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Cardiopulmonary > Coronary Heart Disease & Cardiac Surgery > Flashcards

Coronary Heart Disease & Cardiac Surgery Flashcards

1
Q

Is coronary disease a plumbing or pumping problem?

A

plumbing problem - poor delivery of oxygenated blood to myocardium

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2
Q

how is valve disease defined?

A

reduced or inefficient blood flow

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3
Q

Is heart failure a plumbing or pumping problem?

A

pumping problem - systolic or diastolic dysfunction

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4
Q

when do people become symptomatic with coronary artery disease?

A

only when their arteries become >80% occluded

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5
Q

what are the symptoms of coronary artery disease?

A

decreased exercise tolerance 2° can’t squeeze effectively, fatigue, angina, heart failure, and death

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6
Q

what is the process of coronary artery disease?

A

irregularly distributed lipid deposits - atherosclerotic plaque. deposits in intimal layer of medium/large arteries

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7
Q

what is the progression of coronary artery disease?

A

fatty streaks lead to plaque build up –> leads to thrombus formation –> progressive narrowing of vessel diameter –> can progress to either full occlusion or clots can dislodge and lead to emboli

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8
Q

what is hyperlipidemia?

A

elevation in blood lipid levels

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9
Q

what is a major risk factor for contributing to CAD?

A

hyperlipidemia

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10
Q

what is the more important indication of risk for CAD?

A

ratio of total cholesterol to HDL

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11
Q

What is the “good” and “bad” cholesterol?

A

good = HDL, high density lipoprotien inversely related to CAD. bad = LDL, low density and contributes to atherosclerotic plaque formation

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12
Q

what is clinical hypertension?

A

> 130/80

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13
Q

what is normal BP?

A

< 120 / < 80

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14
Q

what is prehypertension?

A

120 - 139 / 80 - 89

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15
Q

what is stage I hypertension?

A

140 - 159 / 90 - 99

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16
Q

what is stage II hypertension?

A

> 160 / >100

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17
Q

how does CAD present symptomatically?

A

SOB, postural hypothension, edema if enough to affect the pump, angina at rest (very bad sign), angina with exertion - starving tissue of oxygen

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18
Q

what is myocardial ischemia?

A

lack of blood/oxygen *what we care about

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19
Q

what are the types of myocardial ischemia?

A

prinzmetal angina, atypical angina, stable angina, unstable angina

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20
Q

what is Prinzmetal (variant) angina?

A

**NOT CAD // vasospasm that occurs in the coronary arteries, exclusively at rest in the morning, not associated w/ exertion, relieved w/ nitroglycerin, vasodilators, especially calcium channel blockers

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21
Q

what is increased diastolic pressure associated with?

A

increase in mortality rate because there is not enough relaxation / perfusino of coronary arteries

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22
Q

When someone is experiencing Prinzmetal angina, how will it present on an EKG?

A

it will look like an MI due to vasospasm, but it is not.

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23
Q

what is atypical angina?

A

may not present as pain, may present as discomfort, pressure, squeezing feeling, heaviness, burning, indigestion. **women far more likely to experience this than men

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24
Q

what is angina?

A

imbalance of supply and demand, substernal pressure, squeezing/tightness/crushing sensation

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25
Q

what is stable angina?

A

occurs w/ predictable level of activity, emotional stress/tension, anything that increases myocardial oxygen demand, reproducible, typical HR associated w/ onset

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26
Q

Can you exercise with stable angina?

A

yes, you’re aware of the level of exertion before/after your angina starts. determined w/ exercise stress test. exericse can increase threshold.

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27
Q

what is the rate pressure product and how do you calculate it?

A

HR x SBP = RPP take at onset of chest pain // measurement of the heart’s rate and systolic blood pressure, which is the maximum pressure blood exerts on vessel walls.

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28
Q

what is stage 1 on the angina scale?

A

onset of angina, mild but recognizable symptom familiar to patient

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29
Q

what is stage 2 on the angina scale?

A

some pain, moderately severe, uncomfortable but tolerable

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30
Q

what is stage 3 on the angina scale?

A

severe anginal pain at level where pt wants to stop activity

31
Q

what is stage 4 on angina scale?

A

unbearable chest pain

32
Q

how do you diagnose CAD?

A

typically diagnosed w/ exercise stress test, diagnostic test confirms atherosclerosis through cardiac catheterization / coronary angiography

33
Q

what do you do for patients who can’t perform an exercise stress test?

A

pharmacologic stress testing - give medications to a patient to simulate exercise when the patient isn’t, can be very uncomfortable.

34
Q

what are the two types of pharmacologic stress testing?

A

induce coronary artery vasodilation to highlight stenosed vessels/areas of poor perfusion OR stimulate exercise response by increasing HR/contractility in myocardial oxygen demand

35
Q

what is acute coronary syndrome?

A

a spectrum of conditions such as: unstable, NSTEMI, STEMI, sudden cardiac death. Greater pace of instability with greater demand

36
Q

how do you treat ACS?

A

getting blood flow, opening vessels, decreasing clot response

37
Q

what is unstable angina?

A

presence of signs/symptoms of inadequate blood supply to myocardium in absence of typical demands – requires quick recognition and referral for treatment

38
Q

what are clinical warning signs?

A

angina at rest, occurrence of typical angina at sig. lower level, change in previous stable patter, longer than 20min, loss of myocardial reserve seen w/ drop in BP or increase in HR in activity levels previously well tolerated

39
Q

What’s the difference between Prinzmetal vs. Unstable angina?

A

Prinzmetal is usually not severe and is relieved with minor activity, unlike unstable angina

40
Q

what is the difference between angina and MI?

