Term
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Definition
| What is the leading cause of death in the US? |
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Term
|
Definition
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Term
Heart rate
Contractility
Filling pressure (tone & volume) |
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Definition
| Three components of Cardiac Output (CO) |
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Term
Arterial diameter
Arterial length
Elasticity |
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Definition
| Three Components of Peripheral Resistance (PVR) |
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Term
Increase HR
Increase contractility
Increase Venous return |
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Definition
| How can you increase cardiac output? |
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Term
Vasodilation which can be achieved by:
Direct action on the vessels
Central control (CNS) action |
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Definition
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Term
Alpha 1 vascular receptors
Beta 1 cardiac receptors |
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Definition
| Two Sympathetic nervous system inputs |
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Term
|
Definition
Causes vasoconstriction
Triggers aldosterone production & release |
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Term
|
Definition
Most potent natural mineralocorticoid
Helps with sodium & fluid retention
Is also a cardiac growth factor |
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Term
Sympathetic receptor blocker
Renin-Angiotensin-Aldosterone inhibitors
Reduce blood volume via diuretics |
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Definition
| Hypertension Treatment Targets |
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Term
|
Definition
The main cause of cardiovascular disease
Refers to vascular narrowing due to fatty (lipid) deposits within arteries and arterioles |
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Term
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Definition
| What is arherosclerosis related closely to? |
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Term
Exogenous
Dietary consumption & absorption
Endogenous
Production of cholesterol in the liver |
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Definition
| Two Sources of Cholesterol: |
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Term
|
Definition
| macromolecule consisting of lipid and specialized protein |
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Term
| Low-Density-Lipoproteins (LDL) |
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Definition
| Transporter of endogenous cholesterol |
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Term
| High-Density-Lipoproteins (HDL) |
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Definition
Reverse cholesterol transport”
Removes LDL-cholesterol and triglycerides |
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Term
| Lowering LDL and raising HDL |
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Definition
| What are the best goals for lipids? |
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Term
Yes
No (for some strange reason "HDL paradox) |
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Definition
Do drugs that lower LDL reduce risk of arthroscelrosis?
What about drugs that raise HDL? |
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Term
|
Definition
| LDL-cholesterol accumulated under endothelium |
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Term
|
Definition
| Monocytes become macrophages which ingest oxidized LDL |
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Term
Women have higher levels of HDL
Estrogen is known to raise HDL |
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Definition
| Why is there a gender age difference in arthroscelrosis risk? |
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Term
Coronary
Angina pectoris
Congestive heart failure
Peripheral vascular disease
Renal artery stenosis
Femoral or popliteal stenosis
Aorta aneurysm formation |
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Definition
| What are the Chronic Effects of Atherosclerosis? |
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Term
|
Definition
| Most myocardial infarctions and strokes are caused by what? |
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Term
Lifestyle changes
Treat hyperlipidemia
Treat hypertension
Treat diabetes |
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Definition
| Atherosclerosis Treatment |
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Term
Niacin (nicotinic acid)
Bile acid-binding agents
Cholestyramine, Colestipol)
*** HMG-CoA reductase inhibitors
“Statins”(lovastatin, pravistatin et al)
Fibric acid derivatives
“Fibrates” (gemfibrozil, fenofibrate)
Inhibitors of sterol absorption |
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Definition
|
|
Term
Reduce endogenous cholesterol synthesis
Lowers LDL levels
Reduces risk of heart disease in proportion to decrease in LDL |
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Definition
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Term
Liver damage
Monitor hepatic enzymes during treatment
Muscle damage (Myopathy & Rhabdomyolysis)
Contraindicated:
Pregnancy
Children/Teens |
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Definition
| What are the Adverse Effects of The Statins? |
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Term
|
Definition
| Pressure at which flow first resumes in an occluded artery |
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Term
|
Definition
| Pressure at which flow returns to normal in an occluded artery |
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Term
|
Definition
| Persistent elevation of blood pressure to 140/90 or above |
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Term
|
