CardioVascular

Question 1

Arteries

Answer 1

carry blood away from heart

Question 2

Veins

Answer 2

Carry blood towards the heart

Question 3

Capillaries

Answer 3

Where nutrients and gases exchange occur

Question 4

Functions of the cardio system?

Answer 4

Regulates blood flow to tissues
Retrieves waste products
Thermoregulation
Gas exchange
Closed loop of blood vessels

Question 5

Blood flow pattern??

Answer 5

1. 02 poor blood returns via inferior and superior vena
2. R atrium
3. R ventricle
4. LR Pulmonary
5. Lungs
6. Co2 removed and O2 added
7. Blood returns
8. Heart via LR pulmonary vein
9. L atrium
10. L ventricle
11. Pumped to the systemic circulation through aorta

Question 6

SA node?

Answer 6

Sinoatrial node (Pacemaker)
Initiates heartbeat and causes atria to contract on average 0.85 seconds

Question 7

Systole?

Answer 7

Contraction of the heart chambers

Question 8

Diastole?

Answer 8

Relaxation of the heart chambers

Question 9

Stroke volume?

Answer 9

Volume of blood ejected with each contraction of the L ventricle with each systolic phase

Question 10

Ejection Fraction (EF):

Answer 10

Fraction of blood that is ejected from heart by contraction of left ventricle.

Question 11

Mean arterial BP(MAP):

Answer 11

determined by a combo of cardiac output and total peripheral resistance

Question 12

Normal range BP:

Answer 12

70-110 mm Hg to perfuse all organs, tissues

Question 13

Regulation of MAP:

Answer 13

Sympathetic nervous system
Renin-angiotensin system
The role of kidney in BP regulation

Question 14

Kidneys role in RAAS

Answer 14

Kidneys secrete peptide hormone renin in response to reduced NaCl, ECF volume, and arterial BP.
Renin activates angiotensinogen

Question 15

What is angiotensinogen?

Answer 15

plasma protein produced by the liver

Question 16

Conversation of angiotensinogen

Answer 16

Angio 1 to angio 2 by ACE (angiotensin-converting enzyme) produced by lungs.
Ang 2 stimulates the adrenal cortex to secrete hormone aldosterone which stimulates Na reabsorption by kidneys. Resulting retention of Na exerts osmotic effect that holds more h20 in ECF.

Question 17

Vasopressin?

Answer 17

Antidiuretic hormone
known as Arginin Vasopressim (AVP)
Secreted from posterior pituitary gland in response to increased plasma osmolality. Results in concentration of urine and reduced urine volume

Question 18

Hypertension

Answer 18

Defined as chronic elevation in BP > 140/90 mmHg

Silent killer damages heart and arteries

Question 19

Etiology of HTN

Answer 19

Primary or essential idiopathic- no known causes 90% of all cases
Age, ethnicity, family history. high BW
Secondary- results of another chronic condition: Renal, cvd, endocrine disorders, or neurogenic disorders.
Lifestyle factors- smoking, exercise, diet, sodium intake

Question 20

Pathophysiology of HTN?

Answer 20

Excessive secretion of Vasopressin and angio2-increase BP
Smoking
Renal disease: interferes with action of nitric oxide, impairs endothelial relation and vasodilation
Adrenal disorders: excessive secretion of epinpherine and norepinephrine
Neurological disease: affecting medulla oblangata

Question 21

Treatment of HTN?

Answer 21

Reduce risk of CVD and renal disease
Lower BP < 140/90
Weigh reduction, physical activity, nutrition therapy, pharmocological intervention

Question 22

Medical treatment for HTN?

Answer 22

1. Loop diuretics: Acted by inhibiting Na, Cl, K reabsorption in loop of henle of kidney
2. Thiazides: same action as loop but in distal tubule and ascending loop of henle
3. Carbonic anhydrase inhibitors: block enzyme involved with exchange of H+ with Na and H20.
4. Potassium sparing diuretics: acts within the collecting and convoluted tubes- prevent sodium-potassium exchange and reduce aldosterone stimulation

Question 23

Lasix

Answer 23

Lasix (furosemide) is a loop diuretic (water pill) that prevents your body from absorbing too much salt. This allows the salt to instead be passed in your urine.

Question 24

DASH diet?

