pathophysiology Flashcards
What is the number one cause of death in the world and the leading cause of death in the US?
Heart disease
What are the nine factors significantly associated with acute MI worldwide?
1) current smoking
2) diabetes
3) hypertension
4) abdominal obesity
5) psychosocial index
6) fruits/vegetables
7) exercise
8) alcohol
9) ApoB-ApoA1 (LDL-HDL)
Which type of angina is the least life threatening among acute coronary syndromes?
unstable angina
What are the 3 layers of the arterial walls?
- tunica intima – endothelium that lines the lumen of all vessels
- tunica media – smooth muscle cells and elastic fibers
- tunica adventitia – collagen fibers
What is the initial cause of atheroclerosis damage to the blood vessel endotherlium?
high levels of LDL
What happens when LDL oxidizes?
releases anions (oxidative stress)
What occurs during oxidative stress due to the endothelium being damaged?
- LDL migrate into the vessel (subendothelial layer)
- monocytes migrate into the subendothelium
- LDL’s are taken up by monocytes which forms into a foam cell
- the foam cell is the initial start to a fatty streak in the vessel wall
- the fatty streak becomes plaque which begins to build up in the vessel
foam cell production activates what?
activates some of the smooth muscle cells to migrate from the middle layer in towards the lumen into the subendothelial space –> leading to plaque formation
smooth muscle cells adhere to what to form plaque?
adhere to foam cells
What are referred to as lipid enhanced macrophages?
foam cells
What type of plaque remains on the vessel wall causing a narrowing of the lumen?
stable plaque
What type of blood flow does stable plaque cause?
turbulent blood flow
What type of plaque is more likely to rupture and if so, releases plaque into the blood causing a stroke or MI?
unstable plaque
When does myocardial perfusion occur?
during periods of muscle relaxation (diastole)
When does the heart muscle receive the most blood?
diastole
What type of heart disease is caused by an imbalance of myocardial supply and demand?
ischemic heart disease – the heart is NOT getting the oxygen it needs
What anatomical region of the heart is supplied by the right coronary artery?
inferior and posterior (right atrium and ventricle) regions
What anatomical region of the heart is supplied by the left anterior descending artery (anterior interventricular artery)?
anteroseptal region
What anatomical region of the heart is supplied by the distal portion of LAD?
anteroapical region (left ventricle)
What anatomical region of the heart is supplied by the circumflex artery?
anterolateral region
What are the 2 branches of the left coronary artery?
LAD and circumflex
What are the 5 symptoms/signs of MI in a male?
- crushing pain
- “elephant on my chest”
- nausea
- left arm pain
- jaw pain
What are the 5 symptoms/signs of MI in a woman?
- nausea/vomiting
- fatigue
- anxiety
- midback tightness
- discomfort
What symptoms/signs are associated with stable angina?
- substernal chest pain radiating to elbow
- crushing/pressure
- associated with SOB, nausea, diaphoresis
- relieved by rest or nitroglycerin
- occurs with predictable level of activity
What is the equation for rate pressure product?
HR x SBP = workload of the heart
What is known as the presence of angina in the absence of increased demand (workload)?
unstable angina
Lack of what can lead to tissue cell death?
lack of oxygen (blockage)
Scar tissue is the result of what?
tissue cell death
Does scar tissue conduct electricity?
NO – will normally see a change in the QRS complex
ST segment change indicates what?
the presence of scar tissue in the heart – due to a change in the QRS complex
What biomarker is specific to heart muscle?
troponin
Will you see an increase or decrease in troponin when there is damage to cardiac muscle cells?
increase
Will you see an increase or decrease in creatine kinase levels due to the occurrence of MI?
increase
What 2 EKG changes do you see with MI?
- ST segment elevation
- Q waves
ST segment depression represents what?
ischemia
What does NSTEMI represent?
non-ST segment elevation myocardial infarction
What occurs at the ST segment during NSTEMI?
- not receiving an ST segment elevation from a MI
- the whole wave form has shifted, making it appear that the ST segment has been depressed
What does STEMI represent>
ST segment elevation myocardial infarction
What occurs at the ST segment during STEMI?
- the wave has shifted downward, making the ST segment appear to be elevated
Which classification of MI is subendocardial (below the surface of the cardiac muscle)?
NSTEMI
Which classification of MI is transmural (throughout the entire muscle)?
STEMI
Exercise test responses suggesting myocardial ischemia?
- ST segment depression
- multifocal PVC or runs of V-tach
- peak exercise HR > 2 SD below age predicated HR
- exertional hypotension
What type of PVC originates in various locations and contraction occurring in the ventricle before the SA node can fire?
multifocal PVC
What medication reduces LDL?
Statin
What does PAD represent?
peripheral artery disease
What does ABI represent?
Ankle-brachial index
What are normal ABI levels?
ABI > 0.90
What are the 2 main risk factors for PAD?
smoking and diabetes
Signs of intermittent claudication?
- achy, cramping feeling in legs
- occurs w/ walking or exercise
- decreases w/ rest
- onset of pain is predictable
Main sign of intermittent claudication?
cramping, aching pain in legs
