Mstest2(Ch34)

Front 1

hardening of the artery blood vessels

occurs in the large/medium arteries

Back 1

arteriosclerosis

Front 2

hardening of the small arteries and arterioles (0.01-1mm)

Back 2

arteriolosclerosis

Front 3

process of lumen narrowing due to fatty deposits and calcification of vessels

Back 3

atherosclerosis

Front 4

can be caused by increased bp which causes small vessels to lose compliance

Back 4

hyaline/hyperplastic arteriolosclerosis

Front 5

arteries have 3 layers :

Back 5

tunica intima/ tunica media/ tunica externa

Front 6

Atherosclerosis steps

Back 6

takes place in tunica intima

1:Starts w/ an irritant (^LDL,HBP, Lipids, Cigs)

2: The irritant upsets the inner endothelial cells which causes endothelial breakdown

3:LDL goes into tunica intimate walls

4: macrophages (big eater) sense disruption - follow ldl and eat fat

5:Macrophages die and become foam cells

6:smooth muscle cells move into tunica intimate and make a fibrous cap between the fatty streak and endothelial cells

7: SMC place Ca in intima (bonylike)

Front 7

LDL

Back 7

low density lipoprotein

carry fat/ cholesterol

Front 8

key changes in atherosclerosis 3

Back 8

smaller radius = ^resistance

more stiff/ lower compliance (less flex)

^BP

Front 9

Hyaline arteriolosclerosis

Back 9

serum proteins move from lumen to t media

can be caused by: hypertension (forces proteins out), Diabetes (basement membrane becomes leaky)

Front 10

if hyaline arteriolosclerosis continues, it will become _____

this occurs when the tunica media continues to expand and the lumen becomes tiny

Seen often in malignant HTN

Back 10

Hypoplastic arteriolosclerosis

Front 11

heart pumps ____x day on average

Back 11

100k

Front 12

clogged vessels + atherosclerosis

deposited WBC & cholesterol on DMG wall creates plaque

Back 12

CAD

Front 13

^HR and ^muscle becomes hypoxic because of extra o2 requirement

pain on exertion

Back 13

Stable angina

Front 14

Acute Coronary syndrome 2

Back 14

Unstable angina

MI

Front 15

plaque cover ruptures and plaque materials are exposed to blood (thrombogenic)

blood clot forms on plaque

chest pain at rest - unpredictable

Back 15

unstable angina

Front 16

clot completely blocks off blood vessel - thrombosis

thrombus breaks off - "embolism" - occludes smaller vessel

if not fixed in 20 min, myocardium dies

Back 16

heart attack (myocardial infarction)

Front 17

race most at risk for CAD

Back 17

african americans

Front 18

non modifiable risk factors for CAD4

Back 18

age (m:45/f:55)

sex: men

family history

ethnicity

Front 19

modifiable risk factors for CAD

5

Back 19

Less LDL/triglycerides

HTN management

cigarette cessation

diabetes manangement

exercise

Front 20

causes vessels to spasm and constrict

Back 20

cocaine/amphetamines

Front 21

heart muscle, death of tissue (from lack of o2)

Back 21

Myocardial Infarction

Front 22

when heart doesn't receive enough 02 - sends pain signals to brain (feeling of indigestion), referred pain (l arm), crushing chest pain

Back 22

MI

Front 23

lack of 02

heart slows

Cardiomyocytes (heart muscle cells) release ___ into blood

blood may back up in lungs (causing dyspnea)

20 minues: irreversible dmg from muscle cell death

Back 23

mi

troponin

Front 24

2 types of M infarct

Back 24

full thickness (transmural)

partial thickness

Front 25

artery occludes on outside of heart

Back 25

full thickness infarct (transmural)

Front 26

artery occludes on inside of heart

Back 26

partial thickness infarct

Front 27

in regards to MI

time is ____

Back 27

muscle

Front 28

three factors to diagnosing MI

2/3 likely to have MI

3/3 Def MI

Back 28

History (Q&A about immediate symptoms)

