cardio risk factors, pathology and diagnostics

low, 10-20%

greatest reduction in risk occurs at the __ end of the fitness spectrum with 1 met increase in CRF = __% reduction in mortality

beta

type 1 diabetes targets __ cells of pancreas

tobacco

single greatest preventable cause of disease and premature death

catecholamine, HR and BP

tobacco injuries vasculature through __ release

• increases __ and __

constricts, lowers, V-fib

tobacco __ peripheral arteries and __ threshold for __

increases, increases, decreases

on a lipid panel - tobacco __ platelet activation, __ LDL oxygenation and __ HDL

>25-29.9

BMI for overweight

>30

BMI for obesity

cytokines, leukocyte adhesion

activated endothelium produces __ which signals the immune system for __ __ molecules

monocytes

activate endothelium is more permeable to

vasodilatory, antithrombotic 

activated endothelium decreases __ and __ molecules

endothelial dysfunction

first step in atherogenesis

LDL

what lipoprotein do lipids come from to create foam cells

thrombosis

ultimate complication of atherosclerosis

plaque rupturing

cause of most MIs

shear forces, vasoconstriction

rupture of a plaque is precipitated by __ and __

vessel narrowing, vascular tone

ischemia results from a combination of __ __ and abnormal __ __

normal, reduced

when stenosis narrows the diameter by more than 70% resting blood flow is __ and maximal blood flow is __ with full dilation 

90%

when stenosis reaches __%, blood flow will be inadequate to meet baseline requirements at rest

stenosis, inappropriate vasoconstriction

stable angina is usually caused by __ and __ __

unstable

type of angina that may progress to MI

40

silent ischemia can occur in __% of patients with stable angina

ECG or stress testing

how is silent ischemia observed

elderly, diabetics, women

silent ischemia is most common in 

tachycardia, diaphoresis, nausea, fatigue

accompanying symptoms of stable angina

myocardial oxygen demand

precipitants for stable angina are conditions that increase

(PA, cold weather, excitement, anger) 

50

% of resting ECGs that are normal with ischemia

horizontal/downsloping depression

ST segment changes with ischemia

flattening or inversion

T wave changes with ischemia

ST elevation

in more severe ischemia or variant angina vasospasm, __ __ may be seen on ECG

acute coronary syndromes

disruption of plaque with platelet aggregation and formation of intracoronary thrombus

NSTEMI

acute coronary syndrome with partially occlusive thrombus and unstable angina

STEMI

acute coronary syndrome with complete obstruction

transmural

MI that spans entire thickness of myocardial wall - total prolonged occlusion of coronary artery

subendocardial

MI exclusively involving inner layers of myocardium

fulfill definition of MI, <50% stenosis, no clinical cause

3 diagnostic criteria for MINOCA

cardiac magnetic resonance (CMR)

diagnosis of MINOCA

SCAD

intimal tear/flap or an intramural hematoma that obstructed blood flow suddenly

• nonatherosclerotic acute MI 

ventricular contractility and relaxation, afterload

heart failure includes impaired __ __ and __, and increased __

stiffened

HFpEF is characterized by a __ heart muscle

weakened

HFrEF is characterized by a __ heart muscle

mitral stenosis

narrowed valve orifice caused by rheumatic fever

mitral stenosis

obstruction of blood flow across valve - emptying of LA is impeded which increased pressure

dyspnea and reduced exercise capacity

clinical manifestations of mitral stenosis 

mitral valve regurgitation

disruption to the structural integrity of any component (annulus, two leaflets, chordae tendineae or papillary muscles) or action that results in abnormal closure 

volume and pressure, forward cardiac output and stress

mitral valve regurgitation results in elevated left atrium __ and __, reduction in __ __ __, and __ on left ventricle

eccentric hypertrophy, decreased  

in chronic mitral valve regurgitation: LV compensatory dilation response is __ __ and results in __ systolic ventricular function

calcification (in trileaflet or bicuspid aortic valve), rheumatic aortic valve disease

