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PSIO 485 Exam 03 > Lecture 14: Coronary Artery Disease > Flashcards

Lecture 14: Coronary Artery Disease Flashcards

1
Q

What are the two major coronary arteries?

A

Right and Left Coronary Artery

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2
Q

The Coronary Arteries transverse the ______ and ____ several times

A

Epicardium;

Branch

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3
Q

Right Coronary Artery:
It originates from the ______ behind the right aortic ____, travels behind the _____ ______, and extends around the right heart to the heart’s _____ surface, where it branches to the _____ and the _______

A

ostium
cusp; pulmonary artery
posterior
atrium; ventricle

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4
Q

What are they 3 major branches of the right coronary artery?

A

1) Conus
2) Right Marginal Branch
3) Posterior Descending Branch

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5
Q

Left Coronary Artery:

Arises from a single ______ behind the left ____ of the ____ _____ ______

A

ostium, cusp

aortic semilunar valve

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6
Q

Left Anterior Descending Artery:

Delivers blood to portions of the left and right ____ and much of the ______ ______

A

ventricles;

interventricular septum

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7
Q

Left Anterior Descending Artery:
The left anterior descending artery travels down the _____ ______ of the _________ _______ toward the ______ of the heart

A

anterior surface; interventricular septum

apex

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8
Q

Circumflex Artery:

Travels in the ______ ____, which separates the ____ _____ from the _____ _____, to the left boarder of the heart

A

coronary sulcus

left atrium; left ventricle

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9
Q

Circumflex Artery:

Supplies blood to the left _____ and the ____ ____ of the left ventricle

A

atrium; lateral wall

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10
Q

Circumflex Artery:

Often branches to the _____ surface to the _____ _____ and _____ _____

A

posterior

Left Atrium, Left Ventricle

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11
Q

Coronary Capillaries:
The heart has an extensive ____ ______. with approximately ______ capillaries per square millimeter or about ____ capillary per muscle cell

A

capillary network
3300
1

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12
Q

_____ of the cardiac muscles dramatically affect ____ _____ in the capillaries

A

Alterations

blood flow

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13
Q

Coronary Veins:
After passing through the extensive capillary network, blood from the _____ _____ drains into the _____ _____, which travel alongside the ______

A

Coronary arteries
cardiac veins
arteries

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14
Q

Matching of Flow to Needs
Under normal circumstances, the _____ muscle does receive adequate ___ _____ to support its activities, even during ____, when the rate of coronary blood flow increases up to ____ times its resting rate

A

cardiac
Blood flow
exercise
5

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15
Q

Nutrient Supply to the Heart
The heart has little ability to support its ______ needs by means of ______ metabolism and must rely heavily on its ____ supply

A

energetic
anaerobic
O2

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16
Q

Nutrient Supply to the Heart
As fuel sources go, the heart primarily uses ___ _____ ____ and, to a lesser extent, ____ and _____, depending on their availability

A

free fatty acids

Glucose and Lactate

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17
Q

Diseases of the Whole Heart
_____ _____ _____, Myocardial _____ and Myocardial ______ form a pathophysiologic continuum that impairs the _____ ability of the heart by depriving the heart muscle of ______ ______ _____ and nutrients.

A 
Coronary Artery Disease
Ischemia
Infarction
Pumping
Blood Borne Oxygen
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18
Q

Risk factors for CAD can be categorized as:
______ (major) vs ______ (minor)
_______ versus non-_______

A

Conventional; non traditional

modifiable (for both)

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19
Q

Risk Factors:
Conventional or major risk factors for CAD that are nonmodifiable include:
(3)

A

1) Advanced Age
2) Male gender or women after menopause
3) Family History

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20
Q

Modifiable Major Risk Factors include:

7

A

1) Dyslipidemia
2) Hypertension
3) Cigarette Smoking
4) Diabetes and Insulin Resistance
5) Obesity
6) Sedentary Life-Style
7) Atherogenic Diet

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21
Q

Dyslipidemia
Strong link between CAD and ALTERED plasma lipoprotein concentrations is well documented.
T/F

A

True

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22
Q

Dyslipidemia

The term _______ refers to lipids, phospholipids, cholesterol, and triglycerides bound to ____ _____

A

lipoprotein

carrier proteins

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23
Q

Total Cholesterol
Less than 200 mg/dL: ______
200-239 mg/dL: _______
Higher than 240 mg/dL:_____ _____ _____

A

Desirable
Borderline
High Blood Cholesterol

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24
Q

HDL
Less than 40 mg/dL (for men) or less than 50 mg/dL (for women)____ ____ _____
60 mg/dL and above: ___ _____ _____

