Basics of disease and diagnosis 1

unstable angina

-(also called pre-infarction angina or crescendo angina). -the decrease in oxygen results in heart muscles that don't work the way they should. This change may be temporary or permanent. When acute coronary syndrome doesn't result in cell death, it is called unstable. -symptoms increase in frequency and severity; may not be relieved with rest or nitroglycerin

metabolic syndrome

-A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure - 130/85 mmHg, abdominal obesity - >35 inches in women and >40 inches in men, high triglyceride levels - >150mg/dL, low HDL levels - <50mg/dL in women & <40mg/dL in men, and high fasting levels of blood sugar - 100mg/dL) that are linked to increased risk of cardiovascular disease and Type 2 diabetes. -Also proinflammatory state [high levels of c-reactive protein] and pro-thrombotic state [high fibrinogen level].

Chronic Kidney Disease (CKD)

-Atherosclerosis can cause the arteries leading to kidneys to narrow, preventing oxygenated blood from reaching them. -Over time, this can affect kidney function, keeping waste from exiting body

conditions that cause myocardial ischemia

-Coronary artery disease (atherosclerosis): Plaques made up mostly of cholesterol build up on your artery walls and restrict blood flow. Atherosclerosis is the most common cause. •Blood clot: The plaques that develop in atherosclerosis can rupture, causing a blood clot. The clot might block an artery and lead to sudden, severe myocardial ischemia, resulting in a heart attack. Rarely, a blood clot might travel to the coronary artery from elsewhere in the body. •Coronary artery spasm: This temporary tightening of the muscles in the artery wall can briefly decrease or even prevent blood flow to part of the heart muscle. Coronary artery spasm is an uncommon cause.

Trans esophageal Echocardiography [TEE]

-Doctors use it to find problems in your heart's structure and function. -TEE can give clearer pictures of the upper chambers of the heart, and the valves between the upper and lower chambers of the heart, than standard echocardiograms. -Doctors may also use if you have a thick chest wall.

ECG (electrocardiogram)

-Electrodes attached to skin record the electrical activity of heart. Certain changes in heart's electrical activity may be a sign of heart damage.

Jugular Venous Distention (JVD)

-Enlargement of the jugular vein of the neck; caused by an increase in jugular venous pressure. -The blood flow from the head to the heart is measured by central venous pressure or CVP. -it is when the increased pressure of the superior vena cava causes the jugular vein to bulge, making it most visible on the right side of a person's neck. -The appearance of the vein is similar to a rope/raised tube below the surface of the skin, and its height can be measured to indicate the CVP. -This measurement will be taken when a person is lying down with their head elevated at an angle of 45-60 degrees. -BCS, the venous waves are visible just above the clavicle when the patient is sitting at 30-45 degrees. -A normal jugular venous pressure should not exceed 3-4 cm above the sternal angle. -Higher readings may signify right-sided heart failure, constrictive pericarditis, pleural effusion, obstructed vena cava and other pathologies of the heart and lungs.

Nonmodifiable risk factors for atherosclerosis

-Family history of CAD (first-degree relative with cardiovascular disease at 55 years of age or younger for men and at 65 years of age or younger for women) -Gender (men develop CAD at an earlier age than women) -Race (higher incidence of heart disease in African - Americans than in Caucasians)

chest x-ray (CXR)

-Fluid in or around lungs, Enlarged heart, Blood vessel problems, such as an aortic aneurysm. Congenital heart disease (heart problems you're born with, Calcium build-up in the heart or blood vessels, which could make a heart attack)

modifiable risk factors of atherosclerosis

-Hyperlipidemia -Hypertension -Cigarette smoking/tobacco use -Diabetes mellitus -Inflammation -metabolic syndrome -obesity -physical inactivity

A fasting lipid profile should demonstrate the following values:

-LDL cholesterol less than 100 mg/dL (less than 70 mg/dL for very high-risk patients) -Total cholesterol less than 200 mg/dL -HDL cholesterol greater than 60 mg/dL -Triglyceride less than 150 mg/dL

Several factors associated with typical anginal pain are:

