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What are the uncontrollable risk factors of CVD?
- age
- male gender
- heredity and race
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What are the controllable risk factors?
- physical inactiity
- hypertension
- high cholesterol
- overweight and obesity
- diabetes (type II)
- Smoking
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What is atherogenic?
- means that it irritates vascular endothelial cells and increases platelet adhesion
- an inflammatory response to damage of vascular endothelium
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How does smoking affect CVD?
- atherogenic
- increases blood pressure
- increases LDL (bad) cholesterol and decreases HDL (good) cholesterol
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What are the several types of CVD?
- 1. ischemic heart disease
- 2. hypertension
- 3. arrhythmias
- 4. heart failure
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What is ischemic heart disease?
definition: oxygen consumption of heart exceeds supply
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What is the most common type of heart disease?
- Ischemic heart disease
- 6.8% of Americans (1 in 14, about 18.5 million ppl)
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What is the most probable cause of ischemic heart disease?
atherosclerosis in coronary arteries (CAD)
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How is plaque form?
- expansion of the intimal layer of an artery
- consist of a fibrous cap that overlays a lipid core (intensely thrombogenic)
- form at branches and curves in arteries = areas with increase hemodynamic forces on walls = sheart stresses - turbulent instead of laminar blood flow
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How is plaque ok?
- usually not the cause of acute problems
- stable plaques can be stenotic - narrowing the arteries - tend to be benign
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How are plaques bad?
- plaque can rupture
- lipid core escaptes -> clot formation
- sudden and dramatic occlusion of artery = myocardial infarction or ischmemic stroke (80% of strokes)
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What is angina pectoris? What are the symptoms?
- strangling in the chest
- episodes of chest pain/tightness/heaviness (poorly localized, difficult to describe)
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What caused angina pectoris?
transient decrease in blood flow (so cardiac demand transiently exceeds supply)
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What provokes demand angina?
Provoked by increase physical work (exercise/exertion) and stress (cold, emotion) relieved within minutes by rest
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What provokes supply angina?
- provoked by sudden decrease in supply
- ex. occlusion from clot
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Describe stable angina.
- demands angina
- short term prognosis fairly good
- 2-3% death per year if truly stable
- if underlying CAD is managed
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Describe unstable angina.
- intermediate between stable agina and infarction
- usually corresponds to worsening of stable angina (severity or duration of events increased, or exertion to trigger events decreased)
- caused by dynamic plaque
- considered a medial emergency, prognosis
- highly increase risk of myocardial infarction, esp in first 6-8 weeks
- acute mortality (24 h) - about 4%
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What is myocardial infarction?
death of myocardial tissue caused by lack of blood supply
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Where does myocardial infarction happen most often?
in left ventricle
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In myocardial infarction, the myocardial cell death begins within 15-40 minutes after what?
After occlusion of artery, very few ceels left after 6 hours
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after mycocardial infarction, cells are replaced with what?
with collagen scar = no contraction -> weakens heart
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What are the symptoms of myocardial infarction?
- sudden onset
- sever chest pain
- shortness of breathe
- autonomic symptoms: sweating, weakness, nausea, vomiting
- loss of heart function
- arrhythmias
- more than 30% SILENT (more common in elderyly and diabetics due to poor innervation so less feeling of pain)
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How do you diagnosis myocardial infarction?
- Diagnosis needs 2 of 3 but markers very reliable
- damaged cells leak proteins into blood = markers for infarction
- medical history indicates ischemic chest pain >20 mintues
- ECG changes (ST segment shifts, abnormal Q waves)
- stress test
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what are the proteins that can leak into blood as markers of myocardial infarction?
- creatine kinase
- troponin T (sepcific for cardiac muscle damage, rises quickly. before permanent damage)
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What are the limitations of stress tests for myocardial infarction?
- evaluate blood flow during exercise vs. during rest - only detects severe narrowing
- cannot detect vulnerable plaques, which cause most infarctions but which are usually <50% occlusion
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Define hypertension.
blood pressure of more than 140/90 compared to normal of 120/80
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What is hypertension bad?
- "silent killer" - no symptoms
- irreversible so drugs can only treat condition
- can lead to left ventricular hypertrophy => eventual cause of heart failure
- damages vascular endothelium - so causes atherosclerosis
- can caus aneurysms (bulges in vessels) =weak, chance of rupture; ruptures in cerebral arteries = hemorrhagic stroke
- usually results in arteriosclerosis = hypertrophy in veesls, reduced compliance - normal increase in BP w/ aging
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What causes hypertension?
- not well understood
- kidney and adrenal gland (not heart) are major determinants
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what are the controllable risk factors of hypertension?
- obesity/ overweight
- high salt intake
- high alcohol consumption
- lack of physical acdtivity (ind. of weight)
- stress
- high cholesterol
- diabetes
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What are the uncontrollable risk factors of hypertension?
- older than 60
- family history
- race
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Hypertension is clear cause of death in ______ of patients who suffer from it.
- 90%
- 50% die from heart disease or heart failure, 33% stroke, 5% renal failure
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Linear relationship between degree of hypertension and risk - after 115/75, each increase of 20/10 ________ risk of cardiovascular disease incidents.
- DOUBLES
- 135/80 prehypertension = 2x risk
- 155/95 hypertension = 4x risk
- 175/105 stage 1 hypertension = 8x risk
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Define arrhythmias.
- as disorders of cardiac rate and rhythm
- can be benign or acutely life-threatening
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What are the rate disorders?
- bradycardia - too slow
- tachycardia - too fast
- can be supraventricular or ventricular (usually more severe)
- caused by sinus node dysfunction and/or ectopic pacemakers
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