Term
| Where does the right atria receive blood from? |
|
Definition
| Superior and Inferior Vena Cava |
|
|
Term
| What does the right atria pump blood through to get to the lungs? |
|
Definition
|
|
Term
| Where does the left heart receive blood from? |
|
Definition
|
|
Term
| What is the function of the left heart? |
|
Definition
| Pumps blood through the aorta to systemic ciruculation |
|
|
Term
| What is the structure of the pericardium? |
|
Definition
| Double Walled - parietal and visceral layers |
|
|
Term
| What is the pericardium filled with? |
|
Definition
|
|
Term
| What inflammatory condition affects the pericardium? |
|
Definition
|
|
Term
| What is the thickest layer of the heart wall? |
|
Definition
|
|
Term
| Why is the myocardium the thickest layer? |
|
Definition
| Because it is the part that has to pump the heart |
|
|
Term
| What is the endocardium made up of? |
|
Definition
| connective tissue and squamous cells |
|
|
Term
| What is the innermost layer of the heart wall? |
|
Definition
|
|
Term
| What is the endocardium continuous with? |
|
Definition
|
|
Term
| What inflammatory condition affects the pericardium? |
|
Definition
|
|
Term
| What are the three layers of a blood vessel? |
|
Definition
1. Tunica Intima
2. Tunica Media
3. Tunica Adventitia or Externa |
|
|
Term
| What is the channel within a blood vessel called? |
|
Definition
|
|
Term
| What do endothelial cells produce in blood vessels? |
|
Definition
| Vasodilators, vasoconstrictors, anticoagulants and growth factors |
|
|
Term
| What is an example of a growth factor produced in the endothelial cells? |
|
Definition
| VEGF (Vascular Endothelial Growth Factor) |
|
|
Term
| What are the vaso vasorum? |
|
Definition
| Small vessels in adventitia that provide blood to larger vessels |
|
|
Term
| What are the causes of Cardiovascular Disease? |
|
Definition
1. Genetic
2. Neurohumoral
3. Inflammatory mechanisms
4. Underling tissue and cellular processes |
|
|
Term
| What are some underlying tissue and cellular processes that can cause Cardiovascular Disease? |
|
Definition
| Endothelial injury, remodeling, stunning, reperfusion injury, and autoimmune disease |
|
|
Term
| How does arterial coronary circulation work? |
|
Definition
| Receive blood from opening in aorta (coronary ostia) and cardiac veins that empty into right atrium via coronary sinus |
|
|
Term
| What are 2 parts to the right coronary artery (RCA)? |
|
Definition
1. Right marginal branch
2. Posterior descending branch |
|
|
Term
| What are the 2 parts to the left coronary artery? |
|
Definition
1. LAD = Left anterior descending artery
2. CX=Circumflex artery |
|
|
Term
| Which side of the heart does the majority of the pumping? |
|
Definition
|
|
Term
| What are 3 types of coronary vessels? |
|
Definition
1. Coronary cappilaries
2. Coronary veins
3. Coronary lymphatic vessels |
|
|
Term
| What are 3 types of coronary veins? |
|
Definition
1. Coronary sinus
2. Great cardiac vein
3. Posterior vein of the left ventricle |
|
|
Term
| Atherosclerosis is a form of what? |
|
Definition
|
|
Term
|
Definition
| Abnormal thickening, hardening of vessel walls ("Hardening and gruel") |
|
|
Term
| What migrates to the tunica intima during atherosclerosis? |
|
Definition
| Smooth muscle cells and collagen fibers |
|
|
Term
| Atherosclerosis is the primary cause of what diseases? |
|
Definition
1. CAD
2. PAD
3. Cerebrovascular disease |
|
|
Term
| True or False: Atherosclerosis can be a normal part of aging? |
|
Definition
|
|
Term
| When you have an occluded artery, what tissues will be affected? |
|
Definition
| Distal to the blockage will get less blood flow, causing them to die |
|
|
Term
| What are the 3 stages of atherosclerosis? |
|
Definition
1. Fatty Streak
2. Fibrous Plaque
3. Complicated Lesion |
|
|
Term
|
Definition
| Cholesterol and different types of fat |
|
|
Term
| What class of meds will we give to people with atherosclerosis? |
|
Definition
|
|
Term
| What is the class of meds for cholesterol? |
|
Definition
|
|
Term
| What is the process of forming atherosclerosis? |
|
Definition
1. Inflammation of endothelium
2. Cellular proliferation
3. Macrophage migration
4. LDL oxidation (foam cell formation)
5. Fatty Streak
6. Fibrous Plaque
