Quiz 2 Flashcards by Alexander Crist

What are the 4 major cardiovascular diseases?

-Ishemic Heart Disease (MI), Hypertension, HF, and CVD (stroke)

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What is the leading cause of death in the US?

-Heart disease

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What is the outer layer of coronary arteries called?

-Adventitia

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What is the adventitia formed by?

-collagen fibers

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What is the basic support structure of the coronary arteries?

-The adventitia

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What is the term for the blood supply to arterial walls?

-Vaso Vasorum

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What is the name of the middle layer of coronary arteries?

-Media

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What is the media composed of?

-Several layers of smooth muscle and an elastic membrane

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What is the media of coronary arteries responsible for?

-Making adjustments to lumen diameter

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What is the inner most layer of coronary arteries called?

-The intima

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What is the intima composed of?

-Endothelial layer, basement membrane, smooth muscle cells, elastic and collagen fibers

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Lipoprotiens and fibrinogen is most likely to accumulate in what layer of coronary arteries?

-The Intima

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What two layers are on each side of the media?

-Internal and External elastic lamina

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What are the 3 basic rules of fluid dynamics for myocardial perfusion?

Fluid flow from an area of high pressure to low pressure
Fluids follow the path of lest resistance
if there is a blockage, the surrounding vessel will dilate to allow flow around the blockage

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What are the 4 major determinants of myocardial blood flow?

Diastolic BP
Vasomotor tone
Resistance to flow
Left Ventricular end-diastolic pressure

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What is the primary driving force for moving blood into myocardial tissue?

-Diastolic BP

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What determines the volume of blood passed along to myocardial tissue?

-Vasomotor tone

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A decrease in vasomotor tone will do what to the amount of blood passed along to myocardial tissue?

-It will increase it

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What normally causes increased resistance to flow in myocardial tissue?

-Atherosclerosis

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What is an atherosclerosis made up of?

-lipids and thrombus

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Exposure of what leads to platelet aggregation and the formation of a thrombus?

-Endothelial layer

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What is a hallmark sign of of advanced atherosclerosis?

-Hyperplasia of intimal smooth muscle

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What gender is more likely to had CAD?

-Males, until 55 y/o then it is equal

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What is the best predictor of a persons risk of CAD?

-Ratio of total cholesterol to HDL

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What is considered low for HDLs?

-50 mg

What is considered high for triglycerides?

-150

BP greater than what presents you with a risk for CAD?

-140/90

BMI greater than what increases risk for CAD?

-30

What mainly causes sudden cardiac death?

-ventricular tachycardia or fibrillation

Why does ventricular fibrillation cause sudden cardiac death?

-The fluttering will not allow blood to be ejected from the ventricles

For those already diagnosed with CHF, an ejection fraction less than what increases a persons risk for sudden cardiac death?

-35%

What are the classical signs of stable angina?

-Tightness or pressure anywhere above the waist

Where can pain from angina radiate?

-Neck, arms and between the shoulder blades

When do symptoms develop and diminish with stable angina?

-develop with exertional activity and deminish with rest

What do women tend to complain of with unstable angina?

-indigestion, and pain between shoulder blades

What may diabetics present with with with stable angina?

-SOB

What mainly causes prinzmetal angina?

-Vasospasm

What will patients with prinzmetal angina present with on an EKG?

-Elevated ST segment

When will patients with Prinzmetal angina have symptoms?

-In the morning

How will pain with pericarditis present?

-pain at rest, worsening with activity and does not get better with nitroglycerin

How can you tell if chest pain in the chest wall is MSK related?

-there will be pain with palpation

When is pain worse with pulmonary pain?

-Worse with breathing

What is the only way to tell if an MI occured?

-ECG

What 4 factors contribute to unstable angina?

- circadian variation in catecholamine levels - increased plasma viscosity - increased platelet aggregation - pathological changes in atherosclerosis

What causes a STEMI acute coronary syndrome?

-an occlusion of a major coronary artery

What will present on a ECG with a STEMI?

