Test 2 lecture 4 Flashcards
1
Q
What type of angina is this:
- most common form
- occurs at a given activity level
- Fibrous cap is not ruptured
A
Stable Angina
2
Q
What type of Angina:
- New onset
- unpredictable
- Fibrous capsule ruptures
- May lead to Heart attack
A
Unstable Angina
3
Q
In 2010 what was the leading cause of death?
A
Diseases of the heart (heart disease)
4
Q
Acute coronary syndrome impacts:
Amount of people with history of MI’s
is ___________
A
Aprox. 16 Million Americans
5
Q
Acute coronary syndrome impacts:
Amount of people with history of angina
_________
A
Aprox. 9 million
6
Q
Acute coronary syndrome impacts:
amount of people with history of New acute coronary syndrome
_________
A
Aprox. 785,000 per year
7
Q
Acute coronary syndrome impacts:
amount of people with recurrent acute coronary syndrome
_________
A
Aprox. 470,000 per year
8
Q
Acute coronary syndrome impacts:
amount of people who have Silent MI’s
_________
A
Aprox. 195,000 per year
9
Q
Total costs for diseases of the heart in 2007:
_______
A
177.5 Billion
10
Q
coronary arteries are
- Off the _____ ____ ____
- are made up of the Right and left coronary arteries
A
Root of the Aorta
11
Q
The RCA or Right coronary Artery
supplies the ______ &_____
A
Right Atrium and Ventricle
12
Q
The Left coronary splits into the
________
and
_______
A
Left Anterior Descending (LAD)
&
Circumflex Artery (LCx)
13
Q
The left Coronary supplies blood to the _______ &______
A
Left Atrium and Ventricle
14
Q
At rest the Coronary blood flow should be
___-___ ml/min/100g
A
60-90 ml/min/100g
15
Q
During exercise the Coronary blood flow should be
____-___ Times higher than resting blood flow
A
5-6 Times higher than resting
“60-90 ml/min/100g (Resting)”
16
Q
what is MVO2 ?
A
Myocardial Oxygen uptake
17
Q
MVO2 at rest should be ____-____ ml/min/100g
A
8-10 ml/min/100g
18
Q
______ occurs when the o2 supply is greater than the o2 demand
A
Ischemia
19
Q
Ischemic _______
- stiffening of LV
- Systolic Dysfunction
- Locallzed hypokinesis
- Left Ventircal ejection fraction is decreased
- arrhythmia
- Angina Pectoris
A
Ischemic Cascade
20
Q
The number of people who have had Silent Ischemia is
_________
A
195,000
21
Q
High BP can damage _________ cells
A
Endothelial
22
Q
Damage to endothelial cells effects the ability to _____ and _______
A
Dilate and Constrict
23
Q
The ______ ______ is responsible for vasoconstriction and vasodilation
A
Tunica Media
24
Q
In Atherosclerosis the ________ ____ is made up of Cell debris, cholesterol crystals, Foam cells, & calcium.
A
Necrotic Center
25
What are the Risk Factors for Atherosclerosis?
* **age**
* **male sex**
* **Family History** **& genetics**
* **Smoking**
* **pre-diabetes and diabetes**
* **obesity**
* **metabolic syndrome**
* **hypertension**
* **dyslipidemia**
* **physical inactivity**
* **psycho-social factors**
* **homocysteine**
* **C-reactive protein**
* **inflammatory proteins**
* **Fibrinogen**
26
**Pathophysiology of Progressive Atherosclerosis:**
1. **\_\_\_\_\_\_\_\_\_ Dysfunction**
2. **\_\_\_\_-\_\_ accumilation and oxidation in \_\_\_\_\_\_\_**
3. **injury and \_\_\_\_\_\_\_\_\_**
4. **\_\_\_\_\_\_\_\_ and entry into cell**
5. **Monocyte \_\_\_\_\_\_\_\_\_\_\_\_\_**
6. **Macrophage engulfs oxidized LDL and creates \_\_\_\_\_**
7. **\_\_\_\_\_\_ and calcification**
**Pathophysiology of Progressive Atherosclerosis:**
1. **Endothelial** Dysfunction
2. **LDL-C** accumulation and oxidation in **arterial wall**
3. injury and **inflammation**
4. **Monocyte binding** and entry into cell
5. Monocyte **differentiation into macrophages**
6. Macrophage engulfs oxidized LDL and creates **Foam Cells**
7. **Plaque maturation** and calcification
27
**What can trigger an MI?**
**_Triggers for MI_**
* **Exertion**
* **Emotional Stress**
* **Sympathetic activation**
* Heart rate variability and prognosis
* **Surgery causing blood loss**
28
What is a thrombus?
