exam 4

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  1. Artery carrying blood from the left outdside around to the back outside of the heart
    circumflex artery
  2. Artery carring blood from the right outside around to the back of the heart
    right coronary artery
  3. Left outside arter carrying blood down to the lobe
    left anterior descending artery
  4. Valve in the left side that allows flow from the atrium to the ventricle.
    Mitral valve (left "atrioventricular valve)
  5. The valve on the right side of the heart that allows blood flow from the atrium to the ventricle.
    Tricuspid valve ( atrioventricular valve)
  6. Valve on the right side of the heart that allows blood flow out to the pulmonary artery
    pulmonery semilunar valve
  7. Valve on the left side of the heart that regulates blood flow out to the aorta
    aortic semilunar valve
  8. General pressure range of the right atrium
  9. end diastolic range of the right ventricle
  10. systole range of the right ventricle
  11. diastole range of the pulmonary artery
    3-12 mmhg
  12. systole range of pulmonary artery
  13. end diastolic range of the left ventricle
  14. systole range of the left ventricle
  15. general pressure range of the left atrium
  16. systole range of the aorta
    96-140 mmhg
  17. diastole range of the aorta
    60-90 mmhg
  18. what effect does the vagus nerve have on the heart
    cholenergic effect, slows the heart
  19. what effect does the sympathetic system have on the heart
    adrenergic - speeds up the heart
  20. what four systems, that regulate arterial pressure, affect the BP
    • adrenergic system
    • renal function
    • hormonal function
    • vascular function
  21. dysfuntion of the adrenergic, renal fx, hormonal fx, and the vascular fx will lead to what
  22. What is Cardiac output and the formula
    Volume of blood flowing through either systemic or pulmonary circuit.

    CO (in L/min) = HR (beats/min) X stroke vol. (L/beat)
  23. What is the normal ejection fraction
  24. Normal ventricular end-diastolic volume (VEDV)
    70-80 mls
  25. stroke volume / end diastolic volume
    ejection fraction
  26. The load on the heart at the end of diastole (just before systole)
  27. resistance to ejection during systole

    determines the force that the contracting heart must generate to eject blood

    affected by peripheral vascular resistance and arterial pressure and pulmonary vascular resistance
  28. what is the major dietary lipid
  29. four main groups of lipids
    • triglycerides
    • cholesterol
    • phospholipids
    • fat soluble vitamins
  30. protein-lipid complex that carries cholesterol to cell for membranes and other uses
  31. produced by intestines, travel through lymph to thoracic duct into veins at jugular/subclavian jct

    carry triglycerides and some cholesterol to tissues

    very large (0.8 - .6 microns)
  32. produced by the liver

    carry triglycerides, cholesterol, and phospholipids

    after triglyceride is avsorbed, VLDL remnnt = IDL
    VLDL (very low density lipoprotein)
  33. VLDL remnant
    much of triglycerideds are gone
    increase % of cholesterol and phospholipids
    IDL - intermedicate density lipoprotein
  34. major cholesterol carriers

    almost all triglycerides are gone

    thus, increase % of cholesterol and increase phospholipids
    LDL (low density lipoproteins)
  35. produced by liver

    carry cholesterol away from cells to liver, where it is excreted

    high in protein (50%) low in cholesterol and phospholipids
    HDL (high density lipoproteins)
  36. unemulsified lipids are processed where
    GI Tract
  37. emulsifying and lipolytic agents
    bile acids, fatty acid, monoglycerides, licithin, protein, and pancreatic lipase
  38. Three factors of micelle formation and absorption
    bile salts + fat hydrolysis products, cholesterol

    glycerol and fatty acids

    monoglycerides and fatty acids
  39. This activates lipoprotein lipase
  40. This apoprotein binds LDL receptors
    ApoB 100
  41. This apoprotein is required for hepatic uptake of remnants and binds LDL receptor once VLDL --> LDL
    Apo E
  42. Which Apoprotein is common in Alzheimers Disease
    Apo E 4
  43. Three mechanisms to control high levels of free intracellular cholesterol
    suppress HMG C0-A reductase

    Suppresses synthes of LDL receptor expression on the cells

    activate the enzyme that esterifies cholesterol
  44. Which apoprotein is protective against alzheimers disease
    Apo E 3

    If homozygous for ApoE 3: age of onset of AD is >90 yrs
  45. A receptor disease
    familial hypercholesterolemia
  46. elevated serum cholesterol levels and loss of feedback control

    defect in LDL receptor
    familial hypercholesterolemia
  47. This class of familial hypercholesterolemia mutations impairs transcriptions
    Class I
  48. This class of familial hypercholesterolemia mutations prevent transport newly synthesized LDL-R protein from ER to Golgi for export to surface
    Class II
  49. This class of familial hypercholesterolemia mutations has reduced binding capacity
    Class III
  50. This class of familial hypercholesterolemia mutations can ind LDL cut can't internalize it
    Class IV
  51. This class of familial hypercholesterolemia mutations can be expressed and internalized, but can't recycle it.
    Class V
  52. optimal level of LDL
  53. desired level of total cholesterol
    < 200
  54. what is low for HDL cholesterol
  55. what is high for HDL cholesterol
    > 60
  56. what is a high level for LDL cholesterol
  57. high value for total cholesterol
  58. Normal level of triglycerides
  59. high level for triglycerides
  60. what is the desirable level of total cholesterol/HDL ratio
  61. any vascular disorder that narrows or occludes the coronary arteries
    coronary artery disease
  62. cardiac cells temporarily deprived of blood supply

