Chapter 33 Flashcards by Desiree Namou

Coronary Artery Disease
any vascular disorder that narrows or occludes the coronary arteries
results in in imbalance between coronary supply of blood and myocardial demand for oxygen and nutrients

nonmodifiable risk factors:

_________, _______
______ gender or women after __________

modifiable risk factors:
-__________
-_________
_________ injury, increase in __________
-_________ smoking
_______ and increase in ____, decrease in ______
-_________ and _______ resistance
-risk of developing coronary artery disease is inceased up to _____ by which factor
_______ damage, _______ of the vessel wall
-_______ and ______ lifestyle
________ diet

advanced age
family history
male gender
menopause

dyslipidemia
hypertension
endothelial
myocardial
cigarette
vasoconstriction
LDL
HDL
diabetes mellitus
insulin
endothelial
thickening
obesity
sedentary
atherogenic diet

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Modifiable risk factors
why are they risk factors for CAD?

__________ is associated w CAD because of the resulting alteration of ______________ synthesis; it increases ______ levels and is involved in ___ oxidation

_________ is the only factor responsible for a _____ to ______ increased risk of ________ cardiovascular disease

__________: nicotine stimulates the release of ___________ (eg the neurotransmitters: _________, ______) which increase the heart rate, and causes ___________ vascular _______
as a result, _________ increases, as do both cardiac workload and ______ demand

diabetes mellitus
hepatic lipoprotein
triglyceride
LDL
hypertension
twofold, threefold
atherosclerotic
cigaratte smoking
catecholamines
epinephrine, norepinephrine
periperal, constriction
blood pressure
oxygen

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why are they risk factors for CAD?

high levels of HDL
high levels of HDL may be more ______ for the development of _________ that low levels of ____

low levels of HDL
low levels of HDL cholesterol are also a strong indicator of ______ risk

protective
atherosclerosis
LDLs
coronary

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coronary artery disease

nontraditional risk factors:
markers of inflammation and thrombosis
-\_\_\_\_\_\_\_ protein is a lab test and indirect measure of \_\_\_\_\_\_\_\_\_
-\_\_\_\_\_\_\_ I
-\_\_\_\_\_\_\_\_\_\_
-\_\_\_\_\_\_\_\_
-adiponectin and leptin
-\_\_\_\_\_
-microorganisms and \_\_\_\_\_\_ disease
-\_\_\_\_\_ pollution
-coronary artery \_\_\_\_\_\_\_\_ and \_\_\_\_\_ wall thickness

c-reactive
atherosclerosis
troponin
hyperhomocysteinemia
adipokines
infection
periodontal
air
calcification
carotid

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coronary artery disease
myocardial ischemia
-develops if the supply of coronary ______ cannot meet the demand of the myocardium for _______ and ________
-stable angina: causes _______ chest pain.
-_________ (variant): causes ________ chest pain
-silent ischemia: causes ________ symptoms
-angina pectoris: causes _________ ______ chest discomfort
-_________ is triggered by myocardial ischemia!!!!

blood
oxygen
nutrients
predictable
prinzmetal
unpredictable
no detectable
transient substernal
angina pectoris

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coronary artery disease
acute coronary syndromes (ACS)
-\_\_\_\_\_\_\_ coronary obstruction because of \_\_\_\_\_\_\_\_ formation over a ruptured atherosclerotic \_\_\_\_\_\_\_\_\_\_
examples: 
\_\_\_\_
\_\_\_\_\_\_
most common complications
\_\_\_\_\_\_\_\_,\_\_\_\_\_\_\_, and \_\_\_\_\_\_\_

sudden
thrombosis
plaque
unstable angina
MI
dysrythmias
CHF
sudden death

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fixed stenosis of the coronary arteries

stable angina

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transient clotting of the coronary arteries

unstable angina

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persistance of thrombus with greater plaque disruption then in ___________ angina

NSTEMI (MI)

undstable

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complete thrombosis of the coronary arteries

STEMI

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myocardial infarction
individuals at highest risk
-_________ elevations (______) on the ECG requires immediate intervention

ST segment

STEMI

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subendocardial MI
if the thrombus breaks up before complete distal breaks up before complete distal tissue necrosis occurred, the infarction will involve only the myocardium directly beneath endocardium
causes marked ___ segment _______ and __ wave _______
_________

