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Clin Med Exam 2 > coronary artery disease > Flashcards

coronary artery disease Flashcards

1
Q

ischemia

A

decrease in blood flow to the myocardium

angina is a symptom

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2
Q

infarction

A

is death of myocardium caused by lack of blood flow

angina is a symptom

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3
Q

angina

A

90% of cases caused by CAD

when cardiac workload exceeds the oxygen supply to the myocardial tissue, ischemia occurs causing chest pain

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4
Q

chronic stable angina

A

classic

exertional

occurs at predictable levels of physical or emotional stress

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5
Q

new onset angina

A

has developed in the past 2 weeks

unstable

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6
Q

nocturnal angina

A

awaken a person from sleep w/ same sensation experienced during exertional

unstable

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7
Q

postinfarction angina

A

after an MI

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8
Q

periinfarction angina

A

a symptom of worsening cardia ischemia

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9
Q

prinzmetal’s angina

A

vasospastic/variant

cuased by coronary artery spasm

not arthrosclerosis

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10
Q

decubitus (resting) angina

A

occurs often at rest and at same time everyday

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11
Q

clinical manifestations of angina

A

pain or discomfort (dermatome from C3-T4)

sensation described as squeezing, burning, pressing, heartburn, indigestion or choking

recognizing symptoms more difficult in women

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12
Q

diagnosis angina

A

history

supported by sublingual nitroglycerin shortening attack

DO NOT TAKE VIAGRA

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13
Q

treatment of angina pectoris

A

drugs that help restore or maintain balance b/w myocardial oxygen supply and demand

organic nitrates

beta-adrenergic blockers

calcium channel blocker

anticoagulants

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14
Q

organic nitrates (angina)

A

decrease myocardial oxygen demand

dilates the veins and decreased the amount of blood returning to the heart

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15
Q

beta-adrenergic blockers (angina)

A

decrease HR and force of myocardial contraction by antagonizing Beta-1 receptors

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16
Q

calcium channel blockers (angina)

A

increase coronary blood flow

increasing myocardial oxygen supply by dilation

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17
Q

anticoagulants (angina)

A

heparin

aspirin to prevent further blockage of the coronary arteries

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18
Q

implications for PT

A

watch out for orthostatic hypotension

monitoring vital signs

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19
Q

myocardial infarction

A

development of ischemia w/ resultant necrosis of myocardial tissue

heart attack

occur more frequently in early morning hours, holiday season

genetics play a major role in CVD

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20
Q

what percent of MIs result from coronary thrombosis

A

80-90%

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21
Q

risks of MI

A

upper reparatory tract illnesses

periodontal disease

acute respiratory tract infections

increased PAI-1 in people with diabetes

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22
Q

PA-1 (MI)

A

plasminogen activator inhibitor 1

increases the risk of thrombosis

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23
Q

one of the best indicators for heart attack risk

A

bigger waist to hip ratio

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24
Q

pathogenesis of MI

A

occlusion of the coronary arteries (esp left coronary artery) and its branches effecting the left ventricle

