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
- Degenerative changes in small arteries and arterioles
- Loss of elasticity
- Lumen gradually narrows and may become obstructed
- Cause of increased BP
2
Q
Atheroma
A
Plaques consisting of lipids, calcium, and possible clots in the large arteries
3
Q
What actions/behaviors is the presence of atheroma’s in large arteries related to? (3)
A
- Diet
- Exercise
- Stress
4
Q
How are lipids transported?
A
Lipids are transported in combination with proteins
5
Q
What is LDL?
A
Low Density Lipoproteins
6
Q
What do LDL’s do?
A
Transport cholesterol from liver to cells
7
Q
What do LDL’s contribute to?
A
Major factor contributing to atheroma formation
8
Q
What is HDL?
A
High Density Lipoprotein
9
Q
What do HDL’s do?
A
Transport cholesterol away from the peripheral cells to liver
Catabolism in liver and excretion
10
Q
Which is the “good” lipoprotein?
A
HDL
11
Q
What are the 8 steps to atheroma formation?
A
- Starts with endothelial injury in an artery
- Inflammation results in the area of injury: increased CRP
- Tunica intima and tunica media
- Accumulation of monocytes, macrophages, and lipids
- Smooth muscle cells proliferate
- Now the plaque has formed
- Inflammation persists
- Platelets adhere to rough surface of arterial wall
- Thrombus forms
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
13
Q
What are the 3 nonmodifiable risks for Atherosclerosis?
A
- Age
- Sex
- Genetic or familial factors
14
Q
What are the 6 modifiable risks for Atherosclerosis?
A
- Obesity
- Sedentary Lifestyle
- Cigarette Smoking
- Diabetes mellitus
- Poorly controlled hypertension
- Combination of oral contraceptives and smoking
15
Q
What diagnostic test can be performed to investigate Atherosclerosis?
A
Blood test for serum lipid levels
16
Q
Name the 8 treatments of Atherosclerosis
A
- Weight loss
- Increase exercise
- Lower total serum cholesterol and LDL levels by dietary modification
- Reduce Sodium intake (leads to #5)
- Control Hypertension
- Cessation of Smoking
- Antilipidemic drugs
- Surgical intervention (i.e. coronary artery bypass grafting)
17
Q
What are antilipidemic drugs?
A
They prevent or counteract the accumulation of fatty substances in blood.
18
Q
What is the cause of angina pectoris?
A
When there is a deficit of oxygen to meet myocardial needs.
19
Q
What are the 3 types of Angina Pectoris?
A
- Classic or exertional angina
- Variant Angina
- Unstable Angina
20
Q
Define Classic or Exertional Angina
A
Pain with activity, relieved by rest
21
Q
Define Variant Angina
A
Vasospasm occurs at rest
22
Q
Define Unstable Angina
A
Prolonged pain at rest
May precede myocardial infarction
23
Q
Etiology of Angina Pectoris (4)
A
- Insufficient arterial blood
- Severe anemia
- Respiratory Disease
- Activities which increase demand for blood
24
Q
What could cause there to be insufficient arterial blood? (4)
A
- Arteriosclerosis
- Atherosclerosis
- Vasospasm
- Myocardial hypertrophy
25
What is Myocardial hypertrophy
When the heart grows but the vessels do not
26
What activities increase demand for blood? (6)
1. Exercise
2. Emotional stress
3. Respiratory infection with fever
4. Exposure to weather extremes
5. Exposure to pollution
6. Eating a large meal
27
Clinical Manifestations of Angina Pectoris (4)
1. Typically recurrent, intermittent brief episodes of sub-sternal chest pain triggered by physical or emotional stress
2. Pallor
3. Diaphoresis
4. Nausea
28
Do the episodes remain the same throughout the duration of Angina Pectoris?
Attacks vary in severity and duration but become more frequent and longer as disease progresses
29
Describe the pain of angina pectoris?
- Tightness or pressure
| - May radiate to left arm and neck
30
Define Diaphoresis
Sweaty
31
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?
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)
32
Myocardial Infarction: Pathophysiology
| When does it occur?
