week 1 (53-78)

Question 1

ECG alterations associated with ischemia (3)

Answer 1

ST depression
ST elevation
T-wave inversion

Question 2

How does ischemia affect ECG leads (2)

Answer 2

damaged area will have less effect on that particular lead
complete reversal because the signal wont travel that area the same way

(slide 53, per Dr Dick)

Question 3

Angiotensin II Systemic effects (2)

Answer 3

Peripheral vasoconstriction
fluid retention

Question 4

is secreted from kidney and helps produce Angiotensin I

Answer 4

Renin

Question 5

which is a more potent vasoconstrictor: angiotensin I or angiotensin II?

Answer 5

angiotensin II?

Question 6

Increasing Angiotensin leads to (2)

Answer 6

↑vasoconstriction
↑aldosterone (works in kidneys to ↑ salt and water reabsorption which increases BP)

Question 7

Many drugs that control BP will block

Question 8

T/F Lots of BP meds block Angiotensin converting enzyme and ARB’s

Answer 8

True

Question 9

if angiotensin is secreted myocardial work increases or decreases?

Answer 9

increases–> thus the effects of loss of myocyte contractility are exacerbated

bec of the increase in vasoconstriction (afterload)
and increasing afterload means heart has to push harder against it

Question 10

Angiotensin II Local effects (4)

Answer 10

Growth factor for vascular smooth muscle cells, myocytes, and cardiac fibroblasts.
Promotes catecholamine release
Causes coronary artery spasms

Question 11

Involved in myocardial remodeling and causes myocyte hypertrophy, scarring and loss of contractile function in areas of heart distant from infarction site

Answer 11

angiotensin II

Question 12

Types of myocardial infarction (2)

Answer 12

Subendocardial infarction
Transmural infarction

Question 13

non-STEMI

Answer 13

subendocardial

Question 14

STEMI

Answer 14

transmural infarction

Question 15

smaller infarctions are associated with ST segment elevations (STEMI)

Answer 15

False
smaller infarctions are NOT assoc with ST segment elevations (non-STEMI)

Question 16

infarcted myocardium is surrounded by a zone of ____ ____, which may progress to necrosis or return to normal

Answer 16

hypoxic injury

Question 17

how can infarcted myocardium return to normal

Answer 17

if blood flow is returned fast enough

Question 18

drug that help break up clot and restore BF to infarcted area/tissue

Answer 18

thrombolytics

Question 19

adjacent to the zone of hypoxic injury is a zone of

Answer 19

reversible ischemia

Question 20

2 enzymes that are markers for myocardial infarction

Answer 20

Creatine phosphokinase–MB (CPK-MB) and LDH-1

Question 21

Which biomarker is most specific for myocardial damage?

Answer 21

Troponin I, which elevates in 2 to 4 hours post-infarction.

Question 22

Troponin I elevates betw. how many hours post-infarction?

Answer 22

2 to 4 hours

Question 23

clinical manifestations of myocardial infarction

Answer 23

Sudden severe chest pain (radiating to left arm or jaw/shoulder pain)
ECG changes
↑Troponin I
↑Creatine phosphokinase–MB (CPK-MB), LDH-1
Hyperglycemia (d/t alterations in glucose metabolism)

Question 24

Treatment of MI (7)

Answer 24

Hospitalization Immediate administration of supplemental oxygen and aspirin Morphine Bed rest (↓workload) Cardiac medications: Thrombolytic, antithrombotic, vasodilators Percutaneous coronary intervention (PCI) Surgery

Question 25

why is immediate administration of O2 critical with MI?

Answer 25

To avoid further damage to the area surrounding the ischemic zone

Question 26

if infarction occurs in area that contains ______ tissue, dysrhythmias are more likely to occur

Answer 26

conductive

Question 27

MI complications

Answer 27

Dysrhythmias Cardiogenic shock Pericarditis Dressler (postinfarction) syndrome (pericarditis) Organic brain syndrome

Question 28

Disorders of the pericardium (3)

Answer 28

acute pericarditis pericardial effusion Constrictive (restrictive) pericarditis

Question 29

acute inflammation of pericardium with fever, myalgias, and malaise, followed by the sudden onset of severe chest pain

Answer 29

acute pericarditis

Question 30

treatment of acute pericarditis

Answer 30

Rest, salicylates and nonsteroidal anti-inflammatory drugs; combined nonsteroidals and colchicine

