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DPT732: MAP II > MAPIISG1 - Atherosclerosis > Flashcards

MAPIISG1 - Atherosclerosis Flashcards

1
Q

What is atherosclerosis?

A

disease of large and intermediate-sized arteries in which fatty lesions/plaques develop on inside surfaces of arterial walls –> narrowing/smaller diameter, stiiffness/less reactivity, blockage

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2
Q

What are CV risk factors and which are primary?

A

primary: cigarette smoking, dyslipidemia (apo-B)

age, family history, sedentary, obesity (BMI, abdominal), HTN, psychosocial stress

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3
Q

What are protective factors?

A

fruits/veggies, exercise, moderate alcohol

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4
Q

How does development of atherosclerosis start?

A

damage to vascular endothelium –> excess LDLs penetrate subendothelial spaces and become trapped

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5
Q

What happens to the LDLs in the subendothelial spaces?

A

LDL oxidizes, releasing anions = oidative stress (antioxidants = preventative)

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6
Q

After LDL oxidize in subendothelial space, what is happening along side?

A

Monocytes cross endothelium and differentiate into macrophages which ingest oxidized LDLs

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7
Q

After macrophages ingest oxidized LDLs, what happens?

A

release foam cells

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8
Q

What happens to foam cells?

A

Smooth muscle cells engulf the foam cells and lipids

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9
Q

The engulfing of foam cells by smooth muscle cells causes what to form?

A

fatty streak

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10
Q

What happens to the fatty streak?

A

a fibrous cap forms over the fatty streak

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11
Q

What are the two types of plaque?

A

Stable and Unstable

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12
Q

What is the consequence of a Stable Plaque?

A

thick calcified cap, smaller fatty core –> hardened, narrow arteries which leads to atherosclerosis

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13
Q

What is the consequence of Unstable Plaque?

A

thin calcified cap, large fatty core –> rupture leads to MI or stroke

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14
Q

What are two consequences of Atherosclerosis?

A

Decrease in NO –> decrease in vasodialation/vascular reactivity

Decrease in Blood Flow (F ~ r^4)

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15
Q

What is Coronary Artery Disease (CAD)?

A

atherosclerosis of coronary arteries alters myocardial perfusion; myocardial perfusion occurs during diastole, when semilunar valves close

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16
Q

What does the Right Coronary Artery supply?

A

Inferior, posterior region

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17
Q

What does the Left Anterior Descending Artery (LAD) Supply?

A

LAD - anteroseptal

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18
Q

What does the LAD distal supply?

A

anteroapical

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19
Q

What does the Circumflex supply?

A

anterolateral

20
Q

What is Ischemic Heart Disease?

A

Imbalance of myocardial supply and demand

21
Q

What are gender differences for Ischemic Heart Disease?

A

Male - Crushing pain, “elephant on my chest”, nausea, left arm pain, jaw pain

Female - Nausea/vomiting, fatigue, anxiety, mid back tightness, discomfort

22
Q

What is a stable angina?

A

substernal chest pain radiating to elbow, assocatied with curshing/pressure, SOB, neusea, diaphoresis occuring w/ predictable level of activity

23
Q

What relieves a stable angina?

A

nitroglycerin

24
Q

How can Myocardial O2 consumption be estimated?

A

Rate Pressure Product = HR X SBP

25
Q

What is PT role in a stable angina?

A

Use RPP to correlate activity/exerise levels to episode of angina

26
Q

What is a unstable angina?

A

angina in absense of increased demand

  • angina at rest
  • angina at lower levels of activity/exercise, different from normal pattern
27
Q

With an unstable angina, what happens to BP with activity?

A

decreases

28
Q

What is a Myocardial Infarction (MI)?

A

lack of blood, O2 supply to myocardium –> death of myocardial tissue, abnormal myocardial function

29
Q

What is an indication that an MI has occurred?

A

Rise of cardiobiomarkers (troponin, CK-MB) >99th percentile and evidence of other signs

30
Q

What are other signs that a MI has occurred?

A

Discomfort > 20 minutes

31
Q

What are 2 EKG changes indicated an MI has occurred?

A

STEMI and NSTEMI

32
Q

What is a NSTEMI and what does it look like on an EKG?

A

Non-ST Elevated MI: function of elevated baseline

  • Not most serious
  • subendocardial

injured segment is partially depolarized prior to stimulation, ischemic cells have leaky cell membranes

33
Q

What is a STEMI and what does it look like on an EKG?

A

ST Elevation MI: ST segment appears elevated but function of depressed baseline
-Transmural damage - across whole wall

injured segment is partially depolarized prior to stimulation

34
Q

What do pathologic Q waves represent?

A

previous cardiac event - necrotic muscle does not generate electrical forces - Q wave results from absence of electrical force

-often provides permanent EKG evidence of previous MI in multiple leads

35
Q

Is exercise testing recommended diagnosing CAD for asymptomatic individuals with low CV risk (

A

no, useful for moderate pre-test probability (those w a greater likelihood of CAD

36
Q

What variables are evaluated with exercise testing for diagnosing CAD? (4)

A
  1. Hemodynamic response (HR and BP)
  2. EKG waveforms
  3. Limiting signs and symptoms (chest pain or shortness of breath)
  4. Gas exchange or ventiliatory response (VO2 max)
37
Q

What are exercise test responses that suggest myocardial ischemia?

A
  1. ST depression >= 1mm
  2. ST segment elevation with previous MI (pathologic q waves)
  3. Multifocal PVCs or run of V-tach
  4. Peak exercise HR >2 SD below age predicted HR (not on beta blockers)
  5. Exertional Hypotension (SBP drops > 10mmHg)
38
Q

What are the three medical or surgical management?

A
  1. Control Risk Factors
  2. Control Symptoms
  3. Revascularization
39
Q

How can symptoms be controlled?

A

nitroglycerin

40
Q

What are the two methods of revascularization and what are they?

A
  1. PCI - percutaneous coronary intervention: baloon angioplasty, stent
  2. CABG - coronary artery bypass graft
41
Q

What is Peripheral Artery Disease (PAD)?

A

decrease blood flow to legs

42
Q

What is Claudication pain?

A

angina in legs

43
Q

What are signs of intermittent claudication

A

achy, crampy feeling in legs
occurs w walking, exercise
decreases w rest
onset of pain predictable

44
Q

What does PAD mean in terms of risk of MI or stroke?

A

both increase

45
Q

What effect does smoking and diabetes have on PAD?

A

increase risk

46
Q

How do you diagnose PAD?

A

Ankle-Brachial Index

47
Q

What is a normal ABI?

A

> 0.9

DPT732: MAP II (14 decks)

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