    imbalance between oxygen supply and metabolic demand of mycardial
    ishcemic heart disease
  63. A condition in which the blood vessel walls thicken, harden, lose elasticity, and typically accumulate lipids, resulting in elevated blood pressure and constriction of the coronary arteries and pain when walking caused by decreased perfusion to leg vessels
  64. a type of arteriosclerosis in which cholesterol and lipid deposits accumulate on the innermost layer of the walls of large and medium-sized arteries
  65. This disease causes more deaths and disability and icurs greater economic costs than any other illness in the developed world
    ischemic heart disease
  66. most common, serious, chronic, lifethreatening illness in the united states
    ischemic heart disease
  67. platelet adhesion and thrombosis

    release of inflammatory cytokines

    injured endothelial cells can't synthesize antithrombotic and vasodilatory sytokines

    adhesion of macrophages
    acute endothelial injury of arteries
  68. changes in vessel walls leading to arterioscleerosis

    vessel remodeling involving Ang II and growth factors
    chronic endothelial injury of arteries
  69. most common cause of coronary artery disease
  70. xanthelasmas,arcus senilis & peripheral or carotid arterial bruits are markers for what
  71. Temporary reduction in blood supply, but cells still viable. Complication fo CAD
  72. Persistent ischemia or complete occlusion of a coronary artery cn cause myocardial cells to die. a complication of CAD
  73. Which disease state is effected by:

    Prevention of atherosclerosis with drugs

    prevention of thrombus formation

    reduction of load on the heart

    non-pharmacological therapies (diet,appropriate, exercise, stress reduction)
  74. Which type of angina pectoris is increased myocardial oxygen demand and pain w/ exertion
    Stable angina
  75. which type of angina pectoris is associated with arterial spasm mostly at rest.
  76. which type of angina pectoris is pre-infarction angina, thrombosis related - potential to cause an infarct if untreated
    Unstable angina
  77. Which form of angina pectoris can be mistaken for "indigestion"
    stable angina
  78. Severe chest pain from transient ischemia
    angina pectoris
  79. Recurrent, often predicatable and reversible chest pain
    stable angina
  80. Discomfort usually transient, lasting 3-5 minutes (resting should result in relief)

    repsonds positively to rest and/or nitroglycerin
    stable angina
  81. What does ABCDE tx of stable angina stand for
    • Aspirin
    • Blood pressure control and Beta-adrenergic antagonists
    • Cholesterol lowering agents and Cigarette smoking cessation
    • Diet
    • Exercise
  82. What effect does aspirin have for stable angina
    anti-platelet action
  83. what effect does nitrates have for stable angina
    • increase oxygen supply
    • reduce demand - dialtion, decrease work load)
    • reduces vasospasms may improve myocardia blood flow
  84. What effect do beta adrenergic blockers have on stable angina
    • reduce demand of myocardium
    • reduce heart rate
  85. Another name for prinzmetal's angina
    variant angina
  86. Which typ of angina pectoris

    chest pain due to coronary vasospasms

    abnormal, unpredictable

    often occurs at rest, during REM sleep

    responds positively to nitroglycerin
    prinzmetal's angina
  87. What are two determining factors that distinquish Unstable angina from the other two?
    Rupture of atheroma

    Partial thrombosis with vasospasms
  88. Which type of angina pectoris may progress to - subendocardail MI or Transmural MI
    unstable angina
  89. What is the preferred site of myocardial infarction
    Usually left ventricle - more muscle mass, greater workload, and larger distribution of coronary arteries
  90. what is the "gold standard" for diagnosing stable angina
    coronary angiography
  91. What is the most common cause of myocardial ischemia
  92. Narrowing of lumen by 50% impairs blood flow enough to hamper cellular metabolism during increased demand for which disease state
    Myocardial Ischemia
  93. Symptoms of Ischemia onset within 10 seconds
    severe chest pain, or referred pain
  94. symptoms of ischemia for several minutes
    lactic acid accumulates (pH change may cause pain)
  95. symptoms of ischemia for 20 minutes or longer increases chances of this
  96. Four treatments of Ischemia due to Angina (and preventing MI)
    • nitrates
    • beta adrenergic blockers
    • calcium antagonists
    • anti-platelet therapy
  97. This process can measure
    blood pressure within the heart
    oxygenation in the blood
    pumping ability of the heart muscle
    contrast dye to reveal the location of a narrowing in an artery
    cardiac cathetderizaion
  98. Three main functional changes before a MI
    • myocardial stunning
    • hibernating myocardium
    • myocardial remodeling
  99. Which troponin is specific to the normal adult heart
    Troponin I
  100. How fast can troponins become positive before onset of MI
    4-6 hours
  101. How long before troponins should be abnormal after an MI
    8-12 hours
  102. How long can circulating levels of troponins be elevated
    5-7 days longer
  103. localized dilation or out pouching of a vessel wall or cardiac chamber
  104. What is the difference between a true and a false aneurysms
    False involves a break in the vessel wall
  105. Swelling of the sack around the heart
  106. Two major types of cardiomyopathy
    • asymmetrical septal
    • hypertensive or valvular
  107. Inflammation of the inside lining of the heart and valves
  108. Disease of the heart muscle
  109. This condition allows valve leaflets to billow back into atrium during systole
    mitral valve prolapse
  110. Treatment for endocarditis
    antibiotics for 4-6 weeks
  111. Three clinical manifestations of Rheumatic fever
    • carditis
    • arthritis
    • valvulitis
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exam 4
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