Week 4

Question 1

Collateral Circulation

Answer 1

• Additional arterial connections found in areas of occlusion
• Occurs in response to chronic ischemia
• Factors that influence: genetic predisposition, chronic ischemia

Question 2

Triggers of Inflammation

Answer 2

HTN: shearing
Tobacco: Nicotine releases catecholamines (epi)
Hyperlipidemia: High LDL, low HDL
Diabetes: Hyperglycemia thickens basement membranes, impacting integrity
Homocysteinemia: high AA byproducts of protein metabolism, inherited
Viruses and Toxins: cause endothelial dysfunction

Question 3

CAD risk factors

Answer 3

Nonmodifiable
- Age: more time for plaque to build
- Male: until age 65 when estrogen drops in females
- Family History: 1st degree relative with CAD or hypercholesterolemia
Modifiable
- Elivated serum lipids
- HTN
- Tobacco use
- Physical inactivitiy
- Obesity
Psychological risk factors (type A)

Question 4

Clinical Manifestations of Angina

Answer 4

• Pain: radiate to neck, jaw left arm, between scapula or down right arm
• Indigestion
• Fatigue or SOB or weakness
• Dizziness
• General anxiety
• Older adults: disorientation or acute confusion

Question 5

Clinical Manifestations of Myocardial Infarction

Answer 5

• Chest pain: radiating to left arm, severe, central, heaviness/tightness/indigestion (last longer than 20 mins)
• Dyspnea
• Skin: ashen, cool, diaphoretic (due to release of epi/norepi from ischemic heart cells)
• CVS: initialy high HR and BP, CO drops and then there is low BP, dysrhythmias
• GI: nausea and vomiting
• Atypical: weakness, fatigue, anxious, dizziness
• Older patients: sudden confusion and atypical
• fever (due to inflammation from cardiac death lasting up to a week)