Answer 24

Dietary Approaches to Stop Hypertension
4-5 servings of Fruit
4-5 servings of vegetables
2-3 servings of nonfat, low fat dairy
6-8 servings of whole grains
2 or less servings of meat, poultry, or fish
Nuts, seeds, and dry beans- 4/5 week
Decrease total and sat fat
Decrease sodium: 1500-2400mg/d
Increase Ca, K, and Mg

Question 25

Core of Lipoprotein

Answer 25

TG and Cholesterol esters

Question 26

Lipoprotein surface?

Answer 26

Phospholipids Proteins Cholesterol

Question 27

LDL is made up of what?

Answer 27

Mostly free cholesterol

Question 28

Atheroscelrosis

Answer 28

Thickening of blood vessel walls caused by presence of plaque (AS) "hardening"

Question 29

Arterioscelerosis

Answer 29

more general term includes loss of vascular elasticity- results in restriction of blood flow

Question 30

Plaque development?

Answer 30

Renin-angiotensin system plays a role, tobacco, oxidized LDL, glycated substances from DM, and homocysteine.

Question 31

What does nitric oxide have to do with atheroscelrosis?

Answer 31

An imbalance of NO is caused by oxidative stress, and NO contributes towards endothelial control like normal relaxation of smooth muscle in arteries, regulates leukocyte adhesion, platelet adhesion, and thrombosis.

Question 32

Foam cells?

Answer 32

filled with cholesterol and are released into EX spaces where they form fatty streaks. This streak can occur as early as age 5

Question 33

Thrombus

Answer 33

blood clot that stays

Question 34

Embolus

Answer 34

blood clot that breaks from cellular surface and freely moves through the circulation.

Question 35

Pathophysiology of Athersclerosis

Answer 35

``` Inflammatory response Injury to endothelial lining Attracts platelets Forms small clots Continued migration of cells to area Proliferation of the plaque Rupture of fibrous cap can occur ```

Question 36

Gynoid obesity?

Answer 36

Fat around the hips

Question 37

Android?

Answer 37

Fat around abdominal fat and insulin resistance, have a higher waist circumference which is assoc with risk of CVD

Question 38

Diagnosing criteria for Metabolic Syndrome

Answer 38

``` Any 3 of the 5 constitutes MS Waist circumference TG HDL BP and Fasting Glucose ```

Question 39

Desirable Lab Values

Answer 39

Total Cholesterol: <200 mg/dL HDL >60mg/dL LDL: <100mg/dL TG: <150mg/dL

Question 40

TLC Diet

Answer 40

``` Sat fat: <7% PUFA: up to 10% MUFA: Up to 20% Total F: 25-35% of kcal Chol: <200 mg/day Carb: 50-60% kcal Fiber: 20-30g/day Pro: Approx 15% of kcal Na: 2400 mg/day Stanol esters: 3.4g ```

Question 41

Plant sterols?

Answer 41

Naturally occuring component of plant membranes just as cholesterol (animal). Most abundant: Beta-sitosterol Campesterol Stigmasterol Structurally resemble cholesterol, not synthesized by humans. Lowers serum cholesterol by inhibiting absorp of dietary and biliary cholesterol

Question 42

Foods bearing claim must contain:

Answer 42

0. 65g of plant sterols per serving | 1. 7g of stanol esters per serving

Question 43

Ischemia:

Answer 43

local temporary reduced blood supply d/t obstruction of heart "restriction"

Question 44

Soft lipid?

Answer 44

more likely to cause MI less likely to occlude large areas within the lumen More prone to rupture have a fibrous cap covering lipid rich core with macrophages Inflammation from within the plaque will weaken the cap Macrophages secrete substances that weaken cap

Question 45

Large hardended plaques

Answer 45

``` Have more smooth muscle cells Less likely to rupture May occlude up to 70% of artery May cause angina Collateral circulation may develop over time will occlude the artery without infarct ```

Question 46

Occlusion

Answer 46

Narrowing of the coronary artery from the buildup of cholesterol. This buildup is known as plaque in arteries throughout the body is called atheroscelrosis

Question 47

Angina

Answer 47

Condition when a pt complains of chest pain due to lack of blood supply Happens slowly with warning signs Sudden blockage of vessel d/t acute plaque rupture and closure of artery w/ clot buildup

Question 48

Stable angina

Answer 48

sub sternal pain when workload is increased, physical or emotional stress

Question 49

Unstable angina

Answer 49

rapidly worsening chest pain on minimal exertion or at rest

Question 50

MI and angina initiated by:

Answer 50

``` Sudden blockage Hemorrhage Arterial spasm Increase in myocardial oxygen demand One common factor: occlusion of lumen by AS plaque ```

Question 51

Infarction:

Answer 51

area of dead tissue d/t loss of blood supply- resulting in development of necrotic tissue

Question 52

What are the biomarkers for dx in MI?

Answer 52

Levels increase in blood then return to normal CK-MB: more specific for cardiac tissue CK: Creatine kinase M and B: 2 polypeptides and form an isoenzyme of creatine kinase Lactate dehydrogenase isoenzyme (LD-I) cTnT and cTnI: Cardiac troponin T and I

Question 53

What are cardiac biomarkers?

Answer 53

protein molecules released into blood stream from damaged heart muscle Characteristic rise and fall pattern

Question 54

Creatine kinase:

Answer 54

Increased in over 90% of MI, can also be increased in muscle trauma, physical exertion, post-op, convulsions

Question 55

LDH-I

Answer 55

``` Predominates in heart and red cells Increases later than CK Normal levels; 313-618U/L Reaches max level in 48-72h Remains elevated for 7-10 days after MI ```

Question 56

Troponin T and I

Answer 56

protein complex located on thin filament of striated muscles and are used as biomarkers for MI dx Cardiac troponins different than skeletal muscle. Isoforms very specific to cardiac injury Preferred markers Normal levels: 0.5ng/dL Rise 4-6 hours, peak 12 hours, and return to normal 3-10 days

Question 57

Post-MI Nutrition Therapy?

Answer 57

Reduce oral intake d/t pain, anxiety, fatigue, SOB Limit intake to clear liquids No caffeine to prevent arrhythmias, and decrease risk of vomiting and aspiration Progress to soft, easily chewable foods Small freq meals Reduce exertion Follow ATP III guidelines

Question 58

The primary target of therapy

Answer 58

LDL Cholesterol

Question 59

Stroke?

Answer 59

``` Sudden brain damage b/c lack of blood flow to the brain caused by a clot or rupture of a blood vessel Embolic: travels to the brain Thrombotic: Clot develops in artery Hemorrhagic= bleed Bleeindg around brain and into blain ```

Question 60

Peripheral artery disease (PAD)

Answer 60

Occlusion of blood flow in non-coronary arteries (lower extremities) Similar to AS and IHD Eventually suffer from denervation of affected muscle Can cause ulceration; commonly foot or toes.

Question 61

Claudication

Answer 61

fatigue- heaviness, tiredness, cramping in the leg, | Pain or discomfort goes away once the activity is stopped or during rest.

Question 62

Heart failure-

Answer 62

Impairement of ventricles capacity to eject or fill with blood underlying cause- structural or functional End stage CVD

Question 63

Stages of Heat Disease

Answer 63

A: at risk but no structural abnormalities B: Have structural disease but demonstrate no symptoms of HF C: Patients w/ past or current symptoms of HF who have underlying structural HD D: Patients with end-stage disease req specialized treatment, mech circulatory support, procedures to facilitate fluid removal.

Question 64

Dyspnea

Answer 64

shortness of breath (SOB)

Question 65

Orthopnea

Answer 65

SOB of breath associated with lying in supine position

Question 66

Cardiac cachexia

Answer 66

Unintended weight loss due to cardiac complications

Question 67

Left-sided failure

Answer 67

includes dyspnea and orthopnea

Question 68

Right-sided failure

Answer 68

fluid retention | pulmonary congestion, edema, hepatomegaly, splenomegaly, ascites.

Question 69

Nutrition therapy for CHF

Answer 69

``` 50% of HF failure patients are malnourished Increased workload/difficulty eating Goal decrease work of heart 2g sodium is standard fluid restriction 1mL/kcal or 35mL/kg Alcohol non to mod Caffeine can cause MI or cardiac arrhythmia Fluid restricting EN formula if needed ```

Question 70

Arginine

Answer 70

for increased production of NO

Question 71

Carnitine:

Answer 71

ships FA into mitochondria for oxidation

Question 72

Taurine:

Answer 72

reduced BP and combined with carnitine alleviates muscle fatigue in strenous workouts and raises exercise capacity

Question 73

Factors assoc with development of cardiac cachex

Answer 73

``` Generalized cellular hypoxia Decreased energy intake Anorexia secondary to ascites with drug therapy Unpalatable diet and fluid restriction Breathlessness and exhaustion from eating Altered taste and smell Depression N/V ```

Question 74

Heart transplant phases

Answer 74

Pre-transplant: control kcal, pro, Na, K, Fat, Chol Avoid fluid overload Immediate post: increase diet as tolerated Follow DASH diet plan, Omega-3 FA, Vit Supp Long-term post: Continue with education/monitoring