A

Low HDL cholesterol

High HDL cholesterol

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25
Q

HDL
Low HDL means:
High HDL means:

A

high risk factor for heart disease.

protective against heart disease

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26
Q

Decreased HDLs
Low levels of HDL is also a strong indicator of ____ _____, and high levels of HDL may be more protective for the development of ________ than low levels of ____

A

coronary risk
atherosclerosis
LDL

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27
Q

Decreased HDLs

HDL is responsible for “ ______ ______ _____,” which returns _____ cholesterol from the tissue to the _____ for ______

A

Reverse Cholesterol Transport
excess
liver
metabolism

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28
Q

Decreased HDLs

_____, _____ ____, _____ ____ consumption, and moderate _____ use can result in modest increase in HDL

A

Exercise, weight loss, fish oil, alcohol

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29
Q 
LDLs
Less than 100 mg/DL:\_\_\_\_
100 to 129 mg/dL: \_\_\_\_\_ or \_\_\_\_ \_\_\_\_\_
130 to 159 mg/dL: \_\_\_\_\_ \_\_\_\_\_
160 to 189 mg/dL: \_\_\_\_\_
190 mg/dL and above: \_\_\_\_ \_\_\_\_
A 
Optimal
Near; above optimal
Borderline high
High
Very High
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30
Q

LDL_____, migration into the ____ wall, and _______ by macrophages, are key steps in the _______ of ________

A 
oxidation
vessel
phagocytosis
pathogenesis
atherosclerosis
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31
Q

LDL also plays a role in _____ injury, ______, and _____ response that have been identified as being important in _______

A

endothelial
inflammation
atherosclerosis

32
Q

Aggressive ____ of LDL diet and cholesterol lowering drugs, such as _____ and _____, is associated with a dramatic decrease in risk of CAD

A

reduction
Statins
ezetimibe

33
Q 
Triglycerides
Less than 150:\_\_\_\_
150-199:\_\_\_\_\_
 the high 200-499:\_\_\_\_\_
500 and above: \_\_\_\_\_ \_\_\_\_\_
A

Normal
Borderline
High
Very High

34
Q

This is responsible for a twofold to threefold increased risk of atherosclerotic cardiovascular disease

A

Hypertension

35
Q

What are come complications to Diabetes?

4

A

1) Neuropath
2) Retinopathy
3) Renal Disease
4) Cardiovascular Disease

36
Q

Diabetics are more likely to develop _____ _____ disease and the risk of mortality is much greater

A

ischemic heart

37
Q

Non-Traditional Risk Factors include

A

1) Increased Serum markers for inflammation and thrombosis
2) Hyperhomocyseinemia
3) Infection

38
Q

Markers of Inflammation and Thrombosis
C-rp is an acute phase reactant or ____ mostly synthesized in the _____ whose plasma concentration _____ shortly after ______ as part of the systemic inflammatory response.

A

protein
liver
increase
infarction

39
Q

Hyperhomocysteinemia
Occurs because of a ____ lack of the enzyme that breaks down ______ (an amino acid) or because of a nutritional deficiency of _____ (Vitamin B_) or ______ (vitamin B_)

A

genetic
Homocysteine
Folate; 9
Pryidoxine; 6

40
Q

Myocardial Ischemia Pathophysiology
Narrowing a major _____ _____ by more than __% impairs blood flow sufficiently to hamper ____ ______ under conditions of increased ______ demand

A

coronary artery
50
cellular metabolism
myocardial

41
Q

As the _____ increases in size, it may partially occlude the vessel ____, thus limiting coronary _____ and causing ______ especially during exercise

A

plaque
lumen
flow
ischemia

42
Q

Some plaques are “____,” meaning they are prone to _______ or rupture. When this occurs, underlying tissue of the vessel walls are exposed resulting in ______ ______ and _______ formation

A

unstable
ulceration
platelet adhesion
thrombus

43
Q

Myocardial Ischemia also can result from:

4

A
  • Coronary Spasm
  • Hypotension
  • Arrhythemias
  • Decreased Oxyegn carrying capacity of blood (Anemia, hypoxemia)
44
Q

Myocardial cells become ischemic within ___ ____. After several minutes, the heart cells lose the ability to ______. Ischemia also causes _______ _______. Cardiac cells remain viable for 20____ under ischemic condition.

A

10 sec
contract
conduction abnormalities
minutes

45
Q

Clinical Manifestations

Chronic Coronary ____ results in recurrent predictable ___ ____ called stable _____

A

obstruction
chest pain
angina

46
Q

Clinical Manifestations

Abnormal _______ or coronary vessels results in unpredictable chest pain called ______ angina

A

vasospasm

Prinzmetal

47
Q

Clinical Manifestations

Myocardial Ischemia that does not cause detectable symptoms is called ______ ______

A

Silent Ischemia

48
Q

What is Stable Angina?

