Ex Phys Test 2

Front 1

single most preventable cause of death in the US and globally

Back 1

smoking
- 100 million deaths in the 20th century

Front 2

smoking worldwide death toll

Back 2

same as one jumbo jet crashing and everyone dying every hour

Front 3

smoking is responsible for what percent of CV deaths

Back 3

40%

Front 4

effects of smoking depend on

Back 4

# of years u smoked
how much you smoked
depth of inhalation

Front 5

within seconds of inhaling

Back 5

u get the release of dopamine in the brain

Front 6

what kind of drug is a cig

Back 6

psychoactive

Front 7

addictive part and the cancerous part

Back 7

addictive- nicotine
cancerous- tar (60ish carcinogens)

Front 8

reproductive system and smoking

Back 8

ye

Front 9

impedance and erectile dysfunction is 85% higher in male smokers than nonsmokers

Back 9

yea

Front 10

in females, smoking fux with ability to produce estrogen

Back 10

60% more likely to be infertile

Front 11

other female smoking facts

Back 11

- decreases uterine blood flow
- embryo transport problems
- endometrium problems
- increased chance of ADD

Front 12

start then stop smoking

Back 12

effects can linger

Front 13

smoking is a predictor of

Back 13

divorce

Front 14

1st hand
2nd hand

Back 14

mainstream
sidestream

Front 15

both kinds increase mental stress

Back 15

yea

Front 16

smoking causes brain atrophy

Back 16

yea

Front 17

smoking doubles risk for

Back 17

parkinsons and alzheimers

Front 18

smoking contributes to dementia and cognitive issues

Back 18

yea

Front 19

smoking and metabolism

Back 19

speeds it up by 10%

Front 20

substitute for speeding up metabolism

Back 20

- exercise. its been used to help ppl quit since metabolism slows down after u quit

Front 21

more addictive than

Back 21

cocaine, heroin

Front 22

cigarette smoking causes decrease in weight by

Back 22

the overexpression of a gene that is used in fact

Front 23

15 cigs a day

Back 23

puts u at risk for Crohn's disease

Front 24

every organ and tissue in ur body is negatively affected by smoking

Back 24

yea

Front 25

radon

Back 25

risk for lung cancer

Front 26

more than 20 known carcinogens in a cig

Back 26

yea; found in the tar

Front 27

polycyclic aromatic hydrocarbon (PAH)

Back 27

- carcinogen found in the tar
- doesnt dissolve in water, hard to get rid of

Front 28

benzopyrene

Back 28

- type of PAH
- permanently attacks DNA. if it doesnt kill the cell, it causes a genetic mutation to it so that it becomes carcinogenic

Front 29

Acrolein

Back 29

irreversibly binds with DNA; binds with guanine and causes a mutation, and ultimately, cancer
- it is the stench you smell
- irritates eyes
- 1000 times more abundant than PAH carcinogens

Front 30

sidestream smoke

Back 30

- smoke from tip of cigarette- worse than having someone blow smoke in ur face
- 85% of bad stuff are from tip
- makes platelets stickier
- damages lining of blood vessels
- causes problems with endothelium
- decreases coronary blood flow
- increases arterial stiffness
- leads to inflammation of endothelium
- causes oxidative stress
- larger infarct size if u have a MI
- these things can kick in 30 min--1 hour after

Front 31

smoking process

Back 31

injury-->recovery-->injury-->recovery
- stiffens arteries, then they recover, but they get hard over time

Front 32

Exhaled smoke

Back 32

more likely to be reactive chemically bc its a cooler temperature; and the particles are smaller

Front 33

nicotine

Back 33

- addictive; physical and psychological dependance
- 5-10 sec to reach ur brain
- affects dopamine release