ST
depression
T
inversion
non-STEMI

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transmural MI
if the thrombus in a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium
causes marked ______ of ___ segments on the EKG
_____

elevation
ST
STEMI

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MI
clinical manifestations:
\_\_\_\_\_\_\_\_ of cardiac biomarkers means MI!!!!!!!!!
-\_\_\_\_\_\_\_\_: most specific
-elevations in \_\_\_ to \_\_ hours 
-\_\_\_\_\_\_\_\_\_\_\_\_\_\_-\_\_ (\_\_\_\_\_)
-\_\_\_\_

elevations
troponin
2, 4
creatine phosphokinase-MB (CPK-MB)
LDH

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when is the scar tissue that is formed after an MI most vulnerable to injury?

during the ______ period (__ to __ days after infarction), individuals feel more capable of _______ activities and thus may stress the newly formed scar tissue
after __ weeks, the _______ area is completely replaced by scar tissue, which is strong but unable to ______ and ______ like healthy myocardial tissue

recovery
10, 14
increasing
6
necrotic
contract
relax

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factors affecting cardiac output

myocardial contractility
_______: volume of blood ejected during systole

determinants of the force of contraction

changes in the ______ of the ventricular myocardium, caused by changes in ventricular volume (_____)
alterations in the ______ input to the ventricles
adequacy of myocardial _______ supply

stroke volume
stretching
preload
nervous system
oxygen

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factors affecting cardiac output
_________: is the volume of blood flowing through either the systemic or pulmonary circuit
-is expressed in liters per minute
-is calculated by multiplying the ________
in beats per minute by the ______
-normal adult cardiac output at rest is __ L/min

cardiac output
heart rate
stroke volume
5

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_________: is the amount of blood ejected per beat
-normal is __% or higher
is calculated by dividing the ________ by the end ______ volume
-is an indicator of _______ function

ejection fraction
55
stroke volume
diastolic
ventricular

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heart failure
systolic heart failure
inability of the heart to generate adequate cardiac output to perfuse tissue
__________ (_____ and _____)

natrieutic peptides
BNP
ANP

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heart failure
_______ (__________) is produced and released in response to pressure and volume _______ of the cardiac chambers

causes arterial and venous _______, _______
and suppression of the ___________ system

BNP
brain natrietic peptide
overload
dilation
natriueresis
renin-angiotensin-aldosterone

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BNP and heart failure (read 1179 in book)
\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_ of heart failrue

diagnosis
prognosis
monitoring treatment
treatment

systolic heart failure
heart failure with reduced ________ is defined as EF of less than __% and an inability of the heart to generate an adequate __________ to perfuse vital tissue

___ is the most common cause of decreased ________

ejection fraction
40%
cardiac output
MI
cardiac output

heart failure
systolic heart failure
clinical manifestation
-\_\_\_\_\_\_, \_\_\_\_\_\_\_, cough of \_\_\_\_\_\_\_\_\_ 
-\_\_\_\_\_\_\_\_
-decreased \_\_\_\_\_ output and \_\_\_\_\_\_\_

below are the descriptions

_______: SOB when lying down the patient sleeps on more than one pillow or even sitting up
____________ dyspnea
pulmonary _______ (____), _________ on CXR
________
bilateral _________

dyspnea, orthopnea, cough of frothy serum
fatigue
urine, edema
orthopnea
paryoxymol nocturnal 
congestion, rales
kerley B lines
edema
pleural effusions

diastolic heart failure

heart failure with preserved _________
decreased compliance of the _________ and abnormal diastolic ______ (__________)

ejection fraction
left ventricle
relaxation
lusitropy

right heart failure is the inability of the right ventricle to provide adequate blood into the pulmonary circulation -can result from _________ disease and elevated __________ resistance clinical manifestations: ________ distension, ________ edema, ______________(underlying pulm disease) _____

``` diffuse pulmonary pulmonary vascular jugular venous peripheral hepatosplenomegaly ascites ```

left heart failure edema: clinical manifestations pathophys: inability of the heart to generate adequate _______ to perfuse vital tissues

pulmonary dysnpea, orthopnea, cough of frothy sputum cardiac output

right heart failure edema: clin manifestations: pathophys: inability of the heart to provide adequate _______ into the pulmonary circulation at a normal central venous pressure

peripheral jugular venous distention and hepatosplenomegaly blood flow

fail to shut completely, permitting the backflow of blood to continue

valvular regurgitation