A

angina caused by transient lack of blood flow, no heart muscle damage and relieved w/ rest or nitro. Infarctions are when actual tissue death occurs.

41
Q

what leads to a myocardial infarction?

A

Myocardium continues at low O2, critical point reached where tissue can no longer sustain, tissue necrosis occurs

42
Q

what is the most common cause of a MI?

A

prolonged myocardial ischemia precipitated by occlusive coronary thrombus at site of pre-existing plaque

43
Q

what are other causes of an MI?

A

embolization, spontaneous coronary artery dissection, trauma, metabolic/hematologic disorders, cocaine, other coronary vasospasm

44
Q

what are the two types of MI?

A

STEMI (ST elevation MI) and NSTEMI (non-ST elevation MI)

45
Q

What is a STEMI?

A

transmural injury, full or near thickness. occurs distal to occluded artery, extent of injury influenced by presence of collateral, defined by EKG criteria

46
Q

What is a NSTEMI?

A

presents like unstable angina, diagnosed by increase in troponin, may or may not see ST changes, may see T wave inversion

47
Q

how does an MI present?

A

sharp pain that doesn’t respond to rest or nitroglycerin, EKG changes at rest, abnormal lab values, blockage confirmed in cath lab

48
Q

what biomarkers are most commonly used for diagnosis of cardiac injury?

A

creatine kinase and troponins* (*gold standard for myocardial damage)

49
Q

What does creatine kinase tell us regarding MIs?

A

rises in serum 4-9 hours after onset of chest pain, peaks in ~24 hours, returns to baseline in 48-72 hours. early clearance is better for detection of reinfarction, meaning if CKMB is found elevated days later it indicates a 2nd event

50
Q

what do troponins tell us regarding MIs?

A

Trop. I rises in 2-3 hours, peaks in 12-24 hours, normal in 4-7 days. Trop T. rises in 2-3 hours, peaks in 10-24 hours, normal in 10-14 days. 3 sets taken 8 hours apart to monitor evolving MI.

51
Q

what are the different zones in an MI?

A

zone of infarction, zone of hypoxic injury, zone of ischemia

52
Q

what is the zone of infarction?

A

where the injury occurs, the tissue is dead here and is not coming back

53
Q

what is the zone of hypoxic injury?

A

tissue is still viable and can ome back if blood flow is restored, but there is still some death

54
Q

what is the zone of ischemia?

A

there is a lack of blood flow but it can be opened, no damage YET

55
Q

what is cardiac catheterization?

A

catheter introduced to left side of heart, arterial access via radial or femoral artery. used to confirm dx of CAD or MI, allows interventions to open.

56
Q

what are some complications following an MI?

A

damage to myocardium leading to impaired mechanics, persistent angina/arrhythmias, cardiogenic shock - persistent hypotension

57
Q

what is Atherosclerotic Occlusive Disease (AOD)?

A

same atherosclerotic process as CAD // obstruction of large/medium sized arteries supplying blood to one or more extremities

58
Q

what causes intermittent claudication?

A

ischemia occuring w/ exercise because of supply and demand, our muscles demand more oxygen while we exercise and if we have an occusion in our extremities everything below that occlusion won’t get the oxygen it needs so pain occurs.

59
Q

what causes PVD?

A

*atherosclerosis, blood clots, trauma, anatomical anomalies, infection

60
Q

what is PAD/PVD?

A

chronic occlusive arterial vessel disease most commonly from atherosclerotic plaque obstructing blood flow

61
Q

what does the presence of PAD/PVD indicate?

A

strong marker for future cardiovascular problems. pt w/ PAD 20x greater in those w DM. DM complications account for 45% of non-traumatic LE amputations

62
Q

what is the clinical presentation of PAD?

A

claudication, poor capillary refill, cool to touch, potential atrophy, hairless, minimal edema, slow nail growth, pain at night w/ elevation, decreased or absent pulses, pallor w elevation

63
Q

how do you diagnose PAD?

A

pt history, tests of circulation, treadmill exercise test, imaging (doppler, contrast ateriography, CT/MRI/MRA)

64
Q

what does a score of 1 on the claudication scale indicate?

A

initial, minimal discomfort

65
Q

what does a score of 2 on the claudication scale indicate?

A

moderate pain, bothersome

66
Q

what does a score of 3 on the claudication scale indicate?

A

intense pain

67
Q

what does a score of 4 on the claudication scale indicate?

A

excruciating pain, cannot continue

68
Q

what do PTs look for when working with someone with PAD?

A

5 P’s - Pain, Pallor, Paresthesia, Paralysis, and lack of Pulse. requires immediate thrombolysis and revascularization – indiciative of complete occlusion of blood flow

69
Q

when would surgical interventions be indicated for PAD?

A

if it interferes with function

70
Q

what are some surgical interventions for PAD?

A

endarterectomy, by-pass grafting, angioplasty, stent, amputation

71
Q

what are sternal precautions?

A

no WB thru UE, no lifting >10lbs, no shoulder flexion/abduction beyond 90°, splinted coughing, log rolling, no driving/sitting behind airbag

72
Q

what is phase I of cardiac rehab?

A

2-4x/day for first 3 days, <120bpm intensity or >13/20 RPE, 3-5min bouts of walking. when continuous ambulation reaches 10-15min, intensity can be increased within HR/RPE levels. (if 30min continuous ambulation, can increase intensity too)

73
Q

why is pneumonia a risk following cardiac surgery?

A

PAIN* limits ability to take normal breath –> hypoventilation –> atelactasis (lung collapse) and can’t cough effectively –> secretion retension –> atelactasis and pneumonia

Cardiopulmonary (9 decks)

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