Cardiac Alterations-Up two Slide 43 Flashcards by Rachel Belmont

Also called ischemic heart disease and coronary artery disease (CAD)

Coronary heart disease (CHD)

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Characterized by insufficient delivery of oxygenated blood to the myocardium due to atherosclerotic coronary arteries (CAD)

Coronary Heart disease

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Name up to 5 sequelae of CHD

Angina pectoris
Myocardial infarction
Dysrhythmias
Heart failure
Sudden cardiac death

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A known risk factor for CHD is _______

atherosclerosis/microcirculation abnormalities

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Atherosclerosis causes narrowing of the arterial lumen that can lead to cardiac ischemia through (3)_______

Thrombus formation
Coronary vasospasm
Endothelial cell dysfunction

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In coronary atherosclerosis, lipids are transported via ________

apoproteins

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_________associated with a greater risk of atherosclerosis

Lipoproteins

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High-density lipoproteins transport cholesterol from _________ back to the ______ clearing atheromatous plaque

peripheral tissue; liver

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Atherosclerotic plaque formation initiated by injury to coronary artery ________

endothelium

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In coronary atherosclerosis, the_______ becomes permeable and recruits leukocytes

endothelium

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_______ occurs with oxidation by endothelial cells and macrophages in coronary atherosclerosis

LDL insudation (accumulation)

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________are damaging to endothelial and smooth muscle cells, and stimulate recruitment of ______ into the vessel in coronary atherosclerosis

oxidized lipids; macrophages

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In coronary atherosclerosis, ______ engulf the lipids; ______ (lipid-filled macrophages) release inflammatory mediators and growth factors, attracting more leukocytes and stimulating _____proliferation

macrophages; foam cells; smooth muscle

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Excess ____and _____ accumulate within vessel wall and coalesce into lipid core in coronary atherosclerosis

lipid, debris

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Vulnerable plaques may rupture or become eroded, which stimulates clot formation on the plaque in ________

coronary atherosclerosis

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Vulnerable plaques have (3)________

Large lipid core
Thin cap
High shear stress

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Stable plaques have (2)______

More collagen and fibrin

Stable cap

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There is increased plaque ________ in coronary atherosclerosis

vulnerability

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Name 5 signs of plaque vulnerability in coronary atherosclerosis

Active inflammation within the plaque
Large lipid core with a thin cap
Endothelial denudation (erosion) with superficial platelet adherence
Fissured or ruptured cap
Severe stenosis predisposing to high shear stress

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_________ mainstay of treatment and prevention for atherosclerosis; also, stabilize the plaques, making them less prone to rupture

Lipid lowering therapy

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Which plaque is most prone to rupture?

Contains significant collagen and fibrin
Has a large lipid core with a thin cap
Contains high-density lipoproteins
Has areas of ischemia and necrosis

Has a large lipid core within a thin cap

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oxygen supply insufficient to meet metabolic demands

ischemia

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Critical factors in meeting cellular demands for oxygen include: (2)

Rate of coronary perfusion

Myocardial workload

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Large, stable atherosclerotic plaque and acute platelet aggregation/thrombosis can alter _________

coronary perfusion

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Vasospasm, failure of autoregulation by the microcirculation, and poor perfusion pressure can alter________

coronary perfusion

Chronic occlusion of a coronary vessel sign of ______

stable angina

Plaque disruption and thrombus formation and results in unstable angina or MI a sign of _______

acute occlusion

Myocardial ischemia may uncommonly be caused by (3)_______

Coronary vasospasm Hypoxemia Low perfusion pressure from volume depletion or shock

Chronic syndromes with slow progression due to chronic obstruction from ____________

from stable atherosclerotic plaques

Name 2 examples of chronic syndromes with slow progression

Stable angina pectoris | Ischemic cardiomyopathy

__________associated with acute changes in plaque morphology and thrombosis; abrupt and can be life-threatening

Acute coronary syndrome (ACS)

Unstable angina and myocardial infarction associated with _________

Acute coronary syndrome (ACS)

