Cardiovascula I -patho

Question 1

AHA statistics, over 20yo

Answer 1

problems increase as we age . Mostly found in ppl>80y

Question 2

AHA, kids, 12-19 yo

Answer 2

healthy diet is the major cause

Question 3

AHA, adults.20 yo

Answer 3

healthy diet score, physical activity and BMI

Question 4

AHA, over 20yo

Answer 4

obesity, which is a modifiable factor is increasing=> increasing cardiovascular problems in men over 35yo and female at 36yo

Question 5

AHA cost for major cardiovascular disease

Answer 5

Heart rate, and HTN, followed by stroke lead the chart

Question 6

AHA, major cause of deaths

Answer 6

Coronary artery disease (47%), other 16.9%, stroke 16.4%, heart failure, HTN, disease of arteries

Question 7

AHA, CVD (cardiovascular disease) of age group over or less than 85Yo

Answer 7

• under 85yo, the lead is CVD,CA,heart disease

- over 85yo: CA and Alzheimer

Question 8

CVD trends between sexes

Answer 8

1/3 of all deaths is caused by CVD

Question 9

heart disease and storke statistics-2015 update

Answer 9

18% of US have .5 metrics w ideal levels: smoking, physical activity, etc. for ppl over 20yo, caused by poor life style in US and world

Question 10

Health behaviors causes of death:

Answer 10

1 Smoking=2nd leading cause of death/disability; 1/3 of CVD linked to 1ry or 2ry smoking

2. Physical inactivity=only 50% meet req
3. Nutrition, 1 out of 8 CVD deaths
4. Obesity, together w other comorbidities: HTN, high colesterol, DM

Question 11

Health factors/risk factors- 2015 statistics heart disease and stroke

Answer 11

1. Family genetics= 45-90%
2. high cholesterol=only 46% have a normal cholesterol level
3. HTN = 32% mostly Afro Americans
4. Diabetes Mellitus = 1 in 10 Americans, 90% of adults in DM II, 50% in DM II
5. Metabolic syndrome = hyperglycemia, increased circ. waist

Question 12

Risk factors for CV disease

Answer 12

Non modifiable: age, gender, race, hormonal status, fam hx
Modifiable: BP, cholesterol, smoking, and others like physical activity, weight, diet, stress, glucose tolerance

1 of THESE FACTORS IS PRESENT IN ALMOST 50% OF CVD DEATHS

Question 13

hypertension (HTN)-def,

Answer 13

high blood pressure against the walls of arteries greater than 140mmhG systolic, greater than 90mmhg diastolic. Systolic pressure in vv when heart is contracting. Diastolic pressure in vv when heart is relaxed between beats.

Question 14

HTN

Answer 14

primary HTN is idiopathic in 90-95% of cases: related to genetics, smoking, obesity, high cholesterol
- secondarily is a identifiable cause 5-10% of cases related to kidney disease and endocrine disease
I in 3 Americans have HTN
#1 MODIFIABLE risk factor for HEMMORHAGIC and Ischemic strokes, and is 2x more prevalent in Americans than Caucasian

Question 15

HTN

AHA stats

Answer 15

Higher in female over male in ppl. over 75+ yo

Question 16

HTN risk factors - modifiable

Answer 16

Hi Na, Obesity, Insulin resistance, Hi cholesterol, Smoking, Long term alcohol abuse, hi stress, personality, hormonal status in female, and sedentary lifestyle, DM

Question 17

HTN- non modifiable risk factors:

Answer 17

family hx, >55yo,gender,ethnicity

Question 18

Stages of hypertension

Answer 18

Normal: systolic 160, D:>100
Hypertensive crisis (emergency care needed) S >180, D> 110 mmHg

Question 19

HTN causes:

Answer 19

kidney disease, narrowing of Aorta, narrowing of vasoconstriction of peripheral arteries

1. Mechanical damage to epithelial lining of arteries: Inflammatory response or proliferation of smooth muscle in arterial wall
2. Chronic afterload on LV as hyperthrophy or LV failure

Question 20

HTN: s/s, prevention, dx,tx,px(prognosis)

Answer 20

s/s: headache, vertigo, flushed face, blurry vision, nocturnal urinary frequency

prev: PA/exercise, weight control, diet modification
dx: BP, CBC, urinanalysis, serum cholesterol, fasting blood glucose, ECG
tx: ongoing meds, lifestyle modification
px: can lead to ventricular hypertrophy->heart attack.