**Blood Clotting**
29
**Pathophysiology of MI:**
* **\_\_\_\_\_\_\_\_\_\_\_\_\_\_ in coronary artery**
* **Blood ____ \_\_\_\_\_\_\_**
* ________ **of downstream myocardium**
* **\_\_\_\_\_\_\_\_**
* **\_\_\_\_\_\_ \_\_\_\_**
* **\_\_\_\_\_\_\_**
* **Ventricular fibrillation**
* **Ventricular tachycardia**
**Pathophysiology of MI:**
* **_Plaque rupture and ulceration_** in coronary artery
* Blood _**flow****occlusion**_
* **_Necrosis_** of downstream myocardium
* **Protein release:**
* _**Cardiac** **troponin**_
* __**_Dysrhythmias_:**
* Ventricular fibrillation
* Ventricular tachycardia
30
**_Signs and Symptoms of Acute MI:_**
* **\_\_\_\_\_\_**
* **\_\_\_\_\_\_**
* **\_\_\_\_\_\_**
* **Anxiety**
* **Confusion**
* **Dizziness**
* **Nausea**
* **\_\_\_\_\_\_\_\_\_\_\_\_\_**
* **\_\_\_\_\_\_\_**
* **25% of cases**
**_Signs and Symptoms of Acute MI:_**
* **_Angina_**
* **_Dyspnea_**
* **_Sweat_**
* **_Syncope -Loss of consciousness_**
* Anxiety
* Confusion
* Dizziness
* Nausea
* **_ST segment deviation_**
* **_Silent Ischemia_**
* 25% of cases
31
**_Prognosis of Acute MI:_**
Factors assocaied with Poor Prognosis:
* Left Ventrical Ejection Fraction is \< ___ %
* Normal is _\_\_\_-\_\_\_%_
* Congestive Heart Failure
* Poor exercise capacity
* __\< ___ Mets
* Evidence of extensive myocardial ischemia during exercise or ________ \_\_\_\_\_\_ \_\_\_\_\_\_.
* Having survived _____ \_\_\_\_\_\_ \_\_\_\_
**_Prognosis of Acute MI:_**
Factors assocaied with Poor Prognosis:
* Left Ventrical Ejection Fraction is \< **_35_** %
* Normal is _**50-60**%_
* Congestive Heart Failure
* Poor exercise capacity
* \< **_5_** Mets
* Evidence of extensive myocardial ischemia during exercise or **_parmocoligic stress testing_**.
* Having survived **_Sudden_** **_Cardiac_** **_Death_**
32
The presence of Biomarkers of \_\_\_\_\_\_\_\_\_\_\_\_\_
is used to detect Acute MI.
**Myocyte Necrosis**
33
**_Diagnosis of Acute MI:_**
If someone is having chest pain persisting for greater than ____ minutes the person could have ECG changes.
**30 minutes**
34
**_Diagnosis of Acute MI:_**
**Changes in ECG include**:
* ST- Segment
* T-wave
* Bundle branch block
* development of pathologic ___ Wave
**_Diagnosis of Acute MI:_**
**Changes in ECG include**:
* ST- Segment
* T-wave
* Bundle branch block
* development of **_pathologic Q-Wave._**
35
**_Diagnosis of Acute MI:_**
Someone with Acute MI will show imaging evidence what type of imaging is used?
