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ExPhys > RCQ CH 3 > Flashcards

RCQ CH 3 Flashcards

1
Q

name of the outer layer of coronary artery

A

adventitia

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2
Q

function of adventitia

A

collagenous fibers that provide basic support structure

houses vasa vasorum

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3
Q

name of the middle layer of coronary artery

A

media

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4
Q

composition of the media

A

layers of smooth muscle cells that are separated by an elastic membrane

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5
Q

what is the lamina

A

elastic membrane that separates the smooth muscle cells in the media

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6
Q

function of the media

A

luminal diameter control
-vasoconstriction/dilation

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7
Q

smooth muscle cells in the media do this as well as constricting/dilating

A

synthesize:
collagen
elastin
glycosaminoglycans

in response to physical/chemical stimuli

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8
Q

name of the inner layer of coronary arteries

A

intima

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9
Q

composition of intima

A

endothelial layer
basement membrane
isolated smooth muscle cells
collagen/elastin fibers

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10
Q

the arterial endothelium is _____ and this is important because

A

selectively permeable to LDLs
- lipoproteins and fibrinogen are likely to accumulate there

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11
Q

atherosclerosis

A

progressive hardening and narrowing of the coronary, cerebral and peripheral arteries

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12
Q

atherosis initial sign

A

fatty streak
- deposits of lipid laden macrophages and smooth muscle cells

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13
Q

what are foam cells

A

clusters of monocytes between endothelial cells that accumulate lipids

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14
Q

what happens in an intima-based lesion? what is the result of that?

A

underlying CT is exposed to circulation
platelets aggregate and a thrombus forms

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15
Q

what causes end-organ damage

A

not pure atherosis alone, will need sclerosis to cause end damage

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16
Q

sclerosis

A

reduction of blood vessel compliance due to increased collagen and decreased elastin

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17
Q

what causes sclerosis

A

subendothelial structures exposed to thrombus formation

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18
Q

encrustation

A

formation of fibrous cap over advanced plaques in the endothelial lining

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19
Q

role of platelet derived growth factor in sclerosis

A

Stimulates replication of CT cells in the intima
acts as a chemoattractant
—attracts smooth muscle cells to migrate from the media to intima

20
Q

differences between variant and stable angina

A

Associated with the ST segment elevation instead of depression

Occurs at rest rather than activity

Not associated with any preceding increase in myocardial oxygen demand

Those with variant angina will be able to perform high levels of work later in the day without symptoms, those with unstable angina will not be able to

21
Q

similarities of variant and stable angina

A

nitroglycerin/vasodilators aid symptoms

22
Q

proposed origin of variant angina

A

Vasospastic nonlesion that will constrict instead of relaxing when stimulated

hyperreactivity of coronary smooth muscle due to a reduction in the release of nitric oxide

23
Q

characteristics of chronic stable angina

A

Predictable mode of symptom provocation (certain level of myocardial oxygen demand)

Reduction of intensity or nitroglycerin

Slight variability in tolerance of activity (good/bad days)

24
Q

characteristics of sudden cardiac death

A
  • 40-50% of patients –
    related to atherosclerosis
    tachycardia
    ventricular fibrillation
    cessation of cardiac output
    AED within 10 min is only hope
25
Q

categories of acute coronary syndrome

A

unstable angina or acute MI

26
Q

unstable angina definition

A

presence of s/s of inadequate blood supply to myocardium in absence of demands

27
Q

characteristics of unstable angina

A

Atherosclerotic plaque rupture in a partially occluded artery

Coronary vasoconstriction

Inflammation

Increased morbidity/mortality rates

28
Q

AMI definition

A

myocardial necrosis due to ischemia

29
Q

criteria for AMI

A

Troponin rise/drop

evidence of ischemic symptoms

ECG (pathologic Q wave, ST segment changes, and/or new left bundle branch block)

cardiac muscle damage/abnormalities

30
Q

4 typical presentations of coronary heart disease

A

Sudden Cardiac Death
Chronic Stable Angina
Acute Coronary Syndrome
Cardiac Muscle Dysfunction

31
Q

main difference between stable and unstable angina

A

in those with Unstable angina

Absence of increase myocardial oxygen demand in provocation of syndrome and decreased cardiac vein oxygen saturation precedes symptoms

32
Q

what is RPP

A

rate pressure product

HR x SBP

33
Q

key indicators of MI prognosis

A

size/damage related to complication

Infarction size

Presence of disease in other CA

Left ventricular function***

34
Q

what can HTN lead to

A

atherosclerotic heart disease
congestive heart failure
cva
renal failure
dissecting aneurysm
peripheral vascular disease
retinopathy

35
Q

score on the Wells Decision tool that are significant

A

criteria for the likelihood of a DVT
> 2pts = likely
< 2pts = unlikely

36
Q

intermittent claudication

A

ischemia of an extremity
with PAD, lactic acid accumulation
–pain with activity, rest alleviates

37
Q

what is associated with CAD

A

dysfunction of ventricles
atherosclerosis

38
Q

dysschrony

A

uncoordinated contraction of heart at same time

39
Q

hypokinesis

A

decreased strength of contraction

40
Q

akinesis

A

no contraction

41
Q

dyskinesis

A

abnormal movement during contraction
- mvmt at abnormal time

42
Q

15% of LV damage due to MI indicates

A

stroke volume decreases
increase LV end diastolic pressure
increase LV volume
decreased CA perfusion

43
Q

25% of LV damage due to MI indicates

A

s/s of HF

44
Q

40% of LV damage due to MI indicates

A

death

45
Q

20-25% of LV damage due to MI indicates

A

s/s of cardiovascular failure
poor prognosis for long term

46
Q

what are determinants of cardiac muscle perfusion

A

diastolic blood pressure
vasomotor tone
resistance
left ventricle end diastolic pressure

47
Q

what are associated values related to aneurysm

A

dilation that is 50% or greater
>3 cm

ExPhys (9 decks)

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