ischemic heart disease

Question 1

Treatable risk factors for CAD

Answer 1

smoking
hypertension
Dyslipidemia/cholesterol

Question 2

Treatable questionable risk factors for CAD:

Answer 2

diabetes
obesity
inflammation
psychological stress
sedentary lifestyle

Question 3

Not treatable risk factor for CAD

Answer 3

male gender
age
genetics

Question 4

Smoking causes a ______ tendency, promotes _____ by aryl hydrocarbon

Answer 4

thrombogenic

atherosclerosis

Question 5

Smoking causes adverse effect on ____, ___ decrease O2 delivery, and causes ___dysfunction

Answer 5

lipoproteins (decrease DHL)
CO
Endothelial

Question 6

HTN increases shear stress on arterial wall that cause direct ____

Answer 6

endothelial cell injury

Question 7

HTN: Increased arterial wall stress initiates pathologic cell signaling program causing ____

Answer 7

oxidant stress, cellular proliferation

Question 8

Diabetes and insulin resistance are associated with ________

Answer 8

inflammation, oxidative stress, dyslipidemia that predispose to atherosclerosis.

Question 9

dyslipidemic triad includes ___

Answer 9

high LDL
low HDL
high Triglycerides

Question 10

Oxided LDL becomes ___

Answer 10

pro inflammatory/atherogenic

Question 11

Oxidized LDL effects:(4)

Answer 11

1. injure vascular endothelium = impaired endothelial function
2. Deposite in arterial wall = plaque volume/foam cell
3. Activate inflammatory cell = progression/instability of lesion
4. Activates platelet/prothrombotic

Question 12

Roles of HDL (5)

Answer 12

1. inhibit LDL oxidation
2. Inhibit TF
3. Enchance reverse cholesterol transport
4. Stimulate endothelial NO production
5. Inhibit endothelial adhesion molecules

Question 13

DHL Overall function is to oppose ____

Answer 13

atherothrombosis

Question 14

Inflammation plays a key role in ___ and ___

Answer 14

initiation and progression of atherosclerosis

Question 15

Lipid laden macrophages in arterial walls are highly ____

Answer 15

pro-inflammatory

Question 16

Extravascular inflammation (ex: ____) increase risk of _____ ____events

Answer 16

dental diseases

atherosclerotic CV events

Question 17

Circulating markers of inflammation provides _____ about CV ___; ie: ___ (which is released by liver upon ___signal)

Answer 17

info
risk
C-reactive protein
IL6

Question 18

stable CAD causes _____

Answer 18

myocardial ischemia

Question 19

myocardial ischemia is:

Answer 19

tissue blood flow insufficient to meet oxygen requirement

Question 20

Cardinal symptoms of myocardial ischemia is ___

Answer 20

chest pain/agina pectoris

Question 21

coronary circulation is unique in ___ metabolism for energy supply, extract ___% of O2, perfused during ____

Answer 21

aerobic
near 100%
diastole ony

Question 22

If O2 demands increase, supply will increase by ___ in heart

Answer 22

increase blood flow

Question 23

Myocardial O2 supply determined by:

Answer 23

Coronary blood flow rate

Oxygen content of blood

Question 24

Coronary blood flow rate determined by (4)

Answer 24

1. perfusion pressure
2. perfusion time
3. vascular resistance

Question 25

Autoregulation range implies

Answer 25

heart will provide constant coronary flow within moderate change in perfusion pressure

Question 26

_____ can compromise coronary flow by intramural coronary vessel compression

Answer 26

tachycardia

Question 27

O2 supply compromised by:

Answer 27

anemia (less hemoglobin) | Hypoxemia (incomplete O2 sat)

Question 28

Treatment of: 1. perfusion pressure 2. Diastolic time 3. Coronary resistance 4. O2 content

Answer 28

1. prevent HTN 2. rate control drugs 3. Vasodilator/coronary agnioplasy/bypass surgery 4. treat anemia/hypoxemia

Question 29

Determinants of Mycoardial O2 demand

Answer 29

1. heart rate 2. wall tension 3. inotropic state

Question 30

Treatment of: 1. systolic pressure 2. HR 3. Wall tension 4. Inotropic state

Answer 30

1. antihypertensive drug 2. rate slowing drug 3. limit LV - diuretic/nitrate 4. negative inotropes (beta/Ca blocker)

Question 31

stable CAD caused by:

Answer 31

obstructive coronary lesion limits coronary flow

Question 32

Causes of unstable CAD (8)

Answer 32

``` inflammation weakening fibromuscular cap plaque fissue/rupture thrombogenic component to blood Thrombosis partial/complete vessel occlusion MI Cardiac dysfcn ```

Question 33

unstable angina is caused by a ______ occlusion of vessel that ____ heart attack with biomarkers ___

Answer 33

near complete threatened negative

Question 34

Acute MI is a ___ CAD

Answer 34

unstable

Question 35

AMI is caused by ______ coronary flow reduction, thrombus with ___vessle occlusion, wavefront with ______, biomakers ____

Answer 35

persistent/severe complete myocardial necrosis elevated

Question 36

AMI ______ is key to treatment but can also cause ___ injury

Answer 36

early reperfusion | reperfusion

Question 37

AMI high early mortality ___; late mortality ___

Answer 37

1/3 pt don't get to hospital | Extent of LV dysfunction

Question 38

Timeline of acute MI

Answer 38

1. diastolic dysfunction 2. systolic dysfunction 3. ECG sign of M. injury 4. symptoms hour: mycardial necrosis/infarction

Question 39

time: ____ = no harm; ____ 50% infarct

Answer 39

0-30 min 2 hours 3-4 hr = near complete necorsis

Question 40

inflamed arterial atheroma releases ___ markers (ie ___; downstream myocardial injury shows ___ markers (ie__)

Answer 40

Inflammatory (markers) CRP cardiac (markers) Troponin/creatine kinase