Glossary of Mech Arterial Diseases
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- What is temporal arteritis?
- Progressive inflammatory disorder of cranial blood vessels, principally the temporal artery
- What is another name for temporal arteritis?
- Giant Cell Arteritis
- What is a giant cell?
- an abnormally large tissue cell; it often contains more than one nucleus and may appear as a merger of several normal cells
- What is a coarctation?
- A compression, shrivelling, or stricture of the walls of a vessel as the aorta
- What is coarctation of the aorta?
- Coarctation of the aorta is a congenital cardiac anomaly characterized by a localized narrowing of the aorta. It results in increased pressure proximal to the defect and decreased pressure distal to it.
- What is the most common site for coarctation of the aorta?
- The most common site for coarctation of the aorta is just beyond the origin of the left subclavian artery from the aorta.
- In what part(s) of the body does a coarctation of the aorta cause HIGH blood pressure?
- In the upper extremities and the head.
- In what part(s) of the body does a coarctation of the aorta cause LOW blood pressure?
- In the lower body and extremities.
- What are the symptoms of coarctation of the aorta?
- - fatigue in legs
- high blood pressure
- cold legs, feet
- decreased exercise performance
- heart failure
- What is the most common type of coarctation?
- Postductal coarctation, in which the constriction lies at or just distal to the obliterated ductus arteriousus (the ligamentum arteriosum)
- What is pre-ductal coarctation?
- Pre-ductal constriction lies in the aortic isthmus, i.e., the segment of aorta between the left subclavian artery and the point of entry of the ductus arteriosus.
- When (at what age) does post-ductal coarctation usually present?
- Late childhood or adulthood
- When (at what age) does pre-ductal coarctation usually present?
- In infancy
- How often do coarctations occur alone vs. in association with other malformations, e.g., ASD, VSD
- 50% of the time
- How does left ventricle hypertrophy appear on an ECG?
- The depth of the downward S-wave in lead V1, plus the height of the upward R-wave in lead V5 equals more than 35 mm.
- What does "strain" indicate in "left ventricular hypertrophy with strain"?
- The left ventricle is working hard against something…(systemic hypertension, an aortic stenosis, coarctation of the aorta?)…and the chronic strain has caused it to hypertrophy
- How is left ventricular strain diagnosed on an ECG?
- There is asymmetric ST-segment depression in lead V5. The asymmetry of this inversion is a long and gradual downslope, followed by a shorter, more abrupt upslope.
- How is right ventricular strain diagnosed on an ECG?
- An asymmetric T-wave inversion would in lead V2 (instead of V5 for left ventricle).
- What effect can a coarctation have on the ribs?
- A coarctation can cause rib notching.
- What ribs may be notched by a coarctation?
- 4th - 8th ribs
- Is a coarctation the only thing that can cause rib notching?
- No. There are other diseases, including neurofibromatosis, in which enlarged nerves erode the bone.
- Below what artery does an aortic aneurysm frequently occur?
- Below the renal artery.
- What is an aneurysm?
- An aneurysm is a localized dilation of the wall of a blood vessel.
- What is an aortic aneurysm?
- dilation of the wall of the aorta caused by atherosclerosis, hypertension, or, less commonly, syphylis.
- What is aortic dissection?
- Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta. This most often occurs because of a tear or damage to the inner wall of the artery.
- Who are the most common sufferers of aortic dissection?
- 40 - 70 yo men
- Do symptoms of aortic dissection begin slowly or suddenly?
- What is the chief complaint of a person with aortic dissection?
- A "tearing" feeling in the middle of the chest.
- Aortic dissection is common in patients with which two type of hereditary connective tissue diseases?
- Marfan's syndrome and Ehler-Danlos syndrome
- What is Marfan's syndrome?
- a hereditary condition that affects the musculoskeletal system and is often associated with abnormalities of the cardiovascular system and of the eyes.
- What is Ehlers-Danlos syndrome?
- It is a hereditary disorder of conective tissue, marked by hyperplasticity of skin, tissue fragility, and hypermotility of joints.
- What is atherosclerosis?
- Narrowing and hardening of the arteries due to plaques of fats, cholesterol, and cellular debris
- What are the risk factors for atherosclerosis?
- - Age
- Sex - women more protected by estrogen
- Family, genetics
- What is arteriosclerosis?
- Pathologic thickening, hardening, and loss of elasticity of arteriolar walls (usually comes with age)
- What is angina?
- Intermittent chest pain due to myocardial ischemia due to less than normal coronary blood flow
- What is intermittent claudication?
- Cramplike pains in the calves caused at times by poor circulation of blood to the leg muscles. Commonly associated w/atherosclerosis.
