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BHSC 2203 - Patho > Unit 4 - Cardiovascular Disorders 1 > Flashcards

Unit 4 - Cardiovascular Disorders 1 Flashcards

1
Q

What accounts for 80% of cardiac diseases?

A

Atherosclerosis

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2
Q

What are the three layers of an artery?

A
  1. Endothelium (inner!)
  2. Smooth muscle
  3. Collagen and elastic fibers (outer!)
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3
Q

Describe what happens during atherosclerosis.

A
  1. Lipids get into the vascular endothelium - due to injury
  2. WBCs try to clear them away
  3. WBC and vascular endothelium release growth factors that promote plaque formation
  4. Plaque blocks the artery
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4
Q

What 2 effects does plaque have on an artery?

A
  1. Decrease size of lumen

2. Decrease the elasticity of the artery

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5
Q

What is the difference between arteriosclerosis and atherosclerosis?

A

Arteriosclerosis = Ca+2 deposits in the wall of the artery WITHOUT plaque formation

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6
Q

What is the function of lipoproteins?

A

Enable the transportation of lipids in the blood

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7
Q

Why are HDLs good for the body?

A

They pick up excess lipids in circulation and send them to the liver

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8
Q

How much of total cholesterol should someone have in their system?

A
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9
Q

What can a patient do if they have too much cholesterol?

A

Exercise!

  • increases HDLs
  • lowers LDLs
  • lowers total cholesterol
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10
Q

How much HDLs should a patient have?

A

> 1.5 mmol/L

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11
Q

Why is hypertension a risk factor for atherosclerosis?

A

Hypertension causes injury to the inner blood vessel wall - increases probability that lipids will enter blood vessel wall

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12
Q

How much will your risk of a cardiac event be lowered if you decrease cholesterol by 1 mmol/L?

A

50% reduction

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13
Q

What happens if the plaque ruptures in the artery?

A

Mini thrombi form

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14
Q

What do macrophages (WBCs) develop into after eating lipids?

A

Foam cells

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15
Q

Why could it be good if plaque has a thick cap?

A

Lower risk of rupture (forming a thrombus)

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16
Q

Why can heart attacks result from atherosclerosis?

A

If plaque ruptures, a clot forms. Could create a full occlusion if it blocks a small enough artery

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17
Q

What are the characteristics of stable plaque?

A
  • THICK fibrous cap
  • Partially block vessels
  • Do not TEND to form clots or emboli
    “Chronic Ischemic Syndrome”
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18
Q

What are the characteristics of unstable plaque?

A
  • THIN fibrous caps
  • Plaque can rupture and form a clot
  • May completely block an artery
  • Clot may break free and become and embolus
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19
Q

How can an aneurysm form due to atherosclerosis?

A
  • Wall of artery weakens and stretches

bulges outwards

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20
Q

What are the clinical syndromes associated with coronary artery disease?

A
  1. Angina pectoris (chest pain)
  2. MI and unstable angina
  3. Chronic ischemic heart disease
  4. Sudden cardiac death
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21
Q

What are 2 clinical presentations that will occur with plaque?

A
  1. Asymptomatic

2. Angina pectoris

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22
Q

What are 2 clinical presentation that will occur with a non-occlusive thrombis

A
  1. Angina Pectoris

2. Congestive heart failure

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23
Q

What are 2 clincial presentations that will occur with an occlusive thrombus?

A
  1. Congestive heart failure

2. Myocardial infarct

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24
Q

Why can ischemia cause cardiac arrhythmias?

A

When oxygen is lacking, the Na+/K+ pumps don’t work as effectively because the pump needs ATP to function. ATP is formed in the presence of oxygen. When there is not enough oxygen, ATP is lacking, the pumps will fail! = Conduction deficits

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25
Q

What occurs if there is a mismatch between oxygen supply and demand?

A

Angina

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26
Q

What are 4 reasons for increased demand of oxygen?

A
  • Increased afterload (anything that resists blood flow through the arteries)
  • Increased contractility (when exercise occurs)
  • Increased preload (increased stretch of the heart muscle)
  • Increased heart rate
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27
Q

What are 3 reasons for decreased supply of oxygen?

A
  1. Decreased perfusion pressure (flow of blood to the heart vessel is decreased)
  2. Fixed stenosis (STABLE PLAQUE)
  3. Decreased oxygen content
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28
Q

How can you decreased demand of oxygen?

A
  1. Beta-blockers (slow down the heart)
  2. Vasodilators (decrease afterload)
  3. Rest
  4. Calcium channel blockers
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29
Q

How can you increase the supply of oxygen?

A
  1. Supplemental oxygen
  2. Stenting (or bypass)
  3. Vasodilators (nitro)
  4. Thrombolytics (decrease the formation of clots)
30
Q

What are the 3 types of angina?

A
  1. Stable angina (heart’s oxygen demand increases)
  2. Unstable angina (thrombus formation)
  3. Variant angina (when coronary arteries spasm)
31
Q

What are some treatments for stable angina?

A
  1. Rest
  2. Supplement oxygen
  3. Vasodilators
  4. Beta-blockers
  5. Ca+2 blockers
32
Q

What is a treatment for unstable angina?

A 
Blood thinners (thrombolytics/Aspirin)
- REST does NOT extinguish unstable angina
33
Q

What are some treatments for variant angina?

A
  1. Nitroglycerin
  2. Smooth muscle relaxants
  3. Ca+2 channel blockers
  4. Beta-blockers
34
Q

Why would a patient experience tachycardia in the event of an acute MI?

A

Death of cardiac tissue, causes stroke volume to decrease

The compensatory response is to bring CO back to normal = increasing HR (tachy)

35
Q

Define cardiovascular shock

A

Inability to maintain adequate blood pressure in the peripheral circulation

36
Q

Where does the left coronary artery come from?