* \_\_\_\_\_
* \_\_\_\_\_
**_Diagnosis of Acute MI:_**
**Types of Imaging_:_**
* **Nuclear Protrusion scan**
* **Echocardiogram**
36
**_Diagnosis of Acute MI:_**
An ST elevation would represent \_\_\_\_\_\_\_
**_Diagnosis of Acute MI:_**
An ST elevation would represent **_infarction_**
37
**_Diagnosis of Acute MI:_**
An ST depression would represent \_\_\_\_\_\_\_
**_Diagnosis of Acute MI:_**
An ST depression would represent **_Ischemia._**
38
**_MI Classification:_**
* **_ST Segment Elivation (STEMI)_**
* **__**At least _____ Elivation
* Development of _______ \_\_\_\_ \_\_\_\_\_
**_MI Classification:_**
* **_ST Segment Elivation (STEMI)_**
* At least **_1 mv_** Elivation
* Development of **_bundle_** **_branch_** **_block_**
39
**_MI Classification:_**
* **_Non-ST Segment Elivation (NSTEMI)_**
* **__**ST-segment \_\_\_\_\_\_\_\_
* _________ Persisting for at least 24hrs
**_MI Classification:_**
* **_Non-ST Segment Elivation (NSTEMI)_**
* ST-segment **_depresson_**
* **_T-wave inversion_** Persisting for at least 24hrs
40
**_Treatment for acute coronary syndromes:_**
Management of acute coronary syndromes:
* ______ therapy
* oral and intravenous \_\_\_\_\_\_\_\_\_\_\_\_\_
* \_\_\_\_\_\_\_\_\_
* \_\_\_\_\_\_\_\_\_
* ________ \_\_\_\_\_\_
**_Treatment for acute coronary syndromes:_**
Management of acute coronary syndromes:
* **_Anti-ischemia_** therapy
* oral and intravenous **_anti-platelet Therapy_**
* **_anticoagulants_**
* **_Pain Relief_**
* **_Reperfusion**_ _**Therapy_**
41
What is **PCI?**
**Percutaneous Coronary Intervention:**
42
What is **CABG?**
**Cardiac Artery Bypass Graft (Surgery)**
43
**_Protocols for Prognostic GXT Post-MI:_**
* **Pre Discharge:**
* **\<\_\_\_\_\_\_ post MI**
* **\_\_\_\_\_\_\_\_ test**
**_Protocols for Prognostic GXT post-MI:_**
* **Pre-Discharge:**
* **_\< 7d days_** post MI
* **_SubMax_** test
44
**_Protocols for Prognostic GXT Post-MI:_**
* **Pre Discharge:**
* ****
* **\_\_\_\_\_\_\_\_ test**
**_Protocols for Prognostic GXT post-MI:_**
* **Pre-Discharge:**
* **_\< 7d days_** post MI
* **_SubMax_** test
45
**_Complications of Acute MI:_**
* \_\_\_\_\_\_\_\_\_
* _________ abnormalities
* Cardiogenic shock
* Infarct extension or expansion
* ________ \_\_\_\_\_\_
* New _____ \_\_\_\_ \_\_\_\_\_\_\_
* Pericardial effusion and pericarditis
* post-infarction syndrome
* Left Ventricualar mural thrombus
**_Complications of Acute MI:_**
* **_Arrhythmias_**
* **_Conduction_** abnormalities
* Cardiogenic shock
* Infarct extension or expansion
* **_Myocardial_** **_Rupture_**
* New **_mitral valve regurgitation_**
* Pericardial effusion and pericarditis
* post-infarction syndrome
* Left Ventricular mural thrombus
46
**_Protocols for Prognostic GXT Post-MI:_**
* **Pre Discharge:**
* Termination at
* HRPeak :\_\_\_\_\_\_
* \_\_\_\_% age-predicted HRmax
* Achieving ____ METS
**_Protocols for Prognostic GXT Post-MI:_**
* **Pre-Discharge:**
* Termination at
* HRPeak :**_120-130 BPM_**
* **_70_**% age-predicted HRmax
* Achieving **_5_** METS
47
**_Protocols for Prognostic GXT Post-MI:_**
* **Symptom Limited:**
* \_\_\_-\_\_\_ Weeks post-discharge
* May be combined with
