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  1. features of cardiac pain
    • visceral in nature (V for Vague!!)
    • hard to localize
    • hard to describe
  2. features of pericardial pain/pericarditis
    • easier to localize
    • NOT made worse by palpation
    • made worse by lying supine
    • made better by sitting up/leaning forward
  3. issue with unprovoked MFTPs
    can imitate chest wall pain
  4. non-modifiable cardiovascular risk factors
    • 1. age (men 45+, women 55+)
    • 2. gender (more in men)
    • 3. premature CHD
    • 4. family history (male relative <55, female relative <65)
  5. most people with a strong family history of heart disease also have other risk factors
  6. normal laminar flow through a normal artery leads to:
    HIGH arterial wall stress
  7. Problem: decreased arterial stress
    from risk factors causing endothelial activation
  8. endothelial activation
    increase in endothelial permeability
  9. problem: sustained endothelial activation
    sustained risks lead to decreased arterial stress causing the endothelium to favor vasoconstrictina nd platelet aggregation
  10. most suseptible place for dysfunction???
  11. modifiable independent risk factors for cardiovascular disease
    • hypertension
    • smoking/tabacco
    • diabetes mellitus (#1!!)
    • sedentary lifestyle
    • body weight/obesity
    • left ventricular hypertrophy
    • cholesterol
    • hypertriglyceridemia
  12. significance and residual risk of: hypertension
    sig: the relationship is continuous and graded. no clear cut-off. can be partially reversed.

    residual: damage to the arterial endothemium. left ventrical hypertrophy.
  13. significance and residual risk of: tabacco smoking/environmental smoke
    sig: the risk is proportional to the # of cigs smoked and how deeply they're inhaled
  14. significance and residual risk of: diabetes mellitus
    sig: at risk even when blood glucose levels are under control

    residual: increased vascular permeability
  15. significance and residual risk of: left ventricular hypertrophy
    sig: effect of hypertension