-Physical exertion, which can precipitate an attack by increasing myocardial oxygen demand -Exposure to cold, which can cause vasoconstriction and elevated blood pressure, with increased oxygen demand -Eating a heavy meal, which increases the blood flow to the mesenteric area for digestion, thereby reducing the blood supply available to the heart muscle -Stress or any emotion-provoking situation, causing the release of catecholamines, which increases blood pressure, heart rate, and myocardial workload

nuclear stress test

-Small amounts of radioactive material are injected into your bloodstream. -While you exercise, doctor can watch as it flows through heart and lungs — allowing blood-flow problems to be identified.

echocardiogram

-Sound waves directed at heart from a wand-like device held to chest produce video images of heart. -can help identify whether an area of heart has been damaged and isn't pumping normally.

Cardiac CT Scan

-This test can determine if pts have a buildup of calcium in your coronary arteries — a sign of coronary atherosclerosis. The heart arteries can also be seen using CT scanning (coronary CT angiogram).

Symptoms of atherosclerosis

-chest pain or pressure (angina) [cardiovascular atherosclerosis] -sudden weakness or numbness in arms or legs, difficulty speaking or slurred speech, or drooping muscles in the face [Cerebral atherosclerosis] -leg pain when walking or exercising [peripheral artery disease] -high blood pressure or kidney failure

Pharmacologic Therapy

-Thrombolytics (clot busters) help dissolve a blood clot that's blocking an artery. -Nitroglycerin improves blood flow by temporarily widening blood vessels. -Antiplatelet drugs help prevent blood clots from forming and include aspirin, clopidogrel (Plavix), prasugrel (Effient) and others. -Beta blockers help relax your heart muscle and slow your heart rate. They decrease the demand on your heart and lower blood pressure. Examples include metoprolol (Lopressor, Toprol-XL) and nadolol (Corgard). -Angiotensin-converting enzyme (ACE) inhibitors widen blood vessels and improve blood flow, allowing the heart to work better. They include lisinopril (Prinivil, Zestril), benazepril (Lotensin) and others. -Angiotensin receptor blockers (ARBs) help control blood pressure and include irbesartan (Avapro), losartan (Cozaar) and several others. -Statins lower the amount of cholesterol moving in the blood and may stabilize plaque deposits, making them less likely to rupture. Statins include atorvastatin (Lipitor), simvastatin (Zocor, Flolipid) and several others.

carotid artery disease

-When atherosclerosis narrows the arteries close to brain, which can cause a transient ischemic attack (TIA) or stroke.

peripheral artery disease

-When atherosclerosis narrows the arteries in arms or legs, they may develop circulation problems in arms and legs called PAD. -This can make one less sensitive to heat and cold, increasing your of burns or frostbite. -In rare cases, poor circulation in arms or legs can cause tissue death (gangrene).

coronary bypass surgery

-With this procedure, a surgeon takes a piece of blood vessel (graft) from another part of body and creates a new route for blood that goes around (bypasses) a blocked coronary artery -it redirects blood around a section of a blocked or partially blocked artery by removing a blood vessel from the chest, arms, or legs and using it to create a detour or bypass around the blockage

angina pectoris (chest pain)

-a clinical syndrome usually characterized by episodes or paroxysms of pain or pressure in the anterior chest. -is the sensation of chest pain, pressure, or squeezing, often due to not enough blood flow to the heart muscle as a result of obstruction or spasm of the coronary arteries. -The cause is insufficient coronary blood flow, resulting in a decreased oxygen supply when there is increased myocardial demand for oxygen in response to physical exertion or emotional stress. -In other words, the need for oxygen exceeds the supply.

CT Coronarography

-a minimally invasive imaging test to look at the arteries that supply your heart muscle with blood. -Unlike a traditional coronary angiogram, CT angiograms don't use a catheter threaded through your blood vessels to your heart.

CT (computed tomography) scan

-a painless imaging test that uses x rays to take many detailed pictures of your heart and its blood vessels.' -Computers can combine these pictures to create a three-dimensional (3D) model of the whole heart. -This imaging test can help doctors detect or evaluate coronary heart disease, calcium buildup in the coronary arteries, problems with the aorta, problems with heart function and valves

Activated partial thromboplastin time (aPTT)

-a screening test that helps evaluate a person's ability to appropriately form blood clots. (30-40 seconds.)

