Heart Disorders & Diseases

What affect does high serum levels of sodium play in Atherosclerosis?

It causes Hypertension, Hypertension causes Endothelial damage, Endothelia damage leads to the formation of an Atheroma.

What are the benefits of an exercise program?

It improves overall cardiovascular function & circulation. It reduces LDLs & raises HDLs , & decreases stress levels which lower BP & peripheral resistance

What happens to the area of necrosis?

It is replaced by scar tissue, Cardiac cells do not regenerate

Which Isoenzymes are specific to heart tissue?

LDH-1 & CK-MB

What is Unstable Angia?

Prolonged periods of pain at rest, perhaps due to a break of the atheroma it can be the precursor of a Myocardial Infarction

What are some treatments for a Heart Attack?

Rest, oxygen therapy, & analgesics, anticoagulants, defibrillation, a pacemaker, by-pass surgery, drugs specific to the cardiovascular system. After care involves Cardiac rehabilitation, which involves, diet, exercise, & stress reduction

What is the time line to prevent irreversible damage to the heart?

Restore blood flow within 20 minutes.

What is a precipitating factor for Angia?

The Atheroma blockage decreases Oxygen to the heart

What is a precipitating factor for an Aneurysm?

The calcification of an Atheroma leading to a bulge in the artery which may rupture & hemorrhage

The majority of Infarctions of the heart involve what portion?

The left ventricle

Atherosclerosis

The presence of atheromas (plaque, cell debris, cells, fibrin) often attached to a thrombi inside the walls of a large arteries

What does serum level of CRP C-Reactive Protein indicate?

The presence of inflammation. Low levels indicate a low risk of cardiovascular disease while high levels indicate a greater chance of cardiovascular disease.

What are the signs & symptoms of Angia?

Tightness & pressure feeling in the chest that radiates in the neck & down the left arm, pallor, diaphoresis (excessive sweating), and nausea

What are the treatments of Angia?

Vaso dilators E.g. Nitroglycerin

What is Variant Angia?

Vaso spasms occur at rest

What are the steps the heart goes through during a Myocardial Infarction?

1. At point of obstruction the heart tissue become necrotic 2. Inflammation begins due to the injury of the tissue. 3. Ischemia continues to develop around the necrotic zone. 4. As cells are destroyed they release enzymes into the ICF5. The contractile & conduction of the Myocardium are lost as oxygen is depleted.

What will diagnostic test reveal in a Myocardial Infarction?

1. ECG, 2. Serum enzymes & Isoenzyes released by the necrotic cells 3. Serum levels of Myosin & Troponin are elevated for a few hours after MI 4. Serum levels of electrolytes especially Sodium & Potassium 5. Leukocytosis 6. Elevated CPR 7. Erythrocyte sedimentation rate is elevated 8. Arterial blood gases help determine if shock is pronounced 9. Pulmonary artery pressure is used to examine ventricular functions.

The steps of Atheroma Formation.

1. Endothelial injury in the artery 2. Injury causes inflammation leadindin to elevated C-Reactive protein (CRP) 3. Monocyte, Macrophages, & Lipids accumulate in the tunica intima 4. Smooth muscle cells begin multiplying 5. Plaque forms while inflammation persists 6. Platelets begin adhering forming a thrombi which begins obstructing blood flow making it turbulent. 7. Lipids & fibrous tissue continue building; platelets release Prostaglandins which precipitate inflammation & vasospasm this enlarges the thrombi decreasing blood flow even more.

What are the elevated enzymes & Isoenzymes that are present in the event of a MI?

1. LDH-1 Lactic Dehydorgenase 2. AST formally SGOT Asparate Aminotransfearse CK-MB or CK-3. Creatine Phosphokinase with M & B sub units

Myocardial Hypertrophy

1. Severe anemia & respiratory diseases 2. Increased demand of oxygen in Tachycardia associated with Hyperthyroidism 3. Hypertension by the increased force of contractions 4. In general increased demand on the heart.

What are some common drug types used to treat cardiovascular disorders?

1. Vaso dilaters 2. Beta blockers 3. Calcium channel blockers 4. Digoxin 5. Antihypersensative drugs 6. Adrenergi-blocking drugs, ACE/ Angiotesnsin converting enzyme inhibiters 7. Diuretics 8. Anticoagulants 9. Cholesterol or Lipid lowering drugs.

Three ways Infarction develops

1.The thrombus obstructs the artery 2. Vaso spasm occurs due to partial occlusion resulting in full occlusion 3. Part of the Thrombus breaks away forming an embolus that flows to the coronary artery & blocks blood flow

What are some general increased demands that require more Oxygen for the heart that can cause Angia?

Exercise, Stress, anger, cold or hot weather, fever, eating a large meal

What is the mortality rate in the 1st year of the MI?

30-40% mainly due to complications that arise.

