Cardio Week 1

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Questions and Answers

What is the primary cause of death for both genders and most racial and ethnic groups in the US?

Diabetes

Cardiovascular diseases (correct)

Respiratory diseases

Cancer

What percentage of American adults had total cholesterol levels of 200 mg per deciliter or higher?

30%

50%

40% (correct)

20%

What happens to heart muscle when coronary arteries are narrowed or blocked?

It starts to regenerate rapidly.

It becomes ischemic and injured. (correct)

It becomes hypertrophic.

It receives excess oxygen.

Which term is synonymous with coronary artery disease?

Ischemic heart disease Signup and view all the answers

What trend in the death rate from heart disease occurred between 2003 and 2013?

It decreased by about 38%. Signup and view all the answers

What does the Framingham Study primarily focus on?

Identifying risk factors for heart disease Signup and view all the answers

Which of the following is NOT listed as a risk factor for coronary artery disease?

Regular exercise Signup and view all the answers

What can be a potential result of ischemic injury to the heart muscle due to coronary artery disease?

Infarction Signup and view all the answers

Which symptom is most commonly observed in women experiencing myocardial infarction?

Shortness of breath occurring at night Signup and view all the answers

What is the significance of cardiac troponin T (TnT) levels after a myocardial infarction?

It remains elevated for 5 to 7 days and predicts cardiovascular mortality. Signup and view all the answers

Which of the following is considered a postinfarction complication?

Arrhythmias Signup and view all the answers

What is the purpose of transesophageal echocardiography (TEE) in the diagnosis of heart conditions?

To provide a clearer image of the heart's structure. Signup and view all the answers

Which enzyme is specifically associated with myocardial tissue death and elevated during a myocardial infarction?

Creatine phosphokinase-MB (CPK-MB) Signup and view all the answers

How long after a myocardial infarction do CPK-MB levels typically peak?

33 hours Signup and view all the answers

Which clinical manifestation is unusual and may not follow the classic pattern in heart attacks?

Fatigue Signup and view all the answers

What finding would be a definitive indicator for the diagnosis of myocardial infarction?

Serial blood enzyme levels elevated over a period of time Signup and view all the answers

What percentage narrowing of a peripheral vessel must occur for claudication symptoms to appear?

50% Signup and view all the answers

Which symptom indicates mild circulatory inadequacy during walking?

Onset of pain after two blocks or more Signup and view all the answers

What is the primary symptom of peripheral artery disease that may also indicate weakness or fatigue?

Sense of weakness or tiredness Signup and view all the answers

What does the ankle/brachial index (ABI) measure?

Arterial perfusion Signup and view all the answers

Which symptom might be relieved by rest in patients with peripheral artery disease?

Weakness or fatigue Signup and view all the answers

What is the primary cause of mitral stenosis?

Rheumatic heart disease Signup and view all the answers

What is a common clinical manifestation in moderate mitral stenosis?

Dyspnea and Fatigue Signup and view all the answers

What happens to the heart as a result of mitral valve insufficiency?

It dilates due to increased workload Signup and view all the answers

How does mitral stenosis affect cardiac output?

Decreases it due to mechanical obstruction Signup and view all the answers

What characteristic sound is associated with mitral stenosis during auscultation?

A snap in early diastole followed by a murmur Signup and view all the answers

Which heart chamber is primarily affected by left atrial pressure rising in mitral stenosis?

Left atrium Signup and view all the answers

Which effect is NOT a physiological consequence of mitral stenosis?

Increased ejection fraction and stroke volume Signup and view all the answers

What term describes the backward bulging of enlarged leaflets into the atrium in valvular conditions?

Prolapse Signup and view all the answers

What characterizes lesions classified as Acyanotic/Left to Right Shunt?

Blood is shunted from the left to the right side of the heart Signup and view all the answers

Which of the following is an example of a Cyanotic/Right to Left Shunt?

Tetralogy of Fallot Signup and view all the answers

What is the primary consequence of increased preload in Acyanotic/Left to Right Shunt conditions?

Increased contractility and heart workload Signup and view all the answers

What is the most common congenital heart defect seen in children?

