week 4: acute coronary syndromes, ht failure, arrythmias, etc

Question 1

by what percentage does a major coronary artery need to be narrowed for blood flow to be impaired under myocardial demand?

Answer 1

50%

Question 2

____ ____ develops if the supply of coronary blood cant meet demand of myocardium for oxygen and nutrients

Answer 2

myocardial ischemia

Question 3

myocardial ischemia causing chest pain is called ____

Answer 3

angina pectoris

Question 4

what does angina pectoris feel like?

Answer 4

heaviness, pressure, moderately severe pain

pain may radiate to the neck, lower jaw, left arm, left shoulder, occasionally the back or down the right arm

pallor, diaphoresis, dyspnea

pain usually relieved by rest and nitrates

women: may not present this way, may have atypical chest pain, palps, sense of unease, severe fatigue

Question 5

pain from angina pectoris is caused by?

Answer 5

lactic acid and abnormal stretching

Question 6

two types of angina are:

Answer 6

stable and prinzmetal

Question 7

_____ angina is caused by gradual luminal narrowing and hardening of arterial walls, vessels cant dilate in response to myocardial demand. *assoc with physical exertion or emotional stress)

Answer 7

stable

AKA reversible myocardial ischemia

patient may experience normal physical exam bw episodes

Question 8

____ angina (aka variant angina) is from transient ischemia of myocardium. occurs unpredictably and almost always AT REST

Answer 8

prinzmetal angina

Question 9

how much time do you have when there’s a myocardial oxygen deficit?

Answer 9

20 min!!!

Question 10

management of reversible ischemia (stable)

Answer 10

need to increase oxygen delivery by improving coronary artery blood flow and to reduce myocardial oxygen consumption

NITRATES!! improve coronary blood flow and reduce myocardial demand by decreasing peripheral vascular resistance and venous return to the heart (preload) thereby reducing cardiac workload
-help to vasodilate, immediate relief

B-Blockers: diminish catecholamine induced elevations of heart rate, contractility, and blood pressure. leads to enhanced oxygen delivery to heart

Question 11

_____ results in reversible myocardial ischemia – signal that an atherosclerotic plaque that has ruptured, and an infarction may soon follow

Answer 11

unstable angina

the thrombus is rapidly changing and if it occludes the vessel for no more than 10-20 minutes, myocardial necrosis occurs

Question 12

unstable angina presents as:

Answer 12

-new onsent
-angina occurring at rest
-angina increasing in severity or frequency

may experience increased dyspnea, diaphoresis, anxiety

Question 13

true or false:

approx 20% of people w unstable angina progress within hours to days to MI or death

Answer 13

true

Question 14

how to manage unstable angina?

Answer 14

immediate hospitalization

oxygen
asprin
nitrates
morphine

Question 15

_______ ______ is when coronary blood flow is interrupted for an extended period leading to myocyte necrosis

Answer 15

Myocardial Infarction

Question 16

true or false

in majority of MI, decrease in coronary flow is the result of atherosclerotic CAD

Answer 16

true

Question 17

the ____ of ischemia determines the size and character of infarction

Answer 17

duration

Question 18

subendocardial and transmural are 2 types of:

Answer 18

myocardial infarction

Question 19

____ MI = if thrombus breaks up before complete tissue necrosis; only directly beneath endocardium

termed non-STEMI

Answer 19

subendocardial

Question 20

_____ MI = if thrombus lodges permanently in vessel, infarction extends all the way through myocardium - from endo to epicardium

STEMI
highest risk - require immediate intervention

Answer 20

transmural

Question 21

STEMI = ___ elevation MI

Answer 21

STEMI = ST elevation MI

more severe!!

Question 22

______- when ischemic injury is exacerbated once blood flow is restored

involves release of oxygen radicals, ca influx, ph changes, causes sustained mitochondrial permeability

Answer 22

reperfusion injury

Question 23

_____ is released during myocardial ischemia

Answer 23

angiotensin II

Question 24

clinical manifestation of MI

Answer 24

sudden, severe chest pain

heavy, crushing, “elephant”

increased heart rate, blood pressure

severe = hypotension

Question 25

which is the most commonly occluded artery and most associated with death after MI?

Answer 25

left anterior descending artery (LAD)

Question 26

what is the most specific lab indicator of MI ?

Answer 26

cardiac troponin I has sensitivity of more than 95% for the diagnosis of acute MI troponin released when myocardium is damaged

Question 27

_____ occurs when the heart is unable to generate adequate cardiac output (55%) - inadequate perfusion of tissues or increased diastolic filling pressure of left ventricle or both

Answer 27

heart failure

Question 28

most common predisposing risk factors of heart failure?

