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DPT (Cumulative Final) > CV Diseases > Flashcards

CV Diseases Flashcards

1
Q

What is the definition of hypertension?

A

A transitory or sustained elevated systemic arterial blood pressure.

Resting SBP > 140 (and/or)
Resting DBP > 90 (and/or)
Taking Antihypertensive Medication

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2
Q

What is a normal level BP for adults?

A

SBP: 120-139 (and) DBP: <80

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3
Q

What is a BP level for “Prehypertension”?

A

SBP: 120-139 (or) DBP: 80-89

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4
Q

What is BP level for “Stage 1 Hypertension”?

A

SBP: 140-159 (or) DBP: 90-99

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5
Q

What is BP level for “Stage 2 Hypertension”?

A

SBP: >160 (or) DBP: >100

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6
Q

What was the leading factor for global mortality in 2019?

A

Hypertension

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7
Q

What percentage of the population inherent the risk of developing HTN at 65, if there BP: <140/90?

A

95%

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8
Q

What are some health risk factors associated with Hypertension?

A
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9
Q

In Atherogenesis, Endothelial injury from LDL entry & modification causes what?

A

Inflammation.

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10
Q

In Atherogenesis, when Macrophages engulf LDL, what do they become?

A

“Foam Cells” (core can become necrotic)

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11
Q

In Atherogenesis, when a fibrous cap covers a necrotic core, what is the outcome?

A

Atherosclerotic Plaque

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12
Q

What is Atherosclerosis?

A

Hardening and narrowing of the arteries.

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13
Q

When the endothelium (arteries) is damaged what is the pathophysiology (risk)?

A

Predisposes to atherosclerosis and other vascular pathologies.

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14
Q

What are some major risk factors (causes) for Atherosclerosis?

A

Smoking, Hypertension, Sedentary Lifestyle, Cholesterol Levels

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15
Q

What is an optimal Total Cholesterol Level?

A

Under 200

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16
Q

What is an optimal HDL Cholesterol (“the good kind”) Level?

A

Over 60

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17
Q

What is an optimal LDL Cholesterol (“the bad kind”) Level?

A

Under 70 (normal populations)
Under 100 (diabetics & heart disease populations)

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18
Q

What is an optimal Triglycerides Level?

A

Under 150

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19
Q

How do you calculate your cholesterol ratio?

A

Divide your Total Cholesterol by your HDL.

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20
Q

What is an optimal Cholesterol Ratio?

A

Less than 3.5 to 1

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21
Q

What does a higher Cholesterol Ratio mean?

A

Higher risk for heart disease.

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22
Q

What is an average Total Cholesterol/HDL Ratio for women?

A

Average: 4.44

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23
Q

What is an average Total Cholesterol/HDL Ratio for men?

A

Average: 4.97

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24
Q

What are some other “modifiable” contributing risk factors for Atherosclerosis?

A

Diabetes, Obesity, Stress, Sleep Apnea, Metabolic Syndrome

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25
Q

What are some other “non-modifiable” contributing risk factors for Atherosclerosis?

A

Increased Age, Gender, Family History/Heredity, Race/Ethnicity

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26
Q

How much more likely are men to have a MI before 55 then female?

A

6x more likely.

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27
Q

What is hypertension known as?

A

The Silent Killer

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28
Q

What are some signs of severe Hypertension?

A

Headache, Dizziness, Palpitations, Easy Fatigability, Nose Bleeds (Epistaxis), Blurring of Vision

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29
Q

What are some signs & symptoms of Chronic Heart Disease?

A

History of heart failure, renal disease, and endocrine disorder + past/present use of medications & lifestyle habits.

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30
Q

How should you go about getting an accurate BP reading over time?

A

Use the avg. of two measurements over the course of two or more visits.

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31
Q

When getting someones BP, how long should caffeine & smoking be avoided for prior?

A

At least 30 min.

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32
Q

Is BP Higher or Lower with a full bladder & by how much?

