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Cardiopulm > Week 4 CAD, MI, and Vascular Disease > Flashcards

Week 4 CAD, MI, and Vascular Disease Flashcards

1
Q

Blow flow of systemic circulation

A

Heart
arteries
arterioles
capillary bed
venules
veins
vena cave

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2
Q

Atherosclerosis

A

a hardening of the arteries

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3
Q

Coronary artery disease prevalence

A

1 cause of mortality in the U.S., with almost 1 million deaths in 2020

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4
Q

Coronary artery disease risk factors

A

HTN
Diabetes + metabolic syndromes
Tobacco use
Sedentary lifestyle
Nonmodifiable risk factors – age, gender, family hx

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5
Q

Pathophysiology of coronary artery disease

A

development of fatty streak
Progressions of plaque
Plaque disruption

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6
Q

Fatty streak

A

liquid foam cells proliferating in tunica intima -> fibrous plaque/lesion

smooth muscle cells (SMC), macrophages, ECM, lipids

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7
Q

Fatty streak is most com in

A

arterial branches (carotids, coronary arteries)

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8
Q

Fatty streak may be present in

A

most adults by age 20
asymptomatic

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9
Q

Fatty streak cellular processes

A

Increased permeability of endothelium  increased LDL in inner layer of vessel that binds to ECM
Increased leukocyte activation
Release of catecholamines, nitric oxide, other vasoactive substances
Change in normal anti-clotting properties of the vasculature

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10
Q

Progression of plaque

A

Muscle cells produce additional ECM that traps lipoproteins and increases size of lesion/plaque

Over time, turns into fibrous cap with lipid core of varying size + stability

Not always detected by imaging

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11
Q

Plaque disruption

A

Plaque increases in size and occupies more space in arterial lumen
Lipid core can become less stable
Structure of plaque contributes to risk of rupture

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12
Q

Primary prevention for plaque

A

Lifestyle promotion
Wellness
ASCVD risk factor estimation starting at age 40
Health diet
75 min vigorous activity OR 150 min mod intensity activity
Tobacco cessation

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13
Q

PT management for plaque

A

Exercise – decreased insulin resistance, decreased BP, decreased endothelial dysfunction
Education on smoking cessation – decreased endothelial dysfunction, decreased platelet aggregation

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14
Q

lifestyle modifications for pt with coronary artery disease

A

tobacco cessation
body mass index
moderate-intensity activity for 30 to 60 min seven days a week
alcohol consumption in moderation
low-sodium diet
two to three servings a day each fruit and vegetables
saturated fat less than 10 % of daily calories

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15
Q

Medical management for coronary artery disease

A

statin for managing LDL levels
Beta-blockers for HTN
Aspirin or plavix

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16
Q

Ischemic conditions

A

caused by variation in myocardial O2 supply and demand

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17
Q

Myocardial ischemia causes

A

vasoconstriction, increased thrombosis, vessel stenosis d/t atherosclerosis, dysfunction of endothelium, vasospasm

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18
Q

Other causes of myocardial ischemia

A

Other causes: acute respiratory failure, cardiogenic or septic shock, hemorrhage, hypovolemia, severe HTN, aortic stenosis

19
Q

Unstable angina

A

Sudden change in frequency, intensity, type of angina symptoms that may preclude acute MI

20
Q

Stable angina

A

Chest pain/discomfort at specific intervals, activities, etc. – chronic and predictable

21
Q

Variant/prinzmetal angina

A

Vasospasm without presence of known/visible plaques or change in O2 demand, and which may often occur at rest

22
Q

Stable angina last

A

several seconds to minutes

23
Q

Where is stable angina pain

A

diffuse chest, UE, jaw, neck

24
Q

Stable angina clinical manifestations

A

tachycardia, SOB, nausea/GI symptoms, diaphoresis, fatigue

25
Q

stable angina can be treated and resolved with

A

sublingual nitroglycerin

26
Q

What is the gold standard for testing angina

A

angiogram

27
Q

medical treatment for angina

A

PCI
CABG

Medications – nitroglycerin (acute), B-blocker and calcium channel blockers to decrease O2 demand

28
Q

PT considerations for angina

A

Awareness of patient’s baseline angina (if chronic)
Monitoring onset of symptoms, duration, intensity
Ensuring angina is relieved with normal amount of rest or with sublingual nitro

29
Q

Acute coronary syndromes

A

stemi
nstemi
unstable angina

30
Q

stemi

A

ST-elevation MI
Caused by occlusive thrombus resulting in myocardial tissue damage, which can lead to impaired contractility and ventricular remodeling

31
Q

stemi clinical manisfestation

A

acute chest pain, SOB, fatigue, dyspnea, diaphoresis, GI symptoms, S4

32
Q

Nstemi

A

non st elevation MI

33
Q

Type 1 nstemi

A

O2 supply/demand mismatch caused by plaque/thrombus

34
Q

type 2 nstemi

A

O2 supply/demand mismatch not caused by ACS
Can be due to respiratory failure, shock, anemia, arrhythmia, electrolyte imbalance, CKD

35
Q

Unstable angina

A

Changes in typical angina with regards to frequency, intensity, type, quality of discomfort
Caused by CAD with nonocclusive thrombus, plaque rupture, tachycardia, vasoconstriction
No ST-elevation on EKG
Can progress to NSTEMI or STEMI

36
Q

Unstable angina red flags

A

lasts >20 min, lower threshold for onset, change in usual pattern

37
Q

Acute coronary syndrome diagnosis and treatment

A

Combination of EKG, clinical biomarkers, symptoms, imaging
Pharmacologic – B-blocker, Aspirin, heparin, morphine for pain, oxygen
Surgical/interventional – PCI/DES, CABG
Patients may develop arrhythmias

38
Q

Acute coronary syndrome PT management

A

Vitals: HR and rhythm, BP, O2 needs
Symptom onset/prevalence with physical activity
Labs – ensuring that troponin is downtrending
Lines/tubes/drips
Monitoring activity tolerance and capacity for exercise via self-reported symptoms, RPE, or other scale
Patient education and referral to cardiac rehab

39
Q

Cardiac symptoms can often mimic

A

GI, pulmonary, or MSK pain

40
Q

GI discomfort often relieved by

A

by antacids, worse with certain foods, and occurs after meals

41
Q

MSK pain may have more

A

focal tenderness and is worse with movement

42
Q

Differential diagnosis from chest pain

A

GERD
peptic ulcer disease
costochondritis
bronchospasm

43
Q

Medicare Part B will cover cardiac rehab if the patient has been diagnosed with certain conditions

A

MI in last 12 months, CABG, angioplasty, transplant, stable angina, valve repair/replacement

Cardiopulm (11 decks)

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