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medsurg exam 2
CHD patho and definitions
| Question | Answer |
|---|---|
| underlying systemic diseases | atherosclerotic cardiovascular disease |
| possible heart disease | Coronary artery disease, Atherosclerotic heart disease, or Ischemic heart disease |
| coronary heart diseases cause | Impaired blood flow to the myocardium resulting in ischemia |
| coronary heart disease is caused by | atherosclerosis |
| what is important to remember about coronary heart disease | it is an imbalance of supply and demand |
| imbalance of oxygen supply | oxygen-rich blood supply decreased due to plaque |
| imbalance of oxygen demand | amount of oxygen needed by the heart to function properly increased |
| when the heart disease is a temporary/reversible, it is called | angina/ischemia |
| angina means | it is painful and the pt actually felt it |
| when the heart disease is a permanent, it is called | myocardial infarction (MI) resulting in death of tissue |
| ischemia and infarction can be | silent |
| MI is | permanent and results in scar tissue for the rest of time |
| what things cause a compromise in supply | Atherosclerosis Coronary thrombus Coronary vasospasm Hgb and Hct Impaired gas exchange |
| what things cause an increase in demand | Heart rate Metabolic demands like sepsis Workload of the heart like preload, afterload and contractility |
| patho of atherosclerosis | Plaque accumulates in the intimal and medial layers of coronary arteries |
| internal triggers of atherosclerosis | age, genetics, gender, race |
| external triggers of atherosclerosis | diet, lifestyle, stress, HTN, diabetes, smoking, stress, lack of exercise |
| vascular endothelial (damage to internal layer of heart) injury causes | an inflammatory response |
| first step of the inflammatory response | monocytes and macrophages infiltrate the intima |
| monocytes and macrophages at the intima attract | Attract lipids –> dysfunction of macrophages results in foam cells ->attract platelets -> increased risk of clotting |
| Fatty streaks may present early in life would could cause | possible early plaque formation |
| what occurs in the plaque | smooth muscle (middle layer) proliferation |
| after smooth muscle proliferation occurs in the plaque, what happens | Plaque calcifies, fibrous cap forms |
| what does plaque consist of | calcium, smooth muscle, fatty streak |
| what is the result of atherosclerosis | plaque grows and obstructs vessel (decreased supply)w |
| when do symptoms of atherosclerosis begin | with a blockage of 70% or more |
| plaque can be | stable or unstable |
| what is different about stable plaque than unstable | has fibrous cap |
| plaque rupture outcomes | Plaque becomes larger Partial obstruction Clot forms causing total obstruction |
| clots may form causing total obstruction during | First stages of acute coronary syndrome |
| if clots that may cause total obstruction are not interrupted, | death of tissue occurs |
| what is it called when there is death of tissue | infarction |
| collateral circulation is expanded by | arteriogenesis |
| arteriogenesis is when | pre-existing small blood vessels gradually enlarge and mature in response to reduced blood flow |
| arteriogenesis provided a pathway to | deliver blood to ischemic tissue |
| what can promote the development of collateral circulation | aerobic exercise |
| modifiable risk factors for CHD | Diabetes HTN Smoking Obesity Physical inactivity Dyslipidemia Chronic stress Metabolic syndrome |
| unmodifiable risk factors for CHD | Age Gender Race Family history/genetics |
| target BP | 120/80 |
| elevated BP | 120-129/<80 |
| stage I HTN | 130-139/80-89 |
| stage II HTN | >140/>90 |
| DM is associated with | higher blood lipid levels |
| DM has a higher incidence with | HTN and obesity |
| DM affects | endothelium of blood vessels |
| in DM, hyperglycemia and hyperinsulinemia alter | platelet function, elevated fibrinogen levels, inflammation |
| triglycerides target | <150 |
| smoking and CHD | Smokers are 2-4 x’s more likely to develop CHD than nonsmokers |
| second-hand smoke increases risk of CHD disease by | 25-30% |
| why does smoking promote CHD | CO damages vascular endothelium Nicotine stimulates catecholamine release |
| when nicotine stimulates catecholamine release, it causes | an increased BP, HR, MVO2 constricted arteries, reduced HDL, increased platelet aggregation |
| Maintaining a regular program of exercise decreases risk of | CHD |
| cardiovascular benefits of exercise | Increase availability of oxygen to heart muscle Decrease O2 demand and cardiac workload Decrease BP, lipids, insulin levels, platelet aggregation, and weight |
| a diet that decreases risk of CHD looks like | Diets high in fruits, vegetables, whole grains, and unsaturated fats |
| metabolic syndrome causes | Abdominal Obesity Dyslipidemia Hypertension Diabetes/Insulin resistance Endothelial dysfunction Oxidative stress |
| dyslipidemia | Increased LDL Decreased HDL |
| oxidative stress occurs when | Unstable atoms are formed during metabolism or with environmental exposure to toxins every day, have an unpaired electron |
| how are we protective by oxidative stress | Normal body protective mechanisms take care of them |
| if the protective mechanisms fail and the free radicals exceed the antioxidants, what happens? | cell damage occurs, leading to various diseases, including ASCVD |
| risk factors of CHD unique to women | after menopause, the gender risk equalizes because menopause can cause HDL levels to decrease and LDL levels to rise |
| Hormone replacement therapy | May improve cholesterol profiles Increases the risk of clotting Not recommended as often now |
| life's essential 8 | Eat Better Be More Active Quit Tobacco Get Healthy Sleep Manage Weight Control Cholesterol Manage BG Manage BP |
Created by:
leh195