CV Diseases Flashcards
What is the definition of hypertension?
A transitory or sustained elevated systemic arterial blood pressure.
Resting SBP > 140 (and/or)
Resting DBP > 90 (and/or)
Taking Antihypertensive Medication
What is a normal level BP for adults?
SBP: 120-139 (and) DBP: <80
What is a BP level for “Prehypertension”?
SBP: 120-139 (or) DBP: 80-89
What is BP level for “Stage 1 Hypertension”?
SBP: 140-159 (or) DBP: 90-99
What is BP level for “Stage 2 Hypertension”?
SBP: >160 (or) DBP: >100
What was the leading factor for global mortality in 2019?
Hypertension
What percentage of the population inherent the risk of developing HTN at 65, if there BP: <140/90?
95%
What are some health risk factors associated with Hypertension?
In Atherogenesis, Endothelial injury from LDL entry & modification causes what?
Inflammation.
In Atherogenesis, when Macrophages engulf LDL, what do they become?
“Foam Cells” (core can become necrotic)
In Atherogenesis, when a fibrous cap covers a necrotic core, what is the outcome?
Atherosclerotic Plaque
What is Atherosclerosis?
Hardening and narrowing of the arteries.
When the endothelium (arteries) is damaged what is the pathophysiology (risk)?
Predisposes to atherosclerosis and other vascular pathologies.
What are some major risk factors (causes) for Atherosclerosis?
Smoking, Hypertension, Sedentary Lifestyle, Cholesterol Levels
What is an optimal Total Cholesterol Level?
Under 200
What is an optimal HDL Cholesterol (“the good kind”) Level?
Over 60
What is an optimal LDL Cholesterol (“the bad kind”) Level?
Under 70 (normal populations)
Under 100 (diabetics & heart disease populations)
What is an optimal Triglycerides Level?
Under 150
How do you calculate your cholesterol ratio?
Divide your Total Cholesterol by your HDL.
What is an optimal Cholesterol Ratio?
Less than 3.5 to 1
What does a higher Cholesterol Ratio mean?
Higher risk for heart disease.
What is an average Total Cholesterol/HDL Ratio for women?
Average: 4.44
What is an average Total Cholesterol/HDL Ratio for men?
Average: 4.97
What are some other “modifiable” contributing risk factors for Atherosclerosis?
Diabetes, Obesity, Stress, Sleep Apnea, Metabolic Syndrome
What are some other “non-modifiable” contributing risk factors for Atherosclerosis?
Increased Age, Gender, Family History/Heredity, Race/Ethnicity
How much more likely are men to have a MI before 55 then female?
6x more likely.
What is hypertension known as?
The Silent Killer
What are some signs of severe Hypertension?
Headache, Dizziness, Palpitations, Easy Fatigability, Nose Bleeds (Epistaxis), Blurring of Vision
What are some signs & symptoms of Chronic Heart Disease?
History of heart failure, renal disease, and endocrine disorder + past/present use of medications & lifestyle habits.
How should you go about getting an accurate BP reading over time?
Use the avg. of two measurements over the course of two or more visits.
When getting someones BP, how long should caffeine & smoking be avoided for prior?
At least 30 min.
Is BP Higher or Lower with a full bladder & by how much?
Higher when full (SBP can increase by 10-15 mmHg)
What HTN population would Antihypertensive drugs be indicated?
Stage 1 Hypertension
What HTN population would “two-drug combination” Antihypertensive drugs be indicated?
Stage 2 Hypertension
What do ACE (angiotensin converting enzyme) Inhibitors & ARB’s (angiotensin II receptor blockers) do & when are they used?
Reduce BP (used for HF, Diabetes, Chronic Kidney Disease, Recurrent Stroke Prevention)
What do Beta-Blockers do & when are they used?
Reduce BP (used for antihypertensive therapy & high-risk populations for CHO and diabetes)
What do Calcium Channel Blockers do & when are they used?
Reduce BP (used for antihypertensive therapy: high-risk populations for CHD & diabetes)
What do Diuretics do & when are they used?
