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Pathophysiology: Cardiovascular system > Coronary Artery Disease/ Ischemic Heart Disease/ Acute Coronary Syndrome > Flashcards

Coronary Artery Disease/ Ischemic Heart Disease/ Acute Coronary Syndrome Flashcards

1
Q

Arteriosclerosis

  • A general term for __.
  • What are the 4 issues that fall under this diagnosis?
A
  • A general term for all types of arterial changes
  1. Degenerative changes in small arteries and arterioles
  2. Loss of elasticity
  3. Lumen gradually narrows and may become obstructed
  4. Cause of increased BP
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2
Q

Atheroma

A

Plaques consisting of lipids, calcium, and possible clots in the large arteries

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3
Q

What actions/behaviors is the presence of atheroma’s in large arteries related to? (3)

A
  • Diet
  • Exercise
  • Stress
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4
Q

How are lipids transported?

A

Lipids are transported in combination with proteins

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5
Q

What is LDL?

A

Low Density Lipoproteins

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6
Q

What do LDL’s do?

A

Transport cholesterol from liver to cells

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7
Q

What do LDL’s contribute to?

A

Major factor contributing to atheroma formation

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8
Q

What is HDL?

A

High Density Lipoprotein

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9
Q

What do HDL’s do?

A

Transport cholesterol away from the peripheral cells to liver
Catabolism in liver and excretion

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10
Q

Which is the “good” lipoprotein?

A

HDL

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11
Q

What are the 8 steps to atheroma formation?

A
  1. Starts with endothelial injury in an artery
  2. Inflammation results in the area of injury: increased CRP
  3. Tunica intima and tunica media
    • Accumulation of monocytes, macrophages, and lipids
  4. Smooth muscle cells proliferate
  5. Now the plaque has formed
  6. Inflammation persists
  7. Platelets adhere to rough surface of arterial wall
  8. Thrombus forms
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12
Q

What are tunica intima and tunica media?

A

Tunica intima is the innermost layer of an artery or vein

Tunica media is the middle layer of an artery or vein

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13
Q

What are the 3 nonmodifiable risks for Atherosclerosis?

A
  1. Age
  2. Sex
  3. Genetic or familial factors
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14
Q

What are the 6 modifiable risks for Atherosclerosis?

A
  1. Obesity
  2. Sedentary Lifestyle
  3. Cigarette Smoking
  4. Diabetes mellitus
  5. Poorly controlled hypertension
  6. Combination of oral contraceptives and smoking
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15
Q

What diagnostic test can be performed to investigate Atherosclerosis?

A

Blood test for serum lipid levels

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16
Q

Name the 8 treatments of Atherosclerosis

A
  1. Weight loss
  2. Increase exercise
  3. Lower total serum cholesterol and LDL levels by dietary modification
  4. Reduce Sodium intake (leads to #5)
  5. Control Hypertension
  6. Cessation of Smoking
  7. Antilipidemic drugs
  8. Surgical intervention (i.e. coronary artery bypass grafting)
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17
Q

What are antilipidemic drugs?

A

They prevent or counteract the accumulation of fatty substances in blood.

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18
Q

What is the cause of angina pectoris?

A

When there is a deficit of oxygen to meet myocardial needs.

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19
Q

What are the 3 types of Angina Pectoris?

A
  1. Classic or exertional angina
  2. Variant Angina
  3. Unstable Angina
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20
Q

Define Classic or Exertional Angina

A

Pain with activity, relieved by rest

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21
Q

Define Variant Angina

A

Vasospasm occurs at rest

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22
Q

Define Unstable Angina

A

Prolonged pain at rest

May precede myocardial infarction

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23
Q

Etiology of Angina Pectoris (4)

A
  1. Insufficient arterial blood
  2. Severe anemia
  3. Respiratory Disease
  4. Activities which increase demand for blood
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24
Q

What could cause there to be insufficient arterial blood? (4)

A
  1. Arteriosclerosis
  2. Atherosclerosis
  3. Vasospasm
  4. Myocardial hypertrophy
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25
Q

What is Myocardial hypertrophy

A

When the heart grows but the vessels do not

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26
Q

What activities increase demand for blood? (6)

A
  1. Exercise
  2. Emotional stress
  3. Respiratory infection with fever
  4. Exposure to weather extremes
  5. Exposure to pollution
  6. Eating a large meal
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27
Q

Clinical Manifestations of Angina Pectoris (4)

A
  1. Typically recurrent, intermittent brief episodes of sub-sternal chest pain triggered by physical or emotional stress
  2. Pallor
  3. Diaphoresis
  4. Nausea
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28
Q

Do the episodes remain the same throughout the duration of Angina Pectoris?