ECG *

blood work

Front 29

measures electrical activity of the heart

abnormal can tell type of MI

Back 29

ECG

Front 30

ST-elevation myocardial infarct (full thickness)

Back 30

STEMI

Front 31

Non ST- elevation MI (Partial thickness)

Back 31

NSTEMI

Front 32

only in heart if you have cardiac dmg

these will leak out of muscle cells into blood

Back 32

troponins (T&I)

Front 33

After coming to hospital for MI,

6

Back 33

PT will be admitted to ICU

Lay down in bed

continuous ECG monitoring

02 if necessary

Morphine to reduce chest pain/ anxiety

aspirin to reduce symptoms of clot that caused MI

Front 34

after MI is stable the next goal is ____

this is to get rid of the clot and allow blood to flow back into the area that was previously deprived

Back 34

reperfusion

Front 35

STEMI: presented w/in 2 hrs. Pt will be given med to ____

Back 35

break down clot (clot buster - thrombolysis)

Front 36

After MI pt will take the drugs for rest of life to reduce mortality, risk of MI, complications

5

Back 36

B Blocker:decrease rate/ force (o2 demand goes down)

Nitrates: dilate vessels for improve blood flow

anticoagulents: prevent further clots

Statin: lower blood clots

ace inhibitor: reduce BP

Front 37

___ is a type of blood vessel disorder that is included in the general category of atherosclerosis.

Back 37

Coronary artery disease (CAD)

Front 38

The term comes from two Greek words: athere, meaning “fatty mush,” and skleros, meaning “hard.” This combination implies that ___ begins as soft deposits of fat that harden with age.

Back 38

atherosclerosis

Front 39

the ____ (fatty deposits) prefer the coronary arteries.

Back 39

atheromas

Front 40

____, a protein produced by the liver, is a nonspecific marker of inflammation. It is increased in many patients with CAD

Back 40

C-reactive protein (CRP)

Front 41

The stages of development in atherosclerosis are 3

Back 41

(1) fatty streak, (2) fibrous plaque, and (3) complicated lesion.

Front 42

are age, gender, ethnicity, family history, and genetics.

Back 42

Nonmodifiable risk factors

Front 43

___ include elevated serum lipids, elevated blood pressure, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states, and elevated homocysteine level.

Back 43

Modifiable risk factors

Front 44

The incidence of CAD and MI is highest among

Back 44

white, middle-aged men.

Front 45

Heart disease kills almost ___ times more women than breast cancer and is the leading cause of death in women. Yet most women do not consider CAD their greatest health risk.

Back 45

10

Front 46

The second major risk factor in CAD is ____, which is defined as a BP greater than 140/90 mm Hg or greater than 130/80 mm Hg if the patient has diabetes or chronic kidney disease

10x more likely to have cad

Back 46

hypertension

Front 47

A third major risk factor in CAD is ____ use. The risk of developing CAD is two to six times higher in those who smoke tobacco or use smokeless tobacco than in those who do not

Back 47

tobacco

Front 48

Nicotine in tobacco smoke causes ____ (i.e., epinephrine, norepinephrine) release. These neurohormones cause an increased heart rate (HR), peripheral vasoconstriction, and increased BP. These changes increase the cardiac workload. Tobacco smoke is also related to an increase in LDL level, a decrease in HDL level, and release of toxic oxygen radicals.

Back 48

catecholamine

Front 49

____ refers to a cluster of risk factors for CAD whose underlying pathophysiology may be related to insulin resistance. These risk factors include obesity as defined by increased waist circumference, hypertension, abnormal serum lipids, and an elevated fasting blood glucose

Back 49

Metabolic syndrome

Front 50

Clinical manifestations of ___ are not apparent in the early stages of the disease.