How long does it take for inflammation to subside after blood flow is restored?

48 hours

What is the composition of an HDL?

50% Protien 25% Phospholipids, a small amount of Triglycerides, and about ¼ of Cholesterol

About how long does it take the scar tissue to form on the heart?

6-8 weeks

Myocardial Infarction MI/ Heart Attack

A coronary artery is totally obstructed causing ischemia, cell death or infection of the heart wall.

Arterosclerosis

A general term used for changes in an artery or arterioles such as; loss of elasticity, hardening of the walls

What is the composition of an LDL?

A little more than 50% cholesterol , about ¼ each of Protein *& Phospholipids, and a small amount of Triglycerides

What does it mean when we say Infarctions of the heart wall are transmural?

All 3 of the layers of the hearts walls are involved

Angia episodes usually occur because of.

An increased amount of exertion

What are the warning signs of a heart attack?

Angia, Nausea, Indigestion, Shortness of breath, sweating, fatigue, anxiety, fear, & hypotension with a rapid pulse.

What are some complications of an Heart Attack

Arrhythemias, Cardiogenic Shock, (CHF) Congestive Heart Failure, rupture/ aneurysm of necrotic heart tissue, thromboembolisim

What is the common cause of a Myocardial Infaction?

Atherosclerosis with a thrombus attached

What is the Etiology of Angia?

Atherosclerosis, spasms of the coronary arteries, & Arteriosclerosis

What are some surgical repair techniques used in Atherosclerosis?

Balloon Angioplasty, stents, (CABD) Coronary Bypass Grafting (rerouting blood flow around the obstruction)

What is Collateral circulation?

Branches of Anastomoses on the coronary arteries (collateral channels) near the apex that have the potential to open up & and sever as a detour of blood flow, if blood flow is obstructed to the heart.

Angia Pectoris

Chest pain caused by a deficit of Oxygen to the heart muscle

What can reduce the size on an infarct of the heart?

Collateral Circulation if it was activated before the infarction began

What arteries are most affected by Atherosclerosis?

Cornary, Iliac, carotid,

What are some of the dietary modifications needed to improve Cardiovascular function?

Decrease Sodium it can reduce BP, Reduce intake of fat especially Saturated fats which can clog arteries .

What 2 factors can induce endothelial damage?

Diabetes Mellitus & Hypertension

General Treatment for Cardiac disorders include

Dietary modification, a regular exercise program, cessation of smoking,& drug therapy

What is a precipitating factor for a Myocardial Infarction or a Stroke?

Formation of an Atheroma when it totally blocks blood flow cutting off the Oxygen supply to tissues.

What is the Etiology of Atherosclerosis?

Genetics, diet, smoking, sedentary lifestyle, Diabetes Mellitus, uncontrolled Hypertension , a combination of high cholesterol & BP, and oral contraceptive combined with smoking.

Diagnostic Tests for Atherosclerosis include

HDL/LDL serum levels, Stress test, CRP serum levels

What might cause Collateral Circulation to begin?

If the atheroma is a gradual developer, warning signs such as angina might trigger the collateral channels to open up & collateral circulation can occur. It can't stop a Myocardial Infarction but it can reduce the amount of Ischemia & necrosis by supplying blood.

What are the effects of cigarette smoking?

Increases Vasoconstriction, heart rate, platelet adhesion causing Thrmobos formations, & serum lipid levels. Carbon Monoxide a byproduct of smoking displaces Oxygen from Hemoglobin.

What is the treatment for Atherosclerosis?

Lowering LDL levels, sodium intake, lifestyle modifications, anticoagulant therapy , surgical repair, or other cardiac drugs.

LDL Low Density Lipoproteins

Molecules that transport high cholesterol from the liver to all cells. This is considered the bad cholesterol.

HDL High Density Lipoproteins

Molecules that transport low cholesterol away from peripheral cells & to the liver; where catabolism occurs & then the kidneys excrete it .This is considered the good cholesterol.

CHD Coronary Heart Disease/ IHD Ischemic Heart Disease /CAD Coronary Artery Disease

Names used to describe these heart disorders1. Angia Pectoris (temporary cardiac ischemia)2. MI Myocardial Infarction (heart attack)

Can Collateral channels develop in the event of Emboli?

No there is no time or warning signals.

Which oils are considered useful in lowering cholesterol?

Oils containing Linolenic acid & fish oils.

What is the prognosis dependant on?

Size of the infarction, time elapsed before treatment begins, and collateral circulation.

What is the pain like of a Myocardial Infarction?

Sudden, severe, steady, crushing pain that radiates in the neck, jaw, & shoulder, & down the left arm.

When evaluating CRP serum levels in diagnosing cardiovascular disorders, what factor should be taken into consideration?

Whether or not the individual has any chronic inflammation conditions. This will give them an elevated serum level.