EXAM3 Flashcards
an active process involving molecular signals that produce altered cellular behavior as well as endothelial dysfunction and a subsequent inflammatory response
atherosclerosis
explain the disease progression of atherosclerosis
- injury to endothelial lining
- fatty streak
- fibrous plaque
- possible disruption of the lesion
ischemia
lack of blood flow to the heart
angina pectoris
chest pain
myocardial infarction
heart attack (death to heart cells; lack of blood flow due to plaque build-up)
causes of atherogenesis
chronic injury to endothelial cells from tobacco LDL hypertension etc
endothelial dysfunction in atherosclerosis is dangerous because…
endothelial dysfunction leads to:
- increased adhesiveness [platelets monocytes stick]
- increased permeability to LDL
- impaired vasodilation & vasospasm
rupture or fissuring of a plaque formed within the artery in atherogenesis cases is called a
thrombus
SBP & DBP in hypertension
SBP >140
DBP >90
most commonly diagnosed CV disease?
hypertension
hypertension causes constriction of _____ ______ so that blood flow is hindered, increasing workload of the heart
peripheral arteries
hypertension can cause ________ damage to large arteries as well
endothelial
manifestation of advanced atherosclerosis progression in the coronary arteries
coronary heart disease
pain resulting from myocardial ischemia (inadequate blood flow to the heart)
angina pectoris
how is angina pectoris characterized?
substernal pressure, heaviness, burning, sometimes accompanied by dyspnea (trouble breathing)
angina pectoris is labeled “classic” if..
elicited by physical or emotional stress
relieved by nitroglycerin or rest
angina pectoris is labeled “vasospastic” if…
it occurs at rest for no reason
angina pectoris is labeled “unstable” if … **
new onset, lasts for longer duration then last time, increased frequency, occurs at lower level of exertion than usual, (changing, getting worse)
death of myocardial muscle cells that occur when blood flow through the coronary artery is disrupted & tissues are deprived of oxygen for long periods of time
myocardial infarction
what is an acute myocardial infarction
sudden ischemia leading to myocardial damage & infarction (lack of blood flow causing a part of the heart to die)
10 complications of MI
- arrthymias [irregular heartbeat]
- conduction disturbance
- bundle bunch block
- cardiogenic shock
- infarct extension/expansion
- myocardial rupture [muscle cells killed]
- new mitral valve regurgitation
- pericardial effusion [fluid collection] & pericarditis [inflamed sac around heart]
- post-infarction syndrome
- left ventricular mural thrombus [blood not being pumped out sits & clots]
S&S of MI
- angina pectoris
- unusual SOB
- profound weakness/fatigue
- profuse sweating
- loss of consciousness
- confusion
- dizziness
- nausea
death resulting from an abrupt loss of heart function is known as
sudden cardiac death
chronic degenerative condition in which the ability of one or both ventricles to fill with or eject blood is impaired
chronic heart failure
chronic heart failure is usually due to
poor circulation in the heart
chronic heart failure manifestations (S&S)
- dyspnea
- fluid retention
- exercise intolerance
- fatigue
two types of chronic heart failure
left ventricle systolic & right ventricle diastolic dysfunction
LV systolic dysfunction
- reduced blood put out by heart [ejection fraction]
- assessed using echocardiogram, radio-nucleotide test, cardiac catheterization
- ejection fraction
RV diastolic
- diagnosis less exact
- clinical syndrome of congestive HF in the presence of normal ejection fraction
loss of brain function subsequent to the interruption of blood flow
stroke [cerebrovascular accident]
causes of stroke
- ischemic (blockage): decreased blood flow to a portion of the brain
- intracranial hemorrhage: sudden rupture of an artery in the brain leading to compression of the brain structures (hemorrhage/aneurism)
symptoms of stroke
weakness in face arm leg, typically on one side of the body, numbness, sudden confusion, trouble understanding, trouble speaking, etc.
