week 4 patho: the heart

Question 1

which side of the heart pushes blood through pulmonary circulation

Answer 1

The right side

Question 2

which side of the heart contains bicuspid valves

Answer 2

the left side

Question 3

which artery of the heart (in coronary circulation) would be the most lethal if there was an issue

Answer 3

the left anterior descending

Question 4

which two arteries in coronary circulation will contribute to dysrhythmias if there was an issue

Answer 4

the left anterior descending and the circumflex artery

Question 5

which arteries of the heart supply blood to the SA node

Answer 5

50% right coronary artery and circumflex

Question 6

define cardiac output

Answer 6

how well the heart pumps blood to tissues

Question 7

what is end diastolic pressure

Answer 7

the volume of blood in the ventricles at the end of diastole

Question 8

what issues would increase preload

Answer 8

hypervolemia, regurgitation of cardiac valves, heart failure

Question 9

define afterload

Answer 9

resistance left ventricle must overcome to circulate blood

Question 10

which issues can increase afterload

Answer 10

hypertension, vasoconstriction

Question 11

what are the important electrolytes of the heart

Answer 11

Na, K, Ca

Question 12

what is collateral circulation

Answer 12

hypasses the arteries have to help with blockage, basically rerouting of arteries around narrowing of arteries so blood can get where it needs to go (kind of like varies)

Question 13

out of the two factors that determine collateral circulation (genetic predisposition/hypercholesteralemia and chronic ischemia) which is more likely to survive

Answer 13

chronic ischemia necasse they have years to develop good collateral circulation

Question 14

what is artherosclerosis

Answer 14

formation of gunk in arterial wall, primary cause of coronary artery disease

Question 15

how occluded does an artery have to be (artherosclerosis) for an individual to show symptoms

Answer 15

75% occluded, to which they will show signs of ischemia with exertion

Question 16

what is the inner most layer of the heart wall called

Answer 16

the tunica intima

Question 17

what are some important things about the endothelium of the heart wall

Answer 17

it separates the blood stream from the artery wall, protects the artery wall from toxins

Question 18

what happens if there is injury to the endothelium of the heart wall

Answer 18

injury to the endothelium will release cytokines which trigger inflammatory response, resulting in atherosclerosis

Question 19

what are the four stages of atherosclerosis (simplified)

Answer 19

1) tear in lining damages endothelial layer
2) monocytes enter tear and eat LDLs (which also enter tear) making fatty streaks in lining
3) platelets and LDLs release platelet derived growth factor which makes a collagen cap that takes up space and blocks flow
4) collagen can can rupture which blocks artery with thrombus

Question 20

how does tobacco use trigger inflammatory process in the heart

Answer 20

tabacco triggers epinephrine which elevates heart rate, LDLs, and causes vasoconstriction

Question 21

how does homocysteinemia cause inflammatory process in the heart

Answer 21

it is an inherited metabolic defect that leads to high levels of homocysteine which is a metabolite of methionine, which is toxic to the endothelium

Question 22

why are women not as high of a risk for CAD

Answer 22

estrogen is a cardioprotective hormone so females are lower risk of CAD till menopause

Question 23

what is the frenningham risk score

Answer 23

its a score that shows your risk for a cardiac event

Question 24

what is the good cholesterol lipoprotein carrier and what is the bad

Answer 24

LDL= bad, HDL= good
cholesterol binds to these

Question 25

why is HDL good for you

Answer 25

it reduces risk of CAD by removing cholesterol from LDL and stabilising plaques, moves the fat back into the liver to be processed

Question 26

what are foam cells

Answer 26

dead macrophages that sit on artery walls after they eat all LDL's, blocking blood flow

Question 27

what causes angina

Answer 27

an imbalance of the arteries ability to supply O2 to the heart muscle and the hearts need for 02

Question 28

what does angina feel like

Answer 28

pressure, aching, heaviness, or squeezing (as well as disorientation and acute confusion)

Question 29

what's the difference between chronic stable angina and vasospastic angina

Answer 29

chronic: temporary, reversible, predictable, associated with stable plaque vasospastic: due to spasms in the artery wall, lumen narrows which reduces blood flow to areas (usually from cocane), its acute and life threatening

Question 30

how does ischemia from CAD cause dyspnea

Answer 30

blood can back flow and enter pulmonary circulation

Question 31

what is acute coronary syndrome

Answer 31

prolonged ischemia that isn't immediately reversible, associated with unstable plaque which ruptures and forms a thrombus usually artery is 90% occluded

Question 32

what differentiates angina from ACS from CAD?

Answer 32

this chest pain occurs at rest, usually lasts 15-20 mins and isn't responsive to rest or medication

Question 33

what usually causes angina for ACS

Answer 33

rupture of stable atherosclerotic plaque and partial occlusion by thrombus

Question 34

define myocardial infarction

Answer 34

sustained ischemia causing irreversible cell death

Question 35

what's the difference between a STEMI and an NSTEMI

Answer 35

STEMI is a full thickness MI, you can tell because it elevates the ST wave of an EKG NSTEMI is partial thickness

Question 36

how long can the heart tolerate ischemia during a MI

Answer 36

20 minutes before cell death begins

Question 37

what would heart rate and blood pressure look like in a person experiencing MI

Answer 37

initially high HR and BP, but as cardiac output decreases then so will BP

Question 37

what clinical manifestations would you see in an older adult experiencing acute MI

Answer 37

sudden onset confusion, fatigue, anxious, dizziness (atypical symptoms)

Question 38

why would someone experiencing MI have dyspnea

Answer 38

due to pulmonary edema from backup of blood into pulmonary circulation

Question 39

which cardiac enzyme is the most helpful in detecting MI

Answer 39

Troponin is elevated in STEMI and NSTEMI, it rises 3-12 hours after onset of MI

Question 40

how to cardiac enzymes help with identifying an MI

Answer 40

Cardiac enzymes are released everytime we have organ damage and cel death and tell us if there's cardiac damage and how bad it is

Question 41

what happens to necrotic tissue after MI

Answer 41

neutrophils and macrophages remove all necrotic tissue, it is replaced with scar tissue after 2-3 months

Question 42

which coronary artery feeds pacemakers of the heart in most people

Answer 42

the right coronary artery, circumflex feeds blood to the other half of AV node