Week 4 Cardiovascular Function Flashcards
what class of lipids make up the plasma membrane?
phospholipids
What is the name for a bound lipid?
lipoprotein
What are the 4 main functions of lipids?
- stored energy
- make up of cellular membrane
- hormone production (estradiol/testosterone)
- production of bile acids
What organ produces cholesterol?
Liver
What are chylomicrons primarily made of (80%)?
triglycerides
What is the function of chylomicrons
supply tissue with fat from dietary ingestion of cholesterol
What is the smallest lipoprotein?
HDL
What is the largest lipoprotein
Chylomicron
Which lipoprotein causes vascular injury?
LDL
Which lipoprotein is protective to the cardiovascular system
HDL
Where are triglycerides stored?
In fat cells and liver
What protein binds to lipids to form lipoproteins?
apolipoproteins
Which apolipoprotein is attached to HDL?
Apo A1
Which apolipoprotein is attached to LDL?
Apo B
What is the function of Apo A1
To move cholesterol and phospholipids from inside cell to outer surface.
What is the function of Apo B
To carry fat and cholesterol through the bloodstream to the body.
How is hs-CRP used in cardiology? When else could it be elevated?
Non-specific test to determine risk of developing CAD. Can also be elevated in RA, MS, Lupus, etc. due to increased inflammation in autoimmune conditions.
What cardiac testing involves a CT scan?
CT calcium score. Looks for buildup of Calcium.
1-10=minimal
11-100=mild
101-400=moderate
>400=cardiologist referal
What is the optimal value of total cholesterol?
<200
What is the optimal lab value of HDL?
> 40
What is the optimal lab value of Triglycerides?
<150
What is the optimal lab value of LDL?
<100
What is the optimal lab value of Cholesterol to HDL-C Ratio? What does a high ratio indicate?
<3.5 Higher ratio = higher risk of heart disease.
What are 5 treatments for atherosclerosis?
1) Same Tx for dyslipidemia (statin, diet, exercise)
2) angioplasty (opens occlusions)
3) Laser (disintegrates plaque)
4) Atherectomy (removes plaque)
5) B-complex vitamins (reduces inflammation by lowering homocysteine levels)
What is the bpm produced by the AV node?
40-60 bpm
What is the primary pacemaker of the heart?
SA node
What rate can the ventricles generate impulses if the SA and AV nodes fail?
20-40 bpm
What are 5 infections that are associated with pericarditis?
coxsackievirus, echoviruses, HSV, CMV, HIV
What are non-infectious causes of pericarditis?
MI, thoracic trauma or surgery, cancer, Lupus, RA, scleroderma
What are the sx of acute cardiac tamponade?
Beck’s Triad: Low blood pressure, JVD, muffled heart sounds
Tachypnea
Tachycardia
What is the most serious complication associated with pericarditis and what does it do?
Cardiac tamponade. Fluid builds to the point that the heart is compressed leading to reduced cardiac output. (heart failure, death)
What is the treatment for pericarditis?
- Antibiotics - infection
- Steroid - inflammation
- Analgesics - pain
- O2
- Pericardiocentesis or pericardiectomy
Symptoms of pericartitis
- Dyspnea
- chest pain - anterior, sharp, sudden, worsens inspiration and laying flat, decreases sitting up.
- Flu-like sx
- pericardial friction rub
What are the non-infectious causes of endocarditis?
- Clot formation on valves
- Lupus “Libman-Sacks endocarditis”
- IV drug use (tricuspid valve)
What are the infections that cause endocarditis?
Strep. viridans (mouth)
Staph. aureus (skin/gut) (IV drugs)
What are the sx of endocarditis?
- Flu-like sx - fever, chills, fatigue
- heart murmur
- petechiae, under nailbed
What is the diagnostic scale used for endocartitis?
modified Duke criteria
What is the gold standard testing for myocarditis?
endomyocardial biopsy
What 2 valves are most commonly associated with valvular disorders?