-Q wave

STEMI causes a transmural infarct, what does this mean?

-It affects the thickness of the myocardium

What causes a Non-STEMI Syndrome?

-occlusion of a non-major coronary artery or partial occlusion of coronary artery

What can a Non-STEMI syndrome?

-nontrasmural and subendocardial region infarct

With an MI, where does necrosis begin?

- In a small zone of the myocardium beneath the endocardial surface

To aviod necrosis of myocardial tissue, how soon does reprofusion need to occur?

-20 minutes

A right coronary artery infarct will cause what complications?

-Risk of AV block and Arrhythmia; 50% have right ventricular infarct

A left main artery or left anterior descending artery infarct will cause what type of complications?

-pump dysfunction or failure

An infarct of the circumflex artery will cause what type of complication?

-no specific complication

what is dyssynchrony?

-uncoordinated contraction with adjacent segments

What is hypokensis?

-Reduced strength of contraction

A what akinesis?

-Reduced strength of contraction

What is dyskinesis?

-Abnormal movement during the contraction

Individuals with what percent of left ventricular involvement infarct may experience what?

-Sudden death

15% Left ventricle involvement infact can cause what?

-Decrease stroke volume, and elevated LV end diastolic volume

Lower stroke volume and increase left ventricle end diastolic volume can cause what?

-lower aortic pressure and causes decreased perfusion to muscle

What does ventricular remodeling the depend on?

-The type of MI, the size of the infarct, ventricular load, and satency of the artery that was infarcted

BPs greater than what is considered stage I hypertension?

-140/90

BPs greater than what are considered stage II hypertension?

-159/99

What are the major determinants of hypertension?

-Cardiac output and total peripheral resistance

What complications can hypertension cause for the left ventricle?

-Can cause hypertrophy leading to impaired relaxation and diastolic dysfunction

How can uncontrolled hyertension affect the brain?

-Can cause stoke or aneurysm

How can uncontrolled hypertension affect the eye?

-Can affect the retina, and cause a mircoaneurysm

What can uncontrolled hypertension cause in the heart?

-congestive heart failure, angina or MI

How can uncontrolled hypertension affect the kidneys?

-can cause chronic renal failure and nephrosclerosis

What type of heart failure is described as ventricular hypertrophy that decreased stroke volume, and ejection fraction that leave more blood in the ventricle after systole?

-Heart failure with reduced ejection fraction

Diastolic dysfunction that impairs ventricula relaxation and impairs ventricular filling but does not affect ejection fraction is known as what?

-Heart failure with preserved ejection fraction

What are the goal of intervention of hypertension?

-normalize BP and reverse left ventricular hypertorophy

What does prehypertension treatment consist of?

-making life style modifications

In what stage of hypertension of medications introduced?

-type I

By how much can hypertension reduce exercise capacity?

-15 to 30%

Why does hypertension effect exercise capacity?

-It reduced stroke volume and heart rate which lowers cardiac output

How does exercise effect both systolic and diastolic blood pressures?

-it lowers them

What does not increase during exercise because of beta blockers?

-HR

At what BP should you refer a patient to a physician?

-greater than 200/100

BP of what mean you should discontinue exercise testing?

-greater than 250/115

A BP above what requires medical clearance for medical training?

-180/110 or above

What physical presentations can poor circulations cause?

-dry skin, hair loss, thick toe nails, and muscle atrophy

What causes pain that is associated with PAD?

-Lactic acid build up

What is the best functional exercise for those with PAD?

-Walking

How should you dose exercise for those with PAD?

-In short intervals with rest periods in between

What type of exercises can be performed at higher intensities and longer duration for those with PAD?

-NWB activities

Prior to exericsing a patient with arterial insufficiency, what should be performed?

-a sensory exam

What should a person with arterial insufficiency not do?

-Prop up their legs

What does slow blood flow encourage?

-Clotting, especially at bifircations

Quiz 2 Flashcards

(90 cards)