Reduce BP (compelling indications when used for antihypertensive therapy)
How much can chronic aerobic exercise training reduce resting BP?
5-7 mmHg
What is the FITT (aerobic) prescription for HTN patients?
F: 5-7 days/wk
I: Moderate (40-59% VO2)
T: 30-60m Continuous
T: Primary Aerobic / Secondary Resistance
What is the FITT (resistance) prescription for HTN patients?
F: 2-3 days/wk
I: 60-70% 1RM
T: 8-12 reps per 10-15 sets
T: Major Muscle Groups
What is the FITT (flexibility) prescription for HTN patients?
F: 2-3 days/wk
I: Point of tightness or slight comfort
T: Static, Dynamic, PNF
T: 10-30 sec holds / 2-4 reps
How often should you recheck BP for Prehypertension patients?
1 Year
How often should you recheck BP for Stage 1 Hypertension patients?
within 2 months
How often should you recheck BP for Stage 2 Hypertension patients?
within 1 month
What is Angina?
Imbalance in supply & demand of myocardial oxygen.
What is Chronic Stable Angina?
A pattern of symptoms that have been
unchanged for 6 or more weeks
What are they symptoms of Chronic Stable Angina?
-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
How can pain from Chronic Stable Angina be relieved?
Rest or medication (sublingual nitroglycerin)
What are the 2 types of Acute Coronary Artery Syndrome?
- Unstable angina
- Acute myocardial infarction
What are symptoms of UNstable Angina Pectoris?
-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
What are 3 features of chest pain associated with UNstable Angina Pectoris?
- occurs at rest/sleeping (minimal exertion), >10 minutes
- Crescendo pattern (i.e., distinctly more intense, prolonged, or frequent than before).
- Cardiac Troponin (cTn) levels is NORMAL
How is Angina Pectoris diagnosed?
- History
- 2+ mm of ST segment depression
- Exercise stress test
- Cardiac catherization (gold standard)
What is Cardiac Catherization
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.
What is the primary concern for management of Angina?
To reperfuse (restore bloodflow) or improve oxygenation to the area of the heart not receiving enough blood and oxygen
What medications can be used to manage Angina?
Asprin
Nitroglycerin/nitrates
morphine
beta blockers
What are Post or Preventive treatments for UNstable Angina Pectoris?
-Risk factor education
-medications
-Angioplasty- surgically opening up the blood vessels
-CABG (1-4 bypass grafts)- open heart surgery to replace blood vessels
What is Myocardial Infarction
Cell death usually due to thrombosis or coronary artery
What is the pathology of Myocardial Infarction?
Impaired cardiac output (depends on amount/location of heart tissue death
What causes Myocardial Infarction?
Atherosclerosis
Blood clot (thrombosis)
Vasospasm
Anemia
Where do blood clots form in the case of a Myocardial Infarction?
Inside a coronary artery or one of it’s branches
What happens when blood clot forms in a coronary artery?
-Blocks the blood flow to a part of the heart
How does a blood clot form inside a coronary artery?
- Build-up of atheroma (fatty deposits/scar tissue) within the lining of the artery
- 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
What is Coronary Artery Vasospasm?
A sudden, intense vasoconstriction of an epicardial coronary artery that causes vessel occlusion
- can occur spontaneously without any identifiable cause
What is Prinzmetal’s angina and what is it caused by?
Severe chest pain that occurs at rest.
Caused by a coronary artery vasospasm and can lead to an MI
When do most pain patterns occur with a Coronary Vasospasm?
Early morning hours
What are known triggers of coronary vasospasm?
Cocaine
Tobacco use
Histamine
Serotonin
What are the 3 types of Angina?
- Stable Angina - Classic angina/Effort angina
- Unstable Angina- Crescendo angina
- Variant angina- Prinzmetal angina
What is Anemia?
Lack enough healthy red blood cells to carry adequate oxygen to your body’s tissues
Low number of RBC
How does Anemia affect the heart?
