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Cardiac rehabilitation > Cardiac event and intervention > Flashcards

Cardiac event and intervention Flashcards

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1
Q

what makes up the left coronary artery?

A

circumflex

left anterior descending

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2
Q

what makes up the right coronary artery?

A

marginal artery

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3
Q

what are the most important factors that can effect the myocardial blood flow? (2)

A

changes in aortic pressure and compression of myocardial vessels during systole

changes in oxygen demand

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4
Q

what is the coronary perfusion problem?

A

pressure in the muscle tissue during systole opposes blood flow. the effect is maximal in the deeper layers thus harder for blood to flow through the deeper layers

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5
Q

what are the limits to coronary perfusion? (4)

A

Tachycardia

low diastolic pressure

ischemic heart disease

increased HR

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6
Q

what are the 3 basic steps in atherosclerosis?

A
  1. tear in artery wall
  2. fatty material is deposited in vessel wall
  3. narrowed artery becomes blocked by a blood clot
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7
Q

what can atherosclerosis cause?

A

stroke and heart attack

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8
Q

what are the two type of cholesterol involved in atherosclerosis?

A

LDL-C (bad)

HDL-C (good)

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9
Q

what are the three layers of an artery wall?

A

tunica intima

tunica media

tunica adventitia

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10
Q

Name some risk factors for atherosclerosis

A

smoking, high BP, diabetes

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11
Q

How does the body try to defend against LDL-C?

A

activating macrophages to consume the LDL-C

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12
Q

what are foam cells?

A

enlarged cholesterol enriched cells

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13
Q

what is a plaque?

A

fatty streaks surrounded by a fibrous capsule

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14
Q

as the plaque grows, how does the body try to preserve blood flow in the artery?

A

The plaque expands in the elastic layer which stretches in order to keep the size of the artery the same

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15
Q

what is a symptom of continued plaque growth?

A

angina

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16
Q

what ion makes the plaque hard and inflexible reducing the ability for expansion?

A

calcium

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17
Q

what is the final stage of atherosclerosis?

A

as the plaque grows it squeezes the blood through another smaller gap which results in increased pressure which may damage the capsule cover which may then rupture leading to a blood clot which can completely block the artery

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18
Q

what is the name of the inner most layer of the artery?

A

The endothelium

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19
Q

name 3 characteristics of the endothelium

A

permeable

produces growth factors

releases platelets aggregation

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20
Q

In atherosclerosis what causes the endothelium to release leukocyte adhesion molecules?

A

LDL oxidised

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21
Q

what type of components does oxidised LDL have?

A

deformed lipoprotein components

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22
Q

what do the surface proteins do?

A

make the endothelium sticky rater than smooth

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23
Q

what are the surface proteins called?

