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Newman: Questions for CV disease and CAD Flashcards

1
Q

What are the determinants of BP?

A

P = Q x R

*altering flow and resistance

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2
Q

the ability of the arterioles to clamp down ro relax

A

resistance

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3
Q

What substances can increase vascular resistance?

A

Norepi
Epi
Angiotensin II

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4
Q

What substances decrease vascular resistance

A

NO

prostacylin

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5
Q

T or F: Flow = Cardiac Output

A

True

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6
Q

CO =

A

SV x HR

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7
Q

quantity (CCs) of blood ejected from the left ventricle into the aorta every cardiac cycle

A

stroke volume

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8
Q

What are the determinants of SV?

A

preload, afterload, contractility

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9
Q

the volume of the left ventricle at the end of diastole

A

preload (EDV)

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10
Q

T or F: An increase in preload will increase blood pressure

A

T

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11
Q

Why would you insert a pulmonary artery catheter?***

A

to measure preload: ballon inflates in the (left ventricle?) and the preload can be measured (left ventricular end diastolic pressure)

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12
Q

A bigger left ventricle (dilation) will (increase or decrease) the afterload.

A

increase

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13
Q

The inherent ability of the heart to contract–is independent of preload and afterload

A

contractility

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14
Q

SV / EDV =

A

ejection fraction

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15
Q

A pt has an ejection fraction of 30%, is that good or bad?

A

bad

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16
Q

A pt has an ejection fraction of 70%, is that good or bad

A

good

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17
Q

renin is secreted fron JG apparatus in response to ____

A

dec Q, CO, SV

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18
Q

Angiotensin I goes thru the ____ and is converted to ang II by_____

A

lungs

converting enzyme

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19
Q

What 2 important things does angiotensin II do?

A
  1. potent vasoconstrictor (inc resistance)

2. stimulates the secretion of aldo from the adrenal glands

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20
Q

An decrease in the amount of angiotenisn II would (inc or dec) BP

A

decrease

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21
Q

What does aldosterone do?

A

causes reabs of Na and excretion K+

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22
Q

Would a person in HF want to have high or low levels of aldosterone?

A

low – do not was to reabsorb any more Na/H2O

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23
Q

A pt presents to you with chest pain only upon exertion and is relieved by rest.
What would a treadmill test tell you?
What would a cardiac catherterization tell you?
What pharm

A

treadmill: will increase HR and SBP, which exacerbate the exertional chronic stable angina

cardiac cath will tell you how blocked he is, but I don’t think he’s a candidate for this?

