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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

A

HR x SBP

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
Q

cardio biomarkers

A

troponin
-3-4 hours
-peak 18 hours
CK-MB (creatine kinase)

26
Q

EKG changes in MI

A

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
Q

ST segment depression

A

injured cell partially depolarized prior to stimulation
ischemic cells have leaky cell membranes
creates flow directed toward electrode, shifts baseline upward

28
Q

NSTEMI vs STEMI

A

NSTEMI
-partial thickness damage of heart muscle
STEMI
-full thickness damage of heart muscle

29
Q

Q waves during MI

A

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
Q

NSTEMI vs STEMI S/S differences

A 
NSTEMI
-no Q wave
-subendocardial
STEMI
-Q wave
-transmural
31
Q

exercise testing for diagnosing CAD

  • recommendations
  • what does it evaluate
A 
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 &amp; BP)
-EKG waveforms
-limiting signs and symptoms
-gas exchange or ventilatory responses (VO2 max)
32
Q

exercise test responses suggesting myocardial ischemia

A

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
Q

medical/surgical management

A 
control risk factors
control symptoms
-nitroglycerin
revascularization
-PCI (percutaneous coronary intervention)
-CABG (coronary artery bypass graft)
34
Q

what is a CABG

A

take a vessel from another part of the body

replace the constricted area

35
Q

peripheral artery disease (PAD)

  • what happens
  • common symptom
  • higher risk of…
  • two common risk factors
A

decreased blood flow to legs
claudication pain (angina in legs)
higher risk of MI and stroke
smoking and diabetes increase risk of PAD

36
Q

PT implications for MI

-red flags

A

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
Q

common areas for PAD

A 
carotid artery (brain)
aorta (to the body)
superior mesenteric artery and celiac artery (intestines)
renal artery (kidneys)
common iliac artery (legs)
38
Q

ankle-brachial index (ABI)

  • what is it?
  • normal measurement
A

ratio between SBP of ankle/arm

>0.90

39
Q

signs of intermittent claudication

A

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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