Back 50

CAD

Front 51

__3__ products are major sources of saturated fat and cholesterol and should be reduced or eliminated from diets

Back 51

Red meat, egg yolks, and whole milk

Front 52

___ are the most widely used lipid-lowering drugs. These drugs inhibit the synthesis of cholesterol in the liver.

Back 52

The statin drugs

Front 53

____, a water-soluble B vitamin, is highly effective in lowering LDL and triglyceride levels by interfering with their synthesis. Niacin also increases HDL levels better than many other lipid-lowering drugs.

Back 53

Niacin

Front 54

CAD is a progressive disease, and patients may be asymptomatic for many years or may develop chronic stable chest pain. When the demand for myocardial oxygen exceeds the ability of the coronary arteries to supply the heart with oxygen, myocardial ischemia occurs. ____, or chest pain, is the clinical manifestation of reversible myocardial ischemia.

Back 54

Angina

Front 55

____ refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms.

It is an unpleasant feeling, often described as a squeezing, heavy, choking, or suffocating sensation. Angina is rarely sharp or stabbing, and it usually does not change with position or breathing.

5-15min

Back 55

Chronic stable angina

Front 56

are first-line therapy for the treatment of angina

Dilating peripheral blood vessels

Dilating coronary arteries and collateral vessels

Back 56

Short-acting nitrates

Front 57

If a coronary blockage is amenable to an intervention, coronary revascularization with an elective ___is done

Back 57

percutaneous coronary intervention (PCI)

Front 58

percutaneous coronary intervention (PCI)

During this procedure, a catheter with an inflatable balloon tip is inserted into the appropriate coronary artery. When the blockage is located, the catheter is passed through it, the balloon is inflated, and the atherosclerotic plaque is compressed, resulting in vessel dilation. This procedure is called

Back 58

balloon angioplasty.

Front 59

A ___ is an expandable meshlike structure designed to keep the vessel open by compressing the arterial wall . Because stents are thrombogenic

Back 59

stent

Front 60

Intracoronary ___ are often inserted in conjunction with balloon angioplasty.

Back 60

stents

Front 61

When ischemia is prolonged and not immediately reversible, ___develops and encompasses the spectrum of unstable angina (UA), non–ST-segment-elevation myocardial infarction (NSTEMI), and ST-segment-elevation myocardial infarction (STEMI)

Back 61

acute coronary syndrome (ACS)

Front 62

___ is chest pain that is new in onset, occurs at rest, or has a worsening pattern. The patient with chronic stable angina may develop UA, or UA may be the first clinical sign of CAD. Unlike chronic stable angina, UA is unpredictable and is an emergency.

Back 62

Unstable angina (UA)

Front 63

A ____ occurs because of sustained ischemia, causing irreversible myocardial cell death (necrosis) . Thrombus formation causes 80% to 90% of all acute MIs.19 When a thrombus develops, there is no blood flow to the myocardium distal to the blockage, resulting in necrosis. Contractile function of the heart stops in the necrotic area(s).

Back 63

myocardial infarction (MI)

Front 64

Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration is the hallmark of ____. Persistent and unlike any other pain, it is usually described as a heaviness, pressure, tightness, burning, constriction, or crushing. Common locations are substernal, retrosternal, or epigastric areas.

Back 64

MI

Front 65

The most common complication after an MI is ____, which are present in 80% to 90% of patients. Any condition that affects the myocardial cell's sensitivity to nerve impulses (e.g., ischemia, electrolyte imbalances, SNS stimulation) can cause this

Back 65

dysrhythmias

Front 66

___ is a complication that occurs when the heart's pumping action is reduced. Depending on the severity and extent of the injury, this occurs initially with subtle signs such as mild dyspnea, restlessness, agitation, or slight tachycardia

Back 66

Heart failure (HF)

Front 67

____occurs when oxygen and nutrients supplied to the tissues are inadequate because of severe left ventricular failure.

high mortality rate

Back 67

Cardiogenic shock

Front 68

____ may occur if the infarcted area includes or is near the papillary muscle that attaches to the mitral valve . You should suspect this if you auscultate a new murmur at the cardiac apex. An echocardiogram confirms the diagnosis.