7. Complicated lesion |
|
|
Term
| What is a precursor to thrombus? |
|
Definition
|
|
Term
| What holds a thrombus together? |
|
Definition
|
|
Term
| What is a complicated plaque? |
|
Definition
|
|
Term
| What are nontraditional risk factors for Coronary Artery Disease (CAD)? |
|
Definition
-Markers of inflammation and thrombosis
-C-reactive protein (CRP)
-Fibrinogen
-Protein C
-Plasminogen activator inhibitor
-Hyperhomocysteinemia
-Adipokines
-Infection |
|
|
Term
|
Definition
| Protein synthesized in the liver |
|
|
Term
| What is hyperhomocysteinemia? |
|
Definition
| Lack of enzyme that metabolized homocysteine |
|
|
Term
| What does hyperhomocysteinemia cause? |
|
Definition
| Deficiency of folate, Vit B12 (cobalamine) or Vit B6 (pyridoxine) |
|
|
Term
|
Definition
| Hormones released from fat cells |
|
|
Term
| What infections can lead to CAD? |
|
Definition
-Chlamydia pneumoniae
-Helicobacter pylori |
|
|
Term
| True of False: There is not a strong link between CAD and lipoproteins? |
|
Definition
|
|
Term
| What is dietary fat packaged into for absorption in small intestine? |
|
Definition
|
|
Term
| Where do you find triglycerides? |
|
Definition
|
|
Term
| Very low density lipoproteins (VLDL) |
|
Definition
| Mainly triglycerides + carrier protein |
|
|
Term
| Low density lipoproteins (LDL) |
|
Definition
| Mainly cholesterol + carrier protein |
|
|
Term
| True or False: We want LDL's to be high? |
|
Definition
|
|
Term
| High density lipoproteins |
|
Definition
| Mainly phospholipids + carrier protein |
|
|
Term
| True or False: We want HDL's to be high? |
|
Definition
|
|
Term
| What are apolipoproteins? |
|
Definition
| Proteins that bind lipids (oil-soluble substances such as fat and cholesterol) to form lipoproteins and transport the lipids through the lymphatic and circulatory systems (Encase and transfer lipids) |
|
|
Term
| Where is cholesterol found? |
|
Definition
|
|
Term
| Where is cholesterol manufactured? |
|
Definition
|
|
Term
| What is cholesterol necessary for? |
|
Definition
1. Plasma membrane repair
2. Steroid hormones
3. Bile acids |
|
|
Term
| What are sources of cholesterol? |
|
Definition
|
|
Term
| What is the desired cholesterol level? |
|
Definition
|
|
Term
|
Definition
-Carbon atoms are saturated with hydrogen atoms
-Solid at room temp |
|
|
Term
| What are examples of saturated fat? |
|
Definition
| Fatty meats and dairy products |
|
|
Term
| What are considered bad fats? |
|
Definition
|
|
Term
| What is a monounsaturated fat? |
|
Definition
-Have 1 double bond
-Liquid at room temp
-Good for you in moderation |
|
|
Term
| What is an example of monounsaturated fat? |
|
Definition
|
|
Term
| What is a polyunsaturated fat? |
|
Definition
-More than 1 double bond
-Liquid at room temp
-Good for you in moderation |
|
|
Term
| What are examples of polyunsaturated fats? |
|
Definition
| Oil, fatty fish, nuts, and seeds |
|
|
Term
| National Cholesterol Education Program, Adult Treatment Panel 3 |
|
Definition
| Goal is to reduce illness and death from coronary heart disease by reducing # of Americans with high cholesterol |
|
|
Term
| What is myocardial ischemia? |
|
Definition
-Myocardial oxygen supply is insufficient to meet demands
-Temporary reduced coronary blood supply |
|
|
Term
| Clinical manifestations of myocardial ischemia |
|
Definition
-Stable angina pectoris
-Prinzmetal angina
-Silent ischemia |
|
|
Term
|
Definition
-assoc with chronic coronary obstruction
-build-up of lactic acid |
|
|
Term
|
Definition
-variant angina
-vasospasm
-unpredictable
-assoc with transient ischemia |
|
|
Term
|
Definition
-asymptomatic
-more common in women
-fatigue
-dyspnea
-feeling unease |
|
|
Term
| Physiologic responses to acute mental stress |
|
Definition
-Inc. catecholamines
-Inc. heart rate
-Inc. BP
-Dec. plasma volume
-Inc. Coronary constriction
-Inc. platelet activity |
|
|
Term
| Cardiac effects of acute mental stress |
|
Definition
-Inc. electrical instability
-Inc. demand
-Dec. supply |
|
|
Term
| Pathologic result of acute mental stress |
|
Definition
-VF/VT
-Ischemia
-Plaque rupture
-Coronary thrombosis |
|
|
Term
| Cardiac event of acute mental stress |
|
Definition
-Sudden cardiac death
-Myocardial infaction |
|
|
Term