Aortic and Mitral - higher pressures and work load of left side of heart.
What condition does valvular stenosis cause in the heart muscle?
hypertrophy - enlarged heart wall
causing decreased cardiac output
What are the 3 most common causes of Aortic stenosis?
- Congenital
- rheumatic fever
- degenerative calcification.
What are the 2 most common causes of Aortic regurgitation?
- Infective endocarditis (bacterial)
- aortic root disease (degenerative/age)
What is the single most common cause of mitral stenosis?
Rheumatic fever
What are 4 causes of mitral regurgitation?
- Primary mitral regurgitation Dz
- Intrinsic valve Dz
- Ischemia
- Valve displacement - caused by left ventricular enlargement.
What condition develops when the ventricles become enlarged (stretched) and can’t contract efficiently?
Dilated cardiomyopathy (DCM)
Which type of cardiomyopathy has a reduced ejection fraction (EF)?
Dilated cardiomyopathy (DCM)
Which type of cardiomyopathy has a normal ejection fraction (EF)?
Hypertrophic cardiomyopathy (HCM)
What causes 50% of dilated cardiomyopathy (DCM) cases?
Genetic abnormalities. Mutations affecting sarcomere cell function. Ex: PPCM (peripartum-related DCM) in women.
Which cardiomyopathy is the most common familial heart disease? What type of inheritance pattern?
Hypertrophic cardiomyopathy (HCM).
Autosomal dominant inheritance pattern.
Where in the heart is the most common place of hypertrophy?
the septum
In all cardiomyopathies, what does backflow pressures lead to? and what heart rhythm would be seen?
Atrial enlargement. A-fib.
What is the most common dysrhythmia in adults?
Atrial fibrillation.
Which dysrhythmia causes blood to pool increasing clot formation?
A fib.
What are 4 Rx treatments for A fib that focus on the rhythm control?
- Beta-blockers
- Calcium channel blockers
- glycosides (digoxin),
- cardioversion
What are 3 Rx treatments for A fib that focus on anticoagulation?
- direct thrombin inhibitor (dabigatran)
- factor Xa inhibitor (apixaban, rivaroxaban)
- warfarin
What is the definition of HFrEF (heart failure with reduced EF)?
EF <40% resulting from systolic dysfunction (thin weak heart muscle that can’t pump blood out)
What is the definition of HRpEF (heart failure with preserved EF)?
EF >50% resulting from diastolic dysfunction.
Name the two most common causes of heart failure.
- Coronary artery disease
- hypertension
Name the 3 categories of drugs that can cause heart failure.
- anticancer drugs
- antidiabetic drugs
- appetite suppressants
What are attributes of Left ventricular remodeling in heart failure?
- myocyte loss
- decreased contractility
- LV dilation and hypertrophy
- Beta adrenergic desensitization (less responsive)
What type of heart failure is associated with pulmonary congestion?
Left-sided HF
What type of heart failure is associated with systemic edema?
Right-sided HF
What hormone is released when the ventricles are overstretched?
NT-proBNP (N-terminal pro-brain natriuretic peptide)
What Rx’s are used to treat heart failure?
- ACE inhibitors (angiotensin-converting enzyme)
- ARBs (angiotensin receptor blockers)
- ARNIs (angiotensin receptor-neprilysin inhibitors)
- alpha or beta-blockers
What 2 medications can worsen heart failure?
- Calcium channel blockers (depress contractility)
- NSAIDS (cause Na and water retention)
What is the most common congenital heart defect?
Ventricular septal defect.
What part fails to close after birth that causes atrial septal defect?
Foramen ovale located between the atrium. Causes PFO (patent foramen ovale)
Where is the ductus arteriosus located that can cause PDA (patent ductus arteriosus)?
Between the aorta and the pulmonary artery causing left to right shunt.
What are the four abnormalities in Tetralogy of Fallot??
