Newman: Questions for CV disease and CAD Flashcards Preview

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Flashcards in Newman: Questions for CV disease and CAD Deck (84):
1

What are the determinants of BP?

P = Q x R
*altering flow and resistance

2

the ability of the arterioles to clamp down ro relax

resistance

3

What substances can increase vascular resistance?

Norepi
Epi
Angiotensin II

4

What substances decrease vascular resistance

NO
prostacylin

5

T or F: Flow = Cardiac Output

True

6

CO =

SV x HR

7

quantity (CCs) of blood ejected from the left ventricle into the aorta every cardiac cycle

stroke volume

8

What are the determinants of SV?

preload, afterload, contractility

9

the volume of the left ventricle at the end of diastole

preload (EDV)

10

T or F: An increase in preload will increase blood pressure

T

11

Why would you insert a pulmonary artery catheter?*******

to measure preload: ballon inflates in the (left ventricle?) and the preload can be measured (left ventricular end diastolic pressure)

12

A bigger left ventricle (dilation) will (increase or decrease) the afterload.

increase

13

The inherent ability of the heart to contract--is independent of preload and afterload

contractility

14

SV / EDV =

ejection fraction

15

A pt has an ejection fraction of 30%, is that good or bad?

bad

16

A pt has an ejection fraction of 70%, is that good or bad

good

17

renin is secreted fron JG apparatus in response to ____

dec Q, CO, SV

18

Angiotensin I goes thru the ____ and is converted to ang II by_____

lungs
converting enzyme

19

What 2 important things does angiotensin II do?

1. potent vasoconstrictor (inc resistance)
2. stimulates the secretion of aldo from the adrenal glands

20

An decrease in the amount of angiotenisn II would (inc or dec) BP

decrease

21

What does aldosterone do?

causes reabs of Na and excretion K+

22

Would a person in HF want to have high or low levels of aldosterone?

low -- do not was to reabsorb any more Na/H2O

23

A pt presents to you with chest pain only upon exertion and is relieved by rest.
What would a treadmill test tell you?
What would a cardiac catherterization tell you?
What pharm

treadmill: will increase HR and SBP, which exacerbate the exertional chronic stable angina

cardiac cath will tell you how blocked he is, but I don't think he's a candidate for this?

24

A pt has severe chest tightness which wakes him from sleep
normal ECG

acute coronary syndrome

25

You have 3 vessel coronary disease. What do you do now?

bypass--STAT!

26

pt presents to the ED with severe chest pain. the ECK reveals ST elevation in leads 2, 3, and avF what do you do?

cath?

27

3 syndromes of coronary disease

chronic stable angina
Acute coronary syndrome
ST elevation MI

28

62 yr old male walks his dog and gets tightness in chest with SOB. He sits down and the pain goes away.
Dx

chronic stable angina

29

Man carrying bag of groceries upstairs and it got better when he sat down.
Dx

chronic stable angina

30

tighness/contrictoion in chest + SOB + gets better when sits down/at rest

chronic stable angina

31

exertional symptoms

chronic stable angina

32

inadequate supply of blood to myocardium (heart blockages) and increased demand relative to the supply

chronic stable angina

33

2 major determinates of myocardial demand

systolic BP
HR

34

Effect of exercise on HR and systolic pressure

inc HR and inc systolic pressure

35

What reduces supply in chronic stable angina?

arthlerosclerosis

36

Wakes up with elephant sitting on chest
pale
sweating
breathing hard
*this is not dependent upon exertion

acute coronary syndrome

37

pathophys of acute coronary syndrome

arthlerosclerotic plaque narrown lumen --> ruptures-->
1. increased constriction/resistance
2. thrombotic state in which blood clots form at area of rupture

38

T or F: acute coronary syndrome is a problem of supply and demand

false
*there is no inc demand on the heart, just a problem with supply

39

What is the diff btwn MI and acute coronary syndrome?

in MI, there is ZERO perfusion/supply = CA is 100% occluded
Has ECG changes!