Aneurysms

-a serious complication that can occur anywhere in body. -It is a bulge in the wall of artery. -Most people have no symptoms. -Pain and throbbing in the area may occur and is a medical emergency. -If it bursts, you may face life-threatening internal bleeding. -Although this is usually a sudden, catastrophic event, a slow leak is possible. -If a blood clot within dislodges, it may block an artery at some distant point.

acute coronary syndrome (ACS)

-a term used to describe a range of conditions associated with sudden, reduced blood flow to the heart. -usually results from the buildup of fatty deposits (plaques) in and on the walls of coronary arteries, the blood vessels delivering oxygen and nutrients to heart muscles. -When a plaque deposit ruptures/splits, a blood clot forms. This clot blocks the flow of blood to heart muscles. -When the supply of oxygen to cells is too low, cells of the heart muscles can die. -The death of cells — resulting in damage to muscle tissues — is a heart attack (myocardial infarction). -Even when there is no cell death, the decrease in oxygen still results in heart muscles that don't work the way they should. This change may be temporary or permanent. -When ACS doesn't result in cell death, it is called unstable angina

variant angina

-also called Prinzmetal's angina -pain at rest with reversible ST-segment elevation; thought to be caused by coronary artery vasospasm

coronary angioplasty (PTCA)

-also called percutaneous coronary intervention, is a procedure used to open clogged heart arteries. -uses a tiny balloon catheter that is inserted in a blocked blood vessel to help widen it and improve blood flow to the heart. -is often combined with the placement of a small wire mesh tube called a stent. -The stent helps prop the artery open, decreasing its chance of narrowing again. Most stents are coated with medication to help keep artery open (drug-eluting stents).

myocardial ischemia

-blockage of blood to the heart muscle. -occurs when the blood flow through one or more of coronary arteries is decreased. -The low blood flow decreases the amount of oxygen your heart muscle receives. -can develop slowly as arteries become blocked over time. -Or it can occur quickly when an artery becomes blocked suddenly.

lipid profile

-blood test used to measure the amount and type of lipids in a sample of blood. -Total cholesterol, LDL (low-density lipoprotein cholesterol, also called "bad" cholesterol(can build up on the walls of your arteries and increase your chances of getting heart disease.) HDL cholesterol -- "good" cholesterol - a higher number means lower risk. This is because HDL cholesterol) protects against heart disease by taking the "bad" cholesterol out of your blood and keeping it from building up in your arteries. -Triglycerides are the form in which most fat exists in food and the body. A high triglyceride level has been linked to higher risk of coronary artery LDL cholesterol less than 100 mg/dL (less than 70 mg/dL for very high-risk patients) •Total cholesterol less than 200 mg/dL •HDL cholesterol greater than 60 mg/dL •Triglyceride less than 150 mg/dL •disease.

Atherosclerosis

-condition in which fatty deposits called plaque build up on the inner walls of the arteries. -plaques are made up of cholesterol, fatty substances, cellular waste products, calcium and fibrin. -the complications depend on which arteries are blocked: coronary artery disease, carotid artery disease, peripheral artery disease, aneurysms and chronic kidney disease.

coronary artery disease (CAD)

-disease of the arteries surrounding the heart. -When atherosclerosis narrows the arteries close to heart, they may develop this which can cause chest pain (angina), a heart attack or heart failure.

stress test

-heart rhythm, blood pressure and breathing are monitored while pts walk on a treadmill or ride a stationary bike. Exercise makes heart pump harder and faster than usual. -detects heart problems that might not be noticeable otherwise.

International Normalized Ratio (INR)

-is a calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication (anticoagulant) warfarin (Coumadin®). -The PT and INR are used to monitor the effectiveness of the anticoagulant warfarin. -are important constituents of basic examinations in clinical laboratories.( 2.0 to 3.0)

C-reactive protein (CRP).

-is a marker for inflammation, and atherosclerosis has an inflammatory component. -Patients with elevated levels have an increased risk for heart attack, stroke, sudden death, and vascular disease.

