Cardiovascular Disease

Question 1

How many chambers are in the heart?

Answer 1

2 atria
2 ventricles

Question 2

Right side of the heart is responsible for what?

Answer 2

Receiving oxygen-poor blood from the circulation
Pumping blood to the lungs

Question 3

Left side of heart is responsible for what?

Answer 3

Receiving oxygen-rich blood from the lungs
Pumping blood to the body

Question 4

Oxygen-poor blood is returned to the _____ atrium and pumped out the _____ventricle to the ________ arteries.

Answer 4

Right, Right, Pulmonary

Question 5

Where is O2 and CO2 exchanged through diffusion?

Answer 5

At the capillaries and alveoli

Question 6

What type of blood returns to the left atrium and pumps out the left ventricle through the aorta to the systemic circulation?

Answer 6

Oxygen-rich blood

Question 7

“The presence of an obstruction that causes permanent damage to the heart muscle fibers downstream, thus inhibiting heart muscle function”

Answer 7

Coronary Artery Disease

Question 8

What is the outer layer of the artery called?

Answer 8

Adventitia

Question 9

What is the muscle layer of the artery called?

Answer 9

Tunica media

Question 10

What is the inner layer of the artery called?

Answer 10

Tunica Intima

Question 11

What is the most inner structure called of the tunica intima of the artery?

Answer 11

Endothelium

Question 12

What are the key events in artherosclerosis?

Answer 12

1. Fatty streaks
2. Plaque Formation (Endothelium dysfunction)
3. Formation of thrombus
4. Vascular calcification (weakens wall, necrosis, thrombus -> embolus)

Question 13

What is the underlying cause of Atherosclerosis?

Answer 13

Inflammation

Question 14

What are examples of arterial endothelium inflammation initiating cytokines?

Answer 14

-Hyperglycemia
-bacteria
-toxins for smoking
-excessive lipids

Question 15

Endothelium attracts _____ which kicks off an inflammatory response in the vessel wall.

Answer 15

Leukocytes

Question 16

What happens to the vessel walls when leukocytes respond to the inflammation in the endothelium layer?

Answer 16

Leads to structural change in the vessel walls, leading to plaque

Question 17

What is the order of atherosclerosis?

Answer 17

1. fatty streaks
2. Fibrous plaque
3. Occlusion of the vessel lumen

Question 18

Plaque may undergo calcification leading to what?

Answer 18

Ischemia, hypoxia or anoxia to the target organ

Question 19

What are examples of health behavior modifications?

Answer 19

1. Cease cigarette smoking
2. Physical Activity
3. Healthy diet
4. Normal body weight

Question 20

What are some examples of managing health factors?

Answer 20

1. Blood pressure
2. Cholesterol
3. Fasting blood glucose

Question 21

What are some risk factors for cardiovascular disease?

Answer 21

1. GENETICS and environmental
2. Cholesterol, hypertension, diabetes, obesity, smoking
3. Age, gender, race, activity level

Question 22

What is the clinical presentation of the patient with coronary heart disease typically occurs on one of the 4 ways……

Answer 22

1. Sudden cardiac death
2. Chronic stable angina
3. Acute coronary syndrome
4. Cardiac muscle dysfunction

Question 23

What is the umbrella term used to define acute myocardial ischemia?

Answer 23

Acute coronary syndrome

Question 24

Acute coronary syndrome is divided into 3 components, what are they?

Answer 24

1. Unstable angina
2. NSTEMI (non-ST-segment elevation myocardial infarction)
3. STEMI (ST-elevation myocardial infarction)

Question 25

Chest pain related to ischemia of the myocardium is defined as what?

Answer 25

Angina Pectoris

Question 26

What causes angina pectoris?

Answer 26

There is an increased oxygen demand of the heart muscle that cannot be matched by increased perfusion through the coronary arteries.

Question 27

What is caused by coronary artery disease?

Answer 27

-Valve disease -hypertrophy of the heart

Question 28

In angina pectoris, where may the pain be referred to?

Answer 28

The Left shoulder, neck, jaw, and between the shoulder blades

Question 29

What are common symptoms in women that experience angina pectoris?

Answer 29

Fatigue, indigestion, sweating, and a sense of dread

Question 30

Angina Pectoris can be presented how?

Answer 30

Stable, unstable, or variant

Question 31

Angina Pectoris is associated with an increased risk of what?

Answer 31

Myocardial infarction

Question 32

Myocardial Infarction is defined as what?

Answer 32

An interruption in blood supply to the area of myocardium.

Question 33

Myocardial infarction depends on what?

Answer 33

The location and extent of occlusion

Question 34

Diagnosis of MI is based upon…

Answer 34

-ECG -Enzyme levels (troponin, creatine kinase) -symptoms

Question 35

What are the 4 stages of acute coronary syndrome?

Answer 35

1. Stable Angina 2. Unstable Angina 3. NSTEMI 4. STEMI

Question 36

Angina pain develops when there is increased demand in the setting of a stable atherosclerotic plaque. The vessel is unable to dilate enough to allow adequate blood flow to meet the myocardial demand.

Answer 36

Stable Angina

Question 37

Demand ischemia, no infarction is associated with what stage in ACS?

Answer 37

Stable Angina

Question 38

What are stages have normal troponins levels?

Answer 38

Stable and unable angina

Question 39

What level of ACS has a normal ECG?

Answer 39

Stable angina

Question 40

The plaque ruptures and a thrombus forms around the ruptured plaque, causing partial occlusion of the vessel. Angina pain occurs at rest or progresses rapidly over a short period of time. What stage is this?

Answer 40

Unstable Angina

Question 41

What does the ECG during an unstable angina and NSTEMI read?

Answer 41

Normal, Inverted T waves, or ST depression

Question 42

What stage of ACS, where the plaque ruptures and thrombus formation causes partial occlusion to the vessel that results in injury and infarction to the subendocardial myocardium.

Answer 42

NSTEMI

Question 43

Supply ischemia, no infarct is associated with what ACS?

Answer 43

Unstable angina

Question 44

Subendocardial infarct occurs at what stage?

Answer 44

NSTEMI

Question 45

What stages has elevated troponins?

Answer 45

NSTEMI and STEMI

Question 46

What stage is characterized by complete occlusion of blood vessel lumen, resulting in transmural injury and infarct to the myocardium, which is reflected by ECG changes and a rise in troponins.

Answer 46

STEMI

Question 47

Transmural infarct is associated with what stage?

Answer 47

STEMI

Question 48

Transmural infarct is associated with what stage?

Answer 48

STEMI

Question 49

During STEMI, what does the ECG read?

Answer 49

Hyperacute T waves or ST elevation

Question 50

What are some complications of MI?

Answer 50

-Pumping ability of the heart -Persistent angina and arrhythmias -blood flow through the arteries -exercise/activity tolerance -functional/mobility limitations -other systems affected by disease

Question 51

What are some treatment to cardiovascular diseases/MI?

Answer 51

-prompt recognition -Decrease myocardial work/O2 demands -pharmacological -surgical -behavior modification (diet, exercise, smoking cessation, management of HTN)

Question 52

What factors depend on the prognosis when treating cardiovascular diseases/MI?

Answer 52

- Size and location of infarct strongly influence the acute course - Dependent upon L ventricular function

Question 53

What are some PT implications when treating cardiovascular patients?

Answer 53

-once medically stable, progressive mobility -evaluate tolerance to all activities -Goal: return to PLOF -General activity guidelines, role of exercise, and self monitoring techniques -6 minute walk test (outcome measure) -Asses ability to follow up with cardiac rehab