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PTRS 826 Exam 1 > Ischemic Heart Disease > Flashcards

Ischemic Heart Disease Flashcards

1
Q

List the 5 main CV disease

A
  • CAD
  • Ischemia heart disease
  • HTN
  • Peripheral Vascular Disease
  • Stroke
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2
Q

Condition: obstruction but doesn’t affect heart function

A

CAD

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3
Q

Describe the difference between CAD vs. IHD

A

CAD: blockage and the end of a vessel, low % blockage, pt. unaware

IHD: blockage midway down vessel, high % blockage, effects function

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4
Q

List the factors effecting the severity of CAD

A
  • Degree of obstruction
  • Number of vessels obstructed
  • Location of blockage
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5
Q

List the 3 main coronary arteries

A
  1. R coronary
  2. LAD (branch of L coronary)
  3. L circumflex
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6
Q

List the determinants of myocardial blood flow

A
  • DBP (driving force of blood to the heart, too high = limits BF)
  • Resistance (too high = impairs BF, no signaling to release NO)
  • Vasomotor tone (flexibility, shear releases NO, plaques block signal)
  • LV end diastolic pressure (less pressure = less available for coronary circulation)
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7
Q

Condition: active process involving molecular signals that produce altered cellular behavior as well as endothelial dysfunction and a subsequent inflammatory response

A

Atherosclerosis

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8
Q

Describe the progression of atherosclerosis

A
  1. Fatty streaks develop due to the deposition of lipids
  2. Fibrous plaque forms due to increased collagen levels, destruction of elastin, and change in fibrous protein composition [can be stable or unstable]
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9
Q

Describe the atherogenesis chain of effect

A
  1. endothelais injury leads to increased infiltration of LDL
  2. sub endothelial retention and modification of LDL leads entry of monocytes
  3. monocytes > macrophages which internalize LDL creating foam cells
  4. the hemodynamic stress activates an inflammatory response activating PDGF
  5. foam cells die > necrotic core
  6. Rupture of fibrous cap can lead to arterial thrombosis
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10
Q

Describe the effect of exercise on atherosclerosis

A

Exercise promotes HDL

HDL removes LDL from being in vessel/prevents deposit

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11
Q

Condition: chornic elevation in BP

A

HTN

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12
Q

Describe how HTN is dx

A

3 HTN readings in 3 months

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13
Q

Describe the types of HTN

A
  • Essential/primary [occurs in absense of disease]
  • Non-essential/secondary [occurs in presence of disease]
  • Labile [comes/goes w/o rhyme or reason]
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14
Q

Describe cut offs for montioring BP during exercise

A

Need medical clearnace: SBP > 200; DBP > 105

Terminate exercise: SBP > 250; DBP > 115

SE from BP required termination of exercise: SBP drops 20 OR SBP and DBP both drop 10

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15
Q

List the aerobic exercise recommendations for HTN

A

4-7x/wk, 30-45 min, 60-85% HR max; RPE 11-16 (not “very hard”

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16
Q

List the types of ischemic heart disease

A
  • chronic stable angina
  • unstable angina
  • myocardial infarction
  • silent ischemia
  • arrhythmia
  • sudden death
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17
Q

List the signs and symptoms of ischemic heart disease for men

A
  • radiating pain (jaw, L side)
  • crushing pain (elephant sitting on my chest)
  • sweating
  • skin color (pale, cyanosis)
18
Q

List the signs and symptoms of ischemic heart disease in women

A
  • more flu like sx
  • heart burn
  • feel off
  • fatigued
19
Q

List the atypical signs and symptoms of ischemic heart disease

A
  • indigestion
  • LV dysfunction
  • Arrhythmia
  • Syncope
  • Silent
20
Q

Condition: ST segment depression

A

Ischemia

21
Q

List the key features of stable angina

A
  • Well established onset (myocardial O2 demand, rate pressure product)
  • Stable characteristics remain unchanged for 60 days
  • Characterized by chest pain (transient hypoxia)
  • Relieved with change in activity or sublingual nitroglycerin
22
Q