A

vascular cell adhesion molecule

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24
Q

what cells adhere to the VCAM

A

monocytes and lymphocytes

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25
what do monocytes differentiate into and what does this create?
macrophages to create more foam cells
26
what do foam cells do?
release chemical messengers that cause m-RNA to produce further inflammatory factors that cause further tissue damage to area
27
what cells release growth factors that cause proliferation and attraction of smooth muscle cells to area
T-cells
28
what has it been suggested that MI is caused by and how?
an inflammatory response - They release inflammatory cytokines (eg TNF) and these reduce stability of plaque making it more likely to rupture
29
Why do VCAM exacerbate the prothrombotic risk?
they make it sticky
30
What causes instability of the fatty plaque? (3)
the stretch of the artery localised increase in blood pressure release protease - weakening the wall
31
what damages the endothelial layer in the first place?
Normal microvascular wear and tear Viral attack High blood pressure Turbulent flow Free radicals Carbon monoxide Elevated glucose and blood lipids
32
where does atherosclerosis lesions often occur and why?
at artery intersections of curves - blood flow speed or direction changes creating turbulence
33
what is stenosis?
the narrowing
34
if we are inactive how blocked can our artery be to still deliver enough blood?
90%
35
what type of plaque is more likely to rupture?
fatty plaque
36
what can make a plaque more stable?
a fibrous cap
37
what are the 8 events leading to an MI?
1. atherosclerosis 2. plaque rupture 3. platelet aggregation 4. thrombus formation 5. vessel occlusion 6. vasospasm 7. distal ischemia 8. ischaemic complications
38
what are the classic symptoms of an acute MI?
intense, oppressive chest pressure radiating in left arm
39
what is stable angina?
chest pain during exertion resulting from myocardial schema
40
what does an ECG wave show in stable angina?
normal, T-wave changes, or ST depression
41
what is unstable angina?
chest pain when inactive
42
what does an ECG show with unstable angina?
normal, T-wave changes, or ST depression
43
what is ischaemia associated with on an ECG?
inverted T waves or S-T segment depression
44
what is non-STEMI and what does it show on an ECG?
partial or intermittent blockage of the artery. May show ST depression
45
what is STEMI and what does it show on an ECG?
Caused by complete and persisting blockage of the artery - generally associated with S-T segment elevation and T-wave inversion
46
what is an infarct generally associated with on an ECG?
Q waves
47
What is ischaemia?
ST depression
48
is the ischaemia slow or fast to repolarise?
Slow
49
what ion does the cell need to depolarise/repolarise?
ATP
50
what ion is there a high concentration of inside the myocyte?
K (potassium)
51
what ion is there a high concentration of outside the myocyte?
Na (sodium)
52
what is the resting membrane potential?
-90mV
53
what causes the myocyte cell to polarize?
slow leakage of K from in to out the cell
54
what does Ischaemia do to ATP availability?
reduces it
55
what happens to the K+ channels with low ATP availability?
K+ channel open
56
what happens when the K+ channels open?
K+ quickly leaks out triggering depolarisation then Ca and Na ions flood inwards
57
what happens to the K:Na pump activity with loa ATP availability?
reduces the K:Na pump activity - thus K ions increase outside the cell reducing the gradient and cells stay positive for longer
58
At what phase does the ischemic region generate electrical currents?
Depolarized
59
what does this pocket of positive electrical signal do?
elevates baseline voltage
60
How far below baseline does theST segment depression need to be?
>1mm below baseline
61
what can downsloping ST segment be caused by?
digoxin
62
what can upward sloping ST segment depression be caused by?
exercise
63
what is injury generally associated with in regard to ST?
S-T segment elevation due to broken sodium channels
64
what is normal depolarisation?
endocardium to epicardium
65
what is normal depolarisation?
epicardium to endocardium
66
what wave is infarction generally associated with?
Q waves and T wave inversion
67
what's a pathological Q wave?
Q waves of more than 2mm
68
what is the relationship between EF and subsequent death?
Inverse
69
how long do we have to avoid ischemic cells dying?
60 minutes
70
how many minutes of ischemia is required for irreversible injury?
30 minutes
71
after a heart attack what enzymes do we see a certain increase in? (2)
Creatine Kinase and lactate dehydrogenase
72
why do enzymes end up in the blood with cell death?
Hole developed in cell membrane thus contents leak dependent on size, solubility
73
what are anti-thrombotic and give an example
clot busting drugs e.g. antiplatlet agents (tpa)
74
name some anti-ischemics
oxygen, B-blockers, nitrates
75
what is a repercussion drug?
PTCA
76
what happens in the first 4-6 hours post-myocardial infarction?
poor contraction, loss of systolic power
77
what happens in the 7 days post-myocardial infarction? (3)
inflammation, bruising, thinning of ventricular wall and enlargement of infarct site
78
what happens 6-12 weeks post-myocardial infarction?
Necrosis (congestive heart failure)
79
What might scarring of the heart cause?
Increased stiffness
80
What are the 4 main pharmacological treatments used for MI?
Blood thinners ACE inhibitors B-blockers Cholesterol lowering drugs (statins)
81
Give an example of a blood thinner
Aspirin
82
what do ACE inhibitors do?
decrease peripheral resistance = reduce BP and less heart work
83
what does a angiogram do?
Examines any clogged or damaged arteries
84
What does a transluminal extraction extraction device do to plaque in the artery?
cuts away at the plaque and the lose plaque is sucked into a tube through a vacuum
85
what does a rotational extraction device do to plaque in the heart?
spins at a high speed and pulverises plaque, which is then safely washed away in the blood stream
86
what does CABG stand for?
coronary artery bypass graft
87
what is CABG?
a procedure to bypass a blocked section of a coronary artery and to deliver oxygen to the heart
88
Name some complications of heart surgery. (5)
``` Wound infection MI stroke memory loss blood clots ```

Cardiac rehabilitation (13 decks)

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