Question 21

HTN meds:- combination therapy (tbl 12-6), lifestyle modifications

Answer 21

Ace inhibitors, ARB’s , diuretics, Ca channel blockers, L1 -andrenergic blockers, central L2 andrenergic antangonist, peripheral andrenergic blockers, vasodilators, aldosterone receptor blockers, direct renin inhibitors

Question 22

HTN meds:

Answer 22

1. diuretics= decrease plasma volume, decrease K having an effect on kidneys
2. ACE inhibitors= lower peripheral resistance, SE (side effect) chronic cough
3. Renin inhibitors= prevent angiotensin from forming
4. Beta blockers= decrease catecholamine response. Side effect for exercise
5. Angiotensin receptor blocker= decrease angiotensin to vasoconstrict
6. Ca- channel blockers= relax coronary smooth msc, vasodilate

Question 23

HTN meds effect on excercise

Answer 23

remember to note the pt’s meds, and use the inf to det their effect on BP and possible symptoms

Question 24

Cholesterol

Answer 24

Insoluble, so binds w PROTEINS
- used for cell membrane and hormones
-75% is manufactured by body
LDL = transport cholesterol TO cells
HDL transport FROM body to liver

Question 25

Cholesterol, increased risk for CAD

Answer 25

``` High LDL (transport cholesterol TO cell) low LDL (transport From body) to liver forms plaque between layers of artery wall-> plaque can cause blood clots->CVA, MI ```

Question 26

Cholesterol stats in adults >20yo

Answer 26

form 1988 to 2012, all the levels of cholesterol decreased, but its still high. Between populations mexican americans have the highest levels, followed by white and black ppl.

Question 27

Cholesterol levels:

Answer 27

Total cholesterol: 40mg/dl in men and >50 mg in female | Triglyceride (demo atherosclerosis)

Question 28

Smoking

Answer 28

pack/year hx type of smoking 1st hand or 2nd hand NON smokers exposed to smoke HAVE an increase risk of heart disease up to 25-30%

Question 29

Smoking over 18yo

Answer 29

around 23-24% of smoking

Question 30

Smoking effects

Answer 30

Carbon monoxide and nicotine Oxihemoglobine curve: CO binds 250x more to Hgb vs Oxigen = decreased oxygen carrying capacity + increased workload of heart Chronic HYPOXIA => increased HVT and increased risk of CLOTS CO (carbon monoxide) damages epithelial lining=> increased permeability tio lipids, smooth muscle into lumen and causes CAD

Question 31

Smoking and Nicotine- vasoconstriction, increased clotting, increased total cholesterol

Answer 31

Vasoconstriction: decreased coronary flow at rest and with exercise Increased clotting: increased in fibrinogen + increased platelet aggregation Increased total cholesterol

Question 32

Quit smoking effects:

Answer 32

after 1yr:- drop heart disease risk by 50% | 5-15 y later risk of CVA is the same as of a non smoker

Question 33

Inactivity and obesity -vs exercise

Answer 33

exercise can: modify BMI, lower BP, improve insulin secretion, increase HDL + lower LDl, reduce stress, improve endothelial fct, reduce inflammatory markers, reduce homocysteine and improve C REACTIVE PROTEIN = for inflammatory markers

Question 34

AHA dietary recommendation:

Answer 34

variety of fruit and vegetables whole grain, low fat dairy product, skinless poultry and fish, nuts and legumes, non-tropical vegetables oils. Limited saturated fats and TRANS fat, Na, red meat and sweet and sugar sweetened beverages.

Question 35

Diabetes -risk factors

Answer 35

- adults w diabetes have 2-4 X more likely to have CVD or CVA (top 2 killers of those w DM are heart disease and CVA) - comorbidities w diabetes: HTN, obesity, abnormal cholesterol level, decreased PA, poor blood glucose level, smoking

Question 36

Non modifiable risk factors:

Answer 36

family hx:

Question 37

Aging and CV - pathology

Answer 37

- Reduction in fct: decreased myocytes and cells in conduction tissue, devel of cardiac fct., reduction in Ca transport, lower capillary density, decreased response to B-adrenergic stimulation, impaired autonomic reflex control - cholesterol dep. and changes by the age of 30yo - increased collagen and Ca deposits=> atherosclerosis plaque.