| What is an acute coronary syndrome? |
|
Definition
| SUDDEN obstruction of myocardial blood supply |
|
|
Term
| What are the MI pathological classifications? |
|
Definition
-Subendocardial infarction
-Transmural infarction |
|
|
Term
| What are MI clinical classifications? |
|
Definition
-Non-ST segment elevation Non-STEMI
-ST segment elevation STEMI |
|
|
Term
|
Definition
| Cellular injury and death |
|
|
Term
| How long can cardiac cells be viable without oxygen? |
|
Definition
|
|
Term
| What is a good antiplatelet drug? |
|
Definition
|
|
Term
| Who has smaller vessels: Men or Women? |
|
Definition
|
|
Term
| What interval are you looking at on an EKG during MI? |
|
Definition
|
|
Term
| What Will myocardial ischemia lead to? |
|
Definition
|
|
Term
|
Definition
-Stent
-Bypass
-Thrombolytic agents
-Angioplasty |
|
|
Term
| Which arteries are used for bypass? |
|
Definition
-Greater saphenous (leg)
-Left internal mammary artery (chest wall) |
|
|
Term
|
Definition
|
|
Term
| What is acute coronary syndrome? |
|
Definition
| Sudden obstruction of myocardial blood supply |
|
|
Term
| MI pathological classification |
|
Definition
Subendocardial infarction
Transmural infarction |
|
|
Term
| MI clinical classification |
|
Definition
Non-ST segment elevation Non-STEMI
ST segment elevation STEMI |
|
|
Term
| How long can cardiac cells be viable without oxygen? |
|
Definition
|
|
Term
| Which type of MI is most severe? |
|
Definition
|
|
Term
| What does STEMI stand for? |
|
Definition
ST wave
Elevation
Myocardial
Infarction |
|
|
Term
| What does the name of an MI represent? |
|
Definition
| Locations of infarct (Subendocardial or Transmural) |
|
|
Term
|
Definition
-Monitor ECG changes
-Obtain serial cardiac markers |
|
|
Term
| What is the most specific cardiac marker? |
|
Definition
|
|
Term
|
Definition
-Elevated in 2-4 hours
-Remain elevated for 7-21 days
-If have elevated troponin = MI!! |
|
|
Term
|
Definition
-Actin, myosin
-Troponin-tropomyosin |
|
|
Term
| What are actin and myosin responsible for? |
|
Definition
|
|
Term
|
Definition
-Myocardial oxygen consumption
-Measured with MVO2 |
|
|
Term
|
Definition
| Myocardial Volume Oxygen (consumption) is a value that is frequently used to assess a patient's hemodynamic status. Specifically, this formula approximates the amount of oxygen used by the heart. This formula is also called the pulse pressure product. |
|
|
Term
|
Definition
-Obtain serial cardiac markers
-Treat hyperglycemia with insulin
-Provide stool softner
-Bed rest, gradual activity |
|
|
Term
| When will hyperglycemia occur post MI? |
|
Definition
|
|
Term
| Why do you provide a stool softener? |
|
Definition
| -so you don't increase BP or decreased HR with valsalva maneuver (straining) |
|
|
Term
| Why do you recommend gradual activity? |
|
Definition
| Don't want to put extra strain on heart muscle |
|
|
Term
| What does the QRS wave represent? |
|
Definition
| Ventricular depolarization |
|
|
Term
| What does the T wave represent? |
|
Definition
| Ventricular repolarization |
|
|
Term
| What does the P wave represent |
|
Definition
|
|
Term
|
Definition
-Normal
-Ischemia
-Injury (ST elevation)
-Infarction |
|
|
Term
|
Definition
| Consistent elevation of systemic arterial blood pressure |
|
|
Term
| What BP is considered hypertension? |
|
Definition
| Sustained elevation of 140/90 or higher |
|
|
Term
| What BP is considered prehypertension? |
|
Definition
|
|
Term
|
Definition
-AKA Essential or Idiopathic
-Genetic and environmental factors |
|
|
Term
|
Definition
| Caused by systemic disease that raises peripheral vascular resistance/cardiac output |
|
|
Term
| What is the most common type of hypertension? |
|
Definition
| Primary (90-95% of people with HTN) |
|
|
Term
| What BP is considered Isolated Systolic Hypertension |
|
Definition
| Sustained systolic BP >140; diastolic <90 |
|
|
Term
| What causes isolated systolic hypertension? |
|
Definition
-Increases in cardiac output
-Total peripheral vascular resistance
-Or both |
|
|
Term
| Which part of BP represents contraction? |
|
Definition
|
|
Term
| Which part of BP represents relaxation? |
|
Definition
|
|
Term
| Hypertension Risk Factors |
|
Definition
Family history
Age
Cigarette smoking