    residual: change to ventricular myocardium
  16. LDL risk stratification
    • very high risk: prior heart attack/stroke
    • low risk: 0 or 1 traditional risks
  17. LDL target goals
    • very high risk: target <70
    • high risk: target <100
    • moderate risk: target < 130
    • low risk: target <160
  18. hypertriglyceridemia is caused by:
    • poorly controlled diabetes
    • obesity
    • excessive alcohol consumption
  19. hypertriglyceridemia can lead to:
    • fatty liver disease
    • pancreatitis
  20. acute arterial occlusion can be caused by:
    embolim or thrombi
  21. embolus:
    a mass traveling in the blood stream
  22. embolism:
    an embolus that lodges to obstruct a blood vessel
  23. emboli are most often associated with??
    ischemic heart disease from arterial fibrillation
  24. emboli typicall lodge in?
    • 50-80% in aortic bifurcation/legs
    • 20% in carotid arteries
  25. thrombus:
    a blood clot that remains attached at its origin
  26. thrombi occur at:
    the site of plaque
  27. thrombi are precipitated by:
    • inflammation of arterial wall
    • chronic mechanical irritation
  28. during episodes of increased oxygen demand, the myocardium:
    • has a limited ability to increase oxygen extraction
    • (in healthy people, the maximun is 4-6x resting flow)
  29. CFR in normal arteries
    -> increase in demand-> increase blood flow-> no problems
  30. CFR with plaque < 50%
    -> increase demand-> significant reduction in flow-> typical angina and Levines sign
  31. CFR with plaque >90%
    -> no increase in demand-> no CFR to increase flow-> angina at rest
  32. most common type of angina??
  33. typical angina due to?
    coronary artery plaque fron decreased CFR
  34. featurs of typical angina
    • reproducable pattern (same level of exercise to reproduce)
    • attacks start abruptly and seize the patient
    • retrosternal pain (poorly localized, visceral in nature, strangling)
    • attacks last 1-5 minutes
    • pain relieve by rest!
  35. other triggers of typical angina?
    • emotion
    • exposure to cold
    • heavy metals
    • (these triggers decrease the amount of exertion needed to cause the angina)
  36. is typical angina pain graded?
    no, it is always the same, severity does not change
  37. levines sign
    the patient holds a clenched fist of the sternum when describing/experiencing the discomfort.
  38. pattern of typical angina
    • pain radiates to the left shoulder/arm (typically!)
    • location can vary greatly for each individual but a persons angina is always in the same place/predictable
  39. when to suspect typical angina?
    pain anywhere from umbilicus to eyebrows that is provoked by exercise and relieved by rest
  40. atypical angina due to problems with?
    coronary or intramyocardial arteries (they have very low flow reserve since surrounded by heart muscle)
  41. coronary artery near normal....smoking cigs:
    Prinzmetal angina/coronary vasospasm-> angina at rest
  42. normal intramyocardial arteries
    normal coronary As--> good blood flow--> no problems
  43. dysfunctinal intramyocardial arteries:
    increased resistance-> less exertion needed-> angina at rest
  44. common symptons of atypical angina
    • shortness of breath
    • nausea
    • diaphoresis (sweating)
    • discomfort NOT in the chest
  45. atypical angina is common among:
    • older/female patients
    • diabetic patients
    • patients with hypertension
    • patients with collagen vascular disease
  46. patients with atypical angina are less likely:
    to recieve rapid/aggressive treatment. once hospitalized there is no difference in mortality rates
  47. prolonged myocardial ischemia= bad, bad, very bad
  48. acute coronary syndrome
    unstable cardiac symptoms that are happening in real time
  49. end results of acute coronary syndrome:
    • atypical angina
    • MI
    • death
  50. signs of acute coronary syndrome
    • abrupt onset
    • 14% with pleuritic pain
    • 33% without chest pain
    • non-pain angina equivalents (nausea, shotrness of breath, fatigue)
    • symp. activity (diaphoresis, pallor, pilomotor activity)
  51. problem with a physical exam of a patient with acute coronary syndrome?
    the exam might be normal!
  52. at risk for acute coronary syndrome:
    • older
    • women
    • diabetics
  53. compensated congestive heart failure
    C for comfortable!!
  54. risks for developing compensatory CHF
    • standard cardiovascular risks
    • history of previous MI
    • heart valve abnormalities
  55. compensatory mechanism of compensated CHF:
    • 1. catecholamines (symp. nervous system)
    • 2. retention of Na and H2O
    • 3. Cardiac remodeling
  56. types of cardiac remodeling
    • 1. dialated cardiomiopathy
    • 2. hypertrophic cardiomiopathy
    • 3. hypertrophic obstructive cardiomiopathy
  57. decompensated CHF
    • D for dying :(
    • inadequate cardiac output even at rest!= not comfortable
  58. dialated cariomiopathy
    • causes reduced contractability and systolic heart failure
    • most common form of heart failure
  59. symptoms of systolic heart failure:
    • abnormal apical impulse
    • cardiac heave (from prolonged contraction)
    • radiographic evidence of cariomegally
  60. hypertrophic cardiomiopathy
    causes muscle to be inelastic and non-compliant and diastolic heart failure
  61. sympoms of diastolic heart failure
    • right jugular vein distension
    • radiographic evidence of pulmonary venous hypertension
  62. signs of left ventricular failure:
    • breathlessness
    • dysphnea on exertion (may be absent in sedentary patients, not specific)
    • orthopnea (early warning sign)
    • paroxysmal nocturial dyspnea (patient is asleep, more specific to heart disease)
    • fatigue and weakness
    • nocturia
    • oliguria
    • cerebral symptoms
  63. orthopnea
    • occurs when patient is awake
    • develops/resolves rapidly
    • measured by the # of pillows needed to make the patient comfortable
  64. paroxysmal nocturnal dyspnea
    • patient is asleep
    • takes hours to develop
    • 30+ minutes for relief
    • "cardiac asthma" from pulmonary edema
  65. causes of right ventricular failure:
    • left sided CHF
    • Cor pulmonale (lungs)
  66. symptoms of right ventricular failure
    • peripheral edema
    • ascites
    • hepatomegaly
    • anasarca
  67. what to look for during a cardiac exam:
    • obvious physical findings are ominous in nature
    • symptomatic arrhythmias
    • symptomatic cardiac murmurs
  68. asculatory points
    • A PET Monkey
    • 1. Aortic valve: 2nd right ICS
    • 2. Pulmonic valve: 2nd left ICS
    • (3. Erbs point: 3rd left ICS)
    • 4. Tricuspid valve: 5th left ICS
    • 5. Mitral valve: 4th/5th left ICS
Card Set:
2011-10-13 19:46:30
PDX Test

cards for test 1
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