Front 34

how much nicotine u get depends on

Back 34

- how much u inhale
- type of tobacco
- filter or not

Front 35

5 months after u start smoking, ur addicted

Back 35

yea

Front 36

states with lowest smoking frequency

Back 36

- utah
- minnesota
- california
- hawaii

Front 37

states with highest smoking frequency

Back 37

- ohio
- michigan
- west virginia
- tennessee

Front 38

James Duke

Back 38

bought rights to cig rolling machines and promoted selling them to women
- bought duke U

Front 39

acute effects of smoking

Back 39

- increases myocardial oxygen demand (check for the by checking RPP, RPP=hr x sbp/100)
- increases hr and bp

Front 40

acute effects con't

Back 40

- reduces oxygen transport
- carbon monoxide takes place of hemoglobin
- arteries contain 20/21ml oxygen per 100 ml of blood
- veins have 5 ml per 100 ml
systemic circulation= 15 ml per 100ml
- increaes susceptability to malignant ventricular arrhythmias
- can cause coronary artery spasm
- makes platelets stickier

Front 41

chronic effects of smoking

Back 41

- deicreases hdl
- promotes oxidation of ldl
- increases fibrinogen concentration
- increases blood viscosity
- damages endothelial lining (the tar does)

Front 42

kicking the habit

Back 42

- over 70% of people quit smoking bc their physician told them to
- 1/3 of smokers who quit relapse
- only 5% successfuly quit
- according to center for disease control- 80% of smokers quit when they began running
- exercise= reduce craving

Front 43

one of the reasons people dont quit

Back 43

dont wanna gain weight
- about 10% increase in calories occurs if u quit (5-10 lbs)

Front 44

CAD

Back 44

yea

Front 45

not the same as CVD

Back 45

- responsible for 25% of all deaths

Front 46

major risk factors

Back 46

- family history- if one of ur family had a MI, revascularization, or sudden death in a father before 55 or mother before 65
- male gender
- increasing age (after 45 in men, 55 in women)
- cigarette smoking- if u smoke 10 cigs a day, or u quit within the last 6 months
- high blood cholesterol
- hypertension
- physical inactvity

Front 47

high blood cholesterol

Back 47

- if total >200 or HDL <40 or LDL >160, you have a risk factor; LDL is more important; we get total cholesterol measured most of the time bc its easier to measure but its not the most important

- as total cholesterol increases, LDL increases. as cholesterol decreases, LDL decreases
- you're also at risk if you're taking lipid lowering medications
- a good LDL level is <130; ideally <100

Front 48

hypertension

Back 48

modifiable; borderline is >140/90, confirmed on 2 separate occasions, or taking antihypertension meds

Front 49

physical inactivity

Back 49

- every other risk factor is quantitative
- if u are less active than 25% of the population, you are a risk factor for CAD

Front 50

what does it take to get angina?

Back 50

a clinically significant lesion- 70% occluded artery
- you have a clinically significant lesion before u feel the effects of it
- you can detect a 50% lesion by exercise test
- chest pain is less likely in women, they get short of breath instead

Front 51

silent ischemia

Back 51

- ECG changes without symptoms; changes in ST segment

Front 52

#1 cause of heart attack

Back 52

bc a plaque plugs coronary artery
- the more well developed a plaque, the more stable it is, and the less likely you are to have a piece break off and plug the artery

Front 53

clinical outcomes of coronary artery disease

Back 53

MI
- ST segment changes- depression; horizontal or downsloping depression. 2 mm drop for .08s; the more depressed, the bigger the problem
- if the depression comes early in exercise, you have a bigger problem than if it comes later in exercise
- transient perfusion problems
- angina

Front 54

angina

Back 54

- stable- predictable; usually lasts 20-30s, relived by nitroglycerin
- unstable- unpredictable; usually last longer than 20min; precursor to MI; usually means some sort of plaque erosion or rupture thats going on
- Variant angina (prinzmetal angina)- coronary artery spasm- you'd see no obstruction if u did an angiogram
- silent ischemia- changes in ST segment, changes in T wave, but no common symptoms. common in diabetics; common in older people; old ppl tend to have shortness of breath
- angina- discomfort, feels retrosternal (under the breast bone) often radiates, squeezing or restricting feeling

