Ischemic Cardiac Conditions

Question 1

What are the three layers of an arterial wall, starting from outer layer in?

Answer 1

adventitia, media, and intima

Question 2

Describe how fluid dynamics rules impact myocardial perfusion?

Answer 2

all fluids flow from areas of high pressure to low pressure, and all fluids follow the path of least resistance so if there is an obstruction, they will take the least resistive path around it-> causes blood flow to decrease more distally

Question 3

What are the 4 major determinants of myocardial blood flow?

Answer 3

1. diastolic blood pressure is the primary driving force moving blood into myocardial tissue
2. vasomotor tone plays a role in determining volume of blood passed along to tissue
3. resistance to flow is commonly caused by atherosclerosis
4. LVEDP- the pressure in the L ventricle at the end of diastole, can put an occlusive force on the capillary beds

Question 4

Which term describes the presence of obstruction but does NOT inhibit heart muscle function?

Answer 4

coronary artery disease

Question 5

Which term describes obstruction that causes permanent damage to muscle downstream, inhibiting muscle function?

Answer 5

coronary heart disease

Question 6

What are the modifiable risk factors for heart disease?

Answer 6

smoking, high blood pressure, proper diet, diabetes, high blood cholesterol, physical inactivity, obesity

Question 7

What are the non-modifiable risk factors for heart disease?

Answer 7

heredity, male sex (earlier age MI risk), increased age (greater than 65 years old)

Question 8

What can occur in about half the patients with CHD within one hour of symptoms?

Answer 8

sudden cardiac death

Question 9

Fill in the blank: chronic stable angina is associated with ______

Answer 9

atherosclerosis

Question 10

Which condition is described as tightness/pressure/ indigestion above the waist that develops with exertional activity and diminishes with rest or nitroglycerin?

Answer 10

chronic stable angina

Question 11

What is angina?

Answer 11

imbalance in supply and demand of myocardial oxygen

Question 12

What are the three types of acute coronary syndrome?

Answer 12

unstable angina, acute MI- STEMI AND NON-STEMI

Question 13

What are clinical clues or signs that would indicate unstable angina?

Answer 13

angina at rest, pts typical angina now occurring at a lower level of activity, deterioration of a previously stable pattern

Question 14

What is the difference between a STEMI and a Non-STEMI?

Answer 14

stemi is totally occluded due to thrombus or plaque and can be seen as a ST segment elevation on the EKG, a non-stemi is not completely blocked

Question 15

How long does it take for necrosis to develop in a MI?

Answer 15

15-20 minutes

Question 16

What are the common sx of MI?

Answer 16

pressure, chest pain that can spread up towards neck, back, jaw, or shoulders, dizzyness, sweating, pallor, SOB, not relieved by nitroglycerin or rest

Question 17

What condition occurs at rest and is due to a spasm in the coronary arteries due to exposure to the cold weather, stress or smoking?

Answer 17

prinzmetal angina

Question 18

What condition has pain at rest that worsens with activity, is NOT relieved with nitroglycerin or rest, and responds to anti-inflammatory medications?

Answer 18

pericarditis

Question 19

How can you differentiate between MI chest pain versus MSK chest pain?

Answer 19

MSK can be palpated, MI cannot

Question 20

What condition is due to an increased thickness of the connective tissue and decreased compliance of collagen and elastic connective tissue in the vessels?

Answer 20

arteriosclerosis

Question 21

What condition is an increased in blood flow that increases BP due to a buildup of plaques?

Answer 21

atherosclerosis

Question 22

What is the gold standard to diagnosis an MI and what is the normal range?

Answer 22

troponin, 0-3.0 is normal

Question 23

How can you diagnose an MI?

Answer 23

EKG, troponin and creatine kinase levels

Question 24

Which creatine kinase isoenzyme is the most conclusive of all the CK isoenzymes and what is the abnormal range?

Answer 24

CKMB, abnormal if it is greater than 3%

Question 25

If you find myoglobin in a pts result, can you be sure that is due to cardiac injury?

Answer 25

no, need to rule out skeletal muscle injury

Question 26

What does an MI infarction need within the first 3 hours of onset?

Answer 26

fibrinolysis and PTCA

Question 27

What is the main concern with an MI?

Answer 27

main concern is to re-perfuse the area of the heart not receiving enough blood and oxygen

Question 28

What is a way to help prevent an MI?

Answer 28

baby aspirin daily (75-325 mg/day)

Question 29

What are some exercise parameters acute post MI (4-6 weeks)?

Answer 29

HR should not exceed 120, exercise should only be 20-30 bpm above the resting HR, if resting HR above 100- contact MD to clear for exercise, SBP: should increase 20-30mmHg above resting, DBP should be within +/-10mmHg, RR SHOULD NOT DOUBLE, RPE: 11-13

Question 30

You have a pt with a systolic BP of 130 and another one with a BP of 160, what categories would each be in?

Answer 30

pre-hypertensive and stage 2

Question 31

t/f, 90-95% of those with HTN have primary HTN with no discernible cause

Answer 31

true, the other 5-10% have secondary HTN which do have identifiable medical conditions

Question 32

Who is most likely to be at risk for hypertension?

Answer 32

overweight, African American male

Question 33

What are some hypertension medications?

Answer 33

beta blockers, calcium channel blockers, ACE inhibitors, diuretics

Question 34

What is the biggest takeaway of someone with cardiac issues in how we treat as PTs (what do we make sure we do?)?

Answer 34

TAKE VITALS

Question 35

What is the most important factor to help reduce the risk of stroke?

Answer 35

reduction in blood pressure

Question 36

What is the name for the pain patients feel with peripheral arterial disease?

Answer 36

intermittent claudication

Question 37

What is the best way to exercise for someone with peripheral artery disease?

Answer 37

walking, for short intervals alternating rest periods

Question 38

t/f, compression stockings would be helpful for someone with peripheral artery disease?

Answer 38

false! would completely obstruct blood flow then

Question 39

What ABI would indicate a severe arterial occlusive disease?

Answer 39

0.5 (1.0-1.4 is normal)

Question 40

You have a pt with thin and shiny skin with loss of hair on the ankle and foot. They have an ulcer with minimal exudate and it looks pale and deep wound bed with even margins, what type of ulcer is it?

Answer 40

arterial ulcer