Question 31

Treatment of pericardial effusion

Answer 31

Pericardiocentesis

Question 32

Accumulation of fluid in the pericardial cavity; Tamponade

Answer 32

Pericardial effusion

Question 33

Fibrous scarring w/occasional calcification of pericardium that causes visceral and parietal pericardial layers to adhere

Answer 33

Constrictive (restrictive) pericarditis

Question 34

Clinical manifestations of Constrictive (restrictive) pericarditis

Answer 34

Exercise intolerance, dyspnea on exertion, fatigue, and anorexia

Question 35

Treatment of Constrictive (restrictive) pericarditis

Answer 35

Dietary sodium restriction digitalis glycosides and diuretics improve cardiac output.

Question 36

Effects of neurohumoral responses to ischemic heart disease or hypertension on the heart muscle cause remodeling

Answer 36

cardiomyopathies

Question 37

(T/F) Most cases of cardiomyopathy are not idiopathic

Answer 37

False Many cases of cardiomyopathy are idiopathic

Question 38

Types of cardiomyopathies (3)

Answer 38

Dilated (congestive) cardiomyopathy Hypertrophic (asymmetric) cardiomyopathy Hypertrophic obstructive cardiomyopathy Hypertensive or valvular hypertrophic cardiomyopathy Restrictive cardiomyopathy

Question 39

clinical manifestations of restrictive cardiomyopathy

Answer 39

Right heart failure occurs with systemic venous congestion

Question 40

treatment for restrictive cardiomyopathy

Answer 40

correct underlying cause

Question 41

what type of cardiomyopathy has Impaired systolic function, leading to increases in intracardiac volume, ventricular dilation, and systolic heart failure

Answer 41

Dilated (congestive) cardiomyopathy

Question 42

causes of Dilated (congestive) cardiomyopathy (5)

Answer 42

MI diabetes alcohol deficiencies of niacin, vitamin D and selenium hyperthyroidism

Question 43

which cardiomyopathy has clinical manifestations of Dyspnea and fatigue

Answer 43

Dilated (congestive) cardiomyopathy

Question 44

Common inherited heart defect of a thick septal wall

Answer 44

Hypertrophic obstructive cardiomyopathy

Question 45

Hypertrophic obstructive cardiomyopathy treatment (4)

Answer 45

Beta blockers or verapamil to slow the heart rate Surgical resection of the hypertrophied myocardium Septal ablation Prophylactic placement of an implantable cardioverter-defibrillators in high-risk individuals

Question 46

clinical manifestations of Hypertrophic obstructive cardiomyopathy (3)

Answer 46

Angina, syncope, palpitations

Question 47

2 types of Hypertrophic (asymmetric) cardiomyopathy

Answer 47

Hypertrophic obstructive cardiomyopathy Hypertensive or valvular hypertrophic cardiomyopathy

Question 48

Hypertrophy of the myocytes: Attempts to compensate for increased myocardial workload

Answer 48

Hypertensive or valvular hypertrophic cardiomyopathy

Question 49

Clinical manifestations of Hypertensive or valvular hypertrophic cardiomyopathy (6)

Answer 49

Asymptomatic or may complain of angina, syncope, dyspnea on exertion, and palpitations

Question 50

Myocardium becomes rigid and noncompliant, impeding ventricular filling and raising filling pressures during diastol

Answer 50

Restrictive cardiomyopathy

Question 51

treatment of restrictive cardiomyopathy (1)

Answer 51

treat underlying issue

Question 51

Clinical manifestations: Right heart failure occurs with systemic venous congestion

Answer 51

restrictive cardiomyopathy

Question 52

Valve orifice is constricted and narrowed

Answer 52

valvular stenosis

Question 53

valve fails to shut completely and aka insufficiency or incompetence

Answer 53

valvular regurgitation

Question 54

Disorders of the endocardium (9)

Answer 54

valvular dysfunction valvular stenosis valvular regurgitation mitral valve prolapse syndrome aortic stenosis mitral stenosis aortic regurgitation mitral regurgitation tricuspid regurgitation

Question 55

A diffuse, inflammatory disease caused by a delayed immune response to infection by the group A beta-hemolytic streptococci

Answer 55

Rheumatic fever

Question 56

febrile illness with inflammation of joints, skin, nervous system and heart

Answer 56

Rheumatic fever

Question 57

what can happen if rheumatic fever is left untreated

Answer 57

can cause rheumatic heart disease (may have genetic component)