Back 68

Papillary muscle dysfunction

Front 69

____ results when the infarcted myocardial wall is thin and bulges out during contraction. This can develop within a few days, weeks, or months.

Back 69

Ventricular aneurysm

Front 70

Acute ____, an inflammation of the visceral and/or parietal pericardium,

Assess the patient for the presence of a friction rub over the pericardium

Back 70

pericarditis

Front 71

____is pericarditis with effusion and fever that develops 4 to 6 weeks after MI. It may also occur after cardiac surgery. It is thought to be caused by an antigen-antibody reaction to the necrotic myocardium. The patient experiences pericardial pain, fever, a friction rub, pericardial effusion, and arthralgia. Laboratory findings include an elevated white blood cell count and sedimentation rate. Short-term corticosteroids are used to treat this condition.

Back 71

Dressler syndrome

Front 72

The patient with UA or NSTEMI may or may not undergo ____to evaluate the extent of the disease.

Back 72

coronary angiography

Front 73

___ is the first line of treatment for patients with confirmed MI (i.e., definitive ECG changes and/or positive cardiac markers).23 The goal is to open the blocked artery within 90 minutes of arrival to a facility that has an interventional cardiac catheterization laboratory.

Back 73

Emergent PCI

Front 74

When ____ occurs (i.e., the coronary artery that was blocked is opened and blood flow is restored to the myocardium), several clinical markers may be seen. The most reliable marker is the return of the ST segment to baseline on the ECG.

Back 74

reperfusion

Front 75

___ consists of the placement of conduits to transport blood between the aorta, or other major arteries, and the myocardium distal to the blocked coronary artery (or arteries). The procedure may involve one or more grafts using the internal mammary artery, saphenous vein, radial artery, gastroepiploic artery, and/or inferior epigastric artery

Back 75

CABG surgery

Front 76

CABG surgery requires a ___ (opening of the chest cavity) and cardiopulmonary bypass (CPB).

Back 76

sternotomy

Front 77

___offers patients with limited disease an approach to surgical treatment that does not involve a sternotomy and CPB.

Back 77

Minimally invasive direct coronary artery bypass (MIDCAB)

Front 78

____ is used in the initial treatment of the patient with ACS. The goal of therapy is to reduce anginal pain and improve coronary blood flow. this decreases preload and afterload while increasing the myocardial oxygen supply. The onset of action is immediate

Because hypotension is a common side effect, closely monitor BP during this time.

Back 78

IV Nitroglycerin.
IV NTG (Tridil)

Front 79

___ is the drug of choice for chest pain that is unrelieved by NTG. As a vasodilator, it decreases cardiac workload by lowering myocardial oxygen consumption, reducing contractility, and decreasing BP and HR. In addition, morphine can help reduce anxiety and fear.

Back 79

Morphine sulfate

Front 80

____ decrease myocardial oxygen demand by reducing HR, BP, and contractility. The use of these drugs in patients who are not at risk for complications of MI (e.g., cardiogenic shock) reduces the risk of reinfarction and the occurrence of HF. The continuation of These indefinitely is recommended.

Back 80

β-Adrenergic blockers

Front 81

____should be started within the first 24 hours and continued indefinitely in patients recovering from STEMI of the anterior wall, with heart failure, or an EF of 40% or less.18 The use of these inhibitors can help prevent ventricular remodeling and prevent or slow the progression of HF.

Back 81

Angiotensin-Converting Enzyme Inhibitors.
ACE inhibitors

Front 82

____ are the most common complications after an MI. In general, they are self-limiting and are not treated aggressively unless they are life threatening (e.g., sustained ventricular tachycardia).

Back 82

Dysrhythmias

Front 83

____is unexpected death resulting from a variety of cardiac causes. An estimated 382,800 people experience SCD yearly.1

Back 83

Sudden cardiac death (SCD)