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PA-S: PATHOPHYSIOLOGY > Chapter 33 > Flashcards

Chapter 33 Flashcards

1
Q

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

A

advanced age
family history
male gender
menopause

dyslipidemia
hypertension
endothelial
myocardial
cigarette
vasoconstriction
LDL
HDL
diabetes mellitus
insulin
endothelial
thickening
obesity
sedentary
atherogenic diet
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2
Q

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

A 
diabetes mellitus
hepatic lipoprotein
triglyceride
LDL
hypertension
twofold, threefold
atherosclerotic
cigaratte smoking
catecholamines
epinephrine, norepinephrine
periperal, constriction
blood pressure
oxygen
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3
Q

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

A

protective
atherosclerosis
LDLs
coronary

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4
Q

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
A 
c-reactive
atherosclerosis
troponin
hyperhomocysteinemia
adipokines
infection
periodontal
air
calcification
carotid
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5
Q

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!!!!

A 
blood
oxygen
nutrients
predictable
prinzmetal
unpredictable
no detectable
transient substernal
angina pectoris
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6
Q 
coronary artery disease
acute coronary syndromes (ACS)
-\_\_\_\_\_\_\_ coronary obstruction because of \_\_\_\_\_\_\_\_ formation over a ruptured atherosclerotic \_\_\_\_\_\_\_\_\_\_
examples: 
\_\_\_\_
\_\_\_\_\_\_
most common complications
\_\_\_\_\_\_\_\_,\_\_\_\_\_\_\_, and \_\_\_\_\_\_\_
A 
sudden
thrombosis
plaque
unstable angina
MI
dysrythmias
CHF
sudden death
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7
Q

fixed stenosis of the coronary arteries

A

stable angina

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8
Q

transient clotting of the coronary arteries

A

unstable angina

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9
Q

persistance of thrombus with greater plaque disruption then in ___________ angina

A

NSTEMI (MI)

undstable

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10
Q

complete thrombosis of the coronary arteries

A

STEMI

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11
Q

myocardial infarction
individuals at highest risk
-_________ elevations (______) on the ECG requires immediate intervention

A

ST segment

STEMI

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12
Q

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 _______
_________

A 
ST
depression
T
inversion
non-STEMI
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13
Q

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
_____

A

elevation
ST
STEMI

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14
Q 
MI
clinical manifestations:
\_\_\_\_\_\_\_\_ of cardiac biomarkers means MI!!!!!!!!!
-\_\_\_\_\_\_\_\_: most specific
-elevations in \_\_\_ to \_\_ hours 
-\_\_\_\_\_\_\_\_\_\_\_\_\_\_-\_\_ (\_\_\_\_\_)
-\_\_\_\_
A 
elevations
troponin
2, 4
creatine phosphokinase-MB (CPK-MB)
LDH
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15
Q

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
A 
recovery
10, 14
increasing
6
necrotic
contract
relax
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16
Q

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
A 
stroke volume
stretching
preload
nervous system
oxygen
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17
Q

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

A

cardiac output
heart rate
stroke volume
5

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18
Q

_________: 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

A 
ejection fraction
55
stroke volume
diastolic
ventricular
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19
Q

heart failure
systolic heart failure
inability of the heart to generate adequate cardiac output to perfuse tissue
__________ (_____ and _____)

A

natrieutic peptides
BNP
ANP

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20
Q

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

A 
BNP
brain natrietic peptide
overload
dilation
natriueresis
renin-angiotensin-aldosterone
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21
Q 
BNP and heart failure (read 1179 in book)
\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_ of heart failrue
A

diagnosis
prognosis
monitoring treatment
treatment

22
Q

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 ________

A 
ejection fraction
40%
cardiac output
MI
cardiac output
23
Q 
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 _________
A 
dyspnea, orthopnea, cough of frothy serum
fatigue
urine, edema
orthopnea
paryoxymol nocturnal 
congestion, rales
kerley B lines
edema
pleural effusions
24
Q

diastolic heart failure

  • heart failure with preserved _________
  • decreased compliance of the _________ and abnormal diastolic ______ (__________)
A

ejection fraction
left ventricle
relaxation
lusitropy

25
Q

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) _____

A 
diffuse pulmonary
pulmonary vascular
jugular venous
peripheral
hepatosplenomegaly
ascites
26
Q

left heart failure
edema:
clinical manifestations
pathophys: inability of the heart to generate adequate _______ to perfuse vital tissues

A

pulmonary
dysnpea, orthopnea, cough of frothy sputum
cardiac output

27
Q

right heart failure
edema:
clin manifestations:
pathophys: inability of the heart to provide adequate _______ into the pulmonary circulation at a normal central venous pressure