Obesity
Heavy alcohol consumption
Gender
Race – blacks
Excess sodium intake
Low potassium, calcium and magnesium
Glucose intolerance |
|
|
Term
|
Definition
-Genetics + Environment leads to:
-Vasoconstriction and renal salt water retention leads to:
-Inc. peripheral resistance and blood volume leads to:
-Sustained hypertension |
|
|
Term
|
Definition
-Chronic hypertensive damage to the walls of systemic blood vessels
-Smooth muscle cells undergo hypertrophy and hyperplasia with fibrosis of the tunica intima and media |
|
|
Term
|
Definition
-Rapidly progressive hypertension
-Diastolic pressure >140 mmHg |
|
|
Term
| What clinical conditions can malignant hypertension lead to? |
|
Definition
-Brain damage
-Heart damage (MI, angina, dysrhythmias)
-Kidney failure
-Blindness
-Pulmonary edema |
|
|
Term
| What are treatment options for hypertension? |
|
Definition
|
|
Term
|
Definition
-Decrease in systolic (20 mmHg or more) and diastolic (10 mmHg or more) blood pressure on standing
-Lack of normal blood pressure compensation in response to gravitational changes on the circulation
-Can be acute or chronic |
|
|
Term
| What conditions cause orthostatic hypotension? |
|
Definition
-Dehydration
-Heart problems (bradycardia and heart failure)
-Diabetes
-Nervous system disorders (Parkinson's, MS) |
|
|
Term
| Why do we need to maintain blood pressure? |
|
Definition
| Maintain tissue perfusion |
|
|
Term
| What effects BP regulation? |
|
Definition
-Mean arterial pressure (MAP)
-Cardiac output
-Total peripheral resistance
-Hyperemia
-Hormones
-Adrenomedullin
-Insulin
-Venous pressure |
|
|
Term
| Why is venous pressure important in blood pressure? |
|
Definition
| It brings volume back to the heart |
|
|
Term
| What is the pacemaker of the heart? |
|
Definition
|
|
Term
|
Definition
-Consists of a cluster of cells that are situated in the upper part of the wall of the right atrium (the right upper chamber of the heart)
-Where the electrical impulses are generated |
|
|
Term
|
Definition
-Cluster of cells situated in the center of the heart between the atria and ventricles
-Serves as a gate that slows the electrical current before the signal is permitted to pass down through to the ventricles
-Delay ensures that the atria have a chance to fully contract before the ventricles are stimulated |
|
|
Term
|
Definition
| -Collection of heart muscle cells specialized for electrical conduction that transmits the electrical impulses from the AV node to the point of the apex of the fascicular branches |
|
|
Term
|
Definition
| Provide electrical conduction to the ventricles, causing the cardiac muscle of the ventricles to contract at a paced interval |
|
|
Term
|
Definition
|
|
Term
|
Definition
-Onset of atrial activation to onset of ventricular activation
-Time from sinus node through the atrium, AV node, and His-Purkinje system to activate ventricular myocardial cells |
|
|
Term
|
Definition
| ventricular depolarizations |
|
|
Term
|
Definition
|
|
Term
|
Definition
| -"electrical systole" of the ventricles |
|
|
Term
| True or False: QT interval varies inversely with the heart rate |
|
Definition
|
|
Term
|
Definition
| Larger than normal stimuli could stimulate during this period |
|
|
Term
| Absolute Refractory Period |
|
Definition
| No stimuli could stimulate during this period |
|
|
Term
|
Definition
| Ability to generate spontaneous depolarization |
|
|
Term
|
Definition
| Regular generation of an action potential |
|
|
Term
|
Definition
-Disturbance in heart rhythm
-Occasional “missed” beats
-Rapid beats
-Severe disturbances
-Abnormal rate of impulse generation
-Abnormal impulse conduction |
|
|
Term
|
Definition
-Bradycardia
-Tachycardia
-Atrial flutter, fibrillation,
-Premature atrial contractions (PACs)
-Heart blocks
-Premature ventricular contractions(PVCs)
-Ventricular tachycardia
-Ventricular fibrillation
-Asystole |
|
|
Term
| Which rhythm is the most life-threatening? |
|
Definition
|
|
Term
|
Definition
1. Atrial systole
2. Ventricular systole
3. Ventricular ejection - semilunar valves open
4. Ventricular relaxation - closure aortic valve
5. Ventricular filling - opening of mitral valve |
|
|
Term
|
Definition
| Relaxation; blood vills ventricles |
|
|
Term
|
Definition
|
|
