Term
| 5 Cardiovascular Diseases |
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Definition
Coronary Artery Disease (CAD, CVD)
Ischemic Heart Disease (IHD, CHD)
Hypertension (HTN)
Peripheral Vascular Disease (PVD)
Stroke (generally ischemic) |
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Definition
| obstruction but doesnt affect heart function |
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Term
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Definition
L coronary a
R coronary a
L circumflex a |
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Term
| Myocardial Blood Flow Determinants |
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Definition
Diastolic BP
Resistance
Vasomotor Tone
LV End-diastolic pressure |
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Term
Atheroslcerosis
(process) |
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Definition
active process involving molecular signals that produce altered cellular behavior and endothelial dysfunction with subsequent inflammation.
(starts with an injury, shearing of the arterial wall, tearing, inflammation, intima and media get LDLs deposited between the layers) |
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Term
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Definition
Fatty Streak (lipid deposits)
*aorta and coronary arteries |
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Term
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Definition
fibrotic (fibrous plaque: increase collagen level, medial elastin destruction, change in fibrous protein composition)
*stable vs. unstable, progression based on risk factors |
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Term
| Atherogensis Chain of Effect |
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Definition
Endothelial injury with increased infiltration of atherogenic lipoprotein(LDL, VLDL)
Sub endothelial retention and modification of LDL,VLDL leads to intimal entry of monocytes and T lymphocytes
Subintimal diffusion of monocytes to macrophage which internalize LDL ,transform into foam cells (First stage of fatty streak development)
Haemodynamic stress or inflammatory process activate PDGF which will stimulate SMCs ending by having atherosclerotic plaque separated from blood by fibrous cap
Death of foam cells by necrosis or apoptosis lead to necrotic core formation
Rupture of fibrous cap, exposure of thrombogenic substrate, subsequent arterial thrombosis |
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Term
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Definition
| smooth muscle cells, macrophages, foam cells, lymphocytes, collagen, elastin, proteglycans, neovascularization |
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Term
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Definition
| cell debris, cholesterol crystals, foam cells, calcium |
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Term
| Mechanism of Vascular Response to Injury |
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Definition
blockage of signaling
build of gunky yellow necrosis
higher shear of blood flow
gross necrotic tissue can rupture and spill out into vessel |
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Term
| Progression of Atherosclerosis |
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Definition
normal artery
fatty streak
fibrofatty plaque
advanced/vulnerable plaque
clinical phases:aneurysm and rupture, occlusion by thrombosis, critical stenosis |
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Definition
gooey is bad
hard fibrous cap = contained and able to be stinted |
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Term
| What is the most powerful contributor to cardiovascular disease? |
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Definition
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Term
| Classification of Hypertension: Normal |
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Definition
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Term
| Classification of Hypertension: Pre-hypertension |
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Definition
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Term
| Classification of Hypertension: Stage 1 |
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Definition
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Term
| Classification of Hypertension: Stage 2 |
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Definition
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| Classification of Hypertension: Stage 3 |
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Definition
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Term
| Classification of Hypertension: Stage 4 |
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Definition
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Definition
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Definition
With activity drop in BP 20 mmHg SBP
or 10 SBP and 10 DBP
chronotrophic incompetence |
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Term
| Hypertension: PT Intervention |
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Definition
avoid valsalva movements
aerobic ex
4-7x's a week
30-45 min
60-85% HR max
RPE |
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Term
| Ischemic Heart Disease: Clinical Presentations |
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Definition
Chronic stable angina
Unstable angina (STOP EX's!)
Myocardial infarction
Silent ischemia
Arrythmia
Sudden death |
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Term
| Typical Signs and Symptoms of a Heart Attack |
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Definition
pain radiating down left arm
females: unusual fatigue, disturbed sleep, shortness of breath, indigestion, anxiety, chest discomfort |
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Definition
| isoelectric line dropping |
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Definition
characterized by chest pain
transient hypoxia
relieved with activity change or SLNG |
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Definition
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Term
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Definition
Circadian variation (4 hours) in catecholamine levels
Increases HR and BP
Increased platelet activation
Pathologic changes in atherosclerotic plaques |
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Term
| Unstable Angina: notify physician if... |
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Definition
Angina at rest
Typical angina occurs at lower exertion
Deterioration of previously stable pattern
Physiological changes
Drop in HR or BP with usual exercise |
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Term
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Definition
Only at rest
ST segment elevation on EKG
increased coronary vasomotor tone or spasm |
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Term
| Prinsmetal Angina: Treatment |
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Definition
nitrates+calcium channel blockers
usually avoid beta blockers(alpha adrenergic activity and worsening vasoconstriction) |
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Term
| MI: pathological diagnosis |
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Definition
| requires evidence of myocyte death as a consequence of prolonged ischemia. |
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Term
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Definition
| requires an integrated assessment of history and combination of indirect evidence of myocardial necrosis using biochemical, EKG, and imaging modalities |
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Definition
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Definition
in at least 2 consecutive leads
>2mm in leads V1, V2, V3
>1mm in all other leads
indicates an occlusion in a large vessel and therefor a large area is at risk
*cardiac emergency* |
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Term
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Definition
findings of MI, without ST elevation on EKG.
