Cardiovascular Diseases

Question 1

What is atherosclerosis?

Answer 1

Disease of lipid panel plaques affecting moderate and large size arteries

Thickening and narrowing of the intimal layer of the blood vessel wall from focal accumulation of lipids, platelets, monocytes, plaque and other debris

Question 2

List 4 non-modifiable risk factors for cardiovascular disease.

Answer 2

1. Age (Men > 45 and women > 55)
2. Family history
3. Race (African Americans have increased risk)
4. Gender (Men > premenopausal women; risk equalized after menopause)

Question 3

List 6 modifiable risk factors for cardiovascular disease.

Answer 3

1. High cholesterol
2. Diabetes
3. Hypertension
4. Obesity
5. Physical inactivity
6. Tobacco use

Question 4

List the 3 conditions that make up coronary artery disease.

Answer 4

Angina pectoris
Myocardial infarction
Heart failure

Question 5

What is angina pectoris? What sign may be part of its clinical presentation?

Answer 5

Chest pain or pressure due to ischemia and diminished myocardial perfusion due to narrowing of the coronary arteries

Levine’s sign: patient clenches fist over sternum

Question 6

What symptoms are associated with angina pectoris?

Answer 6

Pressure, heaviness, burning or aching behind the sternum

Pain can also be felt in jaw, back, shoulders and arms

Question 7

What are three types of angina?

Answer 7

Stable angina
Unstable angina
Prinzmetal (variant) angina

Question 8

Describe stable angina. How are symptoms relieved?

Answer 8

Classic exertional angina occurring during exercise of activity; occurs at a predictable rate pressure product

Relieved with rest and/or nitroglycerin

Question 9

Describe unstable angina.

Answer 9

Coronary insufficiency that occurs without cause and at any time.

Pain is difficult to control

Question 10

Describe Prinzmetal’s angina (variant). How are symptoms treated?

Answer 10

Occurs secondary to coronary vasospasm

Responds well to nitroglycerin and calcium channel blocker long term

Question 11

What is myocardial infarction?

Answer 11

Prolonged ischemia, injury and death of an area of the myocardium caused by occlusion of one or more of the coronary arteries

Question 12

What is the zone of infarction? How does it appear on a ECG?

Answer 12

Consists of necrotic, noncontractile tissue; electrically inert

ECG: pathological Q wave

Question 13

What is the zone of injury? How does it appear on a ECG?

Answer 13

Area immediately adjacent to the central zone, tissue is noncontractile; electrically unstable

ECG: elevated ST segment in leads over injured area

Question 14

What is the zone of ischemia? How does it appear on a ECG?

Answer 14

Outer area; cells undergoing metabolic changes; electrically unstable

ECG: T wave inversion

Question 15

What is the difference between transmural and non-transmural infarction sites?

Answer 15

Transmural: full thickness myocardium, which is often an ST elevated MI or Q wave MI

Non-transmural: subendocardial, subepicardial, intramural infarctions. Non-ST elevated MI or non-Q wave MI

Question 16

Impaired ventricular function results in decrease ____, ____, and ____.

Answer 16

Stroke volume
Cardiac output
Ejection fraction

Question 17

What is heart failure?

Answer 17

A clinical syndrome in which the heart is unable to maintain adequate circulation of the blood to meet the metabolic needs of the body.

Question 18

Left sided heart failure is also known as _____.

Answer 18

Congestive heart failure

Question 19

Describe left sided heart failure.

Answer 19

Characterized by pulmonary congestion, edema, and low cardiac output due to back flow of blood from the left ventricle to the left atrium and lungs.

Question 20

Describe right sided heart failure.

Answer 20

Characterized by increased pressure load on the right ventricle with higher pulmonary vascular pressures (i.e. mitral valve disease, cor pulmonale)

Question 21

What are 2 hallmark signs of right sided heart failure?

Answer 21

Jugular vein distension

Peripheral edema

Question 22

What is compensated heart failure?

Answer 22

Heart returns to functional status with reduced cardiac output and exercise tolerance.

Question 23

List 5 physiological compensatory mechanisms that are present with compensated heart failure.

Answer 23

SNS stimulation
Left ventricular hypertrophy 
Anaerobic metabolism
Cardiac dilation
Arterial vasoconstriction

Question 24

List 4 signs and symptoms of pulmonary congestion secondary to left ventricular failure.

Answer 24

1. Dyspnea, dry cough
2. Orthopnea
3. Paroxysmal nocturnal dyspnea
4. Pulmonary rales, wheezing

Question 25

List 4 signs and symptoms of pulmonary congestion secondary to right ventricular failure.

Answer 25

1. Dependent edema
2. Weight gain
3. Ascites
4. Liver engorgement (hepatomegaly)

Question 26

Describe the activity restrictions following an acute MI.

Answer 26

1. Activity can be increased once the acute MI has stopped (peak in cardiac troponin levels)
2. Activity should be limited to 5 METS or 70% of age predicted HRmax for 4-6 weeks following MI.