Exam Review Week 1 Flashcards
What is myocardial ischemia?
condition in which myocardial oxygen supply does not meet demands and there is myocardial hypoxia
What is angina?
chest pain, typically as a result of myocardial ischemia
What is myocardial infarction?
irreversible necrosis of heart muscle – Heart Attack; occurs if you have enough ischemia
What are cardiomyopathies?
diseases of the muscle
What is a dilated cardiomyopathy?
disease of the muscle caused by infections, toxins, unknown
What is hypertrophic cardiomyopathy?
familial, genetic disease of the muscle
What is restrictive cardiomyopathy?
disease of the muscle caused by infiltrative processes
What are the parts of the cardiac cycle on those square-shaped volume and pressure plots?
bottom of square = filling; right side = isovolumic contraction; top = ejection; left side = isovolumic relaxation
What are some examples of valvular heart disease?
Aortic valve disease Aortic stenosis Aortic regurgitation Mitral valve disease Mitral regurgitation Mitral stenosis Tricuspid and Pulmonic valve disease Prosthetic Heart Valves Endocarditis
What is the typical cause of coronary artery disease?
atherosclerosis
What arrhythmias cause the heart to go too slowly?
heart blocks (1st, 2nd, and 3rd degree)
What arrhythmias cause the heart to go too quickly?
Supraventricular arrhythmias (SVT, atrial fibrillation, atrial
flutter); Ventricular arrhythmias (ventricular tachycardia,
ventricular flutter)
What is pericarditis?
inflammation of the pericardium (multiple causes, including infectious, trauma, radiation)
What is Pericardial Tamponade?
a form of cardiogenic shock
What is heart failure?
Heart failure is the final and most severe manifestation of nearly every form of cardiac disease. Heart failure is present when the heart is unable to pump blood forward at a sufficient rate to the meet metabolic demands of the body or is able to do so only if the cardiac filling pressures are abnormally high or both.
What are clinical sequellae of atherosclerosis?
stroke (embolic or thrombotic), coronary artery disease, renal artery disease, aneurysms, peripheral artery disease
What is prevalence?
Prevalence is an estimate of how many people have a disease at a given point in time
An estimated 80,700,00 American adults (1 in 3) have 1 or more types of cardiovascular disease.
What is incidence?
Incidence refers to the number of new cases of a disease that develop in a population per unit of time.
The average annual rate of first CV events rises from 3/1000 men at 35-44years of age to 74/1000 men at 85-94 years of age. For women, comparable rates occur 10 years later in life.
What are modifiable risk factors for cardiovascular disease?
Dyslipidemia Tobacco smoking High blood pressure Diabetes mellitus/metabolic syndrome Lack of physical activity Obesity
What are non-modifiable risk factors for cardiovascular disease?
Advanced age
Male gender
Heredity
What is normal BP? Pre-hypertension? Hypertension?
Normal: less than 120/80mmHg;
Prehypertension: 120-139 or 80-89
Hypertension: more than 139 systolic or 89 diastolic
What are hypertension risk factors?
family history; Black; prehypertension; increasing age; obesity; high sodium-low potassium intake; excessive alcohol intake; low socioeconomic status; sleep apnea; some illicit drugs or OTCs
What is the DASH diet?
Emphasizes vegetables, fruits. Fat-free or low-fat dairy products; Includes whole grains, fish, poultry, beans, seeds, nuts, and vegetable oils; Limits sodium, sweets, sugary beverages, and red meats
What are lymphatics?
Drain clear fluid (lymph) from tissue spaces (they are more permeable than capillaries). Chyle from GI tract is white with lipid. Endothelium: fenestrated and non-fenestrated. Basement membrane: continuous or non-continuous. Have valves as do veins. Large lymphatics have muscle in wall.
What are the parts of an artery?
intima, media, adventitia; also contains endothelium, internal elastic lamina, external elastic lamina
What is epithelium?
epithelium covers the body surface or lines ducts in solid organs
What is endothelium?
endothelium lines blood vessels & lymphatics
What is contained in the intima?
Endothelium (Continuous (have tight junctions), Fenestrated (intestine, endocrine organs, glomeruli)) Basal Lamina Myointimal cells (smooth muscle, produce collagen, phagocytic ability)
What are the types of capillary endothelium?
