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ischemic heart disease
ischemic heart disease
82
Anatomy
Graduate
05/23/2012

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Term
what is atherosclerosis
Definition
plaque formation on the inner wall of the artery. Forms a layer of scar tissue that progressively increases, occluding the lumen of the artery
Term
what is the most commonsite of atherosclerosis
Definition
brain
Term
what is the second most common target site of atherosclerosis
Definition
heart
Term
what is the 3rd most common site of atherosclerosis
Definition
kidney
Term
what is the 4th most common site of atherosclerosis
Definition
aorta and associated peripheral vessels
Term
how can arterial spasm affect plaque in the arteries
Definition
arterial spasms may cause acute changes/symptoms as plaque breaks off
Term
how can acute increase in BP from exercise or anxiety affect plaque
Definition
causes shearing forces on plaque, leading to breaking off of plaque into the arteries
Term
what does CAD stand for
Definition
coronary artery disease
Term
what do we call documented arterial disease
Definition
atherosclerosis
Term
about how much of the artery must be stenosed before signs and symptoms occur
Definition
70.00000%
Term
what is the gold standard test for documenting that there is arterial disease/coronary artery disease
Definition
catheterization
Term
in coronary artery disease, what do clinical signs and symptoms indicate
Definition
myocardial ischemia
Term
how is myocardial ischemia experiencec
Definition
angina
Term
what are the 2 types of angina
Definition
stable, unstable
Term
which type of angina occurs at a predictable heart rate or workload
Definition
stable angina
Term
which type of angina occurs at unpredictable heart rates or workloads
Definition
unstable angina
Term
which type of angina is identified through stress testing and is maximally medically treated with cardiac meds
Definition
stable angina
Term
which type of angina is not maximally medically controlled or treated
Definition
unstable angina
Term
which type of angina will be documented in a patient's medical record
Definition
stable angina
Term
which type of angina may or may not be documented in a patient's medical record
Definition
unstable angina
Term
for which type of angina can a patient take NTG if it has been prescribed
Definition
both
Term
if the patient has been prescribed NTG, what should we do as PTs
Definition
be sure they have it with them and that it is not expired and tell them to bring it with them to every treatment
Term
patients with which type of angina are candidates for cardiac rehab and exercise training
Definition
stable angina
Term
what causes angina
Definition
ischemia in the heart muscle when the artery is more than 70% blocked.
Term
why is there referred pain in angina
Definition
autonomic and systemic nerve plexus integration for the heart muscle
Term
are patients with unstable angina candidates for cardiac rehab or exercise training?
Definition
no
Term
what should you do if a patient has angina and it is not documented as stable angina
Definition
thoroughly document the note and refer her back to her physician
Term
what is the difference between MI and angina (list descriptions of MI)
Definition
MI is partial or complete blockage of coronary artery. Irreversible damage occurs. Chest pressure/pain lasts hours (not minutes) and is not relieved by nitroglycerin or rest. The evolution of damage is ischemia, injury, infarct. Diagnosed with EKG and enzymes in blood
Term
what is the difference between MI and angina (list descriptions of angina)
Definition
pain lasts a matter of minutes. Pain relieved by nitroglycerin and/or rest. Cell death (infarction) does not occur. If chronic stable angina, it is evoked by increased myocardial demand at established level of onset. If unstable angina, it's not associated with demand and is unpredictable
Term
if a patient gets angina at 108 HR, what HR should you exercise them at?
Definition
below 108
Term
when a patient having a myocardial infarction first presents with ischemia, what are the clinical signs
Definition
ST segment depression or downsloping. May represent clinically as angina
Term
is the initial ischemic part of MI reversible, or does it cause damage?
