artery disease acute coronary syndromes (ACS) -\_\_\_\_\_\_\_ coronary obstruction because of \_\_\_\_\_\_\_\_ formation over a ruptured atherosclerotic \_\_\_\_\_\_\_\_\_\_ examples: \_\_\_\_ \_\_\_\_\_\_ most common complications \_\_\_\_\_\_\_\_,\_\_\_\_\_\_\_, and \_\_\_\_\_\_\_
sudden thrombosis plaque unstable angina MI dysrythmias CHF sudden death
fixed stenosis of the coronary arteries
stable angina
transient clotting of the coronary arteries
unstable angina
persistance of thrombus with greater plaque disruption then in ___________ angina
NSTEMI (MI)
undstable
complete thrombosis of the coronary arteries
STEMI
myocardial infarction
individuals at highest risk
-_________ elevations (______) on the ECG requires immediate intervention
ST segment
STEMI
subendocardial MI
if the thrombus breaks up before complete distal breaks up before complete distal tissue necrosis occurred, the infarction will involve only the myocardium directly beneath endocardium
causes marked ___ segment _______ and __ wave _______
_________
ST depression T inversion non-STEMI
transmural MI
if the thrombus in a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium
causes marked ______ of ___ segments on the EKG
_____
elevation
ST
STEMI
MI clinical manifestations: \_\_\_\_\_\_\_\_ of cardiac biomarkers means MI!!!!!!!!! -\_\_\_\_\_\_\_\_: most specific -elevations in \_\_\_ to \_\_ hours -\_\_\_\_\_\_\_\_\_\_\_\_\_\_-\_\_ (\_\_\_\_\_) -\_\_\_\_
elevations troponin 2, 4 creatine phosphokinase-MB (CPK-MB) LDH
when is the scar tissue that is formed after an MI most vulnerable to injury?
- during the ______ period (__ to __ days after infarction), individuals feel more capable of _______ activities and thus may stress the newly formed scar tissue
- after __ weeks, the _______ area is completely replaced by scar tissue, which is strong but unable to ______ and ______ like healthy myocardial tissue
recovery 10, 14 increasing 6 necrotic contract relax
factors affecting cardiac output
- myocardial contractility
- _______: volume of blood ejected during systole
determinants of the force of contraction
- changes in the ______ of the ventricular myocardium, caused by changes in ventricular volume (_____)
- alterations in the ______ input to the ventricles
- adequacy of myocardial _______ supply
stroke volume stretching preload nervous system oxygen
factors affecting cardiac output
_________: is the volume of blood flowing through either the systemic or pulmonary circuit
-is expressed in liters per minute
-is calculated by multiplying the ________
in beats per minute by the ______
-normal adult cardiac output at rest is __ L/min
cardiac output
heart rate
stroke volume
5
_________: is the amount of blood ejected per beat
-normal is __% or higher
is calculated by dividing the ________ by the end ______ volume
-is an indicator of _______ function
ejection fraction 55 stroke volume diastolic ventricular
heart failure
systolic heart failure
inability of the heart to generate adequate cardiac output to perfuse tissue
__________ (_____ and _____)
natrieutic peptides
BNP
ANP
heart failure
_______ (__________) is produced and released in response to pressure and volume _______ of the cardiac chambers
causes arterial and venous _______, _______
and suppression of the ___________ system
BNP brain natrietic peptide overload dilation natriueresis renin-angiotensin-aldosterone
BNP and heart failure (read 1179 in book) \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_ of heart failrue
diagnosis
prognosis
monitoring treatment
treatment
systolic heart failure
heart failure with reduced ________ is defined as EF of less than __% and an inability of the heart to generate an adequate __________ to perfuse vital tissue
___ is the most common cause of decreased ________
ejection fraction 40% cardiac output MI cardiac output
heart failure systolic heart failure clinical manifestation -\_\_\_\_\_\_, \_\_\_\_\_\_\_, cough of \_\_\_\_\_\_\_\_\_ -\_\_\_\_\_\_\_\_ -decreased \_\_\_\_\_ output and \_\_\_\_\_\_\_
below are the descriptions
- _______: SOB when lying down the patient sleeps on more than one pillow or even sitting up
- ____________ dyspnea
- pulmonary _______ (____), _________ on CXR
- ________
- bilateral _________
dyspnea, orthopnea, cough of frothy serum fatigue urine, edema orthopnea paryoxymol nocturnal congestion, rales kerley B lines edema pleural effusions
diastolic heart failure
- heart failure with preserved _________
- decreased compliance of the _________ and abnormal diastolic ______ (__________)
ejection fraction
left ventricle
relaxation
lusitropy
right heart failure
is the inability of the right ventricle to provide adequate blood into the pulmonary circulation
-can result from _________ disease and elevated __________ resistance
clinical manifestations:
________ distension, ________ edema, ______________(underlying pulm disease) _____
diffuse pulmonary pulmonary vascular jugular venous peripheral hepatosplenomegaly ascites
left heart failure
edema:
clinical manifestations
pathophys: inability of the heart to generate adequate _______ to perfuse vital tissues