- Continuous (e.g. in muscle; tight junctions, pavement-like);
- Fenestrated (fenestrations within endothelial cells; e.g. endocrine glands)
- Sinusoidal (gaps between endothelial cells) (e.g. liver)
What are the functions of endothelium?
1.Barrier – tight junctions
2.Filtering and transport – fenestrated endothelium, pinocytotic vesicles, active transport via proteins (blood-brain barrier)
3.Secretion – vasodilation ( prostacyclin, nitric oxide) & vasoconstriction (angiotensin-converting enzyme (ACE), endothelin)
4.Cell growth – increase (PDGF) or decrease (heparin, TGF-beta)
5.Clotting – inhibit (prostacyclin and NO inhibit platelet aggregation, tissue plasminogen activator regulates fibrinolysis, thrombomodulin) or promote (tissue factor, platelet activating factor, von Willebrand factor)
5.Lipoprotein metabolism: oxidation of low density lipoproteins (LDL) and VLDL
6.Produce extracellular matrix – Type IV collagen, laminin, proteoglycans
7. Immunologic
Activated by cytokines to produce adhesion molecules (selectins, integrins, CD markers).
Which cardiac imaging modalities use radiation? Which don’t?
Radiation: CXR, cardiac CT, nuclear, cardiac catherization, PET; no radiation: echocardiography, cardiac MRI
What is a chest X-ray? How does it work?
Utilizes ionizing radiation to penetrate the body and takes advantage of the fact that penetration is inversely related to tissue density. The lung, an air-filled tissue absorbs few x-rays and appears black. The heart has a density similar to blood. Heart borders adjacent to the lung are clearly depicted because of the different densities.
What can you assess with a chest x-ray?
- cardiac and mediastinal contours
2. pulmonary vascular markings
What are the clinical uses of a chest x-ray?
detect chamber enlargement; detect vessel enlargement; detect pulmonary vascular signs of heart failure; detect shunts (abnormal communication between
cardiac chambers)
What are advantages to chest x-ray? Disadvantages?
Advantages: can be portable;
Disadvantages: radiation, a projection technique where there is superimposition of multiple structures
What is cardiac catheterization? How does it work?
- Intravascular catheters are inserted to measure cardiac pressures and blood flow; 2. Contrast agents can be injected and x-ray can produce a cineangiogram
What can you assess with cardiac catheterization?
1.Pressures in the heart chambers; 2.Measurement of blood flow (cardiac output); 3.Calculation of vascular resistance; 4.Ventricular function, valvular regurgitation, and coronary anatomy
What are clinical uses of cardiac catheterization?
Identify coronary anatomy and severity of stenoses; Visualize ventricular contractile function; Assess valvular regurgitation; Measure intracardiac pressures
What are advantages to cardiac catheterization? Disadvantage?
Advantages:
- Direct measurement of cardiac pressures
- Identify coronary anatomy and severity of stenosis
Disadvantages:
- invasive (must enter artery and/or vein)
- involves radiation
- Contrast can be allergic and damage kidneys, especially in patients with renal dysfunction or diabetes
What is the LAD and what does it supply?
left anterior descending coronary artery;
supplies the anterior two-thirds of the interventricular septum
supplies apical portion of the anterolateral papillary muscle
supplies the anterior surface of the left ventricle
supplies a portion of the anterior RV wall
What is the LCX and what does it supply?
left circumflex coronary artery:
supplies the lateral and posterior walls of the left ventricle
supplies the anterolateral papillary muscle
What is the RCA and what does it supply?
right coronary artery:
supplies blood to the right ventricle
supplies blood to the inferior and posterior walls of the left ventricle
supplies blood to the posterior one-third of the interventricular septum
supplies AV nodal artery (85% of the population)
supplies the SA nodal artery (70% of the population)t
supplies the posteromedial papillary muscle
What is computed tomography? How does it work?
CT!
uses thin x-ray beams to obtain axial plane images. An x-ray tube is programmed to rotate around the body and the generated beams are partially absorbed by body tissues. The remaining beams emerge and are captured by electronic detectors and a computerized image is composed. Intravenous contrast is usually required to distinguish intravascular contents from neighboring soft tissue.
What can you assess with CT?
great vessels
pericardium
myocardial structures
coronary arteries
What are clinical uses of CT?
Diagnose diseases of the great vessels (for example, pulmonary embolism, aortic dissection); Assess pericardial disease/effusion; Detect coronary artery calcification and
stenoses