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52 Cards in this Set
- Front
- Back
to what point is ischemia reversible?
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disruption of cellular membranes
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how long after the loss of coronary blood flow does the myocardium cease to contract?
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60 sec
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coronary artery disease
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ischemia is late manifestation
present in 90% pts begins in childhood fatty streak progresses to occulusive plaque |
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risk factors for CAD
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smoking
diabetes hypercholesterolemia HTN men age |
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Metabolic syndrome
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obesity, HTN, DMII, dyslipidemia, mincroalbuminuria
2-3 fold inc in heart disease |
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Hormone replacement therapy's interaction on CAD
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improved lipids
improves endothelial fxn antioxidants dec adhesion molc dec C-rxtv P |
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The health risks of hormone replacement therapy
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stroke
CAD PE breast cancer |
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statin therapy
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inc HDL
dec triglycerides dec LDL no gender specificity |
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C reactive protien
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marker of inflam expanded core in atheromatous plaques
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C reactive protien is increased in
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smokers
obese diabetics metabolic syndrome |
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homocystine
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may cause endothelial dysfunction
interferes w NO fxn |
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Fatty streak propagation
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activated SM in the presence of hypercholesterolemia
collagen, elastin & matrix P elaborated |
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smooth muscle is stimulated by?
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PDGF
FGF TGF a |
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stable plaques
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raised intimal lesions
fibrous cap protected subendothelial center necrotic center induces collateral circulation 70% occulusion |
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unstable plaques
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eccentric
loss of fibrous caps large inflam center shoulder stress 50-70% occulusion |
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acute plaque changes
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mechanical stress, adrenergic stim w peak in am,
inc BP, platelet activity & MI |
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acute injury to plaque
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loss of fibrous cap
exposure of collagen fragmented capillary damage |
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inflammatory mediators activity
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attract leukocytes & propagate cytokines promoting unstable plaque core
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examples of inflammatory mediators
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ICAM, VCAM, E/P selectins
TNF a, IL6, INFy metalloproteinase |
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what does ICAM, VCAM, E/P Selectins do?
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leukocyte adherence & migration
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what does TNF, IL6, INFy do?
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stimulate endothelium & mp
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what does metalloproteinase do?
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degrades the collagen cap
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thrombis causing total occlusion causes?
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transmural infarct
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thrombis causing partial occulsion causes?
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subendothelial infarct
unstable angina sudden death |
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Symptoms in angina are
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transient...
squeezing chest pain L arm, neck, jaw pain relieved w rest ST segment changes |
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Stable angina
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inc myocardial demand
critical flow reduction stable plaque improves w rest |
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unstable angina
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unstable plaque
inc freq & duration MAY OCCUR @ REST |
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Women and ischemia
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less symptomatic
lower risk below 60 same after |
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Race and ischemia
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more common in whites
less common in AA |
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Prinzmetals angina
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sx @ rest
vasospasm related may or may not have CAD ST segment elevation |
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what EKG change do you see with prinzmetal angina?
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ST segment elevation
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Chronic ischemia causes?
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fibrosis of the myocardium
loss of myocardial compliance & contractility |
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left ventricular hypertrophy due to HTN is
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concentric
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By controlling BP in the elderly, there was a decrease in the risk for?
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stroke
CAD CHF crebrovascular disease *** ind of cholesterol |
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What is the ventricular hyertrophy load theory
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afterload is the primary determinant of ventricular hypertrophy
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early heart disease - diastolic dysfunction
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thick myocardium dec filling
normal systolic fxn greater diastolic filling in LV |
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altered gene expression in early heart disease
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fetal protien forms
inc fibrosis c-myc, c-fos, c-jun |
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what is the histology in early hypertrophy?
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inc myocyte size
pleomorphism fibrosis |
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inc O2 demand of hypertrophy causes
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inc HR
inc ionotropy |
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Myocardial apoptosis is inhibited by
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NO
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myocardial apoptosis is increased by
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Ang II that inc p53
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EKG changes with hypertrophy
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prolonged P wave
high voltage QRS |
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what is the strongest predictor of subsequent cardiac events?
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EKG changes
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Defects in NO cause
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impaired relaxation
endothelial dysfunction inc arteriolar resistance |
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Angiotensin II causes
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reduced LV mass
improved coronary blood flow |
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what does the humoral theory state?
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locals vasoactive mediators initiate hypertrophic changes
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the salt theory says that if you increase dietary salt intake you get..
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inc LV mass
independent of atrial pressure ind of tot peripheral resitance |
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clincial heart failure in late hypertrophic heart disease
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loss of 40-50% myocytes
<50% LV EF SOB (pulmonary edema) renal dysfunction dec exercise tolerance jugulovenous distention |
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Gender & HTN heart disease
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systolic BP inc w age M>F
heart failure 2X M & X3 F EKG evidence in men |
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race & HTN heart disease
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AA more common
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Acute cor pulmonale
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dialated RV
pulmonary embolis |
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Chronic cor pulmonale
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prolonged inc R heart pres
1 pulmonary HTN recurrent emboli radiation induced injury vasculitis COPD restrictive lung disease |