Podcast
Questions and Answers
Which of the following is the primary underlying cause of Coronary Heart Disease (CHD)?
Which of the following is the primary underlying cause of Coronary Heart Disease (CHD)?
The term 'athero' in 'atherosclerosis' refers to which of the following?
The term 'athero' in 'atherosclerosis' refers to which of the following?
Which of the following changes occur in arteries due to atherosclerosis?
Which of the following changes occur in arteries due to atherosclerosis?
Which of the following is a modifiable risk factor for Coronary Artery Disease (CAD)?
Which of the following is a modifiable risk factor for Coronary Artery Disease (CAD)?
Signup and view all the answers
Which of the following biochemical characteristics is a risk factor for CAD?
Which of the following biochemical characteristics is a risk factor for CAD?
Signup and view all the answers
Which of the following is considered a non-modifiable risk factor for Coronary Artery Disease (CAD)?
Which of the following is considered a non-modifiable risk factor for Coronary Artery Disease (CAD)?
Signup and view all the answers
Which of the following lifestyle choices can increase the risk of developing CAD?
Which of the following lifestyle choices can increase the risk of developing CAD?
Signup and view all the answers
Which of the following conditions can contribute to the development of CAD?
Which of the following conditions can contribute to the development of CAD?
Signup and view all the answers
What is the approximate number of deaths in the United States attributable to heart disease in 2022, according to the CDC?
What is the approximate number of deaths in the United States attributable to heart disease in 2022, according to the CDC?
Signup and view all the answers
Which of the following is the most common type of heart disease, based on the data provided?
Which of the following is the most common type of heart disease, based on the data provided?
Signup and view all the answers
For which of the following racial/ethnic groups of women is heart disease the second leading cause of death, after cancer?
For which of the following racial/ethnic groups of women is heart disease the second leading cause of death, after cancer?
Signup and view all the answers
What is the approximate estimated total cost of heart disease to the United States annually, according to the data?
What is the approximate estimated total cost of heart disease to the United States annually, according to the data?
Signup and view all the answers
The medicine admission note references a patient with an ejection fraction (EF) of 30-35%. What does ejection fraction represent?
The medicine admission note references a patient with an ejection fraction (EF) of 30-35%. What does ejection fraction represent?
Signup and view all the answers
What is a likely reason for the 93-year-old male patient's current admission, based on the information provided in the medicine admission note?
What is a likely reason for the 93-year-old male patient's current admission, based on the information provided in the medicine admission note?
Signup and view all the answers
The patient's past medical history includes 's/p CABG x 2 (svg->LAD & 1st diagonal)'. What does this signify?
The patient's past medical history includes 's/p CABG x 2 (svg->LAD & 1st diagonal)'. What does this signify?
Signup and view all the answers
Given the patient's medical history and current presentation, which of the following medications is he most likely prescribed?
Given the patient's medical history and current presentation, which of the following medications is he most likely prescribed?
Signup and view all the answers
Flashcards
Coronary Heart Disease (CHD)
Coronary Heart Disease (CHD)
Build-up of plaque in the heart’s arteries causing heart attacks.
Atherosclerotic plaques
Atherosclerotic plaques
Nodular deposits of fatty material lining artery walls, causing hardening.
Types of angina
Types of angina
Chest pain due to decreased blood flow to the heart; includes stable and unstable.
Myocardial Infarction (MI)
Myocardial Infarction (MI)
Signup and view all the flashcards
Heart failure vs. cardiac pump dysfunction
Heart failure vs. cardiac pump dysfunction
Signup and view all the flashcards
Right vs. left heart failure
Right vs. left heart failure
Signup and view all the flashcards
Risk factors for Coronary Artery Disease (CAD)
Risk factors for Coronary Artery Disease (CAD)
Signup and view all the flashcards
Cardiomyopathy
Cardiomyopathy
Signup and view all the flashcards
Cardiovascular Disease (CVD)
Cardiovascular Disease (CVD)
Signup and view all the flashcards
Leading cause of death
Leading cause of death
Signup and view all the flashcards
Coronary Artery Disease (CAD)
Coronary Artery Disease (CAD)
Signup and view all the flashcards
Cost of heart disease
Cost of heart disease
Signup and view all the flashcards
Demographics of heart disease
Demographics of heart disease
Signup and view all the flashcards
Heart Failure (HF)
Heart Failure (HF)
Signup and view all the flashcards
Atrial Fibrillation (AF)
Atrial Fibrillation (AF)
Signup and view all the flashcards
Patient care importance
Patient care importance
Signup and view all the flashcards
Study Notes
Cardiac Pathophysiology Study Notes
- Cardiac pathophysiology is the study of the disease processes affecting the heart.