MI/reperfusion injury accompanies by inflammatory response

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25
clinical manifestations of MI
sudden sensation of pressure chest pain (occasionally radiating to the arms, throat, neck and back) may be accompanied by pallor, shortness of breath and perspiration post-infarction complications
26
post-infarction complications
arrythmias cardiogenic shock pericarditis rupture of the heart sudden death
27
gender differences of MI
female hearts are smaller and constructed differently LV mass increased with age women delay seeking help, receive less aggressive therapy, therefore death rate for bypass is 2x higher
28
common symptoms of women MI
gripping chest pain and breaking out in a cold sweat symptoms less recognizable (such as pain or discomfort in the stomach, jaw, neck or back, nausea) CHRONIC UNEXPLAINED FATIGUE
29
other considerations for women and MI
hormonal status hypertension cholesterol
30
hormonal status
estrogen has be considered to have a cardioprotective benefit
31
hypertension
more common in women
32
cholesterol
guidelines for on lipid levels have not been standardized in women except HDL
33
diagnosis of MI
measurement of serum levels of cardiac enzymes such as cardiac troponin (TnI) cardiac troponin T (TnT) myocardial isoenzyme of creatine kinase (these are released during a heart attack)
34
treatment MI
thrombolytic agents that dissolve clots promote vasodilation reduce infarct size
35
chart angina v. MI
signs and symptoms pathogenesis in notes
36
congestive heart failure
heart is unable to pump sufficient blood to supply the body's needs 4 types most common cause for hospitalization in people older than 65
37
4 types of congestive heart failure
systolic heart failure diastolic heart failure left sided heart failure (CHF) right sided heart failure
38
systolic heart failure
contractile failure of myocardium
39
diastolic heart failure
increased filling pressures are required to maintain adequate cardiac output
40
left sided heart failure
left ventricle can no longer maintain normal cardiac output
41
right sided heart failure
right-sided ventricular dysfunction secondary to either left-sided heart failure or to pulmonary disease Cor pulmonale
42
cor pulmonale
abnormal enlargement of the right side of the heart as a result of a disease of the lungs or pulmonary vessels
43
risk factors of CHF
hypertension pre-existing heart disease pulse pressure elevation Paget's disease HIV medication
44
CHF pathogenesis
structural changes such as loss of myofilaments, apoptosis, disturbances in calcium homeostasis and alteration in collagen synthesis neurohormonal compensatory mechanisms
45
neurohormonal compensatory mechanisms (MI)
first compensatory phase: ventricular dilation, pulmonary congestion second compensatory phase: sympathetic nervous system increases stimulation the heart muscle third compensatory phase: activation of renin-angiotensin-aldosterone system, kidneys retain water and sodium to increase blood volume
46
clinical manifestations CHF
left sided heart failure: dyspnea, fatigue, muscular weakness, renal changes, PULMONARY EDEMA right-sided heart failure: edema, jugular venous distension, abdominal pain, right upper quadrant pain, cyanosis, PERIPHERAL EDEMA (most prominent in lower extremities)
47
treatment of CHF
goal is to improve the heart's pumping ability
48
drugs that increase myocardial contraction force
positive inotropic agents digitalis phosphodiesterase inhibitors dopamine and dobutamine
49
digitalis
increase intracellular calcium concentration to enhance contractility and increase the heart's mechanical pumping ability
50
phosphodiesterase inhibitors
allow c-AMP concentrations to increase, allowing calcium concentrations to increase
51
dopamine and dobutamine
stimulate beta-1 receptors on the myocardium to increase contractility, usually reserved for pts w. advanced cases
52
agents that decrease cardiac workload
drugs affects the renin-angiotensin system beta blockers diuretics vasodilators
53
drugs that affect the renin-angiotensin system
ACE inhibitors: limits peripheral vasoconstriction, decreased the pressure against which the heart has to pump angiotensin II receptor blockers (ARBS): used as an alternative for those who cannot tolerate ACE inhibitors
54
beta blockers (CHF)
normalize sympathetic stimulation of the heart reduce HR and myocardial contraction force
55
diuretics (CHF)
reduce congestion in the lungs and peripheral tissues by exerting excess fluid
56
vasodilators (CHF)
reduce peripheral vascular resistance
57
implications for PT CHF
prevent complications of bedrest, monitor vital signs exercise should be avoided immediately after eating or taking vasodilators
58
sudden cardiac death
death resulting from abrupt loss of heart function electrical impulses in the diseased heart become rapid (ventricular tachycardia) or chaotic (ventricular fibrillation) or both
59
what can mimic cardiogenic pain
GI distress anxiety (panic attack) muscular strain infectious disease
60
helpful screen
if symptoms worsen w/ effort and abates with rest, its more likely cardiogenic symptom is constant, probably not cardiogenic symptom comes and goes on its own, it is hard tot ell symptom is reproducible w/ pressure, less likely to be cardiogenic
61
cardiomyopathies
conditions affect the heart muscles so that contraction and relaxation of myocardium are impaired primary and secondary
62
primary cardiomyopathies
include genetic, mixed and acquired confined to heart muscle
63
secondary cardiomyopathies
involve myocardial pathology as part of generalized systemic disorders that affect the heart along w/ other organs
64
clinical manifestations cardiomyopathies
dyspnea orthopnea tachycardia palpitations peripheral edema distended jugular vein
65
3 cardiomyopathies
dilated hypertrophic restrictive
66
dilated cardiomyopathy
occurs most often in black men b/w 40 and 60 years old obesity long-term alc abuse systemic hypertension smoking infections pregnancy SECONDARY TYPE fatigue, weakness, chest pain (unlike angina), BP normal or low
67
hypertrophic cardiomyopathy
autosomal dominant trait on chromosome 14 most common cause of cardiac sudden death in the young primary type usually asymptomatic, sudden death being the presenting sign
68
restrictive cardiomyopathy
result of myocardial fibrosis, hypertrophy, infiltration or defect in myocardial relaxation can be either primary or secondary exercise intolerance, fatigue, shortness of breath, peripheral edema
69
nonpenetrating trauma (cardiomyopathy)
any blunt chest trauma, the pain is similar to an MI and is often confused w/ musculoskeletal pain from soft tissue consequences of chest trauma treated similar to MI
70
penetrating trauma (cardiomyopathy)
d/t external objects (bullets or knives), complications include arrythmias, aneurysm formation, death from infection
71
myocardial neoplasm (cardiomyopathy)
primary cardiac tumors are rare 95% malignant tumors are sarcomas 5% of malignant tumors are lymphomas sarcomas replace functional cardiac tissue w/ cancerous cells, may not produce any symptoms or present w/ arrythmias and conduction disturbances benign primary cardiac tumors occur 3x more often than malignant primary tumors
72
cardiac neoplasms come to the attention of the therapist when
progressive interference w/ mitral valve function results in exercise intolerance/ exertional dyspnea embolus causes stroke
73
systemic manifestations of cardiac neoplasms
muscle atrophy arthralgias malaise Raynaud's phenomena

Clin Med Exam 2 (9 decks)

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