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ALU-101 > Coronary Artery Disease > Flashcards

Coronary Artery Disease Flashcards

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1
Q

what is the number one killer in the US?

A

CAD

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2
Q

what organs and tissues are part of the circulatory system?

A

viens, arteries, lungs, capillaries, heart,

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3
Q

what are the 3 layers of the heart

A

inner endocardium,
the middle muscular myocardium
pericardium

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4
Q

what are the the names of the four valves of the heart?

A
  1. pulmonic semilunar valve,
  2. R sided tricuspid valve
  3. L sides mitral valve,
  4. aortic semilunar valve
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5
Q

what are the two entities of the circulatory system?

A

pulmonary circulation

systemic circulation

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6
Q

what is the pulmonary circulation entity?

A

supplied blood soley to the lungs.
superior and inferior vena-> cavae R atrium– tricuspid valve-> R ventricle. —(With ventricular systole)–>pulmonic valve–> pulmonary artery–> lungs. –>pulmonary vien -> heart

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7
Q

describe the systemic circulation entity

A

O2 blood -> L atrium–mitral valve—> Larger L ventricle—(with systole)–> aortic valve—> aorta

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8
Q

what is the main artery of the body? What follows ?

A

aorta -> arterioles-> capillary network

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9
Q

what is the main vein of the body? what leads up to it?

A

capillary network -> venules -> veins, -> vena cavae

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10
Q

how does the heart get it bloods supply

A

coronary circulation (systemic ) is achieved via coronary arteries, (L/R) which branch off the ascending aorta. The L main coronary artery breaks L anterior descending, and L circumflex.

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11
Q

what artery runs down the front of the heart, and suppled blood to the anterior wall, anterolateral wall, and the septum?

A

LAD

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12
Q

what does the LCx artery supply blood to?

A

down the back of the heart, and supplies to the lateral wall via obtuse marginal branches.

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13
Q

What part of the heart does the RCA supply blood to?

A

The thin walled R ventricle

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14
Q

what supplies blood to the inferior and posterior walls of the L ventricle?

A

PAD (posterior descending artery)

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15
Q

what conditions affect the blood flow thorugh the coronary arteries?

A

vasculitis, aneurysm, or spasms, or atherosclerosis.

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16
Q

what is atherosclerosis?

A

The systemic degenerative process that involves the gradual accumulation of a fatty-fibrous material on the inside walls of a large and medium sized arterties. eventually compromising flow and causing Ischemia.

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17
Q

atherosclerosis can lead to what other vascular consequences?

A

angina, MI, CVAs and PVDs, and the aorta causing aneurysm formation.

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18
Q

what is a fatty streak, and when does it occur?

A

in childhood, an accumulation of smooth muscles cells and lipids in the intima or inner layer of the blood vessel, in response to some injury.

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19
Q

at what percentage of blockage does atherosclerosis start to become symptomatic?

A

when the vessel is 70-80% obstruction. At this point a reduction of blood flow produces angina (chest pain)

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20
Q

At least half of all myocardial infarctions are caused by lesions of _____ % obstruction.

A
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21
Q

what are modifiable risk factors to atherosclerosis?

A

age, gender, fx, hyperlipidemia, smoking, hypertension, and diabetes.

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22
Q

are men or women more likley to develop CAD?

A

men, women however become 2-3 x more likley to develop CAD after menopause. Thank those Fatty hormones ;)

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23
Q

how does family history play a role in the risk of CAD?

A

1 member dx, increases your chances by 2 fold.

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24
Q

how does hyperlipidemia play a role in the risk of CAD?

A

TC = LDL + HDL + TG/5

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25
Q

how much does smoking increase your risk of developping CAD?

A

2-3 fold, and once you quit, your chances decrease by 1/2 in just the first year.

26
Q

how does hypertension play a role in CAD?

A

systolic and diastolic HTN play a positive, strong, and continuous graded relationship to the development of CHD with systolic hypertension being more predictive as age increases.

27
Q

what are the statistic of a person with diabetes and their risk of CAD?

A

they are more likely to have extensive CAD, silent ischemia, and less likely to do well after CABG or angioplasty than all the non-diabetics with CAD.

28
Q

what are some other factors that influence the risk of CAD, but are not measurable for insurance purposes?

A 
elevated homocysterin levels, 
elevated inflammatory markers 
obesity
atherohenic diet
lack of exercise 
psychosocial stressors
29
Q

Name two inflammatory markers

A

plasma fibrinogen and C-reactive protein.

30
Q

name other markers that point to an increased risk of atherosclerosis, and should be included in the assesment of the probability of CAD

A
  1. aortic sclerosis
  2. a decreased ankle-brachial index
  3. an increased carotid intimal-media thickness
  4. micoalbuminuria / renal insufficincy
  5. L ventricular hypertrophy on ECK/ECHO
31
Q

what causes angina pectoris?

A

whenever myocardial oxygen demands exceeds oxygen supply.

32
Q

what is prinzmetal’s angina?

A

A spasm of the blood vessel, what causes chest pain in the absence of atherosclerosis.

