Lectures 4-7 Flashcards
(26 cards)
What is the cascade of events in atherosclerosis?
- LDL becomes oxidized within the arterial subendotherlial space
- circulating monocytes are recruited here
- They differentiate into macrophages and engulf the LDL
- They become foam cells which cluster together and form a bulge in the artery
- Bulge, called fatty streak. First sgn of atherosclerotic change.
Compared to atheroscletosis, an MI is an emergency due to
acute plaque rupture/ thrombotic occlusion
What is the process of acute plaque rupture
plaque has increasd inflammation/mechanical stress > plaque rupture > platelet adhesion > platelet activation > platelet aggregation > occlusive thrombosis/ vasoconstriction
A plaque causing greater than 75% narrowing rupturing with NOT cause a STEMI because
the ischemic tissue had time to form collaterals before sudden rupture so large infarct was avoided.
Tx for high cholesterol
high TG?
overall change of lifestyle
- statins
- niacin, fibrates
weak heart/bad pump = what HF
systolic
stiff pump = what HF
diastolic
Causes of CHF
- ischemic heart dz (50-75%)
- non-ischemic cardiomyopathy (20-30%)
- HTN (13%)
- valvular dz (10-12%)
S/S of right sided HF
- Back up of fluid into the extremities
- nausea, anorexia, bloating, early saiety, abd discomfort, ascites
- JVD, edema, hepatojuglar reflux, jaundice, peripheral edema, fatigue
S/S of left sided HF will cause
fluid back up into the lungs causing SOB, dyspnea, oheropnea, PND, crackles, AMS, S3 and S4 gallop
The left ventricle can’t contract vigorously (weak), indicating a pumping problem
systolic HF
The left ventricle isn’t able to relax/fill fully, indicating a filling problem.
diastolic HF
Findings:
- male
- low EF (less than 40%)
- dilated left V cavity
- CXR: congestion and cardiomegaly
- gallop at S3
- pt had prior MI
systolic HF
Findings: -dyspnea -L ventricle hypertrophy - elderly female -normal EF normal ventricular cavity size
Diastolic HF
New Work Heart Association classification (NYHA) of CHF (class 1 to 5)
Class 1: Asymptomatic
Class 2: Comfortable at rest. Slight limitation of physical activity (ie. only SOB when walking a lot)
Class 3: Comfortable at rest. Marked limitation of physical activity.
Class 4: Symptoms at rest. Unable to carry on any activity without symptoms.
High output HF is different then low output HF in that it is…
- rare
- characteristic of thyrotoxicosis, AV fistula, pregnancy, Paget’s disease
- warm extremities
- wide or normal pulse pressure
Findings:
- DOE
- fatigue/lethargy
- CP
- syncope on exertion
- JVD
- pulsatile liver/hepatic tenderness
- murmur of tricuspid regurg
- enlarged pulm arteries
- dilated right atrium and ventricle
- EKG: RV hypertrophy and strain, right axs deviation, RBBB
Cor Pulmonale
1 cause of systolic HF
ischemic heart dz
2 main causes of diastolic HF
DM and HTN
Prehypertension
Stage 1 htn
stage 2 htn
- 120-139, 80-89
- 140-159, 90-99
- greater than 10, greater than 100
Initial dx labs for HTN
urine, uric acid, hematocrit, BMP, lipid panel, EKG, TSH
What are some symptoms of a hypertensive emergency?
- encephalopathy (behavior change)
- blurred vision, HA
- CP
- numbness/tingling
- evidence of end organ failure
Emergently high BP should be reduced by what % the first 24 hours and why?
10-20%
STROKE
Which HTN drug should be paired to each compelling indication?
- HF
- post MI
- high coronary dz risk
- chronic renal dz
- DM
- chronic renal dz
- recurrent stroke prevention
-ACE inhibitors
- B-blocker
- B-bocker
-ACE inhibitors
-ACE inhibitors
-ACE inhibitors
(tx of HTN should begin with lifestyle modification)
