Pathophys Test 2

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Author:
cgordon05
ID:
12836
Filename:
Pathophys Test 2
Updated:
2010-04-01 23:07:43
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Cardiac action potential & lipoproteins
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Cardiac action potential & lipoproteins
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  1. Know mechanism for plateau phase of action potential in cardiac cells.
    • Cardiac cells have plateau phase
    • - Leveling off of repolarization prolongs period of depolarization (electrical excitation)
    • - Duration of action potential (AP) longer
    • - Ensures all cells of ventricles excited at approximately same time so ventricular muscles contract as unit
    • - If no plateau, heart is not an efficient pump
    • Inward movement of Ca2+ - maintain plateau
    • - Channels activated by depolarization
    • - Open when potential reaches -30mV
    • - Influx of Ca2+ important in initiating contraction of cardiac muscle just like skeletal muscle
  2. What measures would you recommend to patients in effort to lower LDL-C and increase HDL-C? (p.22)
    • Decrease SFA and cholesterol in diet
    • Niacin – to decrease liver synthesis of VLDL
    • Exercise – to increase HDL
    • Moderate alcohol intake
    • Cholesterol lower drugs (Statins)
  3. What measures would you recommend to lower TG?
    • Weight loss if overweight
    • Exercise
    • Decrease intake of SFAs
    • Substitute MUFAs for SFAs, but do not increase total calories
    • Limit CHO to 55% of calories or less
    • o Consume more complex CHO like whole grains, fruits, vegetables
    • o Limit simple sugars in sweets and soft drinks
    • Avoid alcohol
    • Fish oil supplements (omega-3)
    • Niacin
  4. Know risk factors for heart disease and mechanisms involved. (p.21-25)
    • Family history of premature coronary heart disease
    • Age – male >= 45; female >=55
    • Personal history of peripheral or cerebrovascular disease
    • Cholesterol levels
    • Hypertriglyceridemia (fasting)
    • Hypertension
    • Cigarette smoking
    • Diabetes
    • Obesity
    • Metabolic syndrome
    • Physical inactivity
    • Diet
    • Hyperhomocysteinemia
    • CRP
    • Lipoprotein a
    • Chronic infection
    • Type A behavior
  5. Know specific values recommended for LDL-C, HDL-C, Total cholesterol, TG, Fasting plasma glucose:
  6. Review JNC hypertension guidelines and know most recent AHA recommendations. (p.22-23)
    • Hypertension = BP > 140-90 mmHg
    • Normal = 120/80 mmHg
    • Pre-hypertension = 120-139 / 80-89
    • Stage 1 HTN = 140-159 / 90-99
    • Stage 2 HTN = SBP > 160; DBP > 100
    • Treatment goal for HTN patients:
    • o Target < 140/90
    • o With renal disease or diabetes < 130/80
  7. Review pathophysiology of atherosclerotic process – from soft lipid “unstable” atheromatous plaque to fibrous plaque to complicated advanced calcified plaque. (p.26-28)
    • Initiating step – development of “fatty streak” – atheromatous soft-lipid plaque
    • Followed by formation of fibrous plaque
    • Ultimately an advanced-complicated lesion
  8. What stage of plaque development most likely (vulnerable) to rupture and thrombus? (p.27)
    • Smaller ones
    • Activated foam cells (fat-filled macrophages) at margins of small lipid plaques secrete enzymes that disrupt integrity of thin fibrous cap, making plaque vulnerable to rupture

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