Ventricular septal defect (VSD) Signup and view all the answers

Which condition is associated with narrowing of the aorta in stenotic lesions?

Coarctation of the Aorta Signup and view all the answers

What percentage of babies born with a non-critical congenital heart defect is expected to survive to 18 years of age?

95% Signup and view all the answers

What is the critical difference between Acyanotic and Cyanotic heart lesions?

Acyanotic lesions involve oxygenated blood, while cyanotic lesions do not Signup and view all the answers

What proportion of children born with congenital heart disease may require intervention during their first year of life?

Around 25% Signup and view all the answers

In which scenario would you expect to see increased heart rate as a compensatory response?

Acyanotic/Left to Right Shunt conditions Signup and view all the answers

What is one significant association found with at least 15% of congenital heart diseases?

Genetic conditions Signup and view all the answers

Which of the following statements about Cyanotic Babies is true?

Cyanotic babies have oxygen deficiency due to right to left shunt Signup and view all the answers

What common physical problems might individuals with congenital heart disease experience?

Developmental or cognitive disorders Signup and view all the answers

Which of these shunt conditions typically leads to heart failure due to increased cardiac workload?

Ventricular Septal Defect Signup and view all the answers

What factor is associated with improved survival rates in individuals with congenital heart disease?

Early surgical intervention Signup and view all the answers

Which demographic is experiencing an equal or greater survival rate due to congenital heart disease advancements?

Adults living with CHDs Signup and view all the answers

What is the estimated occurrence of congenital heart disease in live births?

1 in 110 Signup and view all the answers

Study Notes

Cardiac Pathophysiology: Coronary Artery Disease

Coronary artery disease (CAD) is the most common cause of death in both genders and most racial/ethnic groups in the U.S.
In the U.S., more than 1 in 3 adults have cardiovascular diseases.
Nearly 40% of American adults had total cholesterol of 200 mg per deciliter or higher in 2018.
On average, someone in the U.S. dies of CAD every 36 seconds.

Objectives

Understand the term coronary artery disease.
Identify the risk factors for coronary artery disease.
Recognize the disparity in gender with relation to coronary artery disease.
Describe the pathogenesis of coronary artery disease.
Detect the clinical presentation of coronary artery disease.
List the tools used for diagnosis of coronary artery disease.

Coronary Artery Disease Pathogenesis

When coronary arteries narrow or are blocked, the heart muscle areas supplied by that artery do not receive enough oxygen, becoming ischemic and potentially injured, or resulting in infarction.
CAD is also known as Ischemic Heart Disease (IHD).

Risk Factors for CAD

Modifiable: Smoking, Hypertension (HTN), Hypercholesterolemia, Physical inactivity, Diabetes Mellitus (DM), Obesity, Stress
Non-modifiable: Heredity, Male Sex (until age 50 when women catch up), Age

Myocardial Infarction (MI)

MI (or heart attack) refers to the development of ischemia resulting in necrosis of myocardial tissue.
80-90% of MIs result from coronary thrombus at a pre-existing atherosclerotic stenosis site.
They occur frequently during early morning hours.
Silent ischemia in people with diabetes is prevalent.

MI: Pathogenesis

Plaque ruptures or sclerosed arteries become completely filled with thrombus.
Blood vessels get occluded by a clot.
The most common site involved is the left ventricle.
Next to the zone of hypoxic injury is the reversible zone of ischemia.
The zone of injury is immediately around the zone of infarction, and seriously damaged. This zone may return to normal within 2-3 weeks.
When myocardium is completely deprived of oxygen the cells die and tissue becomes necrotic. The remaining heart muscle cells enlarge to compensate for the loss of heart function.

MI: Classification

Degree of wall involvement: How far does the damage extend into the heart?
Location: What artery is involved and what area does it serve?
Size: Uncomplicated or complicated

Types of MI - Degree of Wall Involvement

Transmural: Extends through the epicardium, myocardium, and endocardium—full wall thickness; the area becomes unable to contract.
Subendocardial (SEMI): Heart muscle just under the endocardial wall, outer wall is spared.

