Reviewer #8 Flashcards
Generic term for disorders of the heart and blood vessels.
CardioVascular Disease (CVD)
Refers more specifically to an ischaemic pathology related to disease of the blood vessels, causing myocardial oxygenation issues.
Coronary Heart Disease (CHD)
Two main clinical forms of this CHD
Angina and Myocardial Infarction
Progressive disease characterised by atheroma
(plaque) formation, which affects the intimal and medial layers of large and midsize arteries.
Atherosclerosis
Myocardial cells become ischaemic when the oxygen supply is inadequate to meet metabolic demands.
Myocardial Ischemia
Coronary heart disease is manifested by
Angina pectoris, Acute coronary syndrome, or Myocardial infarction
Chest pain resulting from reduced coronary blood flow, which causes a temporary imbalance between myocardial blood supply and demand
Angina Pectoris
Byproduct of anaerobic metabolism
Lactic Acid
How does lactic acid cause chest pain?
Stimulates nerve endings in the muscle, causing pain
Occurs when complete obstruction of a coronary artery interrupts blood supply to an area of myocardium. Affected tissue becomes ischaemic and eventually dies (infarcts) if the blood supply is not restored.
Myocardial Infarction
Specific indicators of myocardial infarction.
Elevated levels of Creatine Kinase and Cardiac specific troponins
Coronary heart disease is generally divided into two categories
Chronic Ischemic Heart Disease and Acute Coronary Syndrome
Chronic Ischemic Heart Disease includes
Stable and unstable angina pectoris and silent myocardial ischaemia
Acute Coronary Syndrome includes
Unstable Angina to Myocardial Infarction
Pain lasts a few minutes and occurs in a pattern, such as during exercise or stress and can be relieved by rest
Stable Angina
Pain can be stronger or last longer than stable angina and does not follow a pattern and is not relieved by rest
Unstable Angina
Almost always occurs when a person is at rest, usually between midnight and early morning.
Prinzmetals angina (Variant Angina)
Most common presenting symptom of CHD in women
Angina
Most common presenting symptom of CHD in men
Acute coronary syndromes and myocardial infarction
Pain in angina pectoris is defined as
Tight, squeezing, heavy pressure or constricting sensation.
The gold standard for evaluating the coronary arteries
Coronary Angiography
DOC for Angina
Nitrates (Nitroglycerin)
3 classes of drugs used in angina
- Nitrates
- Beta-blockers
- Calcium channel blockers
A condition of unstable cardiac ischaemia.
Acute coronary syndrome
Procedures may be used to restore blood flow and oxygen to ischaemic tissue
Revascularisation procedures
Procedures are used to restore blood flow to the ischaemic myocardium in the person with
CHD.
Percutaneous Transluminal Coronary Revascularisation
Surgery for coronary heart disease involves using a section of a vein or an artery to create a connection (or bypass) between the aorta and the coronary artery beyond the obstruction
Coronary Artery Bypass Grafting
2 types of atherosclerotic lesion
- Stable
- Unstable
Lesions progress by gradually occluding the vessel lumen
Stable atherosclerotic lesion
Prone to rupture and thrombus formation
Unstable atherosclerotic lesion
If nitrates doesnt work in angina it is
Myocardial Infarction
Depolarization is defined as
Contraction
Repolarization is defined as
Resting
Areas of skin that send signals to the brain through the spinal nerves.
Dermatome map
Technique to evaluate myocardial perfusion
Radionuclide testing
Usually caused by ulceration or rupture of a complicated atherosclerotic lesion.
Coronary occlusion
Disturbances or irregularities of heart rhythm,
and are the most frequent complication of MI.
Arrhythmias
Infarcted tissues are
Arrhythmogenic
These are common following an MI. May also be predictive of more dangerous arrhythmias such as ventricular tachycardia or ventricular fibrillation
Premature Ventricular Contraction (PVC)
Immediate treatment goals for patient with MI
- Relieve chest pain
- Reduce the extent of myocardial damage
- Maintain cardiovascular stability
- Decrease cardiac workload
- Prevent complications
A platelet inhibitor, now considered an essential part of treating AMI
Aspirin
Pain relief is vital in managing the care of a person with AMI so these drugs are used
Analgesia
DOC for pain unrelieved by glyceryl trinitrate and for sedation
Morphine Sulfate
Drugs that dissolve or break up blood clots, are first of line drugs for AMI
Thrombolytic therapy
Mechanical circulatory support device that may be used after cardiac surgery or to treat cardiogenic shock following MI.