A

Attacks vary in severity and duration but become more frequent and longer as disease progresses

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29
Q

Describe the pain of angina pectoris?

A
  • Tightness or pressure

- May radiate to left arm and neck

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30
Q

Define Diaphoresis

A

Sweaty

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31
Q

Treatment for Angina Pectoris

  • What should the pt do? (2)
  • What should be administered? (3)
  • What should be checked? (2)
  • What course of action should be taken if the patient has a history of Angina Pectoris?
  • What course of action should be taken if the patient does not have a history of Angina Pectoris?
A
  1. Rest, stop activity
  2. Patient sitting in an upright position
  3. Administration of coronary vasodilator (i.e. sublingual nitroglycerin)
    - If patient is known to have angina, a 2nd dose of nitroglycerin could be given
  4. Check pulse and respiration
  5. Administration of oxygen, as needed
  6. If patient does not have a history of angina, emergency medical aid is necessary
  7. Take an aspirin (blood thinner - to prevent blood clot)
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32
Q

Myocardial Infarction: Pathophysiology

When does it occur?

A

When a coronary artery is totally obstructed

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33
Q

Myocardial Infarction: Pathophysiology

What does it result in?

A

Cell death of the heart wall

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34
Q

Myocardial Infarction: Pathophysiology

What is the most common cause?

A

Atherosclerosis

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35
Q

Myocardial Infarction: Pathophysiology

Name the 3 ways an infarction can develop?

A
  1. Thrombus from atheroma may obstruct artery
  2. Vasospasm in the presence of partial obstruction
  3. Embolus
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36
Q

Define Embolus

A

A traveling clot from a remote site

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37
Q

Myocardial Infarction: Pathophysiology

What determines the damage caused by the infarct?

A

Size and location of the infarct

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38
Q

Myocardial Infarction: Pathophysiology

What is released into the system during this time?

A

Cardiac Enzymes - They in turn are a diagnostic tool

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39
Q

Myocardial Infarction: Pathophysiology
What happens if blood is restored?
How much time after the episode does blood have to be restored for the effect to take place?

A

Permanent damage may be prevented if blood is restored within 20-30m of the episode

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40
Q

Myocardial Infarction: Pathophysiology

What happens if blood is not restored?

A

Fibrous tissue replaces cardiac tissue

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41
Q

What are the 4 warning signs of a myocardial infarction?

A
  1. Feeling of pressure, heaviness, or burning in chest. Especially with increased activity
  2. Sudden shortness of breath, weakness, fatigue
  3. Nausea, indigestion
  4. Anxiety and fear
42
Q

Clinical Manifestations of Myocardial Infarctions: Hallmark

A

Sudden, sub-sternal chest pain radiating to the left arm, shoulder, jaw, or neck

43
Q

How do you describe the type of pain that the Hallmark sign of Myocardial Infarctions is marked by?

A
  1. Severe
  2. Steady
  3. Crushing
44
Q

Do vasodilators relieve the pain of myocardial infarctions?

A

No, they do not yield any relief.

45
Q

What signifies a silent myocardial infarction?
What type of discomfort might this patient experience?
Who suffers from these more men or women?

A
  1. No Pain
  2. Patient may experience gastric discomfort
  3. More common presentation in women
46
Q

What are the other clinical manifestations of a myocardial infarction? (9)

A
  1. Pallor
  2. diaphoresis
  3. nausea
  4. dizziness
  5. weakness
  6. dyspnea
  7. Anxiety/ fear
  8. Hypotension
  9. Low-grade Fever
47
Q

Define Diaphoresis

A

Sweating, excessively

48
Q

Define Dyspnea

A

Labored Breathing

49
Q

What diagnostic tests are done to diagnose myocardial infarctions? (6)

A
  1. ECG - look for changes
  2. Serum enzyme and isoenzyme levels
  3. Serum levels of myosin and cardiac troponin are elevated
  4. Leukocytosis, elevated CRP and ESR are common
  5. Arterial blood gas measurements may be altered in severe cases
  6. Pulmonary artery pressure measurements are helpful
50
Q

What are some complications of myocardial infarctions? (5)

A
  1. Sudden Death
  2. Cardiogenic shock
  3. Congestive heart failure
  4. Rupture of necrotic heart tissue/ cardiac tamponade
  5. Thromboembolism causing cerebrovascular accident
51
Q

Define Cardiac Temponade

A

the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and increased pressure in the cardiac cavity.