MI - Location of Infarction

Anterior, Posterior, Inferior, Anteroseptal, High Lateral, Apical

Hypertension

Hypertension, or high blood pressure, is a persistent elevation of diastolic blood pressure greater than 90 mm Hg or systolic blood pressure greater than 140 mm Hg, or both.
Measured on at least two separate occasions at least 2 weeks apart.

Hypertension Categories

Primary/Essential: Idiopathic hypertension; 90-95% of all cases.
Secondary: Identifiable cause; 5-10% of cases.
Malignant: Markedly elevated (diastolic > 125 mmHg) blood pressure with target organ damage.

Coronary Artery Disease: Causes

The "3 Es": Exercise/Exertion, Emotions, Eating
Cold weather- excessive vasoconstriction
Smoking

Congestive Heart Failure (CHF)

A group of clinical manifestations caused by inadequate pump performance from the cardiac valves or myocardium.
The heart is unable to pump sufficient blood to meet the body's needs.
Blood backs up into the pulmonary veins and capillaries, causing pulmonary congestion, and pulmonary hypertension.
CHF can occur in the right, left, or both sides of the heart, in systolic or diastolic forms.

Angina Pectoris

Angina pectoris is chest pain due to myocardial ischemia, usually brought on by an imbalance between cardiac workload and oxygen supply, and is secondary to coronary artery disease in 90% of all cases.
It occurs when myocardial oxygen demand exceeds supply.

Diagnosis of MI

ECG: Electrocardiogram shows changes (ST-segment changes).
Serial Blood Enzymes: Elevated (such as troponin or CK-MB) levels over a 24-36-hour period.
Cardiac Catheterization: Assessment of pressures, cardiac output.
Echocardiography/TEE (Transesophageal echocardiography): Assess structural heart disease.
Exercise Tolerance Test: Assess cardiac function under stress.
Angiogram: Visualization of the coronary arteries.

Valvular Heart Disease

Valvular diseases are conditions that affect the heart valves.
The four heart valves are the tricuspid, mitral, pulmonic, and aortic valves.

Aortic Stenosis

Aortic stenosis is narrowing of the aortic valve, leading to left ventricle hypertrophy.
Prognosis is poor if unmanaged.

Aortic Regurgitation

In aortic regurgitation/insufficiency, the aortic valve fails to close tightly, causing blood to leak back into the left ventricle during diastole.
The left ventricle needs to increase in size via hypertrophy to compensate for the leakage-poor prognosis if unmanaged.

Congenital Heart Disease

Congenital heart disease (CHD) is the most common birth defect, occurring in approximately 1 out of 110 births.
Most commonly caused by abnormal fetal development.
May involve a left-to-right or a right-to-left shunt

Peripheral Arterial Disease(PAD)

PAD is a disease of the arteries that supply blood to the extremities.
It's commonly a result of atherosclerosis.
Often affects the legs more than the arms.
Symptoms usually appear when the artery diameter narrows by 50%
Atherosclerosis is the underlying cause.
PAD correlates with smoking, diabetes, or impaired glucose tolerance, male gender, hypertension, low HDL cholesterol levels, and high triglyceride levels.

PAD: Clinical Manifestations

Claudication: Painful leg cramps that occur with exercise or activity and are relieved by rest.
Weakness or fatigue: in the affected extremities.
Numbness or coldness: sensation in the extremities.

PAD: Diagnostics

Ankle-Brachial Index (ABI): A non-invasive measurement of blood flow in the extremities.

PAD: Treatment

Angioplasty: Insertion of a balloon into the artery to widen the narrowed area.
Bypass Surgery: Connecting a healthy blood vessel to the blocked artery to allow blood to bypass the blockage.

Other conditions

Several different conditions may have similar symptoms to decreased activity: Cerebral Palsy, Duchenne Muscular Dystrophy, Spina Bifida, Spinal Atrophy

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Description

Test your knowledge on coronary artery disease, its risk factors, symptoms, and related cardiac studies. This quiz covers important aspects of heart conditions and trends based on statistical studies like the Framingham Study. Perfect for students and professionals in the medical and health fields.