Front 55

other things w similar pain

Back 55

acid reflux
highaytal hernia
spasm of esophagus

Front 56

another characteristic of angina

Back 56

diaphoresis- sweating

Front 57

by age 35, CVD is among the 10 leading causes of death

Back 57

yea

Front 58

CAD=

Back 58

CHD=IHD
- responsible for 1/2 of all cv deaths; 25% of all deaths

Front 59

aerobic exercise

Back 59

- increase HDL

Front 60

causal risk factors for CAD

Back 60

- cigarette smoking (most impt)
- hypertension
- total cholesterol (in particular, LDL)
- diabetes

Front 61

predisposing risk factors for CAD

Back 61

obesity
family history
physical inactivity
male gender
aging
poor socioeconomic status

Front 62

CAD is responsible for deaths

Back 62

1/2 of all cv deaths
1/4 of all deaths

Front 63

CAD=

Back 63

CAD=CHD=IHD

Front 64

CAD def

Back 64

- narrowing (stenosis) of the lumen of the artery
- result of plaque formation
- the fatty streaks become plaques

Front 65

by age 15, u can have fatty streaks in arteries

Back 65

yea

Front 66

how soon u have plaques depends on lifestyle

Back 66

ye

Front 67

ultimately, there can be an obstruction of the coronary artery. the plaque can lead to a

Back 67

focal spasm- in some part of the artery, it contracts and flow is obstructed, leads to angina

Front 68

referred pain

Back 68

not pain in the immediate area of blockage, but in other areas
- ischemia can result in this

Front 69

ischemia can end up in

Back 69

injury, then MI

Front 70

most MI's occur in

Back 70

vessels less than 50% occluded; what you have are young plaques that are likely to have a piece broken off i.e. by hypertension

Front 71

we always have some injury to the endothelium

Back 71

but the insults are withstood bc its pretty strong
- nitrous oxide- vasodilator; helps repair endothelium; it si produced as a result of the insults
- vasa vasorum- the arteries have their own blood supply and the endothelium releases it

Front 72

diabetics have more issues with

Back 72

cardiomypathy

Front 73

ischemia can result in

Back 73

angina

Front 74

angina

Back 74

- symptomatic or asymptomatic
- squeezing or constricting of the chest
- in older people; more shortness of breath
- unstable lasts longer than stable

Front 75

stable

Back 75

- predictable
- mayb 20 sec
- might sweat
- relieved by nitroglycerin given sublingually
- typically occurs when someone has advanced lesions
- recommend exercise to them and have them grade the angina to +1-->+4 (stop at +3)

Front 76

unstable

Back 76

- scab or cap is not stable
- underlying factor for plaque rupture
- dont recommend exercise to them
- usually lasts 20min+
- doesnt go away easily

Front 77

variant (prinzmetal) angina

Back 77

- causes spasm
- the spasm may be due to nitrous oxide as a result of endothelium dysfunction
- males are more likely to have calcium deposits in arteries

Front 78

ischemic cascade

Back 78

diastolic dysfunction
- heart doesnt fill the way it should
- from diastolic dysfunction, it advances to systolic dysfunction; the heart doesnt empty the way it should

Front 79

hypokinesis

Back 79

the heart cant move the way it should in terms of emptying

Front 80

if u wanna measure how hard the heart is working

Back 80

measure RPP

Front 81

left ventricle work is very important

Back 81

measure thru lvef
- percentage of blood in the heart at the end of filling that gets ejected
- during exercise, ef goes up bc of sympathetic
nervous system
- i.e. if only 20% of blood is ejected, the blood leftover tends to clot; bc of this, blood thinners are usually given;
all of this leads to ecg abnormalities
- heart has problems polarizing and repolarizing
- t wave inversion
- electrical instability

- in cardiac patients during exercise, ef stays the same or goes down

Front 82

ischemic heart disease

Back 82

- brought about by a narrowing of the lumen (opening of the artery
- progressive degenerative disease
- results in a narrowing of the lumen by formation of a plaque

