Lecture 4 Flashcards
(38 cards)
1
Q
Unstable Angina Pectoris
A
- unexpected chest pain due to ischemia
- transientive secclusion (<10 min)
- followed by spontaneous thrombolysis
2
Q
Myocardial Infarction
A
- persisting vessel occlusion ( >60 min)
- resulting in death of myocardial muscle cells
3
Q
Difference between Unstable Angina Pectoris and Myocardial Infarction
A
disruption of myocyte membrane
4
Q
Types of Angina
A
Stable and Unstable
5
Q
Stable Angina
A
- more common form
- occurs at given activity level or level of mental stress
- fibrous cap not ruptured
6
Q
Unstable Angina
A
- new onset
- unpredictable
- fibrous cap ruptures
- may lead to heart attack
7
Q
History of Myocardial Infarction affected:
A
16 million Americans
8
Q
History of Angina affected
A
~9 million Americans
9
Q
New acute coronary syndrome affects
A
785,000/year
10
Q
Recurrent incidents affect
A
470,000/year
11
Q
Silent Myocardial Infarction affects:
A
195,000/year
12
Q
Total costs for heart diseases in 2007
A
177.5 billion
13
Q
Coronary Circulation supplies
A
myocardium with Oxygen
14
Q
Coronary Circulation in Coronary Arteries
A
-off the root of aorta RIGHT CORONARY ARTERY ---RCA ---right atrium and ventricle LEFT CORONARY ARTERY ---splits ------anterior descending -----------LAD ------circumflex artery -----------LCx ---left atrium and ventricle
15
Q
Coronary Blood Flow (Blood Flow and Metabolism)
A
- rest
- —60-90ml/min/100 g
- exercise
- —-5-6 times higher
16
Q
ATP Generation
A
- mostly aerobic
- myocardial oxygen uptake
- –rest: 8 - 10 ml/min/100 g
- –exercise: 2 - 3 times higher
- –indirect indicator: RPP
17
Q
Ischemia
A
-O2 supply < O2 demand
ISCHEMIC CASCADE
- stiffness of left ventricle
- systolic dysfunction
- localized hypokinesis
- left ventricle ejection fraction decreases
- arrhythmia
- angina pectoris
SILENT ISCHEMIA
18
Q
risk factors of atherosclerosis
A
- age
- male sex
- family history and genetics
- smoking
- pre-diabetes and diabetes
- obesity
- metabolic syndrome
- hypertension
- dyslipidemia
- physical inactivity
- psycho-social factors
- homocysteine
- c-reactive protein
- inflammatory protein
- fibrinogen
19
Q
Pathophysiology of Atherosclerosis [PROGRESSIVE]
A
- Endothelial dysfunction
- LDL-C accumulation and oxidation in arterial wall
- Injury and inflammation
- Monocyte binding and entry into cell
- Monocyte differentiation into macrophage
- Macrophage engulfs oxidized LDL and creates foam cell
- plaque maturation and calcification
20
Q
Trigger for Myocardial Infarction
A
- exertion
- emotional stress
- sympathetic activation [heart rate variability and prognosis]
- surgery causing blood loss
21
Q
Pathophysiology of Myocardial Infarction
A
- plaque rupture rulceration in coronary artery
- –bifurcations
- thrombosis (blood clotting)
- blood flow acculsion
- necrosis of downstream myocardium
- –protein synthesis
- —-cardiac tropinin
- dysrhythmia
- –ventricular fibrillation
- –ventricular tachycardia
- potentially death
22
Q
Complications of Acute Myocardial Infarction
A
- arrythmias
- conduction abnormalities
- cardiogenic shock
- infarct extension or expansion
- myocardial rupture
- new mitral valve regurgitation
- pericardial effusion and pericarditis
- post-infarction syndrome
- left ventricular mural thrombus
23
Q
Prognosis of Acute Myocardial Infarction
A
Factors associated with poor prognosis
- LIVEF < 5 METs
- evidence of extensive myocardial ischemia during exercise or pharmacologic stress testing
- having survived sudden cardiac death
- servere non-revascularized CAD
24
Q
Protocols from Prognostic GXT-Predischarge
A
- <7 days post myocardial infarction
- sub maximal before discharge
- termination
- —HRpeak: 120-130
- —70% age-predicted HRmax
- —achieving 5 METs
25
Protocols from Prognostic GXT-Symptom Discharge
- 2-3 post-discharge
- may be combined with nuclear imaging and echocardiogram
- stronger prognosis evidence
- --expired gases
26
Long Term Treatment
- medication
| - cardiac rehab
27
Cardiac Rehabilitation Multifactoral Program
- exercise training
- education
- some times
- --dietary management
- --psychological counseling
- -----depression,stress
- --smoking cessation
28
Cardiac Rehabilitation Outcomes
- better prognosis
- --survival; revascularization, subsequent MI
- better risk factor profile
- less signs and symptoms
- improved functional capacity
- better quality of life
- return to work and normal lifestyle
- can be homebased
29
Phases of Cardiac Rehab-Impatient
HOSPITAL STAY AFTER MI
- 2-3 days
- longer with complications
COMPONENTS
- avoid bed rest, early ambulation
- maintain upright posture
- range of motion exercises
30
Phases of cardiac Rehab-Outpatient
should start within two weeks after discharge
31
Outpatient Cardiac Rehab-Multifactorial Program
- exercise training with continuous ECG training
- education
- some times
- ----dietary management
- ---psychological counseling (depression, stress)
- ---smoking cessation
32
The Role of Exercise: Primary Prevention
preventing MIs prior to happening
33
The Role of Exercise: Secondary Prevention
preventing adverse events after first MI
34
Physical Activity and Risk for MI
- inverse curvilinear relationship
- populations risk may be reduced dramatically if sedentary people become modestly active
- pysically inactive people 45% greater risk for developing CAD than active people
35
Exercise and Risk for Subsequent MI
- patients hospitalized for heart attack
| - those who were more active had 55% lower risk for another myocardial infarction compared to sedentary
36
GXT prior to Outpatient Cardiac Rehab
- symptom-limited
- 2-3 weeks following discharge
- protocol based on
- ---physical examination
- ---risk stratification
- ramping protocols common
- record level at which signs or symptoms occurred
- ---angina;dyspnea; 1 mm ST-segment depression
- --usefulness of RPP
- -----HR*SBP
- -----myocardial oxygen demand
37
Exercise Prescription
- impatient rehab
- initial home prescription
- outpatient cardiac rehab
- ----initial assessment
- ----secondary prevention goals
- individualized based on
- --functional capacity
- --ischemic angina/thresholds
- --comorbidities
- --physical activity preferences
- --vocational requirements
- --patient goals
38
Aerobic Exercise Program
```
FREQUENCY: 3-7 days/weel
INTENSITY IF NO GXT
-HR: +20BPM above rest
-RPE: 11-14
BASED ON GXT RESULTS
-40-80% HRR or VO2
-RPE: 11-16
-below ischemic threshold
---1mm ST-segment depression
DURATION
-start with 5-10 minutes
-gradually progress to 20-60 min
TYPE
-large muscle rhythmic activity
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