A

Higher when full (SBP can increase by 10-15 mmHg)

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33
Q

What HTN population would Antihypertensive drugs be indicated?

A

Stage 1 Hypertension

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34
Q

What HTN population would “two-drug combination” Antihypertensive drugs be indicated?

A

Stage 2 Hypertension

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35
Q

What do ACE (angiotensin converting enzyme) Inhibitors & ARB’s (angiotensin II receptor blockers) do & when are they used?

A

Reduce BP (used for HF, Diabetes, Chronic Kidney Disease, Recurrent Stroke Prevention)

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36
Q

What do Beta-Blockers do & when are they used?

A

Reduce BP (used for antihypertensive therapy & high-risk populations for CHO and diabetes)

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37
Q

What do Calcium Channel Blockers do & when are they used?

A

Reduce BP (used for antihypertensive therapy: high-risk populations for CHD & diabetes)

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38
Q

What do Diuretics do & when are they used?

A

Reduce BP (compelling indications when used for antihypertensive therapy)

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39
Q

How much can chronic aerobic exercise training reduce resting BP?

A

5-7 mmHg

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40
Q

What is the FITT (aerobic) prescription for HTN patients?

A

F: 5-7 days/wk
I: Moderate (40-59% VO2)
T: 30-60m Continuous
T: Primary Aerobic / Secondary Resistance

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41
Q

What is the FITT (resistance) prescription for HTN patients?

A

F: 2-3 days/wk
I: 60-70% 1RM
T: 8-12 reps per 10-15 sets
T: Major Muscle Groups

42
Q

What is the FITT (flexibility) prescription for HTN patients?

A

F: 2-3 days/wk
I: Point of tightness or slight comfort
T: Static, Dynamic, PNF
T: 10-30 sec holds / 2-4 reps

43
Q

How often should you recheck BP for Prehypertension patients?

A

1 Year

44
Q

How often should you recheck BP for Stage 1 Hypertension patients?

A

within 2 months

45
Q

How often should you recheck BP for Stage 2 Hypertension patients?

A

within 1 month

46
Q

What is Angina?

A

Imbalance in supply & demand of myocardial oxygen.

47
Q

What is Chronic Stable Angina?

A

A pattern of symptoms that have been
unchanged for 6 or more weeks

48
Q

What are they symptoms of Chronic Stable Angina?

A

-usually during physical exertion
-Not a surprise, and episodes of pain tend to be alike
-Usually lasts a short time (~5 minutes or less)
-May feel like gas or indigestion
-May feel like chest pain that spreads to the arms, back, or other area

49
Q

How can pain from Chronic Stable Angina be relieved?

A

Rest or medication (sublingual nitroglycerin)

50
Q

What are the 2 types of Acute Coronary Artery Syndrome?

A
  1. Unstable angina
  2. Acute myocardial infarction
51
Q

What are symptoms of UNstable Angina Pectoris?

A

-Chest pain that is SEVERE and NEW ONSET
-Chest pain comes on by surprise
-Chest pain that changes or worsens
-Pain is NOT relieved by rest or medicine
-Vessel occlusion (blockage) > 10min

52
Q

What are 3 features of chest pain associated with UNstable Angina Pectoris?

A
  1. occurs at rest/sleeping (minimal exertion), >10 minutes
  2. Crescendo pattern (i.e., distinctly more intense, prolonged, or frequent than before).
  3. Cardiac Troponin (cTn) levels is NORMAL
53
Q

How is Angina Pectoris diagnosed?

A
  1. History
  2. 2+ mm of ST segment depression
  3. Exercise stress test
  4. Cardiac catherization (gold standard)
54
Q

What is Cardiac Catherization

A

Procedure that examines the inside of your hearts blood vessels using special X-rays called angiograms
-Dye is injected into blood vessels using a catheter.

55
Q

What is the primary concern for management of Angina?

A

To reperfuse (restore bloodflow) or improve oxygenation to the area of the heart not receiving enough blood and oxygen

56
Q

What medications can be used to manage Angina?