Inta-Aortic Balloon Pump (IABP) or Intra-Aortic Balloon Counter Pulsation
Long term program of medical evaluation, exercise, risk factor modification, education and counselling designed to limit the physical and psychological effects of cardiac illness and improve quality of life.
Cardiac Rehabilitation
A complex syndrome caused by conditions that impair the ejection of oxygen and nutrient rich blood from ventricles.
Heart Failure
Heart failure is a long term effect of?
Coronary Heart Disease and Myocardial Infarction
Amount of blood pumped from the ventricles in 1 minute
Cardiac Output
Ability of the heart to increase CO to meet metabolic demand
Cardiac Reserve
Cardiac Output is a product of?
Heart rate and Stroke volume
The volume of blood ejected with each heartbeat, determined by preload, afterload, and myocardial contractility
Stroke Volume
Volume of blood in the ventricles at end diastole.
Preload
Force needed to eject blood into the circulation.
Afterload
Natural ability of cardiac muscle fibers to shorten during systole.
Contractility
Percentage of blood in the ventricle that is ejected during systole. Normal fraction is 60%
Ejection Fraction (EF)
The greater the stretch of cardiac muscle fibers, the greater the force of contraction
Frank Starling Mechanism
RAAS
Renin-Angiotensin Aldosterone System
Occurs as existing cardiac muscle cells enlarge, increasing their contractile elements (actin and myosin) and force of contraction.
Ventricular Hypertrophy
Occurs when the ventricle fails to contract adequately to eject a sufficient blood volume into the arterial system.
Systolic Failure
Results when the heart cannot completely relax in diastolic filling decreases, increasing the importance of atrial contraction to preload.
Diastolic Failure
Which side of heart failure is more dangerous?
Left Sided Heart Failure
Can left sided heart failure cause right sided one?
Yes but not vice versa
The greatest risk in the first hour after MI
Ventricular Fibrillation
Abnormal slow rhythms
BradyArrhythmia
Weakening and bulging of the ventricular wall.
Ventricular Aneurysm
Backflow of blood into the atria during systole
Regurgitation
Inflammation of the pericardial tissue surrounding the heart
Pericarditis
Ability of pacemaker cells to spontaneously initiate an electrical impulse (action potential).
Automaticity
Ability of myocardial cells to respond to stimuli generated by pacemaker cells.
Excitability
Ability to transmit an impulse from cell to cell.
Conductivity
Inability of cardiac cells to respond to additional stimuli immediately following depolarisation.
Refractoriness
Ability of myocardial fibres to shorten in response to a stimulus.
Contractility
Primary pacemaker of the heart
SA Node
A phenomenon of normal and slow conduction, is a major cause of tachyarrhythmias.
Re-entry phenomenon
Normal heart rhythm
Normal Sinus Rhythm
Breakdown of cells
Lyse
Condition in which the person awakens at night acutely short of breath
Paroxysmal Nocturnal Dyspnea
Condition in which the person awakens at night acutely short of breath
Paroxysmal Nocturnal Dyspnea
Voiding more than one time at night
Nocturia
Main problem for left sided heart failure
Pulmonary congestion
Main problem for right sided heart failure
Anasarca
Main drug classes used to treat heart failure
Angiotensin-Converting Enzymes (ACE), Angiotensin II Receptor Blockers (ARB), Beta-Blockers, Diuretics, Inotropic
Coronary Heart Disease is usually caused by?
Atherosclerosis
Classic manifestation of MI
Pain
In giving diuretics it is important to check for?
Blood Pressure
Patients with CHF needs daily monitoring of?
Weight
Type of angina that develops due to coronary artery spasm
Prinzmetal angina
Primary test used to establish diagnosis of ACS
Electrocardiogram
In episodes of angina what changes happen in the ECG result?
ST segment sloping down
Drug that has electrophysiological effects. Slows conduction through AV node decreasing heart rate and reducing oxygen consumption
Digoxin
Antidote for digoxin
Digibind
Common side effect of Nitrates
Headache
What does MI show in ECG
Elevated ST segment
STEMI meaning
ST Elevated Myocardial Infarction
DOC for CHF
Digoxin
Digoxin is classified as
Positiove Inotropics