* _______ Imaging &\_\_\_\_\_\_\_\_\_\_\_
**_Protocols for Prognostic GXT Post-MI:_**
* **Symptom Limited:**
* **_2_**-**_3_** **_Weeks_** post-discharge
* May be combined with
* **_Nuclear Imaging_** & **_Echocardiogram_**
48
2 Types of Long-Term Treatment
**Medication & Cardiac Rehab**
49
**_Common Medications used in Outpatients post-MI:_**
* **Class and example**:
* \_\_\_\_\_\_\_\_\_\_\_\_
* ex.(Aspirin)
* **Primary effects**:
* blocks platelet aggregation
* **Exercise Effects:**
* ****\_\_\_\_\_\_\_\_
* **Side effects:**
* ****Increased bleeding
_**Common Medications used in Outpatients post** **post****-MI**_
* **class and example**:
* **_Antiplatelet_**
* ex.(Aspirin)
* **Primary effects**:
* blocks platelet aggregation
* **Exercise Effects:**
* **_None_**
* **Side effects:**
* Increased bleeding
50
**_Common Medications used in Outpatients post-MI:_**
* **Class and example**:
* \_\_\_\_\_\_\_\_\_\_\_\_
* ex.(isosobibe mononitrate)
* **Primary effects**:
* Coronary Vasodilation
* **Exercise Effects:**
* ****\_\_\_\_\_\_\_\_
* **Side effects:**
* Headache, *Hypo*tension
**_Common Medications used in Outpatients post-MI:_**
* **Class and example**:
* **_Nitrate_**
* ex.(isosobibe mononitrate)
* **Primary effects**:
* Coronary Vasodilation
* **Exercise Effects:**
* **_Raises ischemic threshold_**
* **Side effects:**
* Headache, *Hypo*tension
51
**_Common Medications used in Outpatients post-MI:_**
* ***Class and example**:*
* **\_\_\_\_\_\_\_\_**
* drug ex.(**_atorvastatin_**)
* ***Primary effects***:
* Decreases Blood \_\_\_\_\_\_
* ***Exercise Effects*:**
* None
* ***Side effects*:**
* Muscle Pain, Weakness
**_Common Medications used in Outpatients post-MI:_**
* ***Class and example**:*
* **Statin**
* drug ex.(**_atorvastatin_**)
* ***Primary effects***:
* Decreases blood **_cholesterol_**
* ***Exercise Effects*:**
* None
* ***Side effects*:**
* Muscle Pain, Weakness
52
**_Common Medications used in Outpatients post-MI:_**
* ***Class and example**:*
* Beta- blocker
* drug ex.(*metroprolol*)
* ***Primary effects***:
* Reduces \_\_\_\_\_,\_\_\_
* ***Exercise Effects*:**
* Decreases \_\_\_\_& \_\_\_
* ***Side effects*:**
* Fatigue, hypotension,bradycardia
**_Common Medications used in Outpatients post-MI:_**
* ***Class and example**:*
* Beta- blocker
* drug ex.(*metroprolol*)
* ***Primary effects***:
* Reduces **_HR&BP_**
* ***Exercise Effects*:**
* Decreases **_HR&BP_**
* ***Side effects*:**
* Fatigue, hypotension,bradycardia
53
**_Cardiac Rehabilitation:_**
* **_Multifactoral Program includes:_**
* **_\_\_\_\_\_\_\_\_\_ \_\_\_\_\__**
* **_\_\_\_\_\_\_\_\__**
* **_And Sometimes_**
* **_\_\_\_\_\_ \_\_\_\_\__**
* **_\_\_\_\_\_\_\_\_ \_\_\_\_\_**_-_**_**for depression and stress
* Help with Smoking cessation
**_Cardiac Rehabilitation:_**
* **_Multifactoral Program includes:_**
* **_Exercise training_**
* **_Education_**
* And Sometimes
* **_Dietary management_**
* **_psychological training_** -for depression and stress
* Help with Smoking cessation
54
**_Benefits of Cardiac Rehabilitation Programs:_**
* Improvement in aerobic capacity
* Increased submaximal exercise endurance
* Increase in muscular strength.
