CVPP Week 9: framingham Heart Study and Myocardial Infarctions

Metabolic profiling def

Analyzing a person's specific response to diet and activity

Red meat is high in _______ and _______

Methionine and homocysteine

When is methionine converted to homocysteine

Transamination in the liver (metabolized)

What converts homocysteine back to methionine

B vitamins

Which B vitamins break down homocysteine or convert it back to methionine

B6 B9 and B12

High homocysteine levels lead to what

Vascular inflammation —> dementia, heart attack, CV disease and stroke

What cooked formed of eggs are best for minimizing fat and maximizing nutrient retention

Boiling, poaching and baking

Alcohol use does what

Raise systolic BP

What antioxidant is in red wine

Resveratrol

Simple carbs are...

Easily digested and absorbed and leads to spike in blood sugar

Spikes in blood sugar promotes what

Fat storage

Refined carbs do what

Digests quickly and leads to rapid increase in glucose levels

Complex carbs do what

Digest slower so lower glycemic index (GOOD)

Polyphenolic antioxidants

Apples, extra virgin olive oil, dark chocolate, beans and cherries

Anthocyanins

Blueberries, red grapes and strawberries

Antioxidant vitamins

A C E

Exercise minimum time frame

2-3 hours per week min

Stable vs labile fat

Subcutaneous is stable and intraperitoneal fat is labile

Subcutaneous fat is what color and does what

Beige

-used for energy storage and thermoregulation

-protected from metabolic disease (harder to metabolize)

What happens when subcutaneous fat is at max capacity

Start to add fat to visceral compartment

Intraperotineal fat (visceral) dos what

Easier to metabolize (why it's called labile)

-inflammatory and raises free fatty acids then LDL

Why is subcutaneous fat beige

Mix between white and brown adipose tissue

Why is brown adipose tissue brown and what does it do

Mitochondria

-helps generate heat and provide energy

What do white fat cells secrete

Proinflammatory cytokines (TNF and IL-6)

-promotes clean up of dying fat cells by MAC-1

What is visceral fat highly associated with

Dementia and alzheimer's disease

Type 2 diabetes mellitus =

Resistance to insulin

Resistance to insulin causes

Hyperglycemia

Hyperglycemia causes

Increased production of AGE —> inflammation and oxidative stress

AGE acronym

Advanced glycation end product

What happens to food that gets converted to sugar and enters the blood stream

Pancreas secretes insulin to move sugar from blood to the cells

Where is glucose taken up

Taken up by fat cells and stored as glycogen and converted to triglycerides

What happens if the fat cell is compressed or inflamed?

RESISTANCE: it can't activate insulin receptor so it doesn't take in the sugar

What happens when fat cell can't activate insulin receptor to take in sugar

Pancreas releases more insulin to try to get sugar into cells —> overtime is wears out and blood sugar increases

3 bad ingredients in tobacco that affect CV system

Nicotine

Cadmium

Carbon monoxide

Nicotine effects

-Vasoconstrict —> acts are norepinephrine

-Raises TPR and BP

-Promotes endothelial cell proliferation and thickens intima

Cadmium effects

-Toxic heavy metal

-Generates free radials and causes inflammation

Carbon monoxide effects

Harmful to myocardium and brain (displaces O2)

High levels of _____ from long term stress increase blood cholesterol, blood sugar and increase BP through vasoconstriction

Cortisol

Ischemic heart diseased often caused by...

Coronary artery disease

Coronary artery disease occurs from...

Plaque buildup

Where is most common occlusion for coronary artery disease

Left anterior descending artery

Right coronary artery occlusions may cause...

Ischemia of the nodes —> bradycardia and arrhythmias

Clinical presentations of coronary artery disease (3)

1. Stable/exertional angina pectoris (70%)

2. Unstable angina pectoris (90%)

3. Myocardial infarction (100%)

Stable/exertional angina pectoris

Appears with activity and disappears with rest

Unstable angina pectoris

More severe blockage and may occur during sleep

Myocardial infarction

-no relief from nitro tabs

-leads to ischemic necrosis

-irreversible loss of muscle mass

Total occlusion =

Heart attack

Prinzmetal's (variant) angina

-chest pain at rest

-caused by coronary artery spasm (NO PLAQUE INVOLVED)

Acute coronary syndrome def

Range of conditions in which blood flow to the heart decreases

Examples of acute coronary syndrome (3)

1. Myocardial infarction

2. Unstable angina

3. Sudden cardiac arrest

How does acute coronary syndrome occur

Due to abrupt plaque changes followed by thrombosis

Two types of abrupt plaque changes

Erosion: due to endothelial injury

Rupture: unstable plaque with thin overlying fibrous caps

Can you have acute coronary syndrome without thrombosis?

Yes

Are patients with acute coronary syndrome asymptomatic before plaque ruptures?

Yes

Classic phrase to a heart attack?

I feel like an elephant was standing on my chest

Pain referral patterns (5)

1. Left shoulder, medial arm neck and jaw

2. Right shoulder, medial arm neck and jaw

3. Both sides

4. Epigastrium

5. Between shoulder blades

Symptoms of heart attack in women (7)

-unexplained SOB

-unusual fatigue

-jaw pain (most common unusual symptom)

-diaphoresis

-nausea

-high anxiety, rapid pulse

-color/temp changes

When does myocardial infarction happen in kids?

Rare but associated with congenital heart disease or other underlying conditions

Muscle that is replaced with _______ _________ over the next several days after a heart attack

Scar tissue

Scar tissue won't conduct —>

Lead to arrhythmia

Scar tissue won't contract —>

Congestive heart failure

Scar tissue can blow out —>

Transmural infarct = cardiac tamponade

Syncope

Temporary episode of low blood flow to brain due to slowed heart beat and drop in BP

Cardiac syncope

Heart doesn't pump enough blood to brain due

Cardiac syncope may be the first symptom of...

Acute coronary syndrome due to arrhythmia or pump failure

Drop attack

Sudden loss of posture tone without loss of consciousness

Drop attack can be a symptom of...

Vertebrobasilar insufficiency (VBI)

-type of transient ischemic attack (mini stroke)

P wave

Atrial depolarization

-Na/Ca influx

What starts the P wave

SA node

PR segment

Ventricles filling

QRS complex

Ventricle depolarization + atrial repolarization

ST segment

Flat = ventricles fully repolarized

T wave

Ventricle repolarization

-K efflux

Transmural infarct also known as ______ and what does it involve

STEMI (ST-segment elevated MIs)

-involves full thickness of ventricle

What does STEMI look like on EKG

ST segment elevation, pathological Q-waves and T-wave inversion

Subendocardial infarction also known as _____ and what does it involve

NSTEMI (non-ST elevated MIs)

-involves inner third of ventricle wall

What does subendocardial infarction look like on EKG

No ST elevations or pathological Q-waves BUT may exhibit T-wave inversion

Ischemic heart disease abnormal EKG findings (3)

-Shifts of ST segment

-Inverted T-wave

-Suggests ischemia because O2 is required for proper electrical conduction from Na+ pump

Blood lab

When myocardial cells are damaged or die due to infarction, enzymes are released in bloodstream

What enzymes are released in blood stream when myocardial cells are damaged from an infarction (2)

1. Creatine kinase

2. Troponin

Angiogram

Catheter injects dye into coronary artery to show blood flow to determine area of blockage

Patients with suspected acute coronary syndrome take... (3)

Aspirin (anti-platelet aggravation but thins blood)

Nitroglycerin

Supplemental oxygen (if required)

Once diagnosis is confirmed of ACS:

Antigoagulants

Beta-blockers

ACE inhibitors

Statins