Definition
no damage. Reversible
Term
when does injury occur in an MI
Definition
2 weeks to 1 year
Term
what happens in the injury phase of an MI
Definition
the infarction has happened and the heart goes into a healing phase
Term
is there permanent myocardial damage in the injury phase of a heart attack
Definition
yes
Term
is the injury phase of an MI reversible
Definition
no
Term
how does the ST segment change on an EKG in the injury portion of an MI
Definition
elevated
Term
how do T waves appear during the injury phase of an MI on an EKG
Definition
inverted
Term
how do we know that a patient is in the injury phase of an MI
Definition
changes in blood enzyme levels
Term
what 3 enzymes have elevated levels in the injury phase of an MI
Definition
CPK, LDH, troponin
Term
what does CPK stand for
Definition
creatine phosphokinase
Term
when does CPK increase following MI
Definition
increases within 3-6 hours, normalizes in 3 days
Term
what does LDH stand for
Definition
lactate dehydrogenase
Term
when are LDH levels in the blood elevated following MI
Definition
peaks within 48-72 hours, remaind elevated for 11 days
Term
why are there elevated plasma concentrations of troponins T and I following MI
Definition
they are muscle proteins released by damaged myocardial cells
Term
how does the EKG wave change following infarction
Definition
significant Q wave
Term
when does the Q wave of an EKG change (how long after infarction)
Definition
months
Term
how can you tell from an EKG that a patient has had an MI at some point in the past
Definition
significant Q waves remain forever on the EKG
Term
what determines the seriousness of an MI
Definition
depends on where the damage occurs
Term
how do EKGs point to the area of the MI
Definition
there are 12 leads that we can see from doing a complete EKG. On certain leads, if we see abnormalities on the EKG, that points to locations of the MI
Term
if the leads affected are V2, V2, where is the MI
Definition
anteroseptal
Term
if the leads affected are V1-4, where is the MI
Definition
anterior
Term
if the leads affected are II, III, aVF, where is the MI
Definition
inferior
Term
if the leads affected are I, aVL, where is the MI
Definition
high lateral
Term
which MI location is the least clinically significant
Definition
inferior
Term
what is at the inferior part of the heart
Definition
apex, bottom of right ventricle
Term
which MI location is moderately signficatn
Definition
partial-thickness MI
Term
what does partial thickness MI mean
Definition
the MI goes partially through the thickness of the heart muscle
Term
what is the most serious type of MI
Definition
transmural
Term
where is a transmural MI/what part of the heart does it go through
Definition
transmural goes through entire thickness of the heart muscle from epicardium to endocardium
Term
what is a subendocardial MI and what are the outcomes
Definition
subendocardial affects the inner surface of the heart muscle. Ominous outcomes
Term
what is a silent MI
Definition
patient doesn't know they had a heart attack
Term
in what populatoin are silent Mis common
Definition
diabetics
Term
what is usually the outcome of a silent MI
Definition
poor
Term
what factors predispose MI by increasing myocardial demand
Definition
anything that increases HR, contractility, myocardial wall tension such as: heat, cold, shock, hypoxia, stress, fear, exercise, ischemia, arrhythmias, etc. in the setting of atherosclerosis and risk factors
Term
what are major risk factors for coronary artery disease
Definition
hypertension, tobacco smoking, dyslipidemia, sedentary lifestyle, obesity
Term
what are contributing risk factors for CAD
Definition
diabetes, family history, age, gender, stress, metabolic syndrome, ETOH abuse, cocaine use, C-reactive protein, homocysteine
Term
what are C-reactive protien and homycysteine
Definition
enzymes in the body that are connected to heart disease and pulmonary disease
Term
what are modifiable risk factors for CAD
Definition
hypertension, tobacco smoking, obesity, sedentary lifestyle, excessive emotional stress, dyslipedmia, diabetes, stress, metabolic syndrome
Term
what are nonmodifiable risk factors for CAD
Definition
age, gender, family history
Term
what are signs/symptoms of metabolic syndrome
Definition
increased waist circumference, elevated triglycerides, reduced HDL, high blood pressure, high fasting glucose
Term
how does exercise affect the risk of MI
Definition
exercise temporarily increases myocardial demand, therefore there is a transient increased risk of MI during exercise. The more fit, the less risk of event even during exercise. decreased risk of MI at all other times if you exercise regularly.
Term
how does exercise affect SBP and DBP
Definition
decreases resting SBP and DBP
Term
how does exercise affect HDL cholesterol
Definition
increases
Term
how does exercise affect LDL
Definition
decreases
Term
how does exercise affect total cholesterol
Definition
decreases
Term
how does exercise affect triglycerides
Definition
decreases
Term
how does exercise affect blood glucose
Definition
normalizes it
Term
how does exercise affect platelet aggregability
Definition
decreases it
Term
how does exercise affect body fat
Definition
reduces it
Term
what is the medical management summary for an MI
Definition
control pain of angina; mechanical opening of vessel/return of blood flow; decrease platelet adhesion/aggregation; anticoagulants; lipid lowering drugs; manage blood pressure; acutely administer oxygen, thrombolytics
Term
what are new horizons for preventing MI
Definition
prevention measures, stricter cholesterol and BP guidelines, aggressive drug therapy for BP and cholesterol, increased drug therapy to decrease platelet adhesion and/or decrease risk of re-occlusion; diet/exercise; stem cell, genomic research
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