40

problem of supply and demand--inc demand will not lead to a proportinal inc supply

chronic stable angina

41

O2 supply is a function of ____

coronary blood flow

42

arthleroscloerotic plaque causes

inadeqate supply

43

Myocardial demand is a function of

systolic BP and HR

44

blockage restricts O2 supply when it takes up ___% of CA lumen

70%

45

heart pains are always more than _____mins and never more than ____mins (time)

5 mins; 30 mins

46

Heart pains assc with activities is better or worse prognosis

better prognosis

47

Chronic stable angina is assc with (inc or dec) catecholamines

inc catecholamins --> skin gets pale
= over sympathetic activity

48

angina pectoris/chronic stable angina assc with

diaphoresis
sense of breathlessness

49

T or F: heart pains almost always makes a person alter their activities

true

50

angina pectoris is a consequence of myocardial oxygen demand exceeding _____

myocardial oxygen supply

51

can replicates syndrome (see if gets pale, breaks out in sweat, pain, see EKG)

treadmill test

52

At the microscopic level in chronic stable angina, what is happening at microscopic level?

ishemia

53

etiologic factors other than artherlosclerosis that can cause an MI

injury
emboli

54

pt that woke up in middle of the night with an elephant on chest with normal ECG

acute coronary syndrome
*lack of complete occlusion of artery

55

pathophys of ACS

artherlosclerotic CA --> rupture --> platelets move in --> TXA2 made --> momentary vasoconstriction --> decrease in O2 supply/ischemia

56

artherlosclerosis --> ______ --> rupture --> _______

chronic stable angina
acute coroney syndrome

57

What causes the arthlerosclerotic plaque rupture in ACS?

endothelial activation
smoking
cytokines
elevated glc (AGE)
HTN

lead to
-vasoconstrion and platelet aggrgation --> rupture

58

vulnerable plaque vs stable plaque

vulterable have large lipid core, thin cap

stable: more smooth muscle cells and is more well formed

59

role of platelets in ACS

rupture of plaque --> paltelets rush in --> TXA2 produced --> vasoconstriction --> fibrin deposition

60

In ACS the ____ is the culprit

vessel
(platelets are the 2nd most important part)

61

rupture --> thrombus

ACS

62

What is the Tx of ACS

blood thinners (heparin)

63

MI and ACS presents similarly, what is the only distinguishing factor

ECG

64

severe prolong contriction of chest (may last an hour or 2)
very pale
very diaphortetic
difficulty breathing

acute MI

65

Complications of acute MI

syncope
arrythmia
LHF
cardiogenic shock
sudden death

66

Describe the heart pain in an acute MI

30 mis to several hour of chest pain
pain radiates to arm, neck, jaw

67

MI ECG changes

ST elevation

68

ST elevation means

the vessel has been 100% occulded (by thrombus)

69

locations of ST elevation on ECG determines _____

location of MI on heart

70

as myocytes die the secrete enzymes....

CK
SGOT
LDH
troponin

71

_____ is a predictor of ischemic event

troponin

72

more than 1 p wave for every QRS

heart block (casues arrhythmia?)

73

Tx of heart block

pacemaker

74

ventricualr fibrillation

know ECG for it

75

complication of MI

myocardial rupture
-blow hole in wall of ventricle, IV septum, papilary muscle

76

fluid in lungs due do abnormal accumulation of Na and H2O

HF (fluid in alveoli)

77

What to do when person has MI and there is no cath lab

get rid of clot to reperfuse
-streptokinase

78

treateent of choice for a pt with ST elevation MI

put in mesh balloon/stent at area of occlusion = angioplasty

79

take veins from leg, anastomose to proximal aorta and anastomose to area distal to CA blockage

bypass surgery

80

What has a positive effect on SV?
Negative?

positive:
-inc length of myocardial fibers by increasing preload (EDV)

negative:
-inc afterload decreases the contractility (dialated left ventricle); inc systolic BP

81

Formula to calculate ejection fraction

SV / EDV

82

arthlerosclerotic plaque narrown lumen --> ruptures-->
1. increased constriction/resistance
2. thrombotic state in which blood clots form at area of rupture

ACS

83

How are heart pains (in chronic stable angina) distinguished from other pains?

longer than 5 mins and less than 30mins
make a person alter their activities

84

T or F: in ACS the coronary artery is 100% occluded

False, not 100%
This is why the EKG is unremarkable*