-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
Pathogenesis of MI
-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
Distinguishing signs/symptoms of MI
-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
Women experience these symptoms more than men during and MI
Atypical chest discomfort
- neck/shoulder pain, vomiting, fatigue, dyspnea with or WITHOUT chest discomfort
What must cTn level in blood be to diagnose Acute MI?
≥ 0.01 ng/ml
Diagnosis of acute MI must include AT LEAST 1 of the following
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
On an EKG what is a sign of previous myocardial infarction?
-Pathologic Q waves
Q wave ≥ 30ms
-Inverted T wave
Medication for management of Acute MI
-Anti-ischemic therapy- O2, nitroglycerin, β-blocker
-Antiplatelet therapy (aspirin)
-Anticoagulants (heparin)
-Pain relief (morphine)
Reperfusion therapy options for management of Acute MI
Percutaneous transluminal coronary angioplasty (PTCA)
Coronary artery bypass graft surgery (CABG)
Lifestyle modifications for treatment of Acute MI
Diet
Exercise
Smoking
Diabetes control
Managing depression
Surgical treatments for Acute MI
Aortic balloon pump
Swan-Ganz Catheter
Angioplasty/CABG
LVAD – left ventricular assist device
ICD – Implantable Cardioverter Defibrillators
Heart transplant
Common medications given outpatient for Acute MI
Factors linked to poor prognosis Post-MI
-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)
Why do we stress test after Acute MI?
-Evaluate symptoms, ischemia
-Determine need for coronary angiography
-Determine effectiveness of medical therapy
-Evaluate risk/prognosis
-Determine exercise therapy
What do we look for during a stress test after an MI that tells us the patient is at risk?
Failure of SBP to increase 10mmHg during Exercise
Absolute contraindications to stress testing after an Acute MI
-Acute MI within 2 days
-Unstable angina
-Uncontrolled cardiac arrhythmias
Cardiologist preferences on timing of stress testing after Acute MI
< 7 days post-MI: submax test
≥ 7 days post-MI: symptom-limited max
14 - 21d or > 6 weeks, post-MI
Types of stress testing after Acute MI
-Predischarge exercise test (submax effort)
-Standard exercise test (symptom-limited maximal effort)
-Cardiopulmonary exercise test (symptom-limited maximal effort)
Effects of exercise training vs. standard percutaneous coronary intervention (PCI) with stenting in patients with Stable Coronary Artery Disease
-exercise training associated with higher event-free survival and increased maximal oxygen uptake
-reduced rehospitalizations and revascularizations
Activities emphasized during inpatient cardiac rehabilitation
progression:
sit
stand
Aerobic: Walk short distances
Frequency: 2-4x daily
Flexibility: active ROM exercises for major joints (gentle)
When can patients begin outpatient cardiac rehabilitation?
A few days to 2 weeks post-hospital discharge
What activity is added during outpatient cardiac rehab?
Strength training and more aggressive aerobic training
Aerobic FIIT guidelines for Acute MI
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
Strength training FIIT guidelines for Acute MI
F: 2-3 sessions/week (non- consecutive)
I: RPE 11–14 (60%–80% 1RM)
(8-10 exercises, 12-15 reps ea.) No OH!
What is a hallmark of acute MI?
Myocardial necrosis (heart cell death)
How long does it take for myocardial necrosis to occur?
Vessel occlusion persisting for >60 min
Preferred treatment for MI
Prompt perfusion of the occluded vessel
What is the basis for secondary prevention of future cardiac events?
Comprehensive cardiac rehab
How long does it take for Sudden Cardiac Death (SDC) to occur?
Generally within 1 hour of symptom onset.
What are usual causes of death for SDC?
Ventricular Tachycardia & Ventricular Fibrillation.
How wide would the QRS complex be in a case of V-TACH?
Wide & Bizarre (> 0.12 secs)
During Ventricular Fibrillation, how would describe the EKG properties?
“quivering”
What is the difference between MI & SCD?
MI = circulation problem
SCD = electrical problem