When a coronary artery is totally obstructed
33
Myocardial Infarction: Pathophysiology
| What does it result in?
Cell death of the heart wall
34
Myocardial Infarction: Pathophysiology
| What is the most common cause?
Atherosclerosis
35
Myocardial Infarction: Pathophysiology
| Name the 3 ways an infarction can develop?
1. Thrombus from atheroma may obstruct artery
2. Vasospasm in the presence of partial obstruction
3. Embolus
36
Define Embolus
A traveling clot from a remote site
37
Myocardial Infarction: Pathophysiology
| What determines the damage caused by the infarct?
Size and location of the infarct
38
Myocardial Infarction: Pathophysiology
| What is released into the system during this time?
Cardiac Enzymes - They in turn are a diagnostic tool
39
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?
Permanent damage may be prevented if blood is restored within 20-30m of the episode
40
Myocardial Infarction: Pathophysiology
| What happens if blood is not restored?
Fibrous tissue replaces cardiac tissue
41
What are the 4 warning signs of a myocardial infarction?
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
Clinical Manifestations of Myocardial Infarctions: Hallmark
Sudden, sub-sternal chest pain radiating to the left arm, shoulder, jaw, or neck
43
How do you describe the type of pain that the Hallmark sign of Myocardial Infarctions is marked by?
1. Severe
2. Steady
3. Crushing
44
Do vasodilators relieve the pain of myocardial infarctions?
No, they do not yield any relief.
45
What signifies a silent myocardial infarction?
What type of discomfort might this patient experience?
Who suffers from these more men or women?
1. No Pain
2. Patient may experience gastric discomfort
3. More common presentation in women
46
What are the other clinical manifestations of a myocardial infarction? (9)
1. Pallor
2. diaphoresis
3. nausea
4. dizziness
5. weakness
6. dyspnea
7. Anxiety/ fear
8. Hypotension
9. Low-grade Fever
47
Define Diaphoresis
Sweating, excessively
48
Define Dyspnea
Labored Breathing
49
What diagnostic tests are done to diagnose myocardial infarctions? (6)
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
What are some complications of myocardial infarctions? (5)
1. Sudden Death
2. Cardiogenic shock
3. Congestive heart failure
4. Rupture of necrotic heart tissue/ cardiac tamponade
5. Thromboembolism causing cerebrovascular accident
51
Define Cardiac Temponade
the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and increased pressure in the cardiac cavity.
52
What is the treatment for a myocardial infarction? (7)
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
Define Analgesic Drugs
Pain Relievers
54
Define Cardiac Dysrhythmia
Deviations from normal cardiac rate or rhythm
55
What is cardia dysrhythmia caused by?
1. Electrolyte abnormalities (Na, K, or Ca)
2. Fever
3. Hypoxia
4. Stress
5. Infection
6. Drug toxicity
56
What is Electrocardiography used for?
To monitor the conduction system
57
How does a cardiac dysrhythmia affect the efficiency of the hearts pumping cycle?
It reduces the efficiency of the hearts pumping cycle
58
What is the SA node?
The pacemaker of the heart
59
Can the rate of the SA node be altered?
Yes
60
Define Bradycardia
regular but slow heart rate <60 bpm
61
Define Tachycardia
regular but rapid heart rate >100 bpm
62
What is Sick Sinus Syndrome
marked by altering bradycardia and tachycardia, often requires a mechanical pacemaker
63
Define PAC or PAB
PAC: Premature Atrial Contractions
PAB: Premature Atrial Beats
Extra contraction or ectopic beats from irritable atrial muscle cells
64
# Define Atrial flutter
- What is the range of atrial BPM?
| - What slows down atrial or ventricular rate?
Atrial heart rate of 160 to 350 beats/min
| AV node delays conduction - ventricular rate slower
65
Atrial Fibrillation
- What's the bpm?
- What does it cause?
- What is at risk?
- Rate over 350 bpm
- Causes pooling of blood in the atria
- Thrombus formation is a risk
66
Define Heart Block
| - What is it an abnormality of?