A

Asprin
Nitroglycerin/nitrates
morphine
beta blockers

57
Q

What are Post or Preventive treatments for UNstable Angina Pectoris?

A

-Risk factor education
-medications
-Angioplasty- surgically opening up the blood vessels
-CABG (1-4 bypass grafts)- open heart surgery to replace blood vessels

58
Q

What is Myocardial Infarction

A

Cell death usually due to thrombosis or coronary artery

59
Q

What is the pathology of Myocardial Infarction?

A

Impaired cardiac output (depends on amount/location of heart tissue death

60
Q

What causes Myocardial Infarction?

A

Atherosclerosis
Blood clot (thrombosis)
Vasospasm
Anemia

61
Q

Where do blood clots form in the case of a Myocardial Infarction?

A

Inside a coronary artery or one of it’s branches

62
Q

What happens when blood clot forms in a coronary artery?

A

-Blocks the blood flow to a part of the heart

63
Q

How does a blood clot form inside a coronary artery?

A
  1. Build-up of atheroma (fatty deposits/scar tissue) within the lining of the artery
  2. A crack (plaque rupture) develops exposing the inner core of the plaque to the blood triggering the clotting mechanism in the blood to form a clot
64
Q

What is Coronary Artery Vasospasm?

A

A sudden, intense vasoconstriction of an epicardial coronary artery that causes vessel occlusion
- can occur spontaneously without any identifiable cause

65
Q

What is Prinzmetal’s angina and what is it caused by?

A

Severe chest pain that occurs at rest.
Caused by a coronary artery vasospasm and can lead to an MI

66
Q

When do most pain patterns occur with a Coronary Vasospasm?

A

Early morning hours

67
Q

What are known triggers of coronary vasospasm?

A

Cocaine
Tobacco use
Histamine
Serotonin

68
Q

What are the 3 types of Angina?

A
  1. Stable Angina - Classic angina/Effort angina
  2. Unstable Angina- Crescendo angina
  3. Variant angina- Prinzmetal angina
69
Q

What is Anemia?

A

Lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues
Low number of RBC

70
Q

How does Anemia affect the heart?

A

-Significantly decreases oxygen delivery to the myocardium
-Increases the myocardial oxygen demand by requiring a higher stroke volume and HR
-Worse outcomes in patients with MI

71
Q

Pathogenesis of MI

A

-Chest discomfort (angina pectoris)
- Dysrhythmia/arrhythmia (irregular heart beat)
-Death of heart tissue
-Reduction in cardiac output
-Depending on severity: decreased endurance and decreases/impaired renal function

72
Q

Distinguishing signs/symptoms of MI

A

-Squeezing pressure
-Discomfort is NOT relieved by a change in position
-Angina pectoris lasting for 30 minutes or more
-Angina pectoris unrelieved by rest or nitroglycerin

73
Q

Women experience these symptoms more than men during and MI

A

Atypical chest discomfort
- neck/shoulder pain, vomiting, fatigue, dyspnea with or WITHOUT chest discomfort

74
Q

What must cTn level in blood be to diagnose Acute MI?

A

≥ 0.01 ng/ml

75
Q

Diagnosis of acute MI must include AT LEAST 1 of the following

A

Chest pain persisting for >30 min
Vessel occlusion >60 min → necrosis
EKG showing new elevated ST-segment (STEMI) MI, T-wave changes or LBB
Development of pathological Q waves
Imaging evidence
Identification of a thrombus via angiography

76
Q

On an EKG what is a sign of previous myocardial infarction?