4 risk factors for stroke
- asymptomatic coronary disease
- atrial fibrilation (beat irregularity)
- pregnancy (increases chances of blood clot)
- postmenopausal women (lack of estrogen)
a series of disorders in which blood flow through non-coronary arterial beds is inhibited by atherosclerotic plaque
peripheral arterial disease
PAD is characterized by what 5 things
- diminished functional capacity
- limb dysfunction
- reduced QOL
- increased cardiovascular ischemic risk
- increased risk of death
PAD manifestation
intermittent claudication [leg pain that follows physical exertion & is relieved at rest - calf thigh buttocks]
how do you diagnose PAD
- palpate peripheral pulse
- ankle to brachial index 1-1.29
- resting ABI less than 0.5
classifications of PAD
1 - assymptomatic
2 - intermittent claudication
2a - distance to pain onset >200m
2b - distance to pain onset
________ is released by the kidneys in response to _______ stimulation or a decline in renal blood flow
Renin; sympathetic
Explain the renin-angiotension system
- Renin is released by the kidneys in response to sympathetic stimulation or decline in renal blood flow
- renin converts angiotensin to angiotensin I
- angiotensin I is modified to angiotensin II
- angiotensin II stimulates aldosterone secretion, ADH secretion, thirst, & cardiac output [arteriole constriction]
interfere with the coagulation cascade [clotting mechanism]
anticoagulants [warfarin, heparin]
anticoagulants are also referred to as ____ ____, & may cause easy bruising & bleeding
blood thinners
anti-ischemic agents
beta blockers
what do beta blockers do
- reduce ischemia (lower oxygen demand for any work load)
beta blockers reduce 1st year mortality rate in patients after MI by ___-____%
20-35%
with beta blockers there is a reduced __ respond to exercise and a decreased _____ exercise capacity
HR; maximal
what do calcium channel antagonists do
reduce ischemia by altering major determinants of myocardial oxygen supply/demand
Calcium channel antagonists cause ______ by inhibiting _____ influx in vascular ___ muscle {HR decreases because of calcium inhibition in conduction tissue}
vasodilation; calcium; smooth
what do nitrates do?
reduce ischemia by reducing myocardial oxygen demand with a small concomitant increase in oxygen supply
what does a vasodilator do ?
- decreases work load on the heart
- dilates coronary arteries (more blood to heart muscle & pain relief in ischemia–used in acute treatment)
you should not use a vasodilator if BP is
renin is released by the kidneys in response to what two things
sympathetic nerve stimulation
decline in renal blood flow
[medications]
angiotensin-converting enzyme inhibitors
reduce myocardial oxygen demand by reducing systemic vascular resistance [reduce work of heart; may cause cough]
[medications]
ARBs
used when ace can’t be used
prevent binding of angiotensin II (a vasoconstrictor) to its receptors
[medications]
Aldosterone antagonists
blunts SA & AV node conduction resulting in a lower ventricular response [less work for the heart]
[medications] digitalis
enhances contractility of myocardium [increased stroke volume]
[medications] diuretics
loss of water in urine [decrease blood pressure]
nitrates affects on exercise
increase resting HR
decrease ischemia
all medications cause a decrease in HR and BP except
nitrates
FITT for PAD [peripheral arterial disease]
F: 3-5 days
I: moderate - pain score of 3
T: 30-60min. 10 min bouts
T: R training recommended [weight & non weight bearing]
FITT for hypertension
F: aerobic daily; resistance 2-3 I: moderate 40-59% RPE 11-13 T: 30-60min. 1 set 8-12 reps T: any *progress gradually; remember BP meds changes comorbitities
beta blockers may ______ the chance of hypoglycemia, especially in those on ____ or _______
increase; insulin or secretagogues
beta blockers may mask the signs of ________ [tachycardia]
hypoglycemia
beta blockers and diuretics may affect the ________ function
thermoregulatory
BP medication may cause excess decrease in..
BP post exercise [post-exercise hypotension]
those with known ischemia during exercise should keep intensity at least _____ beats per minute below the ______ threshold
10; ischemic
5 surgical treatments for hypertension
- percutaneous transluminal coronary angioplasty
- stent [balloon catheter]
- coronary artery bypass graft [pull artery from somewhere else]
- atherectomy [drill pulls out plaque; common in peripheral]
- laser angioplasty
other treatment options
pacemakers
automatic internal