Any of the coronary heart syndromes may precipitate (2)________

sudden cardiac death and associated dysrhythmias

Chest pain associated with intermittent myocardial ischemia

Angina Pectoris

Burning, crushing, squeezing, choking or referred pain

Angina Pectoris

No permanent _________ damage occurs in Angina Pectoris

myocardial

May result in inefficient cardiac pumping with resultant pulmonary congestion and shortness of breath

Angina Pectoris

What are the 3 patterns of Angina Pectoris

Stable/typical, unstable/crescendo, prinzmetal/variant

Angina pattern that is most common and also called classic

Stable/typical

Angina pattern that is characterized by stenotic atherosclerotic coronary vessels

Stable/typical Angina

Onset of anginal pain is generally predictable and elicited by similar stimuli each time....associated with what angina pattern?

Stable/typical Angina

Stable/typical angina relieved by ______ and _____

rest, nitroglycerin

Angina pattern that may progress to acute ischemia

Unstable/crescendo angina

Unpredictable attacks of anginal pain associated with what angina pattern?

Prinzmetal or variant angina

Onset of symptoms is unrelated to physical or emotional exertion, heart rate, or other obvious causes of increased myocardial oxygen demand...associated with what angina pattern?

Prinzmetal or variant angina

_________ angina characterized by ______, atherosclerosis-induced hypercontractility, abnormal secretion of vasospastic chemicals by local mast cells, and abnormal ______ across vascular smooth muscle

Prinzmetal/variant angina, vasospasms, calcium flux

Responds well to treatment with calcium channel–blocking drugs

Prinzmetal/variant angina

Chest pain usually more severe and lasts longer than typical angina

Acute Coronary Syndrome

In Acute Coronary Syndrome, there is ________ rupture with acute thrombus development

plaque

In acute coronary syndrome, occlusion is partial with ________

unstable angina

In acute coronary syndrome, occlusion is complete with______

Name 2 tools used for diagnosis of acute coronary syndrome

ECG and biomarkers

Patients with acute coronary syndrome that present with ST elevation and show positive biomarkers have _________

STEMI

Patients with acute coronary syndrome that present with No ST elevation and show negative biomarkers have _________

unstable angina

Patients with acute coronary syndrome that present with No ST elevation and show positive biomarkers have _________

NSTEMI

Patients with chest pain and evidence of acute ischemia on the electrocardiogram (ECG) (ST-segment elevation; STEMI) are candidates for _______

acute reperfusion therapy

Patients presenting with symptoms of unstable angina and no ST elevation on the ECG (non-STEMI, NSTEMI) are candidates for ______

anti platelet drugs

Acute occlusion causes a range of cellular events, depending on (3)________

Availability and adequacy of collateral blood flow Relative workload Length of time that flow is interrupted

Ultimate size of the infarcted tissue depends on the extent, duration, and severity of ______-

ischemia

In acute coronary syndrome, after ___ to ___ hours: area of infarction becomes paler than surrounding tissues

18-24

In acute coronary syndrome, ___ to ___days: turns yellowish and soft with a rim of red vascular connective tissue

5-7

In acute coronary syndrome, at ___to ____ weeks: necrotic tissue progressively degraded and cleared away; infarcted myocardium weakened and susceptible to rupture

1-2

In acute coronary syndrome, by _____ weeks necrotic tissue replaced by tough fibrous scar tissue

Electrocardiographic changes Elevations of specific marker proteins in the blood used to diagnose ________

acute coronary syndrome

Severe ______, excruciating ______ pain that may radiate to the arm, shoulder, jaw, or back associated with acute coronary syndrome

crushing, chest

Accompanied by nausea, vomiting, diaphoresis (sweating), shortness of breath

acute coronary syndrome

Acute coronary syndrome lasts more than _____ minutes and is not relieved by ___ or nitroglycerin

15; rest

Those with acute coronary syndrome have clinical manifestations including _____ MI

asymptomatic/"silent"

In those with acute coronary syndrome, ECG changes include _____ segment elevation, large _____ waves, and inverted _____ waves

