Intro to CVD Flashcards
CVD
Cardiovascular disease
CAD
Coronary artery disease
CHD
Coronary heart disease
ASCVD
Atherosclerotic cardiovascular disease
IHD
Ischemic heart disease
HF
Heart failure
MI
Myocardial infarction
STEMI
ST segment elevation MI
UA
Unstable angina
CSA
Chronic stable angina
ACS
Acute coronary syndrome
PVD
Peripheral vascular disease
PAD
Peripheral artery disease
CVA
Cerebrovascular event
Describe the flow of blood through the heart.
Enters the right atrium via the superior and inferior vena cava, passes through the tricuspid valve into the right ventricle, it then exits through the pulmonary valve into the pulmonary arteries which carry it to the lungs. It returns to the left atrium via the pulmonary veins where it passes through the mitral valve into the left ventricle. It then pushes through the aortic valve and out into systemic circulation.
What 3 coronary arteries supply blood to the heart?
- Right coronary artery
2. Left main coronary artery which branches into the left anterior descending artery and the circumflex artery
What supplies oxygen to the brain?
The carotid arteries
What are the layers of an artery from inside out?
- Tunica intima
- Layer of elastin
- Tunica media
- Tunica externa
- Serosa
What cells are the layers of an artery composed of from inside out?
endothelial cells, smooth muscle cells, fibrous connective tissue, and epithelial cells
Which is more elastic: veins or arteries?
Arteries because they sustain a higher pressure and have a layer of elastin
What is the formula for blood pressure?
Blood pressure = cardiac output + systemic vascular resistance
What is the formula for cardiac output?
Cardiac output = stroke volume x heart rate
What are the determinants of stroke volume?
Preload, afterload, and contractility
Which layer of the artery is responsible for vasoconstriction and vasodilation?
The tunica media
Which layer of the artery gives it structure?
The tunica externa
Define CVD:
Any CV event (acute or long-term) that decreases the ability of blood to reach the tissues
What disease states fall under CVD?
- CHD
- PAD (lower extremities)
- CVA (brain)
- HF (heart)
Define ASCVD:
Cholesterol or plaque build up that blocks blood from flowing through the arteries
What does ASCVD generally include in terms of CV disease states?
- CVA
- PAD
- CHD
Define CVA:
Any event in which the brain is not supplied with sufficient blood and oxygen
What are two types of CVA:
Stroke and transient ischemic attack
What is the difference between a stroke and a transient ischemic attack?
The length of symptoms
What are two etiologies of an ischemic stroke?
- Cardioembolic: clot forms in heart and travels to brain
2. Atherosclerosis: plaque formation that partially or completely blocks carotid arteries
Define PAD:
plaque build up in the vasculature limits blood flow to the extremities (typically lower extremities).
Define CAD or CHD:
Plaque formation in the coronary arteries that decreases or blocks blood flow to the cardiac muscle
Describe the formation of atherosclerosis:
- High levels of LDL in the blood, mixed with some kind of damage to the endothelial cells causes LDL to enter the tunica intima.
- Once in the tunica intima they become oxidized
- Oxidized LDL cause the endothelial cells to express receptors for white blood cells
- These T-helper cells and monocytes move into the tunica intima and turn into macrophages
- The macrophages ingest the oxidized LDL and turn into foam cells
- Foam cells recruit smooth muscle from the tunica media to enter the tunica intima where it proliferates and stimulates collagen to harden the plaque. Foam cells also rupture and release the lipid contents to continue fueling this cycle.
What happens when atherosclerosis builds to a high level?
The pressure inside the plaque builds to a point where it ruptures. Once the plaque has ruptured, it damages the endothelium, and this triggers the clotting cascade to form a clot. This clot can then migrate, blocking blood flow to certain parts of the body.
Define ischemic heart disease:
Blood not reaching the heart
Describe the symptoms of stable ischemic heart disease/chronic stable angina:
Chest pain that occurs or worsens with exertion but eases up with rest or minimal intervention
What is the cause of stable ischemic heart disease?
Usually stable plaque and decreased oxygen supply
Define acute coronary syndrome:
When a plaque ruptures and thrombus is formed in the coronary artery
What are two types of ACS?
- Non ST-segment elevation ACS (NSTEMI)
2. STEMI
What are some non-modifiable risk factors for ischemic heart disease?
- Age (increases w/ age)
- Sex (men at higher risk until women reach menopause)
- Family history (race and genetics)
What are some modifiable risk factors for ischemic heart disease?
- Smoking
- Diet
- Physical inactivity
- Alcohol
- Vitamin D deficiency
- Disease states (DM, HTN, Obesity, Dyslipidemia, Metabolic syndrome)
- Hypercoagulable states
- Stress
What is the difference between primary and secondary prevention?
Primary prevention is preventing the first CV event in patients with known risk factors. Secondary is preventing additional or recurrent CV events in patients with known CHD
What are the primary risk assessment tools for CV disease?
- Framingham Risk Score
2. Pooled Cohort Risk Equations
What is C-reactive protein (CRP) used for?
It’s a test to measure inflammation (used for CVD)
What is Apolipoprotein B (Apo B) used for?
How much LDL is present
What is Glomerular Filtration Rate (GFR) and microalbuminuria used for?
Kidney function and amount of protein in urine
What is ankle-brachial index (ABI) used for?
Measurement of BP in the ankle. Should be identical to BP in arm.
What is Carotid media intima thickness (CMT) used for?
to detect plaque formation (higher thickness = more plaque)
What is Coronary artery calcium score (CAC) used for?
to detect hardened arteries (increased calcium leads to hardening)
What are the classifications for heart failure?
- Acute or chronic
2. Diastolic or systolic
What is Diastolic heart failure?
Long standing HTN causes heart remodeling which decreases the space in the ventricle, causing less blood to fill the heart.
What is Systolic heart failure?
When the heart is not able to fully contract. This is caused by the death of myocardial cells, thinning, and hardening of the ventricle wall. Common causes are HTN and IHD
