Coronary Artery Disease

Question 1

Outer Layer

Answer 1

Adventitia

Basic support structure

Question 2

Middle Layer

Answer 2

Media
Multiple layers of smooth muscle cells
Makes adjustments to luminal diameter

Question 3

Inner Layer

Answer 3

Intima

Question 4

Intima

Answer 4

endothelial layer, basement membrane, smooth muscle cells

Question 5

What is the primary driving force moving blood into myocardial tissue?

Answer 5

diastolic BP

Question 6

What plays a role in determining volume of blood passed along to tissue?

Answer 6

vasomotor tone

Question 7

Left ventricular end-diastolic pressure

Answer 7

the pressure within the ventricle at end diastole

Question 8

Atherosis

Answer 8

Fatty streak that consists of lipid-laden macrophages and smooth muscle cells

Question 9

Sclerosis

Answer 9

Responsible for reduction of blood vessel compliance

Organization of “fibrous cap” of thrombi over advanced plaques that have developed on endothelial lining

Question 10

Lesions of Atherosclerosis

Answer 10

Fatty Streak
Raised Fibrous Plaque
Complicated Plaque

Question 11

Vasospasm

Answer 11

Hyperplasia of intimal smooth muscle cells is hallmark of advanced atherosclerosis creating a coronary artery that is prone to spasm

Question 12

Prinzmetal angina

Answer 12

variant angina associated with ST-segment elevation, at rest, and not associated with any preceding increase in myocardial oxygen demand

Question 13

Modifiable risk factors:

Answer 13

Cigarette/tobacco smoking
High blood pressure (over 140/90)
High blood cholesterol levels – best predictor is ratio of total cholesterol to HDL
Physical inactivity

Question 14

Nonmodifiable risk factors:

Answer 14

Heredity
Male sex
Increased age

Question 15

Classic stable angina:

Answer 15

tightness, pressure, indigestion anywhere above the waist that develops with exertional activity and relieved with NTG

Question 16

Unstable angina:

Answer 16

chest discomfort that is accelerating in frequency or severity and may occur while at rest but does not result in myocardial necrosis
-acute MI

Question 17

Pericarditis:

Answer 17

pain at rest, may worsen with activity,but is not relieved with rest or NTG, responds to anti inflammatory meds.

Question 18

Factors that Contribute to Unstable Angina

Answer 18

Circadian variations in catecholamine levels
Increases in plasma viscosity
Increases in platelet activation
Pathological changes in atherosclerotic plaques

Question 19

Printzmetal’s variant angina (vasospasm)

Answer 19

supply ischemia

Question 20

Chronic stable angina (fixed stenosis)

Answer 20

demand ischemia

Question 21

Unstable angina (thrombus)

Answer 21

supply ischemia

Question 22

STEMI

Answer 22

develops a Q wave on ECG in subsequent 24 to 48 hrs (transmural infaction)

Question 23

Non-STEMI

Answer 23

does not develop a Q wave on ECG (referred to nontransmural or subendocardial region infarction)

Question 24

Right coronary artery infarction

Answer 24

increased risk of AV block and/or arrhythmia

50% have right ventricular infarct

Question 25

Left main artery infarction:

Answer 25

pump dysfunction or failure

Question 26

Left anterior descending (LAD) infarction

Answer 26

pump dysfunction or failure

Question 27

Circumflex infarction

Answer 27

non specific

Question 28

Abnormal contraction patterns

Answer 28

Dyssynchrony Hypokinesis Akinesis Dyskinesis

Question 29

Dyssynchrony

Answer 29

uncoordinated contraction with adjacent segments

Question 30

Hypokinesis

Answer 30

reduction in the strength of contraction

Question 31

Akinesis

Answer 31

no contraction

Question 32

Dyskinesis

Answer 32

abnormal movement during contraction

Question 33

Factors that affect remodeling

Answer 33

Size of infarct Ventricular load increased pressure or increased volume will increase load Patency of the artery that was infarcted

Question 34

Hypertensive Heart Disease

Answer 34

Produces a pressure overload on left ventricle | Diastolic dysfunction with impairment of LV relaxation develops early

Question 35

Systolic Dysfunction:

Answer 35

an impairment in ventricular contraction, resulting in decrease in stroke volume and decrease in ejection fraction (less than 40%). An increase in end systolic volume will also occur. Now called heart failure with reduced ejection fraction or HFREF.

Question 36

Prehypertension Systolic

Answer 36

120-139

Question 37

Prehypertension Diastolic

Answer 37

80-89

Question 38

Stage 1 hypertension systolic

Answer 38

140-159

Question 39

Stage 1 hypertension diastolic

Answer 39

90-99

Question 40

Stage 2 hypertension systolic

Answer 40

greater than 159

Question 41

Stage 2 hypertension diastolic

Answer 41

greater than 99

Question 42

Dystolic Dysfunction:

Answer 42

Changes in ventricular diastolic properties that lead to an impairment in ventricular filling and an impairment in ventricular relaxation.

Question 43

Medical clearance needed:

Answer 43

SBP >180 mmHg & DBP >110 mmHg) pt’s must have medial clearance & prescribed medication for HTN

Question 44

Exercise testing should be terminated if

Answer 44

SBP >250mmHg or DBP >115 mmHg

Question 45

Orthostatic hypotension

Answer 45

SBP dop of >20mmHg or DBP drop >10mmHg

Question 46

Refer to physician if resting BP is

Answer 46

(SBP >200 mm Hg or DBP >100 mm Hg)

Question 47

Exercise recommendations for PAD:

Answer 47

short intervals (1-5 mins) with frequent rest breaks (gradually increase) walking longer warm up times in colder environments sensory exam footwear and foot hygiene