Definition
Systolic of >130
Diastolic of >80 |
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Term
|
Definition
Rare tumor of adrenal medulla or sympathetic ganglia
Secretes high levels of norepinephrine |
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Term
|
Definition
| Main symptoms of Pheochromocytoma occur how? |
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Term
Severe headaches
Severe diaphoresis
Palpitations
Tremor
Anxiety |
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Definition
| What are the main symptoms of Pheochromocytoma? |
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Term
|
Definition
| Are there usually symptoms of hypertension? |
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Term
Reduce cardiac output
Reduce peripheral vascular resistance |
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Definition
|
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Term
|
Definition
| Drug groups that Lower blood volume |
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Term
| Sympathoplegic/adrenergic blocking agents |
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Definition
| Drug groups that Block alpha 1 and beta 1 action |
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Term
|
Definition
| Drug groups that Reduce peripheral vascular resistance |
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Term
| Inhibitors of renin-angiotensin-aldosterone system |
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Definition
| Drug groups that Reduce volume and peripheral resistance |
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Term
Toxicity & side effects from drugs
***Orthostatic hypotension |
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Definition
| What are the Risks of Going Too Low with BP? |
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Term
|
Definition
| At what blood pressure is hospitalization required? |
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Term
|
Definition
| Reduced/absent blood flow |
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Term
Hypotension
Chronic anemia
Increased Metabolism |
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Definition
| Insufficient Oxygen Transport can be caused by what? |
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Term
|
Definition
| Initial event is usually what in an acute myocardial infarction? |
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Term
| Acute Myocardial Infarction |
|
Definition
| Myocardial tissue death due to abrupt reduction in coronary blood flow |
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Term
| Chest pain, but up to 30 percent may have no pain *** |
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Definition
| Most patients complain of what in an Acute Myocardial Infarction? |
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Term
Blood pressure is at the diurnal peak
Increased viscosity due to overnight fast
Cortisol at secretion peak |
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Definition
| Why is there an increased risk of Acute Myocardial Infarction in the early morning hours? |
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Term
| ST-segment elevation myocardial infarction |
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Definition
|
|
Term
transmural ischemia***
Involves the full thickness of the cardiac wall |
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Definition
| What does a STEMI usually mean? |
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Term
| Non-ST-elevation myocardial infarction |
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Definition
|
|
Term
| Ischemia is usually subendocardial rather than transmural |
|
Definition
| What does a NSTEMI usually mean? |
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Term
Supportive measures
Rest
Oxygen
Sedation & analgesia
Control arrhythmias
Anticoagulation
Heparin
Antiplatelet agents |
|
Definition
|
|
Term
Most important: Reperfusion! ***
Percutaneous coronary intervention (PCI)
Thrombolytic therapy
Additional measures:
Aspirin: 325mg ASAP
Oxygen per nasal cannula
Reduce myocardial oxygen demand
Control arrhythmias |
|
Definition
|
|
Term
PCI rather than thrombolytic
Early intervention *** |
|
Definition
| What is preferred in STEMI treatment? What is Key in STEMI treatment? |
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Term
Cardiac arrhythmia
Ventricular fibrillation
Massive infarction
Cardiogenic shock |
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Definition
| Main Causes of MI Mortality |
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Term
Stable angina
Unstable angina
Variant (Prinzmetal’s) |
|
Definition
| What are the 3 Faces of Angina Pectoris |
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Term
|
Definition
Type of angina characterized by Recurring episodes of chest pain
Brought on by exertion or stress
Relieved by rest |
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Term
|
Definition
| Type of angina characterized by occurring with minimal activity or at rest |
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Term
|
Definition
Type of angina characterized by atypical characteristics
Extreme fatigue with minimal exertion |
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Term
|
Definition
| What is stable angina caused by? |
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Term
| Congestive Heart Failure (CHF) |
|
Definition
Cardiac function insufficient to meet metabolic and blood flow requirements
The ventricular ejection fraction is reduced*** |
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Term
|
Definition
| What is the incidence doing in CHF? |
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|
Term
Chronic ischemia damages myocardium
Remodeling*** occurs which results in progressive cardiac enlargement (cardiomegaly)
Overstretching of the myocardium reduces ventricular function which leads to…
Fluid overload, increased BP
More Ischemia |
|
Definition
|