Not always, but may represent smaller area, or high grade lesion, without total occlusion.
*better outcome: smaller vessel* |
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Term
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Definition
Onset: 3-4 hours
Peak: 33 hours
Return to normal: 3 days |
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Term
| Cardiac Markers: Troponins |
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Definition
Onset: 3-12 hours
Peak: 18-24 hours
Return to norm: up to 10 days |
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Term
| Cardiac Markers: Myoglobin |
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Definition
Onset: 1-4 hours
Peak: 18-24 hours
Return to normal:- |
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Term
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Definition
Onset: 12-24 hours
Peak: 72 hours
Return to normal: 5-14 days |
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Definition
EKG: II, III aVF
Artery: R Coronary |
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Definition
EKG: I, aVL, V5, V6
Artery: LAD or circumflex |
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Term
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Definition
EKG: V1-V2, tall broad initial R wave, ST depression, Tall upright T wave
Artery: Posterior Descending |
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Term
| Largest most damaging infacrtion |
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Definition
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Term
| What effect does inactivity have? |
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Definition
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Definition
Oxygen- increase oxygen saturation, and delivery
Nitroglycerin- decrease myocardial oxygen demand, vasodilator.
Aspirin/Clopidrigrel- anti-platelet
Heparin/enoxaparin- anticoagulation
Pain relief
Revascularization |
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Term
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Definition
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Term
| Treatment: Coronary Artery Bypass |
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Definition
internal mammary artery bypass
saphenous vein bypass |
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Term
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Definition
| inhibit sympathetic stimulation |
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Term
| Treatment: calcium channel blockers |
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Definition
| if beta blockers are not effective |
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Definition
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Definition
| decrease production of cholesterol in liver, anti-inflammatory |
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Term
| Disease Specific Effects on Physiological responses and Fitness: Chronotropic Incompetence |
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Definition
| Failure to reach 85% of APMHR in the absence of β-blockers or other medications with similar effects |
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Term
| Disease Specific Effects on Physiological responses and Fitness: Abnormal heart rate recovery |
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Definition
| A decrease in HR of <12 bpm at 1 minute of ACTIVE RECOVERY or <22 bpm at 2 minutes of supine recovery |
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Term
| Disease Specific Effects on Physiological responses and Fitness: BP |
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Definition
| In the absence of β-blockers or ACE inhibitors, a failure of systolic BP to rise in proportion to exercise intensity |
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Term
| Disease Specific Effects on Physiological responses and Fitness: cardiac output and oxygen uptake |
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Definition
| The reduction in VO2 is SELDOM the result of decreased oxygen extraction but rather is the result of decreased oxygen delivery |
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Term
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Definition
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Term
| The Fick Equation: compromised cardiac functioning |
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Definition
| a-vO2 allows resting VO2 to be maintained |
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Term
| The Fick Equation: if cardiac output cannot increase |
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Definition
| oxygen extraction can achieve a small increase in VO2 at the onset of exercise, but not enough to sustain exercise for an increased duration |
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Term
| incidence of cardiac arrest survival to discharge |
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Definition
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Term
| causes of post-cardiac arrest damage |
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Definition
Free Radical formation (increase in ROS)
Activation of apoptotic pathways
Activation of inflammatory pathways |
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Term
| most common cause of cardiac arrest |
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Definition
| 60-70% of cardiac arrest occurs in individuals with coronary artery disease |
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Term
| sustainable cardioprotection |
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Definition
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Term
| exercise vs. ischemic preconditioning |
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Definition
IPC: Regulated by iNOS and COX-2
EPC: Regulated by ? HSP72 ? |
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