Coronary Catheterization/Angiography

-is an X-ray with radiocontrast agent in the coronary arteries -Coronary angiograms are part of a general group of procedures known as heart (cardiac) catheterizations. -Cardiac catheterization procedures can both diagnose and treat heart and blood vessel conditions. -A coronary angiogram, which can help diagnose heart conditions, is the most common type of cardiac catheterization procedure. -During a coronary angiogram, a type of dye that's visible by an X-ray machine is injected into the blood vessels of a heart. -The X-ray machine rapidly takes a series of images (angiograms), offering a look at blood vessels. -If necessary, doctor can open clogged heart arteries (angioplasty) during coronary angiogram. -Specifically, coronary catheterization is a visually interpreted test performed to recognize occlusion, stenosis, restenosis, thrombosis or aneurysmal enlargement of the coronary artery lumens; heart chamber size; heart muscle contraction performance; ..

creatine kinase

-is expressed by various tissues and cell types, and can rise after a heart attack, skeletal muscle injury, strenuous exercise, or drinking too much alcohol, and from taking certain medicines or supplements.

CK-MB

-is one particular form of the enzyme creatine kinase that is found mostly in heart muscle; it rises when there is damage to the heart muscle cells and may be used in follow up to an elevated CK and/or when the troponin test is not available.

magnetic resonance angiography (MRA)

-magnetic resonance imaging of the heart and blood vessels for evaluation of pathology. -can find problems with the blood vessels that may be causing reduced blood flow. -With it, both the blood flow and the condition of the blood vessel walls can be seen. -The test is often used to look at the blood vessels that go to the brain, kidneys, and legs

silent ischemia

-objective evidence of ischemia (such as electrocardiographic changes with a stress test), but patient reports no pain

Stable angina

-predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin

stress echocardiogram (stress echo)

-similar to a regular echocardiogram, except the test is done after pts exercise in the doctor's office on a treadmill or stationary bike.

coronary angiography

-specialized type of angiography that helps diagnose stenosis or obstruction of the arteries that supply blood to the heart muscle. -a procedure that uses contrast dye, usually containing iodine, and x ray pictures to detect blockages in the coronary arteries that are caused by plaque buildup. -A dye is injected into the blood vessels of a heart. -Then a series of X-ray images (angiograms) are taken, showing the dye's path. -This test gives doctor a detailed look at the inside of your blood vessels.

Types of Angina

-stable, unstable, intractable/refractory, variant/printzmetal, silent

Troponin

-this is the most commonly ordered and most specific of the cardiac markers. -It is elevated (positive) within a few hours of heart damage and remains elevated for up to two weeks. -rising levels can help diagnose heart attack. -normal range is <0.1 -Most patients who have had a heart attack have increased troponin levels within 6 hours. -After 12 hours, almost everyone who has had a heart attack will have raised levels. -Its levels may remain high for 1 to 2 weeks after a heart attack

intractable/refractory angina

Chest pain that is severe and incapacitating

Angioplasty and stenting

In this procedure, doctor inserts a long, tiny tube (catheter) into the blocked or narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, opening the artery by compressing the plaque deposits against artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.

assessment and diagnostic findings for cardiovascular atherosclerosis

Patient History Electrocardiogram Echocardiogram Laboratory Tests - Creatine Kinase and Its Isoenzymes, Myoglobin, Troponin 12-lead electrocardiogram (ECG) CRP and cardiac biomarker Stress ECG Echocardiogram Cardiac catheterization Coronary angiography

The immediate goals of treatment for acute coronary syndrome are:

Relieve pain and distress Improve blood flow Restore heart function as quickly and as best as possible

Prothrombin Time (PT)

is a test used to help detect and diagnose a bleeding disorder or excessive clotting disorder ( 11 to 13.5 seconds)

signs and symptoms of ACS

•Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning •Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw •Nausea/vomiting •Indigestion •Shortness of breath (dyspnea) •Sudden, heavy sweating (diaphoresis) •Lightheadedness, dizziness or fainting •Unusual or unexplained fatigue •Feeling restless or apprehensive •Hypotension: Indicates ventricular dysfunction due to myocardial ischemia, myocardial infarction (MI), or acute valvular dysfunction •Hypertension: May precipitate angina or reflect elevated catecholamine levels due to anxiety • Palpitations