Cardiovascular Pathophysiology

Question 1

Atherosclerosis

Answer 1

Hardening / lesions of arteries due to accumulation along intima in lumen of vessels of:

• smooth muscle cells
• connective tissue
• macrophages
• lipids
  
  • -> Calcification
    - -> Impairs blood flow

Stages:

1. Initiation/Formation
2. Adaptation
3. Clinical

• Could lead to:
  
  • MI
  • Cerebral infarct
  • Gangrene
  • Aneurysm
  • Occlusion / Ischemia
  • Thromboembolism

Question 2

Lesion

Answer 2

Abnormality in tissue – Atherosclerotic:

- Plaque
- Atheromas
- Fibrous plaques
- Fibro-fatty lesions

Contributing factors:

- Cytokines
- T lymphocytes
- Endothelium
- Thrombosis

Question 3

Atheroma

Answer 3

Arterial wall remodeling
–> area of thickened intima

*Can break off / rupture

Stages:

1. Initiation/Formation
2. Adaptation
3. Clinical

Question 4

Hyperplasia

Answer 4

Excessive cell growth

Question 5

Regression

Answer 5

Body fixes itself

Question 6

Infarct

Answer 6

Cell death caused by restricted blood supply to area

Question 7

Angiogenesis

Answer 7

New vascular formation / regeneration

Question 8

Risk Factors for Development of Atherosclerosis / CAD

Answer 8

• Smoking
• HTN
• Family Hx
• Sedentary lifestyle
• Obesity
• Diabetes
• Dyslipidemia (high LDL, low HDL)
• Age / Sex / Race
• Hot reactor
• High Homocysteine
• High C-Reactive protein

Question 9

CAD

Answer 9

(Coronary Artery Disease) - Ischemic Heart Disease
Deficit in O2 blood to myocardium

*Leading cause of death

Could lead to:

• Angina
• MI
• CHF
• Death

Question 10

HTN

Answer 10

(Hypertension)
Persistent elevation of blood pressure
*Risk factor for CAD

Stage I:
Systolic BP > 140mmHg
Diastolic BP > 90mmHg

Question 11

Obesity

Answer 11

BMI > 30kg/m2

*Risk factor for CAD

Question 12

Diabetes

DM

Answer 12

Impaired fasting glucose > 100mg/dL

*Risk factor for CAD

Question 13

Hypercholesterolemia

Answer 13

High blood cholesterol > 200mg/dL
LDL > 130mg/dL
HDL < 40mg/dL

*Risk factor for CAD

Question 14

Lipid Metabolism

Answer 14

Cholesterol is insoluble, so must be transported in blood bound to lipoproteins

Normal < 200mg/dL

VLDL
LDL - target of therapeutic treatment
HDL

Question 15

HDL

Answer 15

(High Density Lipoproteins) = Good cholesterol
Remove cholesterol from blood
–>liver for removal from body

Normal > 40mg/dL

Question 16

LDL

Answer 16

(Low Density Lipoproteins) = Bad cholesterol
Oxidized and taken up by macrophages to lesions

Normal < 130mg/dL

Question 17

Framingham Heart Study

Answer 17

Study to ID common factors contributing to CVD

Question 18

Raynaud Phenomenon

Answer 18

Intermittent, bilateral attacks of ischemia caused by cold and emotions

Question 19

Aneurysm

Answer 19

Weakening / bulge in wall of vessel

Question 20

DVT

Answer 20

(Deep Venous Thrombosis) *ACUTE
Blood clot formed in vessel of lower extremity
-Inflammatory response
-Constant pain

Question 21

PAD / PVD

Answer 21

(Peripheral Artery / Vascular Disease) *CHRONIC
Complication of atherosclerosis
-Pain with exertion, goes away with rest

Question 22

Coronary Arteries

Answer 22

Right: off anterior aorta
-In right AV sulcus

Left: off posterior aorta

• LAD
• Circumflex

Question 23

Angina

Answer 23

• Most common symptom of CAD
  
  • Caused by ischemia (75-90% occlusion)

Symptoms:

• Substernal pressure (feels like indigestion)
• Pain in L arm, jaw (toothache), scapula
• Ltd duration
• Worse with exertion, better with rest

Question 24

ACS

Answer 24

(Acute Coronary Syndrome)

Umbrella term for CAD symptoms

Question 25

MI

Answer 25

``` (Myocardial Infarction) Death of tissue due to prolonged ischemia, commonly from advanced atherosclerosis --> Decreased effectiveness and efficiency of the pump -Dec ventricular function (EF) -Dec contractility -Abnormal wall motion -Inc ESV / EDV -Inc LV ED pressure ``` Symptoms: - Prolonged angina - Cyanosis - Dyspnea (SOB) - Nausea - Diaphoresis - EKG changes *40% females - no angina

Question 26

Diaphoresis

Answer 26

Excessive sweating / perspiration

Question 27

MI: Immediate Mgmt

Answer 27

Dial 911, Chew aspirin ``` In ER: -EKG -Meds: Nitrates Morphine Antiarrhythmics Anticoagulants = bleed -Thrombolytics -Blood Labs -O2 ```

Question 28

Ischemic Heart Disease

Answer 28

Coronary Artery Disease (CAD)

Question 29

Alphabet Approach to Patient Management

Answer 29

A -antiplatelet - anticoagulant - ACE Inhibitor - Angiotensin receptor blocker B -beta blocker -BP control C -Cholesterol tx -Cig smoking cessation D -Diabetes mgmt -Diet E -Exercise

Question 30

ACE

Answer 30

(Angiotensin Converting Enzyme)

Question 31

Arrhythmia

Answer 31

Irregular heartbeat

Question 32

Physiological Controls of SV

Answer 32

(Stroke Volume) 1. Preload 2. Contractility 3. Afterload

Question 33

mVO2

Answer 33

Myocardial oxygen uptake (WORKLOAD of heart) = How much O2 needs to be delivered to myocardium for adequate function at any given time

Question 34

Preload

Answer 34

Physiological control of SV Degree of stretch of myocardial fibers prior to contraction -Dependent on venous return ^preload = ^mVO2 = ^SV

Question 35

Contractility

Answer 35

Physiological control of SV Increased interaxns of myofilaments at cross-bridges Increased Ca Increased SNS input ^Contractility = ^mVO2 = ^SV

Question 36

Afterload

Answer 36

Physiological control of SV Amount of pressure ventricles must overcome during systole to open semilunar valves and eject blood -If arterial pressure increases, so does afterload ^Afterload = ^mVO2 = Dec SV

Question 37

CHF

Answer 37

(Congestive Heart Failure) Heart unable to maintain adequate output to meet metabolic needs *Abnormally high atrial filling pressures * CO maintained by compensatory mech: - ^LV EDP - ^EDV - ^SNS stimulation

Question 38

Hypertensive Heart Disease

Answer 38

Cardiac hypertrophy secondary to prolonged systemic pressure overload

Question 39

Endocardial / Valvular Disease

Answer 39

Damage to valves, impairing their function --> Regurgitation (retrograde blood flow) Ex: MVP

Question 40

MVP

Answer 40

(Mitral Valve Prolapse) | Most common valvular disease

Question 41

Infective Endocarditis

Answer 41

Inflammation of the endocarditis with vegetations on valves --> Erosion --> Valvular Impotence *Bacterial or viral, IV drugs, catheters

Question 42

Cardiomyopathy

Answer 42

Primary noninflammatory myocardial disease *NOT attributable to pressure or volume overload 1. Dilated / Congestive --> CHF 2. Hypertrophic / ASH / IHSS --> thickened myocardium 3. Restrictive / Infiltrative --> ltd EDV --> CHF

Question 43

ASH

Answer 43

(Asymmetric Septal Hypertrophy)

Question 44

IHSS

Answer 44

(Idiopathic Hypertrophic Subaortic Stenosis)

Question 45

Congenital Heart Disease

Answer 45

Major heart disease within first decades 1. Acyanotic Group (No sys/pulm mixing) 2. Cyanotic Tardive Group (Sys/pulm shunt reversal 3. Cyanotic Group (Mixing of sys/pulm)