List the key features of unstable angina

A
  • presence of signs/sx of inadequate blood supply to myocardium in the absence of demand
  • due to altered catecholamine levels, increased platelet activation
23
Q

List the clinical clues of unstable angina

A
  • angina at rest
  • typical angina occurs at lower exertion
  • deterioration of previously stable pattern
  • physiological changes (drop in HR or BP w/exercise)
24
Q

List the key features of prinzmetal angina

A
  • unusual syndrome of cardiac pain secondary to myocardial ischemia
  • cardiac pain exclusively at rest (sx NOT brought on by exercise)
  • ST segment elevation
  • secondary to increased coronary vasomotor tone/vasospasm

[tx w/nitrates and Ca blockers – beta blockers avoided]

25
Q

List the types of acute MI

A
  1. Transmural
  2. Non-transmural (endocardium to myocardium)
26
Q

EKG abnormality: cardiac cell death

A

ST segment elevation

27
Q

Define ST elevation MI (STEMI)

A
  • ST elevation in: 2 continuous leads, > 2 mm in V1, V2, V3, > 1 mm in other leads
  • indicates occlusion in a large vessel (large area at risk)
  • cardiac emergency
28
Q

Define NSTEMI

A
  • Findings of MI w/o ST elevation on EKG
  • not always, but may represent smaller area or high grade lesion w/o total occlusion
29
Q

Localization of Infraction: Inferior

  1. EKG
  2. Artery
A
  1. II, III, aVF
  2. R Coronary
30
Q

Localization of Infraction: Anteroseptal

  1. EKG
  2. Artery
A
  1. V1-V3
  2. LAD
31
Q

Localization of Infraction: Anterior

  1. EKG
  2. Artery
A
  1. V2-V4
  2. LAD
32
Q

Localization of Infraction: Lateral

  1. EKG
  2. Artery
A
  1. I, aVL, V5, V6
  2. LAD or circumflex
33
Q

Localization of Infraction: Posterior

  1. EKG
  2. Artery
A
  1. V1-V2, tall broad initial R wave, ST depression, tall upright T wave
  2. Posterior descending
34
Q

Describe the Tx of Acute MI

A

MONA

  • Morphine (pain, calming)
  • Oxygen
  • Nitrates (or beta blockers - vasodilate)
  • Aspirin (so they don’t throw a clot)

{draw blood for cardiac markers]

35
Q

List the Risk Factors for Ischemia Heart Disease

A
  1. Fam Hx
  2. Age
  3. Diabetes
  4. Hypercholesterolemia
  5. HTN
  6. Smoking
  7. Obesity
  8. Inactivity/Sedentary Lifestyle
36
Q

Define the Fick Equation

A

VO2 = [SV x HR] x A-VO2

37
Q

Describe the application of the Fick equation in those with compromised cardiac function

A

In those with compromise, A-VO2 allows for resting VO2 to be maintained

If Q can’t increase, O2 extraction can achieve a small increase in Vo2, but not enough to sustain exercise for an increased duration

**The heart is the limiting factor to exercise; but A-VO2 can improve with training

38
Q

Describe the disease specific effects of ischemic heart disease on physiologic responses and fitness

A
  • Decreased peak VO2 (
  • reduced cardiac output
  • chronotropic incompetence (HR/BP doesn’t met demand)
  • abnormal HR recovery
  • failure of SBP to rise in proportion to exercise intensity
39
Q

Define chronotropic incompetence

A
  • Failure to reach 85% of APMHR in the absence of beta blockers
  • Abnormal HR recovery [dec in HR
40
Q

List the surgical and pharmacological tx for ischemic heart disease

A
  • oxygen
  • nitroglycerin
  • aspirin (anti-platelet)
  • heparin (anti-coagulant)
  • pain relief
  • revascularization (catheterization)
  • stent
  • pharm: beta blockers, ca blocker, ACE inhibitors, statins
41
Q

Describe the phases of cardiac rehab very briefly

A

phase 1 = inpatient rehab

phase 2 = outpatient, 12 wk

phase 3 = transition to community

PTRS 826 Exam 1 (6 decks)

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