``` disorders of endocardium _____ stenosis orifice of the aortic semilunar valve narrows, causing diminished blood flow from the left ventricle into the aorta causes: ________ hypertrophy and _____ clinical manifestations: _____ and ________ ```

aortic left ventricular dilation angina, syncope

``` disorders of endocardium _______ stenosis impairment of blood flow from the left atrium to the left ventricle causes: left atrial _______ and ________ most common cause: _______________ ```

mitral hypertrophy, dilation acute rheumatic fever

disorders of the endocardium _________ regurgitation most common cause: mitral valve prolapse and rheumatic heart disease ________ atrial and ventricular _______ and ________ permits backflow of blood from ventricle to atrium

mitral left dilation hypertrophy

disorders of the endocardium __________ regurgitation leads to volume overload in the right atrium and ventricle, increased systemic venous blood pressure and right heart failure ______ atrial and ventricular dilation and hypertrophy

tricuspid | right

_________ prolapse system anterior and posterior cusps of the mitral valve billow upward (prolapse) into the atrium during systole it is also a ______ valvular disorder that is thought to have an __________ inheritance pattern as well as being associated with __________ disease this prolapse tends to be most prevalent in _________ studies suggest an autosomal dominant and _________ inheritance pattern because mitral valve prolapse often is associated with other inherited ________ disorders (eg ____________ syndrome, __________ syndrome, ____________), it is though tto result from a genetic or ________ disruption of valvular development during the _____ or ____ week of gestation

``` mitral female autosomal dominance connective tissue young women x-linked connective tissue Marfan syndrome Ehlers-Danlos syndrome osteogenesis imperfecta environmental fifth, sixth ```

are a diverse group of diseases that affect the myocardium: effects of ________ responses to _______ heart disease or ________ on the heart muscle cause ________ many cases of these are ________

``` cardiomyopathies neurohumoral ischemic hypertension remodeling idiopathic ```

cardiomyopathies _________ (_______) cardiomyopathy -impaired _______ function, leading to increase in ____________ volume. Causes _______ dilation and grossly impaired ______ function, leading to dilated ___________ causes: MI; diabetes; alcohol; deficiences of ______; vitamin D and selenium; hyperthyroidism clinical manifestiations: dyspnea and fatigue treatment: salt restriction, vasodilators, dieuretics, inotropic agents, anticoagulaants and pacemakers

``` dilated (congestive) systolic intracardiac ventricular systolic heart failure niacin ```

cardiomyopathies _____________ cardiomyopathy -common inherited heart defect of a _________ of the ______ wall, which may cause _____ obstruction to the ________ outflow tract

``` hypertrophic obstructive thickening septal outflow left ventricle ```

cardiomyopathies __________ cardiomyopathy myocardium becomes rigid and noncompliant, impeding ventricular filling and raising filling pressures during diastole this cardiomyopathy may occur __________ or as a cardiac manifestation of ________ diseases, such as __________, __________, __________, __________, and _________ or a number of inherited ________ diseases

``` restrictive idiopathically systemic scleroderma amyloidosis sarcoidosis lymphoma hemochromatosis storage ```

disorders of the heart wall disorders of the pericardium ___________ clinical manifestations: describe several days of ________, _______ and _______ followed by sudden onset of severe ________ that worsens with _______ movements and with ________ althought the pain may radiate to the _______, it is generally felt in the ________ chest and may be initially confused with the pain of an ________ individuals with this also may report __________, ________, _________, ________, _______ and _________

``` acute pericarditis fever, myalgias, malaise chest pain respiratory lying down back anterior acute MI dysphagia restlessness irritability anxiety weakness ```

_____________: is a diffuse, inflammatory disease caused by the delayed immune response to infeciton by the _______________________ clinical manifestations: carditis: ______ can cause acquired ____________ ________: large joints mainly affected ________: sudden, aimless, irregular, involuntary movements __________________: ________ causes a transitory truncal rash that is _________ and _______ with _______________ that may fade in the center, making them appear as a __________

``` rheumatic fever group A beta-hemolytic streptococci murmur aortic regurgitation polyarthritis chorea erythema marginatum truncal rash nonpruritic pink erythematous macules ringworm ```