- Pulmonary valve stenosis
- Large ventricular septal defect (VSD)
- overriding aorta over VSD
- right ventricular hypertrophy
What is the pulmonary atresia?
complete closure of pulmonary valve
What arteries are switched in the defect of “transposition of great arteries”?
aorta and pulmonary arteries are switched positions.
What happens in the defect of “coarctation of the aorta”?
The aorta is narrow obstructing blood flow through arch.
How many days until the ductus arteriosus closes completely?
21 days.
What are 3 symptoms of peripheral artery disease?
- pain in extremities, worse with elevation and exercise.
- diminished pulses
- non-healing ulcers
What ABI (ankle brachial index) is diagnostic for peripheral artery disease?
≤0.90
What are the most common triggers of stable angina?
exercise, cold, stress, intercourse, stimulants (cocaine)
When is angina considered unstable?
When it is unstable, occurs at rest, or increases in duration >20 mins.
What type of angina is caused by vasospasms in the coronary arteries WITHOUT atherosclerosis?
Prinzmetal angina
What type of angina affects the small vessels of the coronary arteries?
Microvascular angina
What EKG changes are seen with coronary artery disease?
ST depression
What are 5 Rx treatments for angina?
- nitrates
- beta-adrenergic blockers
- calcium channel blockers
- sodium channel blocker (Ranolazine)
- O2 therapy
What 2 EKG changes are associated with MI (myocardial infarction)?
- ST elevation (STEMI) or normal ST (NSTEMI)
- Pathologic Q wave: deeper and wider than normal.
What cardiac biomarker has the fastest onset (1 hour) with an MI?
Myoglobin. (rapidly returns to normal)
What are the 3 cardiac biomarkers associated with MI?
- CK-MB (creatine kinase-muscle/brain)
- Myoglobin
- Troponins
Which cardiac biomarker requires a repeat screen if the first result is negative for MI symptoms?
Troponin.
What systemic vasculitis disease occurs most often in boys under 5 years of asian or Pacific Island descent?
Kawasaki disease
What are the 5 clinical presentations of Kawasaki disease in addition to high fever?
- Bilateral conjunctivitis
- Oral mucositis, dry/cracked lips, strawberry tongue
- Rash
- Red and swollen hands and feet
- swollen cervical lymph nodes
What is the treatment for Kawasaki disease?
- IV immunoglobulin
- aspirin
What disease is associated with a “white attack” from vasospasms in the hands?
Raynaud Disease
What medications can lead to secondary hypertension?
Birth control pills, HRT (hormone replacement therapy), antihistamines, decongestants, and glucocorticoid steroids.
Which type of hypertension develops gradually?
Essential/primary hypertension
What is the criteria for gestational hypertension?
BP ≥ 140 mmgH systolic OR ≥90 mmgH diastolic at ≥20 weeks gestation.
What diagnostic tests puts a woman into the preeclampsia category?
proteinuria + gestational hypertension.
BP ≥160 systolic AND ≥90 diastolic
Symptoms: headache, blurred vision
impaired liver function tests
renal insufficiency (elevated serum creatinine)
Criteria for eclampsia?
Grand mal seizure with preeclampsia diagnosis.
What is the condition where blood pressure does NOT drop at night by the usual 10%?
Nocturnal hypertension
What BP reading is required to be Hypertensive Urgency?
≥180 systolic AND/OR 120 diastolic but NOT symptomatic
What BP reading is required to be Hypertensive Urgency?
≥180 systolic AND/OR 120 diastolic WITH symptoms.
First line Rx for hypertension recommended by AHA?
thiazide or thiazide-type diuretic, ACEI or ARB or CCB
What are the 6 steps for the one-hour sepsis bundle?
- Lactate level. Redraw if >2
- Blood cultures - prior to Abx
- Abx - broad spectrum within ONE our
- Fluids at 30 mL/kg for hypotension or lactate ≥4
- Vasopressors - hypotension to maintain MAP ≥65
- O2 - high flow for hypoxemic resp. failure.