An AV node abnormality.
| When conduction is excessively delayed or stopped at the AV node or bundle of His
67
What is a First degree heart block?
Conduction delay between atrial and ventricular contractions
68
What is a Second degree heart block?
Every second to third atrial beat is dropped at the AV node
69
What is a Third degree heart block?
No transmission from atria to ventricles
70
Bundle Branch Block
Ventricular conduction abnormality
| Interference with conduction in one of the bundle branches
71
Ventricular tachycardia
likely to reduce cardiac output as reduced diastole occurs
72
Ventricular fibrillation
- What happens to the muscle fibers?
- What occurs if this is not treated immediately?
- The muscle fibers contract independently and rapidly
| - Cardiac standstill occurs if not treated immediately
73
Define PVC
Premature ventricular contractions (PVC)
| Additional beats from ventricular muscle cells or ectopic pacemaker
74
What could PVC potentially lead to?
Ventricular fibrillation
75
During the consumption of which drug could a PVC occur and be considered normal with?
Caffeine, coffee
76
# Define Cardiac arrest
- How do the impulses of the heart act?
| - How do they present on the ECG?
Cessation of all heart activity
- No conduction of impulses
- Flat ECG
77
What are the reasons for Cardiac arrest? (7)
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
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?
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
CHF Definition
Heart is unable to pump out sufficient blood to meet metabolic demands of the body
80
What is CHF usually a complication of?
| When could CHF begin?
```
-Another cardiopulmonary condition: CAD is the leading cause.
Conduction problems
Valvular problems
Pulmonary disease
-Post infarction
```
81
How does the body balance out the effects of CHF and its own needs?
Various compensatory mechanisms maintain cardiac output. Some of these aggravate the condition.
82
- 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
- Decreases.
- It decreases.
- Lethargic and fatigued
- Mild acidosis develops.
83
What develops due to the need for oxygen and glucose in CHF?
Back up and congestion develop as coronary demands for oxygen and glucose are not met.
84
How does CHF affect blood flow into and out of the ventricles?
Output from the ventricle is less than the inflow of blood
85
What happens to the congestion in the venous circulation during CHF?
Congestion in venous circulation drains into the affected side of the heart.
86
Define Cor Pulmonale
Right sided heart CHF dur to pulmonary disease
87
What are the forward effects of CHF (3)? What are these effects similar to?
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
What are the compensation mechanisms in CHF?
1. Tachycardia
2. Cutaneous and visceral vasoconstriction
3. Daytime oliguria
89
Define Oliguria
low urine
90
What problem is left-sided heart failure related to?
Pulmonary Congestion
91
What occurs during left-sided heart failure due to fluid accumulation in the lungs?
Dyspnea and Othopnea (both mean shortness of breath)
92
What occurs during left-sided heart failure due to fluid irritating the respiratory passages?
Coughing
93
What occurs during left-sided heart failure that indicates acute pulmonary edema?
Paroxysmal Nocturnal Dyspnea
94
When does Paroxysmal Nocturnal Dyspnea usually develop?
During sleep
95
What does Paroxysmal Nocturnal Dyspnea lead to?
Excess fluid in lungs frequently leads to infections such as pneumonia
96
Where is the edema when right sided heart failure occurs?
Dependent edema occurs in feet, legs, or buttocks
97
How is the jugular vein affected by right sided heart failure? What does this lead to?
Increased pressure in jugular vein occurs. This leads to distention
98
What swells during right sided heart failure?
What are the proper names from these swollen parts?
What does this cause?
- Liver, spleen, and fluid in the peritoneal cavity
- Hepatomegaly, splenomegaly, and ascites
- Hepatomegaly and splenomegaly cause digestive disturbances.
99
What is ascites marked by?
Marked by abdominal distention
100
What is ascites?
Complication of Right sided heart failure when fluid accumulates in the peritoneal cavity
101
What are the symptoms of acute right sided heart failure (4)?
1. Flushed face
2. Distended neck veins
3. Headache
4. Visual disturbances
102
What are the treatments for CHF?
1. Treat the underlying problem if possible
| 2. Reducing workload on heart