S-T, Q, T

Acute coronary syndrome manifests as atypical symptoms like including fatigue, nausea, back pain, and abdominal discomfort among ______(3)

women/elderly/diabetic neuropathies

Serum marker changes in acute coronary syndrome include increased ______(3)

CK-MB and troponin I and T

Myoglobin, troponin, lactate dehydrogenase, and creatine kinase changes an indicator of _______

acute coronary syndrome

In acute coronary syndrome, ____leads to drop in _____, triggering compensatory responses including sympathetic activation

MI; CO

In acute coronary syndrome, Sympathetic nervous system activation leads to increased myocardial workload by increasing (3)_________

Heart rate Contractility Blood pressure

In acute coronary syndrome, overall prognosis for acute MI difficult to determine because of (5)_______

``` Of particular importance is how quickly treatment is sought Extent and location of the infarct Previous cardiovascular health Age Presence of other disease processes ```

Treatment for acute coronary syndrome includes decreasing_______

myocardial oxygen demand

Treatment for acute coronary syndrome includes increasing_______

myocardial oxygen supply

Treatment for acute coronary syndrome includes managing and monitoring ______

complications

Sympathetic antagonists, rest, heart rate control, pain relief, afterload reduction used to decrease ______in acute coronary syndrome

myocardial oxygen demand

Thrombolysis, angioplasty, coronary bypass grafting | used to increase _________in acute coronary syndrome

myocardial oxygen supply

Early detection and management of_______ and conduction disorders; continuous _____ monitoring treatment for acute coronary syndrome

dysrhythmias; ECG

Reperfusion therapy is indicated for the patient with: hypotension and dysrhythmias. unstable angina and elevated serum markers. chest pain and ST segment elevation. stenosis and regurgitation.

chest pain and ST segment elevation.

Unexpected death from cardiac causes within ____ hour/s of symptom onset

Also called sudden cardiac death

sudden cardiac arrest

Use of external defibrillators and CPR has increased survival of _______

sudden cardiac arrest

____________ is usually the primary cause of sudden cardiac arrest

Lethal dysrhythmia (such as ventricular fibrillation)

Heart failure develops insidiously due to progressive ischemic myocardial damage in ________

Chronic Ischemic Cardiomyopathy

Those with history of Chronic Ischemic Cardiomyopathy | usually have history of ______ or _____

angina; MI

Chronic Ischemic Cardiomyopathy IS MORE COMMON IN _____ and has _____ prognosis

adults; poor

Appears to be a consequence of slow, progressive apoptotic death of myocytes from chronic ischemia

Chronic Ischemic Cardiomyopathy

Apoptotic death of myocytes in Chronic Ischemic Cardiomyopathy scattered throughout ______

myocardium

Endocardial and valvular structures may be damaged by (3)_______

Inflammation and scarring Calcification Congenital malformations

Cause altered hemodynamics of the heart and increase myocardial workload

Endocardial and valvular disease

failure of the valve to open completely results in extra pressure work for the heart

Stenosis

inability of a valve to close completely results in extra volume work for the heart

Regurgitation (insufficiency)

________ are common with valvular disorders

Murmurs

Low-pitched, rumbling diastolic murmur; open snap; atrial dysrhythmias, atrial clots; exertional dyspnea associated with ________

Mitral Stenosis

In Mitral stenosis, blood flow from left _____to left ______ impaired during ventricular _______

atrium; ventricle; diastole

Increased pressure of the left atrium leads to atrial chamber enlargement and hypertrophy in ______

Mitral Stenosis

Mitral Stenosis can lead to chronic pulmonary _______, right ventricular _______, and _____-sided heart failure

hypertension, hypertrophy, right

In Mitral ________, there is a backflow of blood from the left ventricle to the left atrium during ventricular ____

Regurgitation; systole

Mitral regurgitation may lead to ________heart failure

left sided

High-pitched, pansystolic, blowing murmur; giant V waves; chronic weakness and fatigue associated with _______

mitral regurgitation

Left atrium and ventricle dilate and hypertrophy due to extra volume in _________

mitral regurgitation

Cardiac Alterations-Up two Slide 43 Flashcards

(104 cards)