S2 - CVD

Question 1

Where in the U.S. leading causes of death does heart disease fall?

Answer 1

CVD is #1 (for the U.S. and the world)

Question 2

Try drawing out the flow of blood through the pulmonary and systemic circuits.

Answer 2

Question 3

Define thrombus and embolus

Answer 3

Thrombus = stationary blood clot

Embolus = moving blood clot

(or other clumped substance such as bacteria, fat, air, tumors, amniotic fluid, etc.)

Question 4

Describe the difference between ischemia and an infarct

Answer 4

Ischemia refers to reduced blood flow to tissues

Infarct refers to tissue necrosis secondary to reduced blood flow

Question 5

Define the following terms:

Atherosclerosis

Angina

Acute Myocardial Infarction

Answer 5

Atherosclerosis - Arterial hardening due to fatty plaque buildup

Angina - Chest pain

Acute Myocardial Infarction - Infarction of heart tissue

Question 6

Name the main six coronary arteries discussed in class. What part of the heart does each supply?

Answer 6

Right coronary artery

• Acute marginal artery (Anterior right ventricle)
• Posterior descending artery (Posterior right ventricle)

Left main coronary artery

• Left anterior descending (Anterior left ventricle and interventricular septum)
• Lateral and posterior left ventricle

Question 7

Which artery is the most common site of an AMI?

Answer 7

The left anterior descending artery

Question 8

What is the Million Hearts Initiative? Was it successful?

Answer 8

This is awesome:

https://millionhearts.hhs.gov/files/MH-meaningful-progress.pdf

Question 9

What are the four behavioral components of Life’s Simple Seven?

Answer 9

Physical activity

Weight reduction

Diet

Don’t smoke

Question 10

What are the three laboratory tests in Life’s Simple Seven?

Answer 10

Blood pressure

Plasma cholesterol

Plasma glucose

Question 11

Name all seven of the Life’s Simple Seven factors.

Answer 11

Physical activity

Weight reduction

Diet

Stop smoking

Blood pressure

Plasma cholesterol

Plasma glucose

Question 12

Name the type of proteins that help transport cholesterol in the bloodstream (remember, fat is hydrophobic and must be carried by hydrophilic proteins).

Answer 12

Lipoproteins

Question 13

Which type of lipoprotein removes cholesterol from the bloodstream by taking it to the liver? Is this protective or damaging against heart disease?

Answer 13

High-density lipoprotein (HDL)

Protective

(Happy cholesterol)

(Healthy cholesterol)

(Helpful cholesterol)

Question 14

Which type of lipoprotein is bound to cholesterol and contributes to atherosclerotic plaque buildup by increasing the quantity of cholesterol deposited into atheromas?

Answer 14

Low-density lipoprotein (LDL)

(Lousy cholesterol)

(Lame cholesterol)

(Loser cholesterol)

Question 15

What is the underlying problem in angina? Are cells necessarily dying at this point?

Answer 15

Chest pain caused by ischemia in the heart tissues.

This is not necessarily an infarction and so cells are not always dying at this point.

Question 16

Describe stable (classical) angina.

Answer 16

Ischemic chest pain that begins on physical and/or emotional exertion and subsides on rest and/or intake of nitrates

Question 17

Describe unstable (crescendo) angina.

Answer 17

Ischemic chest pain that begins at rest and/or exertion and does not subside after rest and/or intake of medication.

Often called crescendo angina as it tends to worsen over time.

Question 18

Describe Printzmetal (variant) angina.

Answer 18

Ischemic chest pain due to atypical contraction and spasm of the coronary arteries.

Occurs most often in young women

Not related to atherosclerosis

Question 19

Which type of angina pectoris often shows ST-elevation and is most likely to devolve into an AMI?

Answer 19

Unstable (crescendo) angina

Question 20

Are there any recreational drugs that can worsen angina or increase the likelihood of acute myocardial infarction?

Answer 20

Cocaine (Vasoactive - causes arterial constriction)

(Also nicotine)

Question 21

What are the signs and symptoms of AMI? Differentiate between the two sexes.

Answer 21

Women: Typically characterized by flu-like symptoms, fatigue, aches, chest tightness or pain, nausea, dyspnea

Men: More classically associated symptoms such as crushing chest tightness, pain that radiates into the neck and left arm, and dyspnea

Question 22

How does aspirin prevent AMI?

Answer 22

Through decreased production of thromboxane A₂ (A clotting activator) from arachidonic acid

Question 23

What is the difference between a subendocardial and a transmural AMI?

Answer 23

Subendocardial infarction involves only the innermost layer of the heart.

Transmural infarction involves all three layers of the heart (leads to ST-elevation).

Question 24

How is the pathophysiology of heart disease different in women than in men?

How does this difference manifest on angiography (X-ray of the blood vessels)?

Answer 24

Men are characterized by macrovascular atherosclerotic plaque buildup (Fat buildup in clumps in the bigger arteries)

Women are characterized by inflammatory processes which lead to microvascular dysfunction and widespread, even occlusion of the smaller arteries

On angiography, this difference often manifests as women’s arteries being clearer than men’s (even though there may be similar amounts of plaque buildup overall)

Question 25

What are some mechanisms of heart disease diagnosis?

Answer 25

Electrocardiogram (ECG), coronary angiography, stress test, cardiac enzymes present in blood (high-sensitivity C-Reactive protein (hsCRP) specifically in women)

Question 26

What is a common cardiac enzyme often found in the blood during an AMI?

Answer 26

Troponin I

Question 27

Name the three layers of an artery or vein.

Answer 27

Tunica intima (Endothelium)

Tunica media (Smooth muscle)

Tunica externa (Connective tissue)

Question 28

What is the main risk factor for atherosclerosis?

Answer 28

Hypertension

Question 29

Describe the general steps of atherosclerosis.

Answer 29

1. The endothelium is damaged
2. Cholesterol is deposited in the ruptured space
3. Macrophages enter the site, die, and become fat-laden foamy macrophages
4. The vessel lumen continues to narrow, pressure increases, and the risk of full occlusion or vessel rupture increase