pulmonary
dysnpea, orthopnea, cough of frothy sputum
cardiac output
right heart failure
edema:
clin manifestations:
pathophys: inability of the heart to provide adequate _______ into the pulmonary circulation at a normal central venous pressure
peripheral
jugular venous distention and hepatosplenomegaly
blood flow
fail to shut completely, permitting the backflow of blood to continue
valvular regurgitation
disorders of endocardium \_\_\_\_\_ stenosis orifice of the aortic semilunar valve narrows, causing diminished blood flow from the left ventricle into the aorta causes: \_\_\_\_\_\_\_\_ hypertrophy and \_\_\_\_\_ clinical manifestations: \_\_\_\_\_ and \_\_\_\_\_\_\_\_
aortic
left ventricular
dilation
angina, syncope
disorders of endocardium \_\_\_\_\_\_\_ stenosis impairment of blood flow from the left atrium to the left ventricle causes: left atrial \_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_ most common cause: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
mitral
hypertrophy, dilation
acute rheumatic fever
disorders of the endocardium
_________ regurgitation
most common cause: mitral valve prolapse and rheumatic heart disease
________ atrial and ventricular _______ and ________
permits backflow of blood from ventricle to atrium
mitral
left
dilation
hypertrophy
disorders of the endocardium
__________ regurgitation
leads to volume overload in the right atrium and ventricle, increased systemic venous blood pressure and right heart failure
______ atrial and ventricular dilation and hypertrophy
tricuspid
right
_________ prolapse system
anterior and posterior cusps of the mitral valve billow upward (prolapse) into the atrium during systole
it is also a ______ valvular disorder that is thought to have an __________ inheritance pattern as well as being associated with __________ disease
this prolapse tends to be most prevalent in _________
studies suggest an autosomal dominant and _________ inheritance pattern
because mitral valve prolapse often is associated with other inherited ________ disorders (eg ____________ syndrome, __________ syndrome, ____________), it is though tto result from a genetic or ________ disruption of valvular development during the _____ or ____ week of gestation
mitral female autosomal dominance connective tissue young women x-linked connective tissue Marfan syndrome Ehlers-Danlos syndrome osteogenesis imperfecta environmental fifth, sixth
are a diverse group of diseases that affect the myocardium:
effects of ________ responses to _______ heart disease or ________ on the heart muscle cause ________
many cases of these are ________
cardiomyopathies neurohumoral ischemic hypertension remodeling idiopathic
cardiomyopathies
_________ (_______) cardiomyopathy
-impaired _______ function, leading to increase in ____________ volume. Causes _______ dilation and grossly impaired ______ function, leading to dilated ___________
causes: MI; diabetes; alcohol; deficiences of ______; vitamin D and selenium; hyperthyroidism
clinical manifestiations: dyspnea and fatigue
treatment: salt restriction, vasodilators, dieuretics, inotropic agents, anticoagulaants and pacemakers
dilated (congestive) systolic intracardiac ventricular systolic heart failure niacin
cardiomyopathies
_____________ cardiomyopathy
-common inherited heart defect of a _________ of the ______ wall, which may cause _____ obstruction to the ________ outflow tract
hypertrophic obstructive thickening septal outflow left ventricle
cardiomyopathies
__________ cardiomyopathy
myocardium becomes rigid and noncompliant, impeding ventricular filling and raising filling pressures during diastole
this cardiomyopathy may occur __________ or as a cardiac manifestation of ________ diseases, such as __________, __________, __________, __________, and _________ or a number of inherited ________ diseases
restrictive idiopathically systemic scleroderma amyloidosis sarcoidosis lymphoma hemochromatosis storage
disorders of the heart wall
disorders of the pericardium
___________
clinical manifestations:
describe several days of ________, _______
and _______ followed by sudden onset of severe ________ that worsens with _______ movements and with ________
althought the pain may radiate to the _______, it is generally felt in the ________ chest and may be initially confused with the pain of an ________
individuals with this also may report __________, ________, _________, ________, _______ and
_________
acute pericarditis fever, myalgias, malaise chest pain respiratory lying down back anterior acute MI dysphagia restlessness irritability anxiety weakness
_____________: is a diffuse, inflammatory disease caused by the delayed immune response to infeciton by the _______________________
clinical manifestations:
carditis: ______ can cause acquired ____________
________: large joints mainly affected
________: sudden, aimless, irregular, involuntary movements
__________________: ________ causes a transitory truncal rash that is _________ and _______ with _______________ that may fade in the center, making them appear as a __________
rheumatic fever group A beta-hemolytic streptococci murmur aortic regurgitation polyarthritis chorea erythema marginatum truncal rash nonpruritic pink erythematous macules ringworm