- Heart disease is the leading cause of death for most racial/ethnic groups in the US.
- About 702,880 Americans died from heart disease in 2022, which is 1 in every 5 deaths.
- Coronary heart disease (CHD) is the most common type of heart disease, killing more than 375,476 people in 2021.
- Approximately 20.1 million adults aged 20 and older in the US have coronary artery disease (CAD).
- Heart disease costs the US $252.2 billion annually (2019-2020), covering healthcare, medications, and lost productivity.
- Heart disease is the leading cause of death for most racial/ethnic groups in the United States, including African Americans, American Indian, Alaska Native, Hispanic, and White men. For women of Asian American or Pacific Islander, American Indian, Alaska Natives, or Hispanic descent, heart disease is second only to cancer.
Coronary Heart Disease (CHD)
- CHD is the build-up of plaque in the heart's arteries, leading to heart attacks.
- CAD and CHD are often used interchangeably.
- CHD is caused by CAD.
- Ischemia is a lack of blood flow.
- Infarction is the death of tissue due to lack of blood supply.
Risk Factors for Coronary Artery Disease (CAD)
- Modifiable: Tobacco use, diet high in saturated fat, cholesterol, and calories, excess alcohol consumption, lack of physical activity, blood lipid abnormalities, high cholesterol, elevated blood triglycerides, hyperglycemia/diabetes mellitus (DM), obesity, and hypertension (HTN).
- Non-modifiable: Gender, age, family history of CAD, and personal history of CAD.
Cholesterol
- Cholesterol is an essential compound used by the body for cell membrane structure and enzymatic activity.
- It transports fatty acids and lipids.
- The body produces (75%) and receives (25%) from food (animal products only).
Lipoproteins: LDL and HDL
- LDL ("bad" cholesterol): Higher LDL numbers indicate a higher risk. -<100mg/dL is desirable -100-129mg/dL near optimal -130-159mg/dL borderline high -160-189mg/dL high ->190mg/dL very high
- HDL ("good" cholesterol): Higher HDL numbers indicate a lower risk. ->60mg/dL is optimal -<40mg/dL (men) or <50mg/dL (women) is low
- HDL protects against CHD by removing LDL from the blood.
Triglycerides
- Triglycerides are also part of the lipoprotein profile.
- High levels increase the risk of heart disease.
- Fats carried in the blood from food. -<150mg/dL is normal -150-199mg/dL borderline high -200-499mg/dL high ->500mg/dL very high
Total Cholesterol and LDL:HDL Ratio
- Total cholesterol: A measure of LDL, HDL, and other lipid components. -<200mg/dL is desirable -200-239 borderline high ->240mg/dL high
- LDL:HDL ratio: Provides a composite risk marker for CHD. -< or = 3:1 ratio is low risk -> or = 5:1 ratio is high risk
- A high ratio is a major predictor for cholesterol-related blockages.
Atherosclerotic Lesions
- Atherosclerosis: Gradual hardening of the arteries caused by a build-up of fatty deposits.
- Abnormal lipid metabolism, excessive cholesterol/saturated fat intake, and genetic predisposition are contributing factors.
Pathogenic Mechanisms of Plaque Formation
- The earliest detectable atherosclerotic lesion is the fatty streak.
- A fatty streak is mostly made up of foam cells with lipids in the subendothelial space of the artery.
- It develops possibly in early teen years.
Myocardial Ischemia
- Myocardial ischemia occurs when the demand for oxygen by the heart muscle is greater than the supply.
- Myocardial ischemia is reversible
- Increased demand: Exercise, mental stress, spontaneous fluctuations in HR/BP.
- Decreased supply: decreased coronary blood flow.
- Diagnosed via stress test (exercise or pharmacological), arrhythmias, and T-wave inversions; later, ST elevation.
Angina Pectoris (Angina)
- Angina is a classical symptom of ischemia, often described as pressure or heaviness.
- Location: Substernum (midchest), precordial (over the heart), and radiating to shoulder/arm/throat/jaw.