Front 83

arteries consists of tunics

Back 83

- 1st- tunica intima (innermost layer)
- 2nd- tunica media (middle layer)
- 3rd- tunica adventitia (outer layer)

Front 84

CAD affects what layer

Back 84

1 and 2

Front 85

endothelium

Back 85

single layer of cells that lines all the arteries
- adjacent to lumen; deeper than tunica intima
- functioning entity
- when it gets damaged you have a problem

Front 86

ischemia

Back 86

demand for oxygen
- u can test for this by doing an exercise test to see if the supply for oxygen meets demand

Front 87

atherosclerosis

Back 87

- general; more of a pathological process

Front 88

arteriosclerosis

Back 88

specific to the arteries; more of an aging process of the arteries

Front 89

by age 20, 75% of males have some coronary artery disease

Back 89

ye, streaks are evident as early as age 15

Front 90

sclerosis

Back 90

hardening

Front 91

atheroma

Back 91

tumor (plaque)

Front 92

myocardial ischemia results in chest pain and

Back 92

injury. injury leads to MI
ischemia-->injury-->MI

Front 93

necrotic tissue

Back 93

once u have a MI, you have necrotic tissue. necrotic tissue becomes fibrotic tissue that stiffens the heart

Front 94

angiogram

Back 94

shows occlusion. you get a revascularization to prevent an MI
- injury and ischemia are reversible, MI is not; streaks are reversible, plaque is not

Front 95

regression

Back 95

- if u have coronary artery disease, you cant undo the plaques, but you can regress the streaks
- this is all a result of injury or dysfunction of the endothelium
- clinically significant lesions are 70% or more occluded

Front 96

pathogenesis of CAD

Back 96

typically starts out as injury or dysfunction

Front 97

types of injury

Back 97

- mechanical stress associated w hypertension
- carbon monoxide from smoking
- toxic chemicals
- hyperglycemia
- high blood glucose associated w diabetes
- infectious agents- herpes, Chalmydia
- nutrition

Front 98

monocytes and platelets go to injury sites

Back 98

- bind to inner lining of the artery and hold onto endothelial lining
- then they are converted to macrophages
- macrophages have enzymes that cause cell death
- macrophages become foam cells
- foam cells become part of fatty streaks that become plaques
- once they are plaques, it is irreversible
o monocytes->macrophages->foam cells->fatty streaks->plaques

Front 99

c-reactive protein

Back 99

you can measure if the endothelium is injured thru inflammation; c reactive protein is an indicator of inflammation

Front 100

cholesterol

Back 100

yeaa

Front 101

lipids are causative factor for cv

Back 101

ye

Front 102

what is the typical cholesterol associated w cvd?

Back 102

200mg%

Front 103

over 60% of the population has around 200

Back 103

word

Front 104

25% have

Back 104

>240

Front 105

higher the cholesterol

Back 105

greater the death rate (CHECK HANDOUT)

Front 106

good cholesterol

Back 106

lower than 180

Front 107

average cholesterol for children and adolescents

Back 107

160mg%

Front 108

when ur born, you're

Back 108

80mg

Front 109

for every 50mg% increase above 200

Back 109

you're chance of having a heart attack doubles

Front 110

not all cholesterol is bad

Back 110

cholesterol is ubiquitous
- important in growth, structure, transport- in every cell and tissue in the body
- differs in species
- differs in organs

Front 111

cholesterol is a major building block of

Back 111

plasma membranes
- makes up 30% of plasma membranes

Front 112

2 sources of cholesterol

Back 112

- exogenous- dietary- 300mg/day; beef, dairy, organ meats, processed luncheon meats
- endogenous- ur body makes cholesterol in the liver and small intestines; 85% of ur cholesterol is mad in the liver, make about 1g per day

Front 113

if u wanna change ur cholesterol

Back 113

aim for endogenous part
- lower cholesterol= lower death rate= lower risk for cvd