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Term
|
Definition
| air hunger; shortness of breath |
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Term
|
Definition
| Inability to sleep supine without dyspnea |
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Term
| Idiopathic Cardiomyopathy |
|
Definition
Usually seen in young & healthy adults
Usually follows a precipitating event
Viral infection
Pregnancy and delivery
Spontaneous remission is common but…
Severe cases may require cardiac transplantation |
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Term
|
Definition
Valvular defects can lead to myocardial stress, damage and ultimate CHF
Shunts can allow significant amounts of blood to bypass the lungs
Blood is under oxygenated
Results in cyanosis, stunting of growth and shortness of breath |
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Term
|
Definition
| Seen in kids, low blood pressure in LE, high blood pressure in UE |
|
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Term
Overriding Aorta
Pulmonic Stenosis
Ventricular septal defect
Right ventricular hypertrophy |
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Definition
|
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Term
|
Definition
| Formation of a blood clot in an intact vessel |
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Term
|
Definition
| Thrombus that dislodges and travels to a distant site where it occludes an arterial vessel |
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Term
|
Definition
| Venous thrombus that embolizes to a pulmonary artery |
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Term
Venous stasis
Hypercoagulability
Vascular injury |
|
Definition
|
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Term
|
Definition
| Swelling or distention of an arterial segment |
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Term
|
Definition
| What portion of the aorta is most susceptible to aneurym? |
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Term
|
Definition
| Ratio of m/f abdominal aneurysm? |
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|
Term
Back pain
Abdominal pulsating mass |
|
Definition
| What are the early symptoms of abdominal aneurysm? |
|
|
Term
Surgical resection
Endovascular repair |
|
Definition
| What is the treatment of abdominal aneurysm? |
|
|
Term
Disturbances in impulse formation
Disturbances in impulse conduction
Both of the above |
|
Definition
| What is the Immediate Cause of Arrthythmias? |
|
|
Term
Correct causes of electrical impulse abnormalities
Ablate (destroy) areas where abnormal impulses originate
Use drugs that affect ion channels |
|
Definition
| Arrthythmia Treatment strategies |
|
|
Term
Na+ Channel Blockers
Quinidine,Procainamide, Lidocaine |
|
Definition
| Class I Antiarrhythmic Agents |
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|
Term
Beta Blockers
Esmolol, Propanolol, Pindolol |
|
Definition
| Class II Antiarrhythmic Agents |
|
|
Term
K+ Channel Blockers
Sotalol, Amiodarone, Bretylium |
|
Definition
| Class III Antiarrhythmic Agents |
|
|
Term
Ca++ Channel Blockers
Diltiazem, Verapamil |
|
Definition
| Class IV Antiarrhythmic Agents |
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Term
|
Definition
Useful in treatment of:
Ventricular tachycardia & fibrillation
Atrial fibrillation
Side effects numerous:
Pulmonary fibrosis (1% incidence)
Liver toxicity
Blocks T4 to T3 conversion
Photodermatitis (blue-gray skin)
Thyroid dysfunction |
|
|
Term
| No, they can also cause arrhythmias |
|
Definition
| Are anti-arrhythmic drugs useful as a preventative measure? |
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Term
|
Definition
| Most Common Chronic Arrhythmia |
|
|
Term
|
Definition
Loss of normal artial contraction causes 20-30% drop in left ventricular output
Ventricular rate becomes rapid and irregular
Pulse is “irregularly irregular” |
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Term
|
Definition
Clot development in enlarged left atria
Can cause embolic stroke |
|
|
Term
Rate control
Beta blockers
Digoxin
Restore sinus rhythm
Cardioversion
Atrial ablation
Anticoagulation
Warfarin (Coumadin)
Dabigatrin (Pradaxa)
Apixaban (Eliquis) |
|
Definition
| Atrial fibrillation treatment |
|
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Term
|
Definition
Pain with exercise (usually walking)
Relieved with rest |
|
|
Term
| Peripheral Occlusive Disease |
|
Definition
| Plaque buildup in a peripheral artery |
|
|
Term
Medical treatment:
Lifestyle changes
Hypertension and lipid treatement
Evaluate for coronary disease ***
Surgical treatment:
Bypass grafts |
|
Definition
| Treatment for peripheral occlusive disease |
|
|
Term
Narrowing, partial occlusion: “stenosis”
Leaking: “regurgitation”
Mitral valve prolapse
Valve infection: “endocarditis” |
|
Definition
|
|
Term
Mitral stenosis, mitral regurgitation
Tricuspid stenosis, tricuspid regurgitation
Aortic stenosis, aortic regurgitation
Pulmonic stenosis, pulmonic regurgitation |
|
Definition
|
|
Term
|
Definition
| What is often the first symptom of valvular disease? |
|
|
Term
|
Definition
| Most common form of valvular heart disease |
|
|
Term
Symptoms:
None for mild stenosis
Syncope
Chest pain (angina)
Dyspnea |
|
Definition
| Symptoms for aortic stenosis |
|
|
Term
If no symptoms: normal
If symptoms:
50% chance of death in 5 years
90% chance of death in 10 years |
|
Definition
| Aortic Stenosis Prognosis |
|
|
Term
|
Definition
mmunologic complication of streptococcal infection
Peak age of incidence: 5 – 15
Damage to valves can begin 1 – 5 weeks after infection
Mitral valve most commonly affected ( 75%) |
|
|
Term
Mitral valve (75%)
Aortic valve (20-30%) |
|
Definition
| What are the number one and number two most commonly affected valves by rheumatic carditis? |
|
|
Term
| “SBE”: subacute bacterial endocarditis |
|
Definition
Life threatening infection of a heart valve
Organisms in blood stream (bacteremia) lodge on the valve |
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|