- Types include chronic stable angina (associated with a fixed demand for oxygen) and unstable angina (change in pattern or is at rest.
Myocardial Infarction (MI)
- MI (Heart Attack) is the complete interruption of blood supply to an area of the myocardium.
- It is due to MI (sudden arterial or venous insufficiency).
- MI develops from ischemia.
- Causes include prolonged myocardial ischemia (plaque rupture/thrombus formation, spasm, inadequate blood flow (decreased BP, excessive metabolic demand)).
- Less frequent causes: Embolic occlusion, aortitis, vasculitis, or coronary artery dissection.
- Cocaine and other stimulants can lead to severe vasoconstriction, resulting in MI.
Response to MI
- Cells die, forming necrotic tissue (infarct).
- 18-24 hours post-MI: inflammatory response to necrosis.
- 2-4 days: Visible necrosis is present.
- 4-10 days: Myocardial recovery starts
- 10-14 days: Formation of a weak fibrotic scar; revascularization is present.
- The scar tissue is inelastic, impacting the heart's ability to contract and relax.
MI Classification
- Subendocardial (NSTEMI/non-Q-wave MI).
- Partial thickness injury to myocardium, not extending through the full thickness of the wall; ST-segment depression, potentially no Q-wave.
- Transmural (STEMI/Q-wave MI).
- Full-thickness injury extending through the entire muscle wall; ST-segment elevation, with significant Q-wave.
Cardiac Enzymes
- Cardiac muscle cells die, releasing enzymes (markers) into the bloodstream.
- Troponins (I and T): Preferred MI marker; elevated within 4-6 hours of injury, remain elevated; Peaks at 24 hours.
- CK-MB: Specific for myocardial cell necrosis; elevated 4-8 hours post-MI; returns to normal in 2-3 days.
- Myoglobin: Released with injury to the myocardium within 1-4 hours.
Cardiac/Ventricular Remodeling
- Changes in the size, shape, structure, and physiology of the heart after injury (such as MI, chronic HTN).
- Involves both physiological (helpful for adaptation) and pathological (harmful) processes.
- Starts within minutes of injury, progressing over time.
- Remodeling can cause a transition from an elliptical to a spherical shape of the LV.
- Apoptosis (programmed cell death) is involved.
Congestive Heart Failure (CHF)
- A syndrome where the heart cannot pump enough output to meet the body's metabolic demands.
- May result from structural/functional disorders that impair ventricular filling or the pumping mechanism of the ventricles.
- Modifiable risk factors include: CAD, HTN, DM, valvular and congenital heart disease, arrhythmias, ETOH/drug abuse, and age.
Characteristics of CHF
- Dyspnea, tachypnea, orthopnea, PND, fatigue, peripheral edema, and cyanosis.
- Weight gain, hepatomegaly, JVD, rales/crackles (especially wet), S3 heart sound, sinus tachycardia, and poor exercise tolerance.
CHF Classification and Diagnostic Methods
- NYHA Functional Classification: Patients are categorized based on how limited they are with physical activity.
- Echocardiogram: Measures ejection fraction (EF) to assess heart function. EF below 30-40% is a marker.
- BNP assay: Elevated BNP indicates heart failure.
- CXR: Chest X-ray to visualize the heart size and possible fluid collection in the lungs.
- EKG: Electrocardiogram to detect possible arrhythmias.
- Blood values, electrolytes, renal and liver function tests, cardiac catheterization, and endomyocardial biopsy.
Radiologic findings
- CXR reveals cardiac silhouette changes, edema (interstitial, perivascular, alveolar) pleural effusion, or atelectasis.
Medical Treatment of CHF
- Decrease venous return and improve the heart's work.
- Diuretics, vasodilators (digoxin), beta-blockers, ACE (angiotensin-converting enzyme) inhibitors, and inotropes.
Surgical Management of CHF
- Cardiac resynchronization therapy (pacemaker), angioplasty (with or without stenting), or atherectomy, RotoBladder, coronary artery bypass (CABG), intra-aortic balloon pump (IABP), ventricular assist device (VAD), or heart transplant.
Compensated vs Decompensated CHF
- Compensated CHF: Patients are on a cocktail of medications; symptoms are mild to moderate, and volume overload is present.
- Decompensated CHF: Baseline abnormalities become more pronounced, and symptoms worsen.
Cardiomyopathy (CM)
- A diverse group of diseases primarily affecting the heart muscle.