Answer 28

ischemic heart disease and htn

Question 29

most causes of heart failure result in dysfunction of _____

Answer 29

left ventricle (systolic and diastolic ht failure)

Question 30

left sided congestive heart failure process

Answer 30

1. left ventricle weakens and cannot empty 2. decreased cardiac output to system 3. decreased renal blood flow stimulates RAAS and aldosterone secretion ( increase blood pressure/Na and H2O in body) 4. backup of blood into *pulmonary vein* 5. high pressure in pulmonary capillaries leads to pulmonary congestion of edema

Question 31

where does blood back up during left sided congestive ht failure?

Answer 31

pulmonary vein

Question 32

cardinal signs of CHF

Answer 32

dyspnea fatigue edema orthopnea coughing frothy sputum decreased urine

Question 33

evaluation of CHF

Answer 33

x ray ( assess heart size and pulmonary congestion) and echocardiography (confirm decreased cardiac output and cardiomegaly)

Question 34

almost all heart failure results in ____

Answer 34

cardiomyopathy (dzs that weakens ability to pump blood)

Question 35

_____ is the inability of the right ventricle to provide adequate blood flow into pulmonary circulation most often results from left heart failure

Answer 35

right sided ht failure

Question 36

right sided heart failure causes fluid to back up into where?

Answer 36

the veins of the systemic circulation

Question 37

key sxs of right sided ht failure =

Answer 37

pitting edema jugular vein distention

Question 38

flow of right ht failure

Answer 38

1. right ventricle weakens and cant empty 2. decreased cardiac output to system 3. decreased renal blood flow stimulates RAAS and aldosterone secretion 4. back up of blood in systemic circulation 5. increased venous pressure results in edema in legs and liver and abd region 6. very high venous pressure causes distended neck veins and cerebral edema

Question 39

_____ is a disturbance of heart rhythm

Answer 39

arrhythmia or dysrhythmia

Question 40

two types of arrhythmias are:

Answer 40

sinus brachycardia and sinus trachycardia

Question 41

_____ is a cardiac rhythm w a rate of fewer than 60 beats per minute

Answer 41

sinus brachycardia

Question 42

sinus brachycardia is common in ___ ____

Answer 42

athletes and during sleep

Question 43

which patients often have sinus brachycardia?

Answer 43

patients with congestive heart failure

Question 44

sxs of sinus brachycardia

Answer 44

most are asymptomatic some: fatigue, lightheadedness, dizziness, exercise intolerance, syncope, worsening of anginal sxs, worsening of ht failure, cognitive slowing

Question 45

_____ is a regular cardiac rhythm in which heart beats faster than normal and results in increased (cardiac output greater than 100 bpm)

Answer 45

sinus tachycardia

Question 46

sxs of sinus tachycardia

Answer 46

dyspnea, chest pain, lightheadedness, dizzy, syncope, presyncope

Question 47

_____ occurs when heartbeat is initiated by purkinje fibers rather than SA node

Answer 47

premature ventricular cxn (PVC) pvc occurs before a reg heartbeat so there is a pause before the next regular heartbear very common

Question 48

what does patient feel during PVC?

Answer 48

skipped heartbeat and then fluttering sensation

Question 49

PVC manifests in ___ ___ pulse rate

Answer 49

regularly irregular

Question 50

____ is the most common sustained cardiac arrhythmia

Answer 50

atrial fibrillation

Question 51

loss of atrial cxn and the rapidity and irregularity of the ventricular rate =

Answer 51

atrial fibrillation AF

Question 52

___ has a pulse rate of greater than 300 bpm

Answer 52

AF

Question 53

sxs of AF

Answer 53

irregular heart beat, palps, dizziness, SOB, tiredness, anxiety

Question 54

does A FIB have a higher risk of stroke?

Answer 54

yes 6-fold increase (1.5-2 fold for mortality)

Question 55

arrhythmias originating from ventricular myocardium or His-Purkinje system are grouped under _____

Answer 55

Ventricular arrhythmia VA

Question 56

*____ is an extremely dangerous rhythm significantly compromising cardiac output and ultimately leading to sudden cardiac death (SCD) *

Answer 56

ventricular fibrillation

Question 57

the most common presentation for VF is sudden collapse from _____

Answer 57

cardiac arrest

Question 58

true or false w/o treatment, VA is fatal within minutes

Answer 58

true

Question 59

treatment of ventricular fibrillation

Answer 59

CPR, AED

Question 60

____ is the vasospasm in the small of arteries/arterioles of fingers

Answer 60

raynauds

Question 61

what is raynauds triggered by?

Answer 61

cold and emotional stress

Question 62

sxs of raunauds?

Answer 62

*pallor, cyanosis, rubor* changes in skin color, pallor, numb, sensation of cold, cyanotic skin that turns to rubor (redness) as vasospasm ends and capillaries engorge w oxy blood rubor comes w throbbing pain skin returns to normal after attack but freq prolonged attacks interfere with cellular metabolism causing skin of fingertips to thicken and nails to become brittle