causes of aortic stenosis

decreased, increase

during aortic stenosis, blood flow across the aortic valve is __ during systole which requires an __ in LV systolic pressure

concentric hypertrophy

overtime in aortic stenosis the LV undergoes __ __ to reduce wall stress 

aortic regurgitation

results from abnormalities of valve leaflet or dilation of aortic root

diastole 

aortic regurgitation involved regurgitation of blood from aorta into LV during __ 

eccentric hypertrophy, thickness 

with chronic aortic regurgitation, volume and pressure overload causes ventricle to compensate through __ __ and increased __

tricuspid stenosis

rare and long term consequence of rheumatic fever

• abnormal distension/hepatomegaly due to venous congestion 

tricuspid regurgitation

usually function not structural - mostly caused by RV enlargement 

pulmonic stenosis 

caused by congenital deformity - only symptomatic in moderate to severe cases

pulmonic regurgitation

develops with pulmonary hypertension and results from dilating of valvular ring

identical

pathology of PAD and CAD is __

40

% of patients with PAD that have clinically significant CAD

1/3

fraction of patients that experience pain with PAD

chest xray (CXR)

used to assess heart size and pulmonary congestion 

CAC

test not used during ischemic work up

d-dimer

used to diagnose pulmonary embolism

normal resting ECG

indication for stress testing - diagnosis of chest pain in someone with

functional capacity 

indication for stress testing - evaluation of 

>0.5 ST depression, LVH, paced rhythm, LBBB, WPW, digitalis use

abnormalities that would remove someone as a candidate for exercise testing

increases HR

dobutamine in a pharmacological stress test

vasodilator

adenosine in a pharmacological stress test

echo

test using high frequency sound waves to generate pictures of heart and structures 

damage/disease

echo/ultrasound is used to detect

size

info obtained from echo about ventricular cavity

thickness and integrity

info obtained from echo about interatrial/ intraventricular septum

valves

info obtained from echo about functioning of

ventricular wall

info obtained from echo about movement in 

SV and EF

info obtained from echo about estimating

valves and heart muscle

info obtained from echo about motion of

stress echo

may reveal lack of blood flow to certain regions of the heart

stress echo 

dyskinesis, hypokinesis and akinesis can be observed during a __ when ischemia is present 

lower cost, no radiation, shorter time

advantages of stress echo over nuclear testing

stress nuclear (PET/SPECT)

utilizes tracers/radioactive material to be analyzed by computer to construct images of heart

ACS

stress nuclear myocardial perfusion imaging (PET or SPECT) testing would be used after __ is ruled out 

perfusion, LV function

PET/SPECT allows for detection of __ abnormalities, measures of__ function and high risk findings

transient ischemic dilation

high risk finding that may be detected during PET or SPECT

ischemia and infarction 

cardiac MRI used to detect and localize

ventricle function

cardiac MRI is used to evaluate global and regional

viability

cardiac MRI used to determine myocardial ___

cardiac MRI

can be used to differentiate between acute/chronic MI by detecting edema and microvascular obstruction

intravascular ultrasound 

lesion morphology, guide stent sizing/stent expansion

fractional flow reserve

guide wire is inserted through catheter to measure pressure in coronary artery distal to stenosis during drug induced vasodilation

<0.08

FFR value that identifies a severe stenosis that warrants intervention 

spirometry 

measures how much air one can inhale/exhale and how quickly one can exhale 

FEV1

forced expiratory volume in 1 second

forced vital capacity (FVC)

maximum amount of air that can be exhaled when blowing out as fast as possible 

vital capacity

maximum amount of air that can be exhaled when blowing out at a STEADY STATE

FEV/FVC ratio

peak expiratory flow, maximal flow that can be exhaled when blowing out as FAST as possible

inspiratory vital capacity

maximum amount of top air that can be inhaled after a full expiration

functional residual capacity

volume of gas in the lung at the end of expiration

vital capacity

change in volume from full inspiration to full expiration

inspiratory capacity

maximum gas inspired from normal end expiration

body plethysmography

gold standard of lung volume measurement - performed in a closed cabin