____________: inflammation of the endocardium from infections agents -is a general term used to describe infection and inflammation of the endocardium- especially the ________ most common: _________, especially _________, ________, and _________ ``` risk factors: 1 2 _______ drug abuse 3 long term ___________ (eg for _______ monitoring, ________, and _________) 4. recent ___________ ```

``` infective endocarditis cardiac valves bacteria streptococci staphylococci enterococci acquired valvular heart disease intravenous indwelling catheterization pressure hyperalimentation hemodialysis cardiac surgery ```

cardiac complications of ____ | most common: _________ effusion and _______ failure

AIDs pericardial left heart

diseases of the veins ________ cause: trauma or gradual venous ________, damage to the _______ in the veins -superficial and not clot forming

varicose veins distention valves

diseases of the veins ____________ is a usual source of a _________

deep venous thrombosis (DVT) | pulmonary emboli

diseases of the veins _________ vena cava syndrome -progressive __________ of the ___ that leads to venous __________ in the _________ and ______

``` superior occlusion SVC distention upper extremities head ```

hypertension affects the entire cardiovascular system -____________: most significant factor in causing target ______ damage -increases risk for ___________, ______ and ______ caused by increases in __________ or total _________, or both ___________ increase: any condition that increases heart rate or stroke volume ____________ increase: any factor that increases blood viscosity or reduces vessel diameter

``` systolic hypertension organ myocardial infarction kidney disease stroke cardiac output peripheral resistance cardiac output peripheral resistance ```

pathophys of hypertension in the kidney pathological change occurs to the kidneys ________ as a result of ________ cause to have ______ in the kidney _______!!!!

glomeruli hypertension ishchemia tubules

hypertension treatment __________ therapies 1. ______________ (____) _________: angiotensin receptor ______ (___), or __________ antagonists 2. individuals with heart failure, have __________, are ____ myocardial infarction, or have had recurrent _________ 3. __________ 4. combination of _________ and other __________

``` pharmacologic angiotensin-converting enzymes ACE inhibitors blockers (ARBs) aldosterone chronic kidney disease post stroke calcium channel blockers thiazide dieuretics antihypertensives ```

__________ hypotension decrease in the systolic and diastolic blood pressures ___________ (temporary type) may result from 1) altered body _______, 2) drug action (eg _________, _________), 3) prolonged _______ caused by illness, 4) _________, 5) physical ______, 6) any condition that produces volume ________, 7) venous ______ (eg ________, extensive ________ of the ______ extremities) ________ are susceptible to this type of orthostatic hypotension, in which _______ reflexes are slowed as part of the aging process

``` orthostatic acute orthostatic chemistry antihypertensives antidepressants immobility starvation exhaustion depletion pooling pregnancy varicosities lower ``` older adults postural

_________ local dilation or outpouching of a vessel wall or cardiac chamber __________ is a common cause of these because ______ formation erodes the vessel wall clinical manifestations _______ -________(difficulty in swallowing), and _______ (breathlessness) are caused by the _______

``` aneurysm atherosclerosis erodes thoracic dysphagia, dyspnea pressure ```

thoracic aneurysm | _______ resulting from a thoracic aneurysm is due to pressure of a thoracic aneurysm on surrounding _______

dyspnea | organs

peripheral vascular disease ___________________(_______) -occurs mainly in ______ men who smoke -inflammatory disorder of the _________ arteries, small and medium size arteries in the _______ and sometimes in the _______ -______, _______, ______, ______, and _____ arteries -_______ the small and medium sized arteries -______ and _______ develop in the affected part -sluggish ______, _____ and _____ result treatment: -smoking cessation -exercise and dependent positioning; ______ to alleviate vasopspam and _______ agents

``` thromboangiitis obliterans (Buerger disease) young peripheral digital, tibial, plantar, ulnar, and palmar obliterates pain and tenderness blood flow, rubor, and cyanosis vasodilators ```

_________ phenomonon and ______ disease -_______ vasospasm (ischemia) in the _______ and _______ of the fingers; less commonly in the ______ clinical manifestations: changes in _______ and _______ caused by ischemia ___________: secondary to other systemic diseases or conditions treatment: arm exercises and medications __________: primary vasoplastic disorder of unknown origin treatment: avoidance of emotional sress and cold, cessation of cig smoking

``` raynaud episodic arteries arterioles toes skin color sensation raynaud phenomenon raynaud disease ```