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24
Q

A pt has severe chest tightness which wakes him from sleep

normal ECG

A

acute coronary syndrome

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25
You have 3 vessel coronary disease. What do you do now?
bypass--STAT!
26
pt presents to the ED with severe chest pain. the ECK reveals ST elevation in leads 2, 3, and avF what do you do?
cath?
27
3 syndromes of coronary disease
chronic stable angina Acute coronary syndrome ST elevation MI
28
62 yr old male walks his dog and gets tightness in chest with SOB. He sits down and the pain goes away. Dx
chronic stable angina
29
Man carrying bag of groceries upstairs and it got better when he sat down. Dx
chronic stable angina
30
tighness/contrictoion in chest + SOB + gets better when sits down/at rest
chronic stable angina
31
exertional symptoms
chronic stable angina
32
inadequate supply of blood to myocardium (heart blockages) and increased demand relative to the supply
chronic stable angina
33
2 major determinates of myocardial demand
systolic BP | HR
34
Effect of exercise on HR and systolic pressure
inc HR and inc systolic pressure
35
What reduces supply in chronic stable angina?
arthlerosclerosis
36
``` Wakes up with elephant sitting on chest pale sweating breathing hard *this is not dependent upon exertion ```
acute coronary syndrome
37
pathophys of acute coronary syndrome
arthlerosclerotic plaque narrown lumen --> ruptures--> 1. increased constriction/resistance 2. thrombotic state in which blood clots form at area of rupture
38
T or F: acute coronary syndrome is a problem of supply and demand
false | *there is no inc demand on the heart, just a problem with supply
39
What is the diff btwn MI and acute coronary syndrome?
in MI, there is ZERO perfusion/supply = CA is 100% occluded | Has ECG changes!
40
problem of supply and demand--inc demand will not lead to a proportinal inc supply
chronic stable angina
41
O2 supply is a function of ____
coronary blood flow
42
arthleroscloerotic plaque causes
inadeqate supply
43
Myocardial demand is a function of
systolic BP and HR
44
blockage restricts O2 supply when it takes up ___% of CA lumen
70%
45
heart pains are always more than _____mins and never more than ____mins (time)
5 mins; 30 mins
46
Heart pains assc with activities is better or worse prognosis
better prognosis
47
Chronic stable angina is assc with (inc or dec) catecholamines
inc catecholamins --> skin gets pale | = over sympathetic activity
48
angina pectoris/chronic stable angina assc with
diaphoresis | sense of breathlessness
49
T or F: heart pains almost always makes a person alter their activities
true
50
angina pectoris is a consequence of myocardial oxygen demand exceeding _____
myocardial oxygen supply
51
can replicates syndrome (see if gets pale, breaks out in sweat, pain, see EKG)
treadmill test
52
At the microscopic level in chronic stable angina, what is happening at microscopic level?
ishemia
53
etiologic factors other than artherlosclerosis that can cause an MI
injury | emboli
54
pt that woke up in middle of the night with an elephant on chest with normal ECG
acute coronary syndrome | *lack of complete occlusion of artery
55
pathophys of ACS
artherlosclerotic CA --> rupture --> platelets move in --> TXA2 made --> momentary vasoconstriction --> decrease in O2 supply/ischemia
56
artherlosclerosis --> ______ --> rupture --> _______
chronic stable angina | acute coroney syndrome
57
What causes the arthlerosclerotic plaque rupture in ACS?
``` endothelial activation smoking cytokines elevated glc (AGE) HTN ``` lead to -vasoconstrion and platelet aggrgation --> rupture
58
vulnerable plaque vs stable plaque
vulterable have large lipid core, thin cap stable: more smooth muscle cells and is more well formed
59
role of platelets in ACS
rupture of plaque --> paltelets rush in --> TXA2 produced --> vasoconstriction --> fibrin deposition
60
In ACS the ____ is the culprit
vessel | platelets are the 2nd most important part
61
rupture --> thrombus
ACS
62
What is the Tx of ACS
blood thinners (heparin)
63
MI and ACS presents similarly, what is the only distinguishing factor
ECG
64
severe prolong contriction of chest (may last an hour or 2) very pale very diaphortetic difficulty breathing
acute MI
65
Complications of acute MI
``` syncope arrythmia LHF cardiogenic shock sudden death ```
66
Describe the heart pain in an acute MI
30 mis to several hour of chest pain | pain radiates to arm, neck, jaw
67
MI ECG changes
ST elevation
68
ST elevation means
the vessel has been 100% occulded (by thrombus)
69
locations of ST elevation on ECG determines _____
location of MI on heart
70
as myocytes die the secrete enzymes....
CK SGOT LDH troponin
71
_____ is a predictor of ischemic event
troponin
72
more than 1 p wave for every QRS
heart block (casues arrhythmia?)
73
Tx of heart block
pacemaker
74
ventricualr fibrillation
know ECG for it
75
complication of MI
myocardial rupture | -blow hole in wall of ventricle, IV septum, papilary muscle
76
fluid in lungs due do abnormal accumulation of Na and H2O
HF (fluid in alveoli)
77
What to do when person has MI and there is no cath lab
get rid of clot to reperfuse | -streptokinase
78
treateent of choice for a pt with ST elevation MI
put in mesh balloon/stent at area of occlusion = angioplasty
79
take veins from leg, anastomose to proximal aorta and anastomose to area distal to CA blockage
bypass surgery
80
What has a positive effect on SV? | Negative?
positive: - inc length of myocardial fibers by increasing preload (EDV) negative: - inc afterload decreases the contractility (dialated left ventricle); inc systolic BP
81
Formula to calculate ejection fraction
SV / EDV
82
arthlerosclerotic plaque narrown lumen --> ruptures--> 1. increased constriction/resistance 2. thrombotic state in which blood clots form at area of rupture
ACS
83
How are heart pains (in chronic stable angina) distinguished from other pains?
longer than 5 mins and less than 30mins | make a person alter their activities
84
T or F: in ACS the coronary artery is 100% occluded
False, not 100% | This is why the EKG is unremarkable*

Cardio (26 decks)

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