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DPT732: MAP II > MAPIISG1 - Atherosclerosis > Flashcards

MAPIISG1 - Atherosclerosis Flashcards

(47 cards)

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1
Q

What is atherosclerosis?

A

disease of large and intermediate-sized arteries in which fatty lesions/plaques develop on inside surfaces of arterial walls –> narrowing/smaller diameter, stiiffness/less reactivity, blockage

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2
Q

What are CV risk factors and which are primary?

A

primary: cigarette smoking, dyslipidemia (apo-B)

age, family history, sedentary, obesity (BMI, abdominal), HTN, psychosocial stress

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3
Q

What are protective factors?

A

fruits/veggies, exercise, moderate alcohol

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4
Q

How does development of atherosclerosis start?

A

damage to vascular endothelium –> excess LDLs penetrate subendothelial spaces and become trapped

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5
Q

What happens to the LDLs in the subendothelial spaces?

A

LDL oxidizes, releasing anions = oidative stress (antioxidants = preventative)

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6
Q

After LDL oxidize in subendothelial space, what is happening along side?

A

Monocytes cross endothelium and differentiate into macrophages which ingest oxidized LDLs

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7
Q

After macrophages ingest oxidized LDLs, what happens?

A

release foam cells

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8
Q

What happens to foam cells?

A

Smooth muscle cells engulf the foam cells and lipids

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9
Q

The engulfing of foam cells by smooth muscle cells causes what to form?

A

fatty streak

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10
Q

What happens to the fatty streak?

A

a fibrous cap forms over the fatty streak

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11
Q

What are the two types of plaque?

A

Stable and Unstable

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12
Q

What is the consequence of a Stable Plaque?

A

thick calcified cap, smaller fatty core –> hardened, narrow arteries which leads to atherosclerosis

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13
Q

What is the consequence of Unstable Plaque?

A

thin calcified cap, large fatty core –> rupture leads to MI or stroke

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14
Q

What are two consequences of Atherosclerosis?

A

Decrease in NO –> decrease in vasodialation/vascular reactivity

Decrease in Blood Flow (F ~ r^4)

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15
Q

What is Coronary Artery Disease (CAD)?

A

atherosclerosis of coronary arteries alters myocardial perfusion; myocardial perfusion occurs during diastole, when semilunar valves close

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16
Q

What does the Right Coronary Artery supply?

A

Inferior, posterior region

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17
Q

What does the Left Anterior Descending Artery (LAD) Supply?

A

LAD - anteroseptal

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18
Q

What does the LAD distal supply?

A

anteroapical

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19
Q

What does the Circumflex supply?

Study These Flashcards
A

anterolateral

20
Q

What is Ischemic Heart Disease?

Study These Flashcards
A

Imbalance of myocardial supply and demand

21
Q

What are gender differences for Ischemic Heart Disease?

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A

Male - Crushing pain, “elephant on my chest”, nausea, left arm pain, jaw pain

Female - Nausea/vomiting, fatigue, anxiety, mid back tightness, discomfort

22
Q

What is a stable angina?

Study These Flashcards
A

substernal chest pain radiating to elbow, assocatied with curshing/pressure, SOB, neusea, diaphoresis occuring w/ predictable level of activity

23
Q

What relieves a stable angina?

Study These Flashcards
A

nitroglycerin

24
Q

How can Myocardial O2 consumption be estimated?

Study These Flashcards
A

Rate Pressure Product = HR X SBP

25
What is PT role in a stable angina?
Use RPP to correlate activity/exerise levels to episode of angina
26
What is a unstable angina?
angina in absense of increased demand - angina at rest - angina at lower levels of activity/exercise, different from normal pattern
27
With an unstable angina, what happens to BP with activity?
decreases
28
What is a Myocardial Infarction (MI)?
lack of blood, O2 supply to myocardium --> death of myocardial tissue, abnormal myocardial function
29
What is an indication that an MI has occurred?
Rise of cardiobiomarkers (troponin, CK-MB) >99th percentile and evidence of other signs
30
What are other signs that a MI has occurred?
Discomfort > 20 minutes
31
What are 2 EKG changes indicated an MI has occurred?
STEMI and NSTEMI
32
What is a NSTEMI and what does it look like on an EKG?
Non-ST Elevated MI: function of elevated baseline - Not most serious - subendocardial injured segment is partially depolarized prior to stimulation, ischemic cells have leaky cell membranes
33
What is a STEMI and what does it look like on an EKG?
ST Elevation MI: ST segment appears elevated but function of depressed baseline -Transmural damage - across whole wall injured segment is partially depolarized prior to stimulation
34
What do pathologic Q waves represent?
previous cardiac event - necrotic muscle does not generate electrical forces - Q wave results from absence of electrical force -often provides permanent EKG evidence of previous MI in multiple leads
35
Is exercise testing recommended diagnosing CAD for asymptomatic individuals with low CV risk (
no, useful for moderate pre-test probability (those w a greater likelihood of CAD
36
What variables are evaluated with exercise testing for diagnosing CAD? (4)
1. Hemodynamic response (HR and BP) 2. EKG waveforms 3. Limiting signs and symptoms (chest pain or shortness of breath) 4. Gas exchange or ventiliatory response (VO2 max)
37
What are exercise test responses that suggest myocardial ischemia?
1. ST depression >= 1mm 2. ST segment elevation with previous MI (pathologic q waves) 3. Multifocal PVCs or run of V-tach 4. Peak exercise HR >2 SD below age predicted HR (not on beta blockers) 5. Exertional Hypotension (SBP drops > 10mmHg)
38
What are the three medical or surgical management?
1. Control Risk Factors 2. Control Symptoms 3. Revascularization
39
How can symptoms be controlled?
nitroglycerin
40
What are the two methods of revascularization and what are they?
1. PCI - percutaneous coronary intervention: baloon angioplasty, stent 2. CABG - coronary artery bypass graft
41
What is Peripheral Artery Disease (PAD)?
decrease blood flow to legs
42
What is Claudication pain?
angina in legs
43
What are signs of intermittent claudication
achy, crampy feeling in legs occurs w walking, exercise decreases w rest onset of pain predictable
44
What does PAD mean in terms of risk of MI or stroke?
both increase
45
What effect does smoking and diabetes have on PAD?
increase risk
46
How do you diagnose PAD?
Ankle-Brachial Index
47
What is a normal ABI?
>0.9

DPT732: MAP II (14 decks)

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