52
Q

What is the treatment for a myocardial infarction? (7)

A
  1. Reduce cardiac demand
  2. Oxygen therapy
  3. Analgesics
  4. Anticoagulants
  5. Thrombolytic agents may be used
  6. Tissue plasminogen activator
  7. Medication to treat: dysrhythmias, hypertension, congestive heart failure (CHF)
    * cardiac rehab begins immediately*
53
Q

Define Analgesic Drugs

A

Pain Relievers

54
Q

Define Cardiac Dysrhythmia

A

Deviations from normal cardiac rate or rhythm

55
Q

What is cardia dysrhythmia caused by?

A
  1. Electrolyte abnormalities (Na, K, or Ca)
  2. Fever
  3. Hypoxia
  4. Stress
  5. Infection
  6. Drug toxicity
56
Q

What is Electrocardiography used for?

A

To monitor the conduction system

57
Q

How does a cardiac dysrhythmia affect the efficiency of the hearts pumping cycle?

A

It reduces the efficiency of the hearts pumping cycle

58
Q

What is the SA node?

A

The pacemaker of the heart

59
Q

Can the rate of the SA node be altered?

A

Yes

60
Q

Define Bradycardia

A

regular but slow heart rate <60 bpm

61
Q

Define Tachycardia

A

regular but rapid heart rate >100 bpm

62
Q

What is Sick Sinus Syndrome

A

marked by altering bradycardia and tachycardia, often requires a mechanical pacemaker

63
Q

Define PAC or PAB

A

PAC: Premature Atrial Contractions
PAB: Premature Atrial Beats
Extra contraction or ectopic beats from irritable atrial muscle cells

64
Q

Define Atrial flutter

  • What is the range of atrial BPM?

- What slows down atrial or ventricular rate?

A

Atrial heart rate of 160 to 350 beats/min

AV node delays conduction - ventricular rate slower

65
Q

Atrial Fibrillation

  • What’s the bpm?
  • What does it cause?
  • What is at risk?
A
  • Rate over 350 bpm
  • Causes pooling of blood in the atria
  • Thrombus formation is a risk
66
Q

Define Heart Block

- What is it an abnormality of?

A

An AV node abnormality.

When conduction is excessively delayed or stopped at the AV node or bundle of His

67
Q

What is a First degree heart block?

A

Conduction delay between atrial and ventricular contractions

68
Q

What is a Second degree heart block?

A

Every second to third atrial beat is dropped at the AV node

69
Q

What is a Third degree heart block?

A

No transmission from atria to ventricles

70
Q

Bundle Branch Block

A

Ventricular conduction abnormality

Interference with conduction in one of the bundle branches

71
Q

Ventricular tachycardia

A

likely to reduce cardiac output as reduced diastole occurs

72
Q

Ventricular fibrillation

  • What happens to the muscle fibers?
  • What occurs if this is not treated immediately?
A
  • The muscle fibers contract independently and rapidly

- Cardiac standstill occurs if not treated immediately

73
Q

Define PVC

A

Premature ventricular contractions (PVC)

Additional beats from ventricular muscle cells or ectopic pacemaker

74
Q

What could PVC potentially lead to?

A

Ventricular fibrillation

75
Q

During the consumption of which drug could a PVC occur and be considered normal with?

A

Caffeine, coffee

76
Q

Define Cardiac arrest

  • How do the impulses of the heart act?

- How do they present on the ECG?