A

-Pathologic Q waves
Q wave ≥ 30ms
-Inverted T wave

77
Q

Medication for management of Acute MI

A

-Anti-ischemic therapy- O2, nitroglycerin, β-blocker
-Antiplatelet therapy (aspirin)
-Anticoagulants (heparin)
-Pain relief (morphine)

78
Q

Reperfusion therapy options for management of Acute MI

A

Percutaneous transluminal coronary angioplasty (PTCA)
Coronary artery bypass graft surgery (CABG)

79
Q

Lifestyle modifications for treatment of Acute MI

A

Diet
Exercise
Smoking
Diabetes control
Managing depression

80
Q

Surgical treatments for Acute MI

A

Aortic balloon pump
Swan-Ganz Catheter
Angioplasty/CABG
LVAD – left ventricular assist device
ICD – Implantable Cardioverter Defibrillators
Heart transplant

81
Q

Common medications given outpatient for Acute MI

A
82
Q

Factors linked to poor prognosis Post-MI

A

-Left ventricular ejection fraction (LVEF)
≤ 35% or congestive heart failure (CHF) due to diastolic dysfunction
-Poor exercise capacity: <5 METs
-Evidence of extensive myocardial ischemia during exercise or pharmacologic stress testing
-Severe coronary artery disease (CAD)

83
Q

Why do we stress test after Acute MI?

A

-Evaluate symptoms, ischemia
-Determine need for coronary angiography
-Determine effectiveness of medical therapy
-Evaluate risk/prognosis
-Determine exercise therapy

84
Q

What do we look for during a stress test after an MI that tells us the patient is at risk?

A

Failure of SBP to increase 10mmHg during Exercise

85
Q

Absolute contraindications to stress testing after an Acute MI

A

-Acute MI within 2 days
-Unstable angina
-Uncontrolled cardiac arrhythmias

86
Q

Cardiologist preferences on timing of stress testing after Acute MI

A

< 7 days post-MI: submax test
≥ 7 days post-MI: symptom-limited max
14 - 21d or > 6 weeks, post-MI

87
Q

Types of stress testing after Acute MI

A

-Predischarge exercise test (submax effort)
-Standard exercise test (symptom-limited maximal effort)
-Cardiopulmonary exercise test (symptom-limited maximal effort)

88
Q

Effects of exercise training vs. standard percutaneous coronary intervention (PCI) with stenting in patients with Stable Coronary Artery Disease

A

-exercise training associated with higher event-free survival and increased maximal oxygen uptake
-reduced rehospitalizations and revascularizations

89
Q

Activities emphasized during inpatient cardiac rehabilitation

A

progression:
sit
stand
Aerobic: Walk short distances
Frequency: 2-4x daily
Flexibility: active ROM exercises for major joints (gentle)

90
Q

When can patients begin outpatient cardiac rehabilitation?

A

A few days to 2 weeks post-hospital discharge

91
Q

What activity is added during outpatient cardiac rehab?

A

Strength training and more aggressive aerobic training

92
Q

Aerobic FIIT guidelines for Acute MI

A

F: 4-7 days/wk
I: RPE 11–14 (+20 bpm above RHR)
T: Start: 5–10m / Goal: 20-60m
T: Aerobic: rhythmic, large muscle groups

93
Q

Strength training FIIT guidelines for Acute MI

A

F: 2-3 sessions/week (non- consecutive)
I: RPE 11–14 (60%–80% 1RM)
(8-10 exercises, 12-15 reps ea.) No OH!

94
Q

What is a hallmark of acute MI?

A

Myocardial necrosis (heart cell death)

95
Q

How long does it take for myocardial necrosis to occur?

A

Vessel occlusion persisting for >60 min

96
Q

Preferred treatment for MI

A

Prompt perfusion of the occluded vessel

97
Q

What is the basis for secondary prevention of future cardiac events?

A

Comprehensive cardiac rehab

98
Q

How long does it take for Sudden Cardiac Death (SDC) to occur?

A

Generally within 1 hour of symptom onset.

99
Q

What are usual causes of death for SDC?

A

Ventricular Tachycardia & Ventricular Fibrillation.

100
Q

How wide would the QRS complex be in a case of V-TACH?

A

Wide & Bizarre (> 0.12 secs)

101
Q

During Ventricular Fibrillation, how would describe the EKG properties?

A

“quivering”

102
Q

What is the difference between MI & SCD?

A

MI = circulation problem
SCD = electrical problem

DPT (Cumulative Final) (19 decks)

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