Path 300 Cardio

Front 1

Arterial structure from the inside to the outside (3)
And what is in each of the (3) layers

Back 1

Tunica inner intima - endothelial cells + some SMC
Tunica media - more SMC
Tunica adventitia - connective tissues + blood innervation

Front 2

What are the clinical manifestations of atherothrombosis (5) and the subtypes (4) of the 5th manifestation.

Back 2

1. ischemic stroke
2. TIA
3. MI
4. Angina
5. Peripheral arterial disease
a. intermittent claudication, rest pain, gangrene, necrosis.

Front 3

What are fatty streaks

Back 3

Lipid accumulating in the intima.

Front 4

What are the (2) KEY components of athererosclerosis

Back 4

1. endothelial dysfunction + damaage
2. chronic inflammation

(prolif and migration of SMC into intima + synthesis of connective tissue matrix, deposition of lipids, Ca thrombus)

Front 5

What are the (3) components to injury to endothelial cells

Back 5

1 hemodynamic stress + HT
2. cell mediators/cytokines on arterial wall
3. inflammation component: macrophages and T-cells

Front 6

Foam cells?
What are they made of?

Back 6

Macrophages (monocytes) filled with globes of lipid. Ie oxidized LDL in macrophages.

Front 7

What is a lipoprotein?
Name (5) and their functions.

Back 7

A call of lipids surr by proteins on the outside eg apopprotein. TGs and cholesterol ester stored in lipoproteins.
1. Chylomycron
2. VLDL
3. IDL
4. LDL - delivers lipids to tissues + cholesterol to athero plaque
5. HDL (good - more proteins and less cholesterol) - protects and reverse cholesterol transport to liver

Front 8

Stbale vs unstable plaques depend on what?

Back 8

Fibrous cap thickness

Front 9

What is the difference between thrombosis and embolism.

Back 9

Thombosis - ie a blood clot, platelet aggregation and fibrin formation
Embolism - floating thrombus

Front 10

What is familial hypercholesterolemia?
What does it cause?
How do you fix it

Back 10

rare gene defect in LDL R (not able to take it to normal cells)
atherosclerosis due to high LDL in circulation
triple by-pass

Front 11

What are What are (8) risk factors for atherosclerosis

Back 11

1. obesity and metabolic syndrome
2. diabetes
3. HT
4. smoking
5. high LDL,
6. low HDL
7. lack of exercice
8. high cholesterol diet

Front 12

Three major events that increase thrombus risk within vessels (3)

Back 12

1. endothelial injury
2. abnormal blood flow
3. hypercoaguability

Front 13

Red thrombi vs white thrombi?
What is DVT and what does it cause?

Back 13

Red thrombi = venous = more RBCs,
White thrombi = arterial = more WBCs and platelets
DVT = deep vein thrombosis --> causees pulmonary embolism

Front 14

What is anastomosis?

Back 14

Reconnection of two streams that previously branched out, such as blood vessels or leaf veins.
Used to describe the fact that multiple vessels could supply the blood to one place.

Front 15

What is peripheral vascular disease?
Intermittent claudication?

Back 15

impaired blood to periphery
intermittennt ischemia w symptoms, eg can't walk up stairs without symptoms

Front 16

What is an aneurysm?
What are two things that causes it (2)
What are the two types?

Back 16

Blood filled balloon, which could burst and be fatal.
1. BP 2. resistance to distension of vessel wall. (weaked vessel wall)
I. cirumferential (fusiform) - both sides
II. localized (saccular) - on one side

Front 17

Where does a berry aneurysm occur?

Back 17

circle of willis

Front 18

What is aortic dissection?
What is a complication?

Back 18

Second channel at aorta
Blood can start to flow backwards. compresses real lumen

Front 19

What are varicose veins?
Cause? (4)

Back 19

lots of pressure in venous system, not a lot of complications, just obstruction to venous flow.

1. standing 2. obesity 3. age. 4. heredity (valve defect)

Front 20

What pressure is HT defined at?
What is the optimal BP

Back 20

>= 140 systolic
>= 90 diastolic

120/80

Front 21

Name 5 controls of BP

Back 21

1. kidney - RAA
2. diet - Na and H20, salt intake in BP correlated
3. NS - ANS,
4. heart, brain, adrenal , lung - other hormones, like NA
5. arteries - structural changes (contract and relax)

Front 22

Does HT cause atherosclerosis?
Why?

Back 22

Yes
higher pressure = more injury at branch points.

Front 23

What are (3) biggest HT complications

Back 23

1. cardiac hypertrphy,
2. arterial structural changes - SM hyperplasia, renal failure and impaired vision
3. atherosclerosis --> problems in heart and brain

Front 24

What ischemic heart disease

Back 24

inadequate blood flow in one of the three major coronary arteries

Front 25

What are the three main coronary arteries

Back 25

1. left anterior descending LAD
2. left circumflex LC
3. right coronary

Front 26

What is angina pectoris
What is variant angina

Back 26

Chest pain ass w ischemic heart disease
Coronary artery spasms

Front 27

What is seen with coronary artery disease on the EKG

Back 27

ST segment depression

Front 28

Treatment (3) of angina.
Briefly say why it works

Back 28

1. nitroglycerin - relaxes VEINS
2. coronary artery bypass surgery - saphenous veins
3. coronary angioplasty - catheter, balloon, stent

Front 29

What is concentric fibrous plaque and its significance

Back 29

Buildup of plaque that is unaffected by nitro

Front 30

What are (4) causes of MI
What are the common two

Back 30

1. thrombus
2. embolus
3. hemorrahge
4. spasm
first two are most common

Front 31

Which is one is better:
1. acute occlusion after minimal stenosis
2. acute occlusion after gradual stenosis
Why?