33
Q

name some symptoms (anginal equivalents) that can occur with myocardial ischemia

A

squeezing or pressure in middle of the chest
dyspnea (SOB)
fatigue
nausea
light headedness
pain in the upper abdomen, back, jaw, left arm.

34
Q

what is a myocardial infarction (MI)?

A

prolonged occlusion of a coronary artery that leads to injury or death of the heart muscle. This is dx with (CK)-MB or troponin markers in BW, or EKG changes.

35
Q

what is congestive heart failure?

A

the condition where fluid accumulated in the lungs or other body tissues d/t significantly decreases the ejection fraction,

36
Q

what is an electrocardiogram and why is it used?

A

EKG- used to trace the electrical activity of the heart, ie. abnormalities of the heart rhythm or conduction system, presence of myocardinal abnormalities such as ishemic, hypertensive, valvylar or idiopathic disease.

37
Q

how many leads are used in a standard EKG?

A

12,

38
Q

what is an exercise electrocariogram, and when is it used?

A

EET- done to determine the hearts reponse to exercise and is helpful in the diagnosis and prognosis of CAD. its exercisee and EKG and BP measured.

39
Q

what is diagnosed by an exercise electrocardiogram?

A
  1. Development of chest pain
  2. Myocardial ischemia
  3. extream change in BP, a decrease is especially worrisome
  4. ventricular premature contractions
40
Q

what is another name for exercise capacity?

A

MET. its determined by the duration of exercise and the protocol used, when the above average, is a favourable prognostic.

41
Q

what is MPI and what does it do?

A

myocardial perfusion imaging improves the sensitivity and specificity of the EKG. you get a 3D image of blood flow to the myocardium at rest and with exercies.

42
Q

how is an MPI preformed?

A

a radioisotope is injected into a person undergoing exercise, and the images are collected using SPECT.

43
Q

what is an area decoid of tracer called (in an MPI)?

A

a defect.

44
Q

what is a reversible defects

A

tracers that are visualized with exercise but not at rest, - indicate an area of hypoperfused but viable myocardium

45
Q

what is a fixed defect?

A

a tracer present both with exercise and at rest, indicates prior myocardial infarction.

46
Q

what combination of tests is used to asses the cardiac chambers.

A

the echo, radionuclide angiogram ( MUGA) and gated SPECT.

47
Q

how is myocardial ischemia detected?

A

As a decrease in LV ejection fraction, a measure of the pumping ability of the heart, or the development of a regional wall motion abnormality with exercise.

48
Q

how is the severity of the CAD determined >

A

amount of myocardium in jeopardy.

49
Q

what is considered a a significant CAD and what is considered a severe CAD?

A

significant- are athrosclerotic lesions that narrow the vessel lumen by >50%.
severe- when it involves all 3 coronary arteries or L main.

50
Q

What is being used to dx CAD today? note that although it is less accurate, it is still non-invasive and easily preformed.

A

CT and MR angiography, rather than angiogram.

51
Q

what test is used to measure the atheroma size and distribution?

A

IVUS

52
Q

what tests are used to detect deposits of calcium in the arterial walls?

A

EBCT, and ultrafast CT.

53
Q

what percentile of the calcium score distribution is considered at risk for CAD?

A

75th - 90th.

54
Q

what is BNP (brain natriuretic peptide)?

A

hormone produced by the heart in response to the stretching of myocardial cells due to volume and or pressure overload. Its used in dx, prognosis, and tx of congestive heart failure.

55
Q

what is the first line of treatment for those with angina?

A 
medical therapy, such as nitrates, (vasodilators) 
beta blockers (decrease HR and force of contraction), calcium channel blockers, ASA (anti-coagulant)
56
Q

What does Ca++ channel blocks do?

A
  1. ^ coronary artery blood flow

2. decrease O2 demand

57
Q

what is unique about using ASA as a preventative measure?

A

decreases risk by 1/3 in men, its used in those with unstable angina and acute MI, and its secondary prevention in risk of second vascular event by 22%.

58
Q

what is percutaneous transluminal coronary angioplasty (PTCA)? - with or without stenting.

A

for those with stable angina or done acutely in those with acute coronary syndromes. > technique is ballon methode of plaque fracturing to increase lumen of the blood vessel.

59
Q

What is the most common tx being done for the tx of CAD?

A

as technology improved with the use of stents, small metal coils, etc, the procedure continues to advance, more of these are being done in lieu of Coronary artery bypass grafting surgery.

60
Q

what is coronary artery bypass graft surgery CABG?

A

new conection is made from the aorta to the coronary artery by use of a graft. A detour for blood flow from myocardium, by bypassing the problematic blockage.

61
Q

in the prognosis of CAD, what variables must one consider for underwriting?

A
  1. how has the CAD affected the heart?
  2. How can the CAD further affect the heart/ how much of the myocardium is in jeopardy?
  3. how soon will further damage occur or what is the current stability of the CAD?
  4. how will this person do in the long term or what id the future stability of the CAD?
62
Q

what is the predictor for survival for those with CAD?

A

the LVEF percentage- normal MI is considered an LVEF of >50%. anything less decreases the chances of survival.
Other predictor is the exercise capacity.

ALU-101 (14 decks)

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