A

peripheral
jugular venous distention and hepatosplenomegaly
blood flow

28
Q

fail to shut completely, permitting the backflow of blood to continue

A

valvular regurgitation

29
Q 
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 \_\_\_\_\_\_\_\_
A

aortic
left ventricular
dilation
angina, syncope

30
Q 
disorders of endocardium
\_\_\_\_\_\_\_ stenosis
impairment of blood flow from the left atrium to the left ventricle
causes: left atrial \_\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_
most common cause: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
A

mitral
hypertrophy, dilation
acute rheumatic fever

31
Q

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

A

mitral
left
dilation
hypertrophy

32
Q

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

A

tricuspid

right

33
Q

_________ 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

A 
mitral
female
autosomal dominance
connective tissue
young women
x-linked 
connective tissue
Marfan syndrome
Ehlers-Danlos syndrome
osteogenesis imperfecta
environmental
fifth, sixth
34
Q

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 ________

A 
cardiomyopathies
neurohumoral
ischemic
hypertension
remodeling
idiopathic
35
Q

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

A 
dilated (congestive)
systolic
intracardiac
ventricular
systolic
heart failure
niacin
36
Q

cardiomyopathies
_____________ cardiomyopathy
-common inherited heart defect of a _________ of the ______ wall, which may cause _____ obstruction to the ________ outflow tract

A 
hypertrophic obstructive
thickening
septal 
outflow
left ventricle
37
Q

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

A 
restrictive
idiopathically
systemic
scleroderma
amyloidosis
sarcoidosis
lymphoma
hemochromatosis
storage
38
Q

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
_________

A 
acute pericarditis
fever, myalgias, malaise
chest pain
respiratory 
lying down
back
anterior
acute MI
dysphagia
restlessness
irritability
anxiety
weakness
39
Q

_____________: 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 __________

A 
rheumatic fever
group A beta-hemolytic streptococci
murmur
aortic regurgitation
polyarthritis
chorea
erythema marginatum
truncal rash
nonpruritic 
pink
erythematous macules
ringworm
40
Q

____________: 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 \_\_\_\_\_\_\_\_\_\_\_
A 
infective endocarditis
cardiac valves
bacteria
streptococci
staphylococci
enterococci
acquired valvular heart disease
intravenous
indwelling catheterization
pressure
hyperalimentation
hemodialysis
cardiac surgery
41
Q

cardiac complications of ____

most common: _________ effusion and _______ failure

A

AIDs
pericardial
left heart

42
Q

diseases of the veins
________
cause: trauma or gradual venous ________, damage to the _______ in the veins
-superficial and not clot forming

A

varicose veins
distention
valves

43
Q

diseases of the veins
____________
is a usual source of a _________

A

deep venous thrombosis (DVT)

pulmonary emboli

44
Q

diseases of the veins
_________ vena cava syndrome
-progressive __________ of the ___ that leads to venous __________ in the _________ and ______

A 
superior
occlusion
SVC
distention
upper extremities
head
45
Q

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

A 
systolic hypertension
organ
myocardial infarction
kidney disease
stroke
cardiac output
peripheral resistance
cardiac output
peripheral resistance
46
Q

pathophys of hypertension in the kidney
pathological change occurs to the kidneys ________ as a result of ________ cause to have ______ in the kidney _______!!!!

A

glomeruli
hypertension
ishchemia
tubules

47
Q

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 __________

A 
pharmacologic
angiotensin-converting enzymes ACE inhibitors
blockers (ARBs)
aldosterone
chronic kidney disease
post
stroke
calcium channel blockers
thiazide dieuretics
antihypertensives
48
Q

__________ 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

A 
orthostatic
acute orthostatic
chemistry
antihypertensives
antidepressants
immobility
starvation
exhaustion
depletion
pooling
pregnancy
varicosities
lower

older adults
postural

49
Q

_________
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 _______

A 
aneurysm
atherosclerosis
erodes
thoracic
dysphagia, dyspnea
pressure
50
Q

thoracic aneurysm

_______ resulting from a thoracic aneurysm is due to pressure of a thoracic aneurysm on surrounding _______

A

dyspnea

organs

51
Q

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

A 
thromboangiitis obliterans (Buerger disease)
young
peripheral
digital, tibial, plantar, ulnar, and palmar
obliterates
pain and tenderness
blood flow, rubor, and cyanosis
vasodilators
52
Q

_________ 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

A 
raynaud 
episodic
arteries
arterioles
toes
skin color
sensation
raynaud phenomenon
raynaud disease

PA-S: PATHOPHYSIOLOGY (18 decks)

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