A

Cessation of all heart activity

  • No conduction of impulses
  • Flat ECG
77
Q

What are the reasons for Cardiac arrest? (7)

A
  1. Excessive vagal nerve stimulation
  2. Potassium imbalance
  3. Cardiogenic Shock
  4. Drug toxicity
  5. Insufficient Oxygen
  6. Respiratory arrest
  7. Blow to the heart
78
Q

What are 4 treatments for dysrhythmias?

  • What should be determined
  • What, if any, medications can be taken?
  • If the problem originates in the SA node or a total heart block occurs, what treatment should be applied?
  • What is the treatment if the cause is ventricular fibrillation?
A
  1. Cause needs to be determined and treated
  2. Antidysrhythmic drugs are effective in many cases
  3. SA nodal problems or total heart block require a pacemaker
  4. Defibrillator may be implanted for conversion of ventricular fibrillation
79
Q

CHF Definition

A

Heart is unable to pump out sufficient blood to meet metabolic demands of the body

80
Q

What is CHF usually a complication of?

When could CHF begin?

A 
-Another cardiopulmonary condition: CAD is the leading cause. 
    Conduction problems
    Valvular problems
    Pulmonary disease 
-Post infarction
81
Q

How does the body balance out the effects of CHF and its own needs?

A

Various compensatory mechanisms maintain cardiac output. Some of these aggravate the condition.

82
Q
  • When the heart cannot maintain pumping capability, cardiac output or stroke volume _____
  • What happens to the amount of blood reaching the organs?
  • How does the patient feel?
  • What develops due to CHF
A
  • Decreases.
  • It decreases.
  • Lethargic and fatigued
  • Mild acidosis develops.
83
Q

What develops due to the need for oxygen and glucose in CHF?

A

Back up and congestion develop as coronary demands for oxygen and glucose are not met.

84
Q

How does CHF affect blood flow into and out of the ventricles?

A

Output from the ventricle is less than the inflow of blood

85
Q

What happens to the congestion in the venous circulation during CHF?

A

Congestion in venous circulation drains into the affected side of the heart.

86
Q

Define Cor Pulmonale

A

Right sided heart CHF dur to pulmonary disease

87
Q

What are the forward effects of CHF (3)? What are these effects similar to?

A

They are similar with failure on either side.

  1. Decreased blood supply to tissues, general hypoxia
  2. Fatigue and weakness
  3. Dyspnea and shortness of breath
88
Q

What are the compensation mechanisms in CHF?

A
  1. Tachycardia
  2. Cutaneous and visceral vasoconstriction
  3. Daytime oliguria
89
Q

Define Oliguria

A

low urine

90
Q

What problem is left-sided heart failure related to?

A

Pulmonary Congestion

91
Q

What occurs during left-sided heart failure due to fluid accumulation in the lungs?

A

Dyspnea and Othopnea (both mean shortness of breath)

92
Q

What occurs during left-sided heart failure due to fluid irritating the respiratory passages?

A

Coughing

93
Q

What occurs during left-sided heart failure that indicates acute pulmonary edema?

A

Paroxysmal Nocturnal Dyspnea

94
Q

When does Paroxysmal Nocturnal Dyspnea usually develop?

A

During sleep

95
Q

What does Paroxysmal Nocturnal Dyspnea lead to?

A

Excess fluid in lungs frequently leads to infections such as pneumonia

96
Q

Where is the edema when right sided heart failure occurs?

A

Dependent edema occurs in feet, legs, or buttocks

97
Q

How is the jugular vein affected by right sided heart failure? What does this lead to?

A

Increased pressure in jugular vein occurs. This leads to distention

98
Q

What swells during right sided heart failure?
What are the proper names from these swollen parts?
What does this cause?

A
  • Liver, spleen, and fluid in the peritoneal cavity
  • Hepatomegaly, splenomegaly, and ascites
  • Hepatomegaly and splenomegaly cause digestive disturbances.
99
Q

What is ascites marked by?

A

Marked by abdominal distention

100
Q

What is ascites?

A

Complication of Right sided heart failure when fluid accumulates in the peritoneal cavity

101
Q

What are the symptoms of acute right sided heart failure (4)?

A
  1. Flushed face
  2. Distended neck veins
  3. Headache
  4. Visual disturbances
102
Q

What are the treatments for CHF?

A
  1. Treat the underlying problem if possible

2. Reducing workload on heart

Pathophysiology: Cardiovascular system (5 decks)

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