____________: inflammation of the endocardium from infections agents
-is a general term used to describe infection and inflammation of the endocardium- especially the ________
most common: _________, especially _________, ________, and _________
risk factors: 1 2 \_\_\_\_\_\_\_ drug abuse 3 long term \_\_\_\_\_\_\_\_\_\_\_ (eg for \_\_\_\_\_\_\_ monitoring, \_\_\_\_\_\_\_\_, and \_\_\_\_\_\_\_\_\_) 4. recent \_\_\_\_\_\_\_\_\_\_\_
infective endocarditis cardiac valves bacteria streptococci staphylococci enterococci acquired valvular heart disease intravenous indwelling catheterization pressure hyperalimentation hemodialysis cardiac surgery
cardiac complications of ____
most common: _________ effusion and _______ failure
AIDs
pericardial
left heart
diseases of the veins
________
cause: trauma or gradual venous ________, damage to the _______ in the veins
-superficial and not clot forming
varicose veins
distention
valves
diseases of the veins
____________
is a usual source of a _________
deep venous thrombosis (DVT)
pulmonary emboli
diseases of the veins
_________ vena cava syndrome
-progressive __________ of the ___ that leads to venous __________ in the _________ and ______
superior occlusion SVC distention upper extremities head
hypertension
affects the entire cardiovascular system
-____________: most significant factor in causing target ______ damage
-increases risk for ___________, ______ and ______
caused by increases in __________ or total _________, or both
___________ increase: any condition that increases heart rate or stroke volume
____________ increase: any factor that increases blood viscosity or reduces vessel diameter
systolic hypertension organ myocardial infarction kidney disease stroke cardiac output peripheral resistance cardiac output peripheral resistance
pathophys of hypertension in the kidney
pathological change occurs to the kidneys ________ as a result of ________ cause to have ______ in the kidney _______!!!!
glomeruli
hypertension
ishchemia
tubules
hypertension
treatment
__________ therapies
1. ______________ (____) _________: angiotensin receptor ______ (___), or __________ antagonists
2. individuals with heart failure, have __________, are ____ myocardial infarction, or have had recurrent _________
3. __________
4. combination of _________ and other __________
pharmacologic angiotensin-converting enzymes ACE inhibitors blockers (ARBs) aldosterone chronic kidney disease post stroke calcium channel blockers thiazide dieuretics antihypertensives
__________ hypotension
decrease in the systolic and diastolic blood pressures
___________ (temporary type) may result from 1) altered body _______, 2) drug action (eg _________, _________), 3) prolonged _______ caused by illness, 4) _________, 5) physical ______, 6) any condition that produces volume ________, 7) venous ______ (eg ________, extensive ________ of the ______ extremities)
________ are susceptible to this type of orthostatic hypotension, in which _______ reflexes are slowed as part of the aging process
orthostatic acute orthostatic chemistry antihypertensives antidepressants immobility starvation exhaustion depletion pooling pregnancy varicosities lower
older adults
postural
_________
local dilation or outpouching of a vessel wall or cardiac chamber
__________ is a common cause of these because ______ formation erodes the vessel wall
clinical manifestations
_______
-________(difficulty in swallowing), and _______ (breathlessness) are caused by the _______
aneurysm atherosclerosis erodes thoracic dysphagia, dyspnea pressure
thoracic aneurysm
_______ resulting from a thoracic aneurysm is due to pressure of a thoracic aneurysm on surrounding _______
dyspnea
organs
peripheral vascular disease
___________________(_______)
-occurs mainly in ______ men who smoke
-inflammatory disorder of the _________ arteries, small and medium size arteries in the _______ and sometimes in the _______
-______, _______, ______, ______, and _____ arteries
-_______ the small and medium sized arteries
-______ and _______ develop in the affected part
-sluggish ______, _____ and _____ result
treatment:
-smoking cessation
-exercise and dependent positioning; ______ to alleviate vasopspam and _______ agents
thromboangiitis obliterans (Buerger disease) young peripheral digital, tibial, plantar, ulnar, and palmar obliterates pain and tenderness blood flow, rubor, and cyanosis vasodilators
_________ phenomonon and ______ disease
-_______ vasospasm (ischemia) in the _______ and _______ of the fingers; less commonly in the ______
clinical manifestations: changes in _______ and _______ caused by ischemia
___________: secondary to other systemic diseases or conditions
treatment: arm exercises and medications
__________: primary vasoplastic disorder of unknown origin
treatment: avoidance of emotional sress and cold, cessation of cig smoking
raynaud episodic arteries arterioles toes skin color sensation raynaud phenomenon raynaud disease