A

Aorta

37
Q

What does the left coronary artery branch into?

A
  1. Circumflex artery

2. Anterior interventricular artery (groove between right and left ventricles)

38
Q

Which coronary artery is smaller than the other (right or left)?

A

Right is smaller than left coronary artery

39
Q

Which two arteries wrap around the back of the heart?

A
  1. Circumflex artery

2. Right coronary artery

40
Q

Why is the pressure in the left coronary artery greater than in the right?

A

It is in the groove between the ventricles, it causes pressure and resistance

41
Q

What % of case of MI are associated with left anterior interventricular artery?

A

50%

42
Q

What % of cases of MI are associated with an obstruction of left circumflex artery?

A

20%

43
Q

Why is the left side of the heart more likely to have an MI than the right?

A
  • mass of tissue on the left is greater than the right
  • pressure is greater on the left instead of right
  • more likely that damage (plaque) in the left instead of right
44
Q

How can we tell from a blood sample if a patient has experienced a cardiac event?

A

When heart muscle dies, there is an increase in MYOGLOBIN, TROPONIN, CREATINE KINASE in circulation
- the heart can no longer contain these proteins (they are released)

45
Q

Why can thromboemboli occur IN the heart?

A

When the heart doesn’t have enough force to eject blood, blood clots will form when the blood is just sitting in the heart

46
Q

What happens if a thromboembolus leaves the right or left side of the heart?

A

Right side - pulmonary embolism

Left side = stroke (up into brain)

47
Q

On the first day following an MI, what will a patient most likely present with? What percentage

A

20% of patients will have:

  1. Sudden death or
  2. Arrhythmia
48
Q

What are the early complications of an MI (first week following)?

A

Arrhythmias (90%)
CHF (60%)
Shock (12%)
Heat Rupture (1%)

49
Q

What are the late complications of an MI (first year following)?

A

CHF (70%)
Arrhythmia (20%)
Aneurysm (10%)
Thromboemboli (10%)

50
Q

What are the complications of an MI 10 years following?

A

Chronic left hearted weakness
CHF (70%)
Recurrent infarcts
Arrhythmia

51
Q

What is hypertension?

A

Abnormally high blood pressure

  • Systolic BP > 140 mmHg
  • Diastolic BP > 90 mmHg
52
Q

What are 2 reasons that hypertension is bad?

A
  1. Imposes injury to endothelium –> atherosclerosis

2. Imposing high afterload, heart has to work harder

53
Q

What are the 2 types of hypertension?

A
  1. Primary (no other prior disease that predisposes to hypertension)
  2. Secondary (there IS a prior disease that prediposes to hypertension)
54
Q

How does vasodilation influence blood pressure?

A

Decreases blood pressure by decreasing total peripheral resistance

55
Q

How does decreased stretching of baroreceptors influence blood pressure?

A

Double check this one … Decreasing stretching means that there is a decrease in total peripheral resistance = decreased blood pressure

56
Q

How does hypoxemia influence blood pressure?

A

Increased blood pressure (triggers sympathetic nervous system)

57
Q

How does inhibiting angiotensin-converting enzyme influence blood pressure?

A

ACE is a potent vasoconstrictor, inhibiting it will decrease blood pressure, cardiac output and TPR

58
Q

How do beta-blocking influence blood pressure?

A

Administering beta-blockers decrease cardiac output and decrease the contractile force of the heart – CO will decrease and BP will decrease

59
Q

How do alpha 2 agonist influence blood pressure?

A

Stimulate massive vasoconstriction - blood pressure will increase

60
Q

How do calcium channel blockers influence blood pressure?

A

Decrease blood pressure, b/c there will be a decrease in CO and maybe TPR

61
Q

What body system is closely tied to hypertension?

A

Renal system!

  • kidneys expel fluid from the body
  • if the kidneys aren’t functioning properly TPR will increase and BP will increase
62
Q

What is pheochromocytoma?

A

Tumor that affects the adrenal glands and elevates BP by increasing E and NE in circulation

63
Q

When does hypertension stage I begin?

A

> 140

> 90

64
Q

When does hypertension stage II begin?

A

> 160

> 100

65
Q

When does hypertension stage III begin?

A

> 180

> 110

66
Q

What are some clinical complications of hypertension?

A 
Nephrosclerosis
Hemorrhagic Stroke
Left ventricular hypertrophy
Atherosclerosis
Aneurysm
67
Q

Why does left ventricular hypertrophy occur in hypertension?

A
  • Afterload is high
  • Heart has to work harder to overcome this resistance
  • Work of the heart increase over time, causing hypertrophy
    (there is very little room in the heart for blood)
68
Q

What happens during nephrosclerosis?

A

Renal blood vessels get thicker to counteract the pressure/stretch in the blood vessels

  • become constricted
  • reducing blood flow in the kidneys
  • eventually blood flow will be closed off
69
Q

How is the renin-antiotensin-aldosterone system related to nephrosclerosis?

A

Kidneys sense low blood flow in kidneys

  • renin is released b/c the kidneys THINK that the blood pressure is low (b/c of small amounts of blood flowing through the kidney)
  • this increases fluid retention, increases blood volume, and INCREASES BP EVEN MORE
70
Q

How can blindness occur b/c of hypertension?

A

Arterioles in the eye thicken

  • copper wire effect
  • leading to rupturing of the blood vessels
71
Q

Why does chronic hypertension lead to hemorrhagic stroke?

A

High BP encourages development and rupture of tiny aneurysms in small arterioles

BHSC 2203 - Patho (13 decks)

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