Front 114

cholesterol is influenced by

Back 114

obesity and physical actiity

Front 115

cholesterol is not water soluble

Back 115

it only becomes soluble when combined w a protein; as a result, lipoproteins exist

Front 116

classes of lipoproteins

Back 116

- vary in , weight , size, and density
- the whole purpose is to transport cholesterol

Front 117

HDL

Back 117

- about 20-30% of cholesterol. HDL is primarily protein, about 50%; very dense; HDL is inversely related with CHD; as HDL goes up, ur risk goes down. it gathers up the cholesterol in the body, and brings it to your liver, and it gets metabolized there. lowers risk for CVD

Front 118

LDL

Back 118

60-70% is cholesterol. collects cholesterol, but drops it off in the walls of the arteries instead of the liver.
- its an atherogenic protein. (initiates formation of plaques)
- most tissues have ldl receptors. the ess ldl receptors u have, the more susceptible u are to atherosclerosis

Front 119

ldl is most impt

Back 119

ye

Front 120

as total cholesterol goes up and down

Back 120

up- ldl goes up
down- ldl goes down

Front 121

VLDL

Back 121

mostly triglyceride

Front 122

testing cholesterol

Back 122

u can measure cholesterol easier than LDL; also less expensive and doesnt require fasting

Front 123

ldl requires

Back 123

12 hour fast

Front 124

cholesterol measurement requirements

Back 124

cant be sick, pregnant, or in a weightloss program

Front 125

some cholesterol is affected by posture

Back 125

mhm

Front 126

the lab can also vary the value

Back 126

ye

Front 127

the measure should agree within

Back 127

30mg%, and should also be done within 8 weeks; average the 2, and thats ur cholesterol

Front 128

typically cholesterol is measured using

Back 128

serum, but it can also be done using plasma

Front 129

serum

Back 129

portion of blood without clotting factor
- usually taken and put in a red silicon tube

Front 130

plasma

Back 130

with clotting factor
- plasma is usually taken then put in a testtube with EDTA (an anticoagulant), purple top tube

Front 131

cholesterol level measured in serum is different from the cholesterol measured in plasma

Back 131

when taken from plasma, times it by 1.03 to get the serum equivalent

Front 132

ldl is usually calculated

Back 132

based on hdl and triglycerides. but bad bc u might get hdl, vldl, or triglycerdes wrong, which would make ldl wrong

Front 133

start at age 17-30

Back 133

ur cholesterol increases 2.2mg% every year. peaks in middle age and declines in old age

Front 134

there are differences in cholesterol levels in terms of

Back 134

- race
- season- for men its higher in winter and lower in summer; opposite for women
- pregnancy- increased if pregnant; cholesterol levels decreased during ovulation

Front 135

men typically have higher

Back 135

ldl; women typically have higher hdl

Front 136

risk for cholesterol is highest in

Back 136

middle age; thats when u should reduce it the most

Front 137

only about 30% of the cholesterol u ingest is absorbed

Back 137

yea

Front 138

enzyme impt for cholesterol absorption

Back 138

HMG CoA reductase- main enzyme in cholesterol synthesis
- most drugs target this
- most active when ur consuming saturated fat

Front 139

desirable cholesterol value

Back 139

<200

Front 140

high cholesterol

Back 140

>240

Front 141

epidemiologically desirable

Back 141

<180

Front 142

if u have good cholesterol, measure it every

Back 142

5 years

Front 143

if ur cholesterol is >240

Back 143

get a lipid protein profile
- any other decisions after that is based on ur ldl

Front 144

NCEP

Back 144

national cholesterol education program

Front 145

with definite risk factors

Back 145

2 or more; if u have a cholesterol >240, then u have a lipid protein profile

Front 146

LDL desirable level

Back 146

<130

Front 147

LDL high risk

Back 147

> 160

Front 148

if LDL is <130,

Back 148

repeat in 5 years

Front 149

if LDL is >160

Back 149

diet and lifestyle therapy first, then drug therapy
- diet- reduce total fat to <30% of ur total calories and reduce ur cholesterol intake to less than 300mg% per day; do this for 6 weeks and if nothing happens, reduce ur saturated fat intake to <7% and reduce ur cholesterol intake to less than 200mg% per day
- sat fat is bad

