Cardiology Quiz: Myocardial Infarction & Angina

Cardiovascular Pathology: Ischemic Conditions

• Evaluation and Treatment of Clients with Cardiovascular Pathology: This is the topic of the presentation.
• Learning Objectives: Students will be able to perform a brief patient history, reflect on performance, analyze signs/symptoms and pathophysiology, specify medical/surgical interventions and diagnostic tests for common cardiovascular conditions, identify cardiovascular disease risk factors, discuss physical therapy interventions' impact on cardiovascular risk profile, synthesize medical chart information to guide physical therapy intervention and referral decisions, perform a physical therapy evaluation of a mock client, and utilize information from patient/case studies to create a plan of care for a client with cardiovascular disease, including exercise prescription. Students will evaluate a patient's response, recognize common side effects of medications, identify cardiovascular emergencies, and take appropriate next steps.

Ischemic Cardiovascular Conditions

• Atherosclerosis: Progressive hardening and narrowing of coronary, cerebral, and peripheral arteries.
• Coronary Artery Disease (CAD): Presence of an obstruction limiting coronary blood flow without significantly impacting myocardial function.
• Coronary Heart Disease (CHD): Presence of an obstruction causing permanent damage to heart muscle function.

Clinical Presentation of Patients with CHD

• Sudden Cardiac Death (SCD): First presenting symptoms in 40-50% of patients. Death occurs within an hour of symptom onset, often due to a rhythm disturbance.
• Chronic Stable Angina: Symptoms triggered by a known level of exertion or activity, are relieved by rest or nitroglycerin; oxygen supply to the myocardium does not meet demands.
• Acute Coronary Syndrome (ACS): Includes unstable angina (variations from stable angina, more frequent and severe angina at rest, and angina lasting >20 minutes), STEMI (ST-segment elevation myocardial infarction—severe blockage, prolonged), and Non-STEMI (non-ST segment elevation myocardial infarction—partial or temporary blockage).
• Cardiac Muscle Dysfunction (Heart Failure): A fourth way CHD may present.

Coronary Artery Anatomy & Physiology

• Coronary artery perfusion: Occurs during diastole (relaxation of the heart muscle)
• Determinants of blood flow: Diastolic blood pressure, vasomotor tone (vasoconstriction or dilation), resistance to flow, and left ventricular end-diastolic volume.

Plaque Formation

• Fatty Streak: Initial sign of plaque formation, consisting of lipids, connective tissue, smooth muscle cells, platelets, and macrophages.
• Stable Plaques: Often calcified with less risk of rupture.
• Unstable Plaques: Rich in lipids and inflammatory cells, with a thin fibrous cap that is more prone to rupture.

Mechanisms of Atherosclerosis

• Nitric Oxide (NO) Dysfunction: NO in the endothelium is affected causing endothelial dysfunction and an immune response.
• Lipid-filled Macrophages: Cause endothelium stretching and separation. Platelets aggregate, collagen increases, destroying the elastic layer of the media; responsible for dilation. A fibrin cap of thrombi forms over the plaque.

Video: McGraw Hill (Anatomy and Physiology Revealed)

• The video is about cardiovascular anatomy and physiology, focusing on aspects of cardiac disease.

Stable Angina

• Symptoms Trigger: Known level of physical activity or exertion.
• Symptom Relief: Relieved by rest or nitroglycerin; oxygen supply inadequate. -

Angina Pectoris

• Description: Angina means "strangling;" it implies ischemia
• Impulse pathways: Ischemia - sensory impulse travels in unmyelinated sympathetic nerves to the upper thoracic ganglia, then travels through the dorsal horn to the spinothalamic tract, reaching the thalamus, and finally arriving in the cortex.
• Brain input: The brain receives inputs from cutaneous nerves that run through those same spinal levels.
• Pain location: Brain cannot precisely pinpoint the location of the pain.

Chart Review: Lab Values Cardiac Focus

• Complete Blood Cell Count (CBC): WBC (infection), RBC (hydration status, implications for blood pressure / upright tolerance), Hgb (oxygen carrying capacity to do work). Anemia may cause a higher HR at rest, thus limiting HR reserve for exercise and may increase workload.
• Electrolytes: Rhythm disturbances and potassium, can impact heart function.
• Cardiac Enzymes: Key markers include Troponin I (most sensitive and specific marker for MI; levels increase within 3-12 hours of angina reaching a peak in 24-48 hours returning to baseline in 5-14 days); and Creatinine Phosphokinase (CPK-MB) which is also a marker for muscle damage. False positives may occur if a person has muscle disease, diabetes mellitus, muscle trauma, pulmonary embolism (PE), or alcohol toxicity).

Echocardiography

• Technique: Non-invasive technique providing structural info: chamber size/wall thickness and valve function.
• Ejection Fraction (EF): 55-70 percent is a normal assessment; poor EF associate with exercise intolerance.
• Diagnostic insights: Look for EF, valve function (increased myocardial workload) and wall function.

Cardiac Catheterization or Angiography

• Purpose: Visualizing coronary arteries to assess plaque extent and location.
• Procedure: Hollow tube inserted in an artery, threaded up to coronary arteries and dye is injected.

Case Study

• Patient: A 68-year-old male with lab results: -Hgb 13 g/dL -WBC 5k -Plt 200k
• Troponin 1.8 ng/ml
• CK-MB/CK 3.5

Test your knowledge about myocardial infarction (MI) and angina with this comprehensive quiz. Explore key concepts such as Troponin I levels, cardiac catheterization, and the presentations of coronary heart disease. Challenge yourself on critical factors affecting heart health and disease.