A

Chest pain caused by myocardial ischemia

49
Q

When is Angina Pectoris occur?

A

As sub-sternal chest discomfort, ranging from a sensation of heaviness or pressure to moderately severe pain

50
Q

What do people who experience Stable Angina compare it to?

A

Clenching of the first over the left sternal border

51
Q

What is Prinzmetal Angina?

A

Chest pain attributable to transient ischemia of the myocardium that occurs unpredictably and almost exclusively at rest

52
Q

Where does the pain from Prinzmetal Angina originate from?

A

Caused by vasospasm of one or more major coronary arteries with or without associated atherosclerosis

53
Q

Evaluation and Treatment
____ examination may disclose extra, ____ heart sounds (left ventricle _____ or __, __), indicating ____ left ventricular function during the ischemic attack

A

Physical; rapid
gallop; S3; S4
Impaired

54
Q

Evaluation and Treatment:
The presence of ____ (small ___ deposit) around the ______ or arcus senillis of the _____ ( a yellow ____ ring around the _____) suggests _______ and possible ___________.

A

Xanthelasmas; fat
eyelids, eyes; lipid
cornea; dyslipidemia
atherosclerosis

55
Q

Evaluation and Treatment
The presence of peripheral or carotid _____ ______ suggests probable ________ disease and ______ the likelihood that CAD is present

A

arterial bruits
atherosclerotic
increases

56
Q

_____ is a critical tool for the diagnosis of myocardial ischemia

A

ECG

57
Q

Transient __ segment depression and _wave inversion are characteristics signs of ________ ischemia

A

ST;
T
Sub-endocardial

58
Q

__ elevation, indicative of ______ ischemia, is seen individuals with ____ angina

A

ST;
Transmural;
Variant

59
Q

Treatment of Ischemia

____ are often the druge of choice because they ____ oxygen supply and _____ demand

A

Nitrates
increase
reduce

60
Q

Treatment of Ischemia

Nitrates cause _____ veins, and, to a lesser extent, _____ arteries to _____

A

Peripheral (x2)

dilate

61
Q

Beta Blockers

____-_____ blocking agents have a great impact on therapy for _____ heart disease.

A

Beta-Adrenergic

Ischemic

62
Q

Beta Blockers

By _____ Beta receptors, these medication can _____ oxygen supply and ____ myocardial demand

A

blocking;
increase;
reduce

63
Q

Calcium Inhibitors
By Blocking the ____ of calcium into the myocardial cells, the ______ activity of the _____ node and conduction properties of the __ node can be modified

A

influx
Pacemaker;
SA (Sinoatrial)
AV (Atrioventricular)

64
Q

Anti-Platelet Agents
Experimental evidence linking platelet _____ with decreased _____ blood blow has led to the use of anti-platelet agents for individuals with ischemic heart disease

A

aggregation

coronary

65
Q

Blocking of Coronary Arteries

____ within the inner lining of the coronary ____ may develop a slight ____ or _____.

A

Plaque; artery

crack; rupture

66
Q

Blocking of Coronary Arteries
The sudden ____ in the ______ caused by the raised ruptured _____ and associated clot can transform a mild blockage into a ____ one within a matter of hours

A

increase; obstruction
plaque
critical

67
Q

What is “Percutaneous Coronary Intervention?”

A

A procedure whereby Stenotic coronary vessels are dilated with a catheter

68
Q

PCI
______ of the artery is the major complication of the procedure; however, placement of the coronary _____ can reduce the risk

A

Restenosis

Stent

69
Q

PCI

Anti______ treatment with glycoprotein ___/___ receptor antagonists after stenting also can greatly improve outcomes

A

thrombotic

IIB/IIIA

70
Q

ischemic heart disease can be surgically treated by this:

A

Coronary Artery Bypass Graft (CABG)

71
Q

What segment of the blood vessel is generally used in a CABG?

A

Saphenous Vein

72
Q

What is a “Myocardial Infarction?”

A

MI or Heart attack

Death of cardiac muscle resulting from ischemia

73
Q

What is the most effective way to save myocardium?

A

Reperfusion

74
Q

Consequences and Complications of MI
the number and severity of ______ complications depend on the _____ and ____ of necrosis, the individual’s _____ condition prior to the MI and how ____ medical intervention took place.

A

postinfarction
location; extent
physiologic
quickly

75
Q

What are 6 complications of MI?

A

1) Dysrhythmias
2) Cardiomyopathies
3) Organic Brain Syndrome
4) Aneurysm
5) Septal Rupture
6) Sudden Death

PSIO 485 Exam 03 (3 decks)

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