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S2 MAP II > Ischemic Heart and Vascular Disease > Flashcards

Ischemic Heart and Vascular Disease Flashcards

1
Q

INTERHEART study cardiovascular risk factors

A 
cigarette smoking
abnormal lipids
hypertension
diabetes
abdominal obesity
psychosocial stress
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2
Q

INTERHEART study cardioprotective factors

A

fruit/vegetables
exercise
moderate alcohol

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3
Q

what is ApoB?

A

primary protein in LDL

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4
Q

what is ApoA1?

A

primary protein in HDL

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5
Q

an increase in the HpoB-ApoA1 ratio is associated with…

A

an increase in risk

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6
Q

acute coronary syndromes (ACS) definition

A

a sudden loss of blood to the heart

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7
Q

atherosclerosis

  • subset of…
  • affects…
  • consequences
A 
one type of arteriosclerosis
progressive process affecting large and middle size arteries
consequences
-narrow size (smaller diameter)
-blockage
-stiffness (less reactivity)
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8
Q

atherosclerosis initial injury

A

excess levels of LDL in blood penetrate blood vessels and become trapped along endothelial wall
LDL oxidizes, releasing anions (oxidative stress)

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9
Q

atherosclerosis - endothelial dysfunction

A

due to oxidative stress, chemical and adhesion factors attract monocytes and platelets
a foam cell forms

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10
Q

atherosclerosis - plaque development

A

foam cells are lipid enhanced macrophages
smooth muscle cells engulf foam cells and lipids –> leads to a fatty streak
fibrous cap forms over fatty streak

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11
Q

coronary artery disease

A

atherosclerosis of coronary vessels alters myocardial perfusion

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12
Q

when does myocardial perfusion occur

A

during periods of muscle relaxation (diastole)

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13
Q

ischemic heart disease

-what is it

A

imbalance of myocardial supply and demand

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14
Q

myocardial supply

A

coronary blood flow

O2 carrying capacity of blood

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15
Q

myocardial demand

A

increased with HR
increased contractile state (activity, fright)
increased systolic tension (HTN, cold)

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16
Q

anatomic region of heart coronary arteries

A 
inferior
-right coronary
anteroseptal
-left anterior descending
anteroapical
-left anterior descending (distal)
anterolateral
-circumflex
posterior
-right coronary artery
17
Q

chest pain patterns

-areas of radiating pain

A

neck
jaw
upper abdomen
shoulders and arms

18
Q

gender differences in symptoms

A 
men
-crushing pain
-"elephant on my chest"
-nausea
-left arm pain
-jaw pain
women
-nausea/vomiting
-fatigue
-anxiety
-mid-back tightness
-discomfort
19
Q

stable angina S/S

A

substernal chest pain radiating to elbow
crushing/pressure
associated with SOB, nausea, diaphoresis
relieved by rest or nitroglycerin

20
Q

stable angina and activity level

A

occurs with predictable level of activity

myocardial O2 consumption = rate pressure-product

21
Q

RPP

-equation

22
Q

unstable angina

  • what
  • when would you term angina as unstable
A

presence of angina in absence of increased demand
includes
-angina at rest
-angina occurs at lower level of exercise compared to usual
-angina different than normal pattern
-blood pressure decreases with same amount of activity

23
Q

myocardial infarction

-what is it

A

death of myocardial tissue

abnormal myocardial function

24
Q

MI definition

A

rise of cardiobiomarkers > 99th percentile and evidence of one of the following signs of ischemia

  • discomfort > 20 minutes
  • EKG changes
  • development of pathologic Q waves
  • imaging evidence of loss of viable myocardium
25
cardio biomarkers
troponin -3-4 hours -peak 18 hours CK-MB (creatine kinase)
26
EKG changes in MI
the more EKG leads with MI changes, the worse prognosis EKG changes -ST elevation --with myocardial ischemia we would see ST depression -Q waves
27
ST segment depression
injured cell partially depolarized prior to stimulation ischemic cells have leaky cell membranes creates flow directed toward electrode, shifts baseline upward
28
NSTEMI vs STEMI
NSTEMI -partial thickness damage of heart muscle STEMI -full thickness damage of heart muscle
29
Q waves during MI
necrotic muscle does not generate electrical forces - Q wave results from absence of electrical force often provides permanent ECG evidence of previous MI in multiple leads
30
NSTEMI vs STEMI S/S differences
``` NSTEMI -no Q wave -subendocardial STEMI -Q wave -transmural ```
31
exercise testing for diagnosing CAD - recommendations - what does it evaluate
``` recommendations -not recommended for asymptomatic individuals with low CV risk (<10% likelihood of CV disease) -use for moderate pre-test probability evaluates the following -hemodynamic response (HR & BP) -EKG waveforms -limiting signs and symptoms -gas exchange or ventilatory responses (VO2 max) ```
32
exercise test responses suggesting myocardial ischemia
ST segment depression >/= 1 mm ST segment elevation in leads with previous MI (Q wave) multifocal PVCs or runs of V-tach peak exercise HR > 2 SD below age predicted HR (not on beta blockers) exertional hypotension (SBP drops > 10 mmHg)
33
medical/surgical management
``` control risk factors control symptoms -nitroglycerin revascularization -PCI (percutaneous coronary intervention) -CABG (coronary artery bypass graft) ```
34
what is a CABG
take a vessel from another part of the body | replace the constricted area
35
peripheral artery disease (PAD) - what happens - common symptom - higher risk of... - two common risk factors
decreased blood flow to legs claudication pain (angina in legs) higher risk of MI and stroke smoking and diabetes increase risk of PAD
36
PT implications for MI | -red flags
prevention recognize S/S of ischemic disease to refer correctly red flags -angina -nitroglycerin all chest pain needs to be evaluated before PT counsel patients on risk factor management including taking BP initial visit cardiac rehabilitation
37
common areas for PAD
``` carotid artery (brain) aorta (to the body) superior mesenteric artery and celiac artery (intestines) renal artery (kidneys) common iliac artery (legs) ```
38
ankle-brachial index (ABI) - what is it? - normal measurement
ratio between SBP of ankle/arm | >0.90
39
signs of intermittent claudication
achy, cramping feeling in legs occurs with walking/exercise decreases with rest onset of pain is predictable

S2 MAP II (17 decks)

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