Week 7 Flashcards
What is the R and L sides of the heart responsible for?
1) Right side responsible for:
* Receiving oxygen-poor blood from the circulation
* Pumping blood to the lungs
2) Left side responsible for:
* Receiving oxygen-rich blood from the lungs
* Pumping blood to the body
Explain blood circulation
- Oxygen-poor blood is returned to the right atrium and pumped out the right ventricle to the pulmonary arteries.
- O2 and CO2 are exchanged through diffusion at the capillaries and alveoli
- Oxygen-rich blood returns to the left atrium and pumps out the left ventricle through the aorta to the systemic circulation
- Blood travels through the arteries, arterioles, then capillaries where gas and nutrient exchange occurs at various organs and tissues.
WHY SHOULD I BE CONCERNED WITH CV RISK FACTORS?
Cardiovascular and pulmonary are among the leading causes of morbidity and premature mortality
Patients commonly have greater than 1 or more cardiovascular and pulmonary risk factors
Smoking is the primary contributor to cardiovascular disease and COPD
Risk factors should be assessed in every patient
A patient with a primary orthopedic or neurologic diagnosis may have a secondary cardiovascular and pulmonary diagnosis
Must be considered in the overall management of that patient
Common denominator in cardiovascular and pulmonary conditions
Inflammation of the endothelium of the blood vessels and epithelium of airways
DESCRIBE CORONARY ARTERY DISEASE
“The presence of an obstruction that causes permanent damage to the heart muscle fibers downstream, thus inhibiting heart muscle function”
Framingham Heart Study:
5209 apparently healthy men and women between 30 and 62 were followed for 20
years
Biennial examinations
Provided epidemiologic research that has led to the public acceptance of the role of risk factors in the development and progression of CVD
What is the pathophysiology of coronary artery disease?
Triggered by trauma to the intima of
the arterial wall
Hypertension
Cigarette smoking
Diabetes
List the layers
1) outer layer “adventitia”
2) muscle layer “media”
3) elastic layer
4 & 5) inner layer = endothelium “inner”
LIST KEY EVENTS IN ATHEROSCLEROSIS
Fatty streaks
First detectable lesion
Plaque formation
Endothelial dysfunction (injury)
Vascular calcification
DESCRIBE PATHOPHYSIOLOGY OF ATHEROSCLEROSIS
Underlying cause -> inflammation
Arterial endothelium encounters various proinflammatory cytokines
Hyperglycemia, bacteria, toxins from smoking, excessive lipids
Endothelium attracts leukocytes which kick off an inflammatory response in the vessel wall
A) Leads to structural changes in the vessel wall, ultimately leading to plaque formation
B) Fatty streaks C) fibrous plaque D) occlusion of the vessel lumen
Plaque may undergo calcification leading to ischemia, hypoxia or anoxia to the target organ
List some health metrics for ideal CV health
1) Health behaviors
Cigarette smoking
Physical activity
Healthy diet
Normal body weight
2) Managing health factors
Blood pressure
Cholesterol
Fasting blood glucose
What are some risk factors of CV?
Genetic and environmental
Cholesterol, hypertension, diabetes, obesity, smoking
Age, gender, race, activity lever
What is the clinical presentation of the patient with coronary heart disease?
typically occurs on one of 4 ways
Sudden cardiac death
Chronic stable angina
Acute coronary syndrome
Cardiac muscle dysfunction
WHAT IS ACUTE CORONARY SYNDROME
Umbrella term used to define acute myocardial ischemia that is further divided into 3
components
Unstable angina (unstable chest pain)
Non-ST-segment elevation myocardial infarction (NSTEMI)
ST-segment elevation myocardial infarction (STEMI)
DESCRIBE ANGINA PECTORIS
Chest pain related to ischemia of the myocardium
Increased oxygen demand of the heart muscle that cannot be matched by increased perfusion through
the coronary arteries
Typically caused by coronary artery disease
Valve disease, hypertrophy of the heart
Pain may be referred to the left shoulder, neck, jaw, between shoulder blades
Women: often manifests with fatigue, indigestion, sweating, sense of dread
Stable, unstable or variant
Associated with an increased risk of adverse cardiac events (MI)
Describe myocardial infraction
Interruption in blood supply to area of
myocardium
Location and extent depend on anatomic distribution of the vessel occluded, collateral circulation
Diagnosis of MI based upon
ECG
Enzymes (troponin, Creatine
kinase)
lever
What are the types of myocardial ischemia?
1) stable angina
2) unstable angina
3) NSTEMI
4) STEMI