Back 31

2. gradual stenosis, slow build up of plaque and thrombus at last minute is better --> because you have collateral blood flow (anastomsis had a time to kick into action)

Front 32

MI risk are due to what two things / mechanisms (2)

Back 32

1. mechanical failure
2. electrical failure

Front 33

MI on ECGs -- what are three (3) characteristics

Back 33

1. elevation of ST
2. inversion of T
3. increase amplitude of Q

Front 34

Complications of MI

Back 34

1. risk of rupture if insufficient repair after MI
2. injured endocardium may be thrombogenic --> arterial embolism
3. cardiac tamponande --> blood in pericardium sac
4. rupture of papillary muscles
5. inter-ventricular septum defect
6. ventricular aneurusm

Front 35

What is CRP and what is its role in CVD?

Back 35

C reactive protein --> inflammation

Front 36

What are the (3) pacemakers of the heart
What are their intrinsic rates (bpm)

Back 36

1. SA node - 60-100 bpm
2. AV node - 40-60 bpm
3. ventricular cells - 20-45 bpm

Front 37

Why is there a delay at the AV node

Back 37

allows the ventricles to fill (after P wave, ie depol of atrial followed by atrial contraction, but this only add a bit of blood to the ventricles)

Front 38

What is bradycardia
Cause

Back 38

slow rate <50
physiological, fit person
pathological, SA node malfunction

Front 39

What is tachycardia
Causes (3)

Back 39

rapid rate >90 at rest
fever, hypothyroidism, lower bp

Front 40

What is arrhythmia

Back 40

faster HR when inspiration, and lower when expiring

Front 41

What are two abnormal ECG patterns (2)
What are they cause by?

Back 41

1. heart block - AV node blocked. ie conduction block
2. fibrillation - V fib means the electrical conductivity is crazy, contractions are very fast and uncoordinated, dead within minutes ie ectopic focus

Front 42

What is an ectopic focus?

Back 42

circus, reentry depolarization, due to an unidirectional block, maybe because of dead/fibrous myocytes,

Front 43

What is the diff between atrial arrhythmias and ventricular arrhythmias (2 main ones)

Back 43

1. location, atria vs ventricle
2. atrial not lethal, but increas risks for thrombus and embolus 17x for stroke. ventricular are fatal if not treated

Front 44

Name the FOUR valves.
Which two are closed during systole
Which two are close during diastole

Back 44

mitral (bicuspid, or L AV)
tricuspid (R AV)
pulmonary
aortic
L AV and R AV are closed during systole
pulmonary and aortic are closed during diastole

Front 45

Name two mains causes of valvular disease (2)

Back 45

1. stenosis
2. incompetent valve - flips back and forth

Front 46

What is vegetation (valves)

Back 46

Ca deposition and damage to valves - stenosis and decrease flow of blood

Front 47

What is Rheumatic Heart Disease
What causes it

What is rheumatic fever

Back 47

autoimmune disease against cardiac sarcolemma
beta-hemolytic strptococcus infection > Ab made > cross react with cardiac sarcolemma. the valve glucopeptides > damage and heart valve failure.

Rheumatic is autoimmune disorder to the heart.

Front 48

What is aortic stenosis
How does heart compensate

Back 48

less space in the aortic valve, causes angina, workload heart increase. leads to syncope

LV hypertrphy

Front 49

What is aortic regurgitation
How does the heart compensate

Back 49

open and closing of the aortic valve, decrease CO, fatigue, dyspnea, difficulty breathing, shortness of breath (affects lungs as well as heart)

LV dilation and hypertrphy

Front 50

What is mitral stenosis
How does heart compensate

Back 50

Stenosis of the mitral valve, increase pressure in LA, back pressure to pulmonary veins, leads to fatugue due less blood and dyspnea

LA hypertrphy and dilation
RV hypertrophy (pulm resistance)

Front 51

What is mitral regurgitation
How does the heart compensate

Back 51

blow flow back and forth between LA and LV
leads to dypsnea, increas pressure to pulm circuit

RV hypertrophy
LA dilation and hypertrophy
LV dilation and hypertrophy

Front 52

What is congestive heart failure?
What is is caused by? (4)

Back 52

inadequate CO
1. coronary heard disease
2. HT, eg with pulmonary HT
3. valvular disease and myocardial damage
4. arrhythmias

Front 53

What are symptoms of congestive heart failure (7)

Back 53

1. edema,
2. cyanosis
3. dyspnea
4. orthopenea
5. fatigue
6. weakness
7. nocturia

Front 54

What is cor pulmonale?
What happens to the heart?
What causes is?

Back 54

R side heart failure
enlargement of RV due to pulm HT
COPD + pulm HT

Front 55

HF leads to what? (4)

Back 55

1. cardiogenic shock
2. hypotension
3. low BP
4. decreased coronary blood flow leading to arrythmias and myocardial dysfunction

Front 56

What kind of necrosis happens during a stroke

Back 56

Liquefactive

Front 57

What is the most common occluded artery during a MI

Back 57

LAD

Front 58

What is the most common occluded artery in stroke

Back 58

middle cerebral

Front 59

Causes of stroke (4)

Back 59

1. thrombus
2. embolus
3. intracraneal hemorrahge - squeeze blood vessles
4. aneurysm

Front 60

What are the consequences of stroke

Back 60

depend on site, extend, collateral circulation, speaking writing, understanding problems.
speech, balance, moving, paralysis, contralateral hemiplegia, hemianesthesia, speech impairment, headache, dixxiness, confusion, visual distubance, slurred speech, difficulty swallowing, neglect the other side.

Front 61

two are symptoms better after stroke (2 reasons)

Back 61

1. neurons may recover
2. plasticity in NS

Front 62

What is multi infact dementia

Back 62

multiple mini strokes