* Reduction in symptoms:
* angina pectoris, dyspnea on exertion, fatigue, claudication
* improved endothelial function
* Many more on page 233 in book
**Info to know on the front of the card.**
55
**_Phases of Cardiac Rehab:_**
* **_Inpatient:_**
* Located in the _______ after MI
* \_\_\_-\_\_\_ Days
* longer with complication
* **_Components_**:
* Avoid \_\_\_\_\_\_
* Maintain ____ \_\_\_\_\_
* Range of motion exercises
**_Phases of Cardiac Rehab:_**
* **_Inpatient:_**
* Located in the **_Hospital_** after MI
* **_2_**-**_3_** Days
* longer with complication
* **_Components:_**
* *Avoid* **_bedrest_**
* *Maintain* **_Upright posture_**
* *Perform* Range of motion exercises
56
**_Phases of Cardiac Rehab:_**
* **_Outpatient:_**
* Should start within \_\_\_-\_\_\_ Weeks after discharge.
* **_Involves_**:
* Exercise training
* Continuous ____ monitoring
* Education
* dietary management
* psychological counseling
**_Phases of Cardiac Rehab:_**
* **_Outpatient:_**
* Should start within **_1-2_** **_Weeks_** after discharge.
* **_Involves_**:
* Exercise training
* Continuous **_ECG_** monitoring
* Education
* dietary management
* psychological counseling
57
**_The Role of Exercise:_**
* _**\_\_\_\_\_\_\_ \_\_\_\_\_**_
* ****Preventing MI prior to happening
* **_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\__**
* **__**Preventing adverse events after first MI
**_The Role of Exercise:_**
* **_Primary prevention_**- Preventing MI prior to happening
* **_Secondary prevention_**- Preventing adverse events after first MI
58
**_Physical Activity & Risk for MI:_**
* Physical activity and the risk for MI have a _______ \_\_\_\_\_\_\_ relationship.
* The Population risk may be dramatically if sedentary people become modestly active.
* Physically ***inactive*** people have \_\_\_% greater risk of developing CAD than active people
**_Physical Activity & Risk for MI:_**
* Physical activity and the risk for MI have an **_inverse curvilinear_** relationship
* population risk may be dramatically if sedentary people become modestly active.
* Physically ***_inactive_*** people have **_45%_** greater risk of developing CAD than active people!
59
**_Aerobic Exercise Program:_**
* **_Frequency:_**
* **_\_\_\_-\_\_\_ Days/Week_**
* **_Intensity:_**
* **__****If no GXT**
* **HR: \_\_\_\_\_\_**
* **RPE:\_\_\_-\_\_\_**
* **Based on GXT results:**
* **\_\_\_\_-\_\_\_\_% HHR or Vo2R**
* **RPE: 11-16**
* **Below ischemic threshold**
* **\_\_\_ mm ST-segment depression**
**_Aerobic Exercise Program:_**
* _Frequency:_
* _**3-7** Days/Week_
* _Intensity:_
* __If no GXT
* HR: **+20 at rest**
* RPE: **_11-14_**
* Based on GXT results:
* **_40_**-**_80_**% HHR or Vo2R
* RPE: 11-16
* Below ischemic threshold
* **_1_** mm ST-segment depression
60
**_High-intensity interval training (HITT):_**
* Intensities up to \_\_\_\_% Vo2 Peak
* For short Bouts
* \_\_\_-\_\_\_ Seconds
* Feasible and safe for select cardiac patients
* usually starts after a few weeks of regular continuous aerobic exercise.
**_High-intensity interval training (HITT):_**
* Intensities up to **_95_**% Vo2 Peak
* For short Bouts
* **_30_**-**_120_** Seconds
* Feasible and safe for select cardiac patients
* usually starts after a few weeks of regular continuous aerobic exercise.
61
**_Resistance Exercise:_**
* \_\_-\_\_ sessions per week
* \_\_-\_\_ different exercises
* \_\_\_-\_\_% of 1RM
* initial resistance should allow for \_\_\_-\_\_\_ Reps
* RPE: \_\_\_-\_\_\_
* Below \_\_\_\_\_\_\_\_\_\_/\_\_\_\_ \_\_\_\_\_\_
**_Resistance Exercise:_**
* **2-3** sessions per week
* **8-10** different exercises
* **30-80%** of 1RM
* initial resistance should allow for **12-15** Reps
* RPE: **11-14**
* Below **ischemic/anginal threshold**
