Exam 2 Wk 1 Flashcards
Fluid flows from ___ pressure to ____ pressure
High to low pressure
T or F: Fluid takes the path of least resistance
TRUE
What pressure is the primary driving force moving blood into myocardial tissue?
Diastolic BP
3 layers of arteries
Adventitia: outer - basement membrane
Media: middle; makes adjustments to luminal diameter
Intima: endothelium layer; semipermeable to lipoproteins
Atherosclerosis
Accumulation of material between the tunica intima;
- material is debris, calcium, macrophage cells, cholesterol, fibrous connective tissue
Atherosis
Fatty streak of lipid laden macrophages and smooth muscle cells
Sclerosis
Inability of blood vessel to be compliance
- organization of “fibrous cap” of thrombi
Explain lesion progression
Build up of tissue into vessel lumen
Progression of atherosclerosis
Fatty streak > plaque > increasing plaque > obstructive atherosclerotic plaque > plaque fissure results in thrombosis
Risk factors for atherosclerosis
- smoking
- uncontrolled DM
- HTN
- hyperlipidemia
- high velocity/turbulent flow
- systemic inflammation (Hs-CRP, homocysteine)
- suboptimal diet
Which of the risk factors of heart and lung disease are non modifiable?
Age & Heredity
Total Cholesterol Values
Normal < 200mg/dL
Borderline = 200-239 mg/dL
High >= 240 mg/dL
LDL Values
Normal <130 mg/dL
Borderline = 130-159 mg/dL
High > 160
HDL Values
Low < 40 mg/dL
Cardioprotective > 60 mg/dL
- this is the good cholesterol
Lack of exercise increases the risk of CV disease by ___%
Stress and depression __x the risk
Healthy diet decreases the risk by close to ___%
20%
3x
30%
As HDL gets lower or LDL gets higher, the likelyhood of a cardiovascular event __________
Increases
High glucose —> high ____
High insulin levels
Obesity BMI
> 30
Atherosclerosis
Plaques composed of lipid and thrombus
Thrombus
Occludes vessel of piece breaks off (embolus)n
Vasospasm
Build up or migration of cells in the area
Prinzmetal angina
Referred pain patterns in MEN vs WOMEN
MEN: substernal pressure type of pain, radiating down LUE, through to the back, up to the jaw
WOMEN: subtle indigestion, unusual fatigue, SOB w activity
Angina Pectoris
- distress/pain of the chest
- secondary to imbalance of coronary oxygen delivery
3 types of Angina
Stable (typical)
Unstable
Prinzmetal’s (variant)
Stable (typical) angina
Cause: fixed atherosclerotic lesion; result of not enough blood subtly to meet metabolic demand (after increased exercised)
- not present at rest but can be reduced by rest
unstable angina
- chest discomfort accelerating in freq or severity
Cause: typically thrombosis of a coronary plaque
EMERGENCY - acute myocardial infarction
Prinzmetals Angina
Cause: coronary vasospasm due to endothelial dysfunction
- more difficult to diagnose (even at rest)
Acute coronary syndrome
Acute MI or unstable angina
Non STEMI diagnosis
Rupture of coronary plaques; partial occlusion of coronary artery
- subendocardial wall infarction
How does non stemi look on EKG
ST Segment Depression
T wave inversion
ST Elevation MI
Rupture of coronary plaques that causes a thrombus that totally occludes an artery = TRANSMURAL INFARCTION
What are the 2 main serum enzymes?
Troponin & CK-MB
Ratio of CK-MB to total creatine kinase in the blood
> 2.5 -3 = MI
Beta Blockers effects
Reduce work of the heart
Organic Nitrates (sublingual nitroglycerine)
- reduce preload —> reduce work
- potential for excessive preload reduction
Thrombolitics are used for
Acute mi, ischemic cva, stokes
Anticoagulant vs anti platelet
Anticoagulant: slow clotting; preventing clots from clotting/growing (heparin)
Antiplatelets: prevent platelets from clumping and prevents clots from forming and regrowing; interfere with clotting cascade (thrombin formation)
T or F: a patient should always have their sublingual nitroglycerine tablets with them during exercise
TRUE
Effects of Antithrombotics
- reduce risk of bleeding and bruising
- internal hemmorhage risk
- avoid bumping
Potential results of MI
MI= death of tissue
- Arrhythmias
- contractile issues
- wall weakening
When does cardiac death occur
Within the first 2 hours
Cardiogenic shock
- heart is damaged and unable to supply blood to other organs of the body ; greater than 40% of LV
Ventricular remodeling
- MI tissue death causes change in shape, size, and thickness of myocardium
- ventricular dilation & hypertropy
Factors that effect ventricular remodeling
- size of infarction
- ventricular load
- patency of the artery that was infarcted
STEMI and non STEMI COMPLICATIONS
- hypertrophy
- ventricular aneurysm
- dyskinesia
- hypokinesia
What is a ventricular aneurysm
Ballooning out of a weakened LV
What is dyskinesia ?
- uncontrolled/ uncoordinated contraction
What is hypokinesia
Decreased of no wall contraction
What VO2 means that the patient will have decreased ability to perform ADLs independently and is a poor prognosis for survival ?
<21ml/kg/min
Signs and Symptoms of MI
- chest pain
- SOB
- Diaphoresis
- st seg elevation
- enzymes of cardiac monocytes in blood (CK-MB)