- The disease leads to problems with the contraction and/or relaxation of the heart muscle.
- Main types: dilated, hypertrophic, and restrictive cardiomyopathy.
Dilated Cardiomyopathy (DCM)
- Enlargement of all four heart chambers with little or no wall thickening.
- Problems with systolic function are typical.
- DCM is often noted with shortness of breath, fatigue, other symptoms of heart failure, and may present with symptomatic ventricular dysrhythmia.
Hypertrophic Cardiomyopathy (HCM)
- Characterized by a considerable increase in cardiac mass (hypertrophy); no cavity dilatation.
- Typically normal or increased systolic function; may present with left ventricular outflow obstruction (hypertrophic obstructive CM or IHSS); and impaired filling of the ventricles.
Restrictive Cardiomyopathy (RCM)
- In restrictive cardiomyopathy, ventricular filling is restricted due to endocardial/myocardial disease.
- The ventricular walls may be stiff, but thickened.
- The walls are not necessarily thickened.
- Heart failure is typical and usually accompanied by symptoms.
Valvular Heart Disease
- Problems with heart valves, typically due to stenosis (narrowing), insufficiency (leaking), or prolapse (bulging).
- Congenital conditions, infections, or mechanical stress are common causes.
- Symptoms: signs of exhaustion, symptoms of heart failure (depending on the valve affected).
Sudden Cardiac Death (SCD)
- Abrupt cessation of heart function; clinical manifestation of CAD.
- Loss of consciousness; cessation of arterial pulse without preceding circulatory collapse.
- Often a result of fatal arrhythmias.
- Causes include myocardial infarction, ischemic heart disease, cardiomyopathy, valvular heart disease, electrical abnormalities, blood vessel abnormalities, or medications.
Aneurysms
- Localized, pulsating, and palpable swelling of a blood vessel due to dilatation/weakening.
- Types:
- True aneurysm: Involves all layers of the vessel wall.
- False (pseudo) aneurysm: Blood escapes the vessel wall and collects in the surrounding tissues.
- Saccular aneurysm (bulging out).
- Fusiform aneurysm (the entire width of the vessel dilates/bulges).
- Causes include atherosclerosis and Marfan syndrome, and can be mycotic (fungi/bacteria). Dissecting aneurysms involve splitting of the artery wall, often in the aorta.
Peripheral Artery Aneurysms
- Usually in men.
- Symptoms include a pulsatile mass in the thigh.
- Often asymptomatic, although rupture/other complications are potential concerns.
- Popliteal artery aneurysms are more common than femoral.
Treatment of Aneurysms
- Surgical excision and grafting (often via endovascular repair if possible) is used to treat aneurysms.
- Potential complications include MI, bleeding, respiratory insufficiency, limb ischemia, ischemic colitis, renal insufficiency, and stroke.
Endocarditis
- Inflammation of the endocardium, usually due to microbial infection.
- Typically caused by bacteria entering the bloodstream.
- Causes valve damage; can be fatal.
- Characterized by fever, murmur, vegetation, low-grade fever, fatigue, weight loss, and night sweats.
- Treatment is typically with antibiotics.
Pericarditis
- Inflammation of the pericardial sac (pericardium).
- Commonly viral in origin, but can be caused by heart surgery/MI/trauma or autoimmune diseases.
- Symptoms include chest pain, dyspnea, high HR, fever, and a pericardial rub on auscultation.
- May progress to pericardial effusion (fluid around the heart), which can lead to cardiac tamponade, an emergency.
- Treatment options include position changes, non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics if bacterial, and surgery in severe cases.
Cardiac Tumors
- Generally rare.
- Benign tumors are more common. Myxoma is a common benign tumor; symptoms vary but often include DOE, PND, fever, weight loss, dizziness, and sudden death.
- Malignant tumors are mostly sarcomas (e.g. Hemangiosarcomas, Rhabdomyosarcoma).
- Some tumors (e.g., metastases) have a higher propensity for cardiac or pericardial spread.
- Treatment is related to the cause (often surgery in benign or metastasis removal).
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Test your knowledge on Coronary Heart Disease (CHD) and Coronary Artery Disease (CAD) with this informative quiz. Explore risk factors, lifestyle choices, and the impact of atherosclerosis on heart health. Perfect for health students and those interested in cardiovascular wellness.