Front 150

drug therapy

Back 150

- problems: once u go on them, u dont come off them (particularly with statins)= liver problems down the line
- if u have LDL >225, def need drugs
- >190, ur a candidate, but not definite
- the minimum goal is to reduce LDL to 130mg%

Front 151

statins

Back 151

use HMGCoA reductase
- aims at HMGCoA to reduce cholesterol
- HMGCoA reductase converts HMGCoA to cholesterol
- statins act on the reductase, so the conversion of HMGCoA to cholesterol cant happen, therefore, lowers cholesterol and ldl
A CoA- comes from saturated fat, increases HMG CoA levels, and therefore cholesterol synthesis

Front 152

more statins

Back 152

mimic HMG-CoA
- taken at night bc cholesterol is synthesized at night
- Lipitor (atorvastatin)- best selling pharmeceutical in history
- can lower ldl by 70mg% aka very effective
- 60% reduction in the number of cardiac events after statins have been prescribed
- better given as secondary prevention rather than primary prevention
- not as good at reducing tryglycerides, but better at lowering LDL
- problem is, theres an increased risk for rhabdomyolysis; rapid breakdown of skeletal muscle (usually happens when u mix statins and nicotinic acid (i.e. niacin))
- symptoms- live enzyme problems and muscle problems like myalgia

Front 153

nicotinic acid

Back 153

water soluble b vitamin
- wont reduce as much as a statin though
- lowers ldl, total cholesterol, raises HDL, lowers triglycerides
- side effects- flushing of the skin, but u build tolerance after a few weeks
- to reduce flushing- take the acids in time released preparations, avoid taking on empty stomach, and start w a low dosage, or take aspirin with it
- initial dose- 100-250 mg a day
- usually after dinner, bc u produce cholesterol at night. some ppl take up to 6g, over 2g u should ask ur dr first.
- contraindications- can affect blood glucose, liver function, u can develop uric acid crystals (gouty arthritis- crystals in joint), and ulcers

Front 154

bile acid sequestrants

Back 154

- lower LDL
- increase synthesis of bile acids in liver; bile acids are made from cholesterol
- problems- GI side effects- bloating, fullness, constipation, nausea, flatulence, can interfere w absorption of other drugs

Front 155

top drug

Back 155

use nicotinic acids first, then statins, then bile acid sequestrants

Front 156

top ways to lower cholesterol

Back 156

- weight reduction, lower body fat; 15 miles of aerobic activity a week, or 90 min of exercise
- most impt thing exercise does is lower triglycerdies and raise HDL
- smoking cessation

Front 157

factors that affect cholesterol

Back 157

- genetics; family disorders
- gender
- pregnancy
- birth control pills
- saturated fat in diet
- high calorie diets
- gorging
- uncontrolled diabetes
- inactivity (indolence)- exercise raises hdl
- anxiety (raises it)
- cigarette smoking
- excess coffee consumption- coffee causes the release of fatty acids into the blood stream; excess is more than 5 cups a day

Front 158

HMG stands for

Back 158

3 hdroxy, 3 methyl glutaryl CoA

Front 159

taking in less saturated fat can

Back 159

lower cholesterol

Front 160

if u reduce ur dietary intake

Back 160

sometimes what happens is u increase ur cholesterol synthesis; to reduce synthesis, reduce saturated fat

Front 161

statins general

Back 161

- improve endothelial function
- modulate (reduce) inflammatory response
- make plaque more stable
- prevent clotting

Front 162

mevastatin

Back 162

- produced by a fungus; same fungus that penicillin is produced from
- first statin identified