Question 38

Gender and CV - pathology

Answer 38

- before age of 65 y. ratio of incidence in men vs women is 4:1 WOMEN: depends on timing + symptoms, Hormones(estrogen increases HDL and decreases clot formation. Estradiol improves vasodilaton), surgery (CABG = more fatalities) , oral contraceptive( including MI and CVA if smoker and >35yo), HTN and cholesterol ( especially after menopause)

Question 39

Coronary artery disease (CAD)+ atherosclerosis - definition

Answer 39

- CAD aa carry O2 to myocardium = creates ischemia and possible infarction when injured at endothelial level - Atherosclerosis = formation of plaque that narrows aa. Causes include: 1. High cholesterol and triglycerides 2. HTN 3. Smoking 1st signs is the formation of fatty streak ( lipids, connective tissue, smooth muscle cells and platelets). and it could be stable or not.

Question 40

endothelial layer fct.

Answer 40

endothelial layer of artery or the intimal layer makes the vessel permeable to lipoproteins

Question 41

fatty streak

Answer 41

is the penetration of lipoproteins into the smooth muscle cells of the intima

Question 42

Atherosclerosis mechanism = lipid hypothesis

Answer 42

increased LDL penetrates the arterial wall and the lipids starts to build up in the smooth muscle layer. LDL causes smooth muscle hyperplasia and cells migrate to intima. Sub endothelium is exposed to blood at sites of tears and platelets aggregate => in plaque that will partially or totally block blood flow through the artery.

Question 43

CAD - predictors

Answer 43

markers for CAD in pt's: serum cholesterol, homocysteine, CRP (inflammation marker), fibrinogen, LP (a) - slows down the breakdown of clots, pulse pressure (

Question 44

Myocardial ischemia

Answer 44

happens when: O2 demand NOT = O2 demand ( exercise activity and psychological stress) plaque, vasospasm, decreased CO, low O2 levels (lung disease)

Question 45

Angina pectoris- def, s/s

Answer 45

cardiac workload > than O2 supply to myocardial tissue => ISCHEMIA => Angina pectoris = 70% or more occlusion of coronary artery. All this will irritate the myocardial fibers and -> ANS (C3-T4) -> Radiation PAIN Symptoms: last 1-5 min, occlusion up to 20 min: squeezing, burning, pressing, heartburn, indigestion, choking which could mimic: dyspnea, fatique, diaphoresis, pallor Women: inhale cold air, weakness, lethargy, midthoracic pain, R biceps pain Angina pectoris can be relieved by NITRATES

Question 46

Angina pectoris causes:

Answer 46

- total occlusion of arteries - platelet activation w occlusive thrombus - high demand w. limited blood flow - vasospasm of diseased artery/pain

Question 47

angina pectoris types:

Answer 47

1. Stable angina = workload precedes ischemia, reduced by rest 2. Unstable ischemia = lower workload precedes ischemia or lasts longer or different quality esp. in women

Question 48

Zone of hypoxic injury

Answer 48

from interior to exterior: 1. Zone of infarct = necrosis as a weak vulnerable scar for 10-14 days and fibrous scar 6-8 wks 2. zone of hypoxic injury = may return to normal but susceptible to injury, regain fct. 2-3 wks 3. zone of ischemia = reversible zone and may have EKG changes nut return to normal as heals.

Question 49

Myocardial infarction ( heart attack) Dx:

Answer 49

- prevalence of symptoms: (+) - cardiac enzymes: creatine kinase, homocysteine, LP(a), CRP and (+) ECG changes - biochemical markers include: cardiac troponin I and cardiac troponin T 1. Cardiac catheter 2. Thallium stress test 3. Echocardiogram

Question 50

MI -tx

Answer 50

1. Pharmacologic= improve blood flow 2. Surgical: a) PTCA- percutaneous translumen coronary angioplasty = balloon ono obstructed artery and moves the plaque and restores blood flow b) STENT = helps keep open artery c) CABG - coronary artery bypass graft, internal mammary artery, saphenous vein, brachial artery to graft coronary artery. Bypass to occlusion to return flow.