- When do angina and claudication occur, i.e., what's missing from the affected tissue?
- The tissue has an insufficient supply of O2.
- How is blood flow related to a blood vessel's radius.
- Blood flow is directly proportional to the radius to the 4th power, r4.
- Why is angina intermittent?
- The supply of O2 to the tissue may be sufficient for resting conditions.
- What is stable angina?
- Angina in which attacks occur w/ predictable frequency and duration and are precipitated by circumstances, such as exercise or emotional stress, that increase myocardial O2 demands.
- What is variant angina?
- Chest pain caused by reversible, severe coronary artery spasm which causes temporary stenosis.
- What is another name for variant angina?
- Prinzmetal's angina
- When does variant angina often occur?
- At rest (may awaken patient at night).
- Who is a typical sufferer of variant angina?
- Women under 50 yo.
- What is unstable angina?
- Acute change in atherosclerotic plaque and adherent partial thrombosis which make stenosis worse.
Compared to stable angina:
1. less exertion causes more pain
2. pain lasts longer time
3. attacks are more frequent
- What are 4 causes of stable angina?
- 1. fixed atherosclerotic stenosis of one or more coronary arteries
2. aortic stenosis
3. aortic regurgitation
4. myocardial hypertrophy
- How long do stable angina attacks usually last?
- 3 - 20 minutes
- What sort of terms does a patient use when describing the substernal sensation of stable angina?
- - pressure
- vague pain
- What % stenosis of a coronary artery qualifies as "critical stenosis"?
- Where does the sensation of angina begin?
- - Back of neck
- Lower jaw
- Interscapular area
- Where may the sensation of angina radiate?
- - left shoulder, upper arm
- inner aspect of elbow, forearm, wrist, or 4th & 5th fingers
- When may threshold for pain of angina be lowered?
- - After meals
- When excited
- When exposed to cold
- What dermatomes are typically referred to by angina?
- C8 - T4; however, jaw and neck are not in this range, but may be affected.
- What are some differential diagnoses for anginal type pain?
- - dissecting aortic aneurysm
- pulmonary embolism
- esophageal spasm
- GERD, peptic ulcer, cholecystitis (gall bladder)
- chest wall pain (inflam of costochnodral joints)
- cervical or thoracic radiculopathy (disease involving a spinal nerve root)
- What can be administered to (not) diagnose angina?
- Nitrate will relieve the pain if it IS angina.
- Does BP increase or decrease during an anginal attack?
- BP may do either.
- What unusual heart sound might you hear during an angina attack?
- An apical systolic murmur
- due to mitral regurg
- due to papillary muscle ischemia
- What are 4 historical signs of angina?
- - diabetes
- xanthelasma (lipid plaques on eyelid)
- What lab tests may be ordered for angina?
- - serum (cardiac) lipids
- resting, anginal ECG's
- stress test
- coronary angiography
- What will a coronary angiography of an anginal patient show?
- Stenosis of left anterior descending (LAD) coronary artery and/or its branches
- What is the treatment for an acute angina attack?
- sublingual nitroglycerin
- How do nitrates affect afterload?
- They cause arteriolar dilation ->
decreased TPR ->
- How do nitrates affect preload?
- They cause venous dilation ->
decreased venous return ->
- How do decreased afterload and decreased preload affect ventricular work and O2 demand?
- They decrease the demand for ventricular work and for O2.
- What existing conditions should be treated in an angina patient?
- HTN and high LDL
- What types of drugs can be prescribed as prophylaxis for angina?
- - long-lasting nitrates
- calcium-channel blockers
- antiplatelet agents
- How do beta blockers work (against angina)?
- They decrease heart rate and contractility which decreases the demand for O2.
- How do calcium-channel blockers work (against angina)?
- - They decrease heart rate and contractility
- They cause coronary dilation which allows for better blood flow.
- What is a common antiplatelet agent and how is it used as a prophylaxis for angina?
- Aspirin. It destroys platelets or inhibits their function (clotting) -> prevents coronary thrombosis
- What are 2 coronary revascularization procedures that can be used in the treatment of angina?
- 1. coronary artery bypass grafting - CABG
2. percutaneous transluminal coronary angioplasty - PTCA
- What is the cause of variant/prinzmetal angina?
- The cause is unknown. It is NOT triggered by exertion.
- How do the symptoms for variant/prinzmetal angina compare to those for stable angina?
- The symptoms are the same.
- What does an ECG show for variant/prinzmetal angina?
- Usually ST segment elevation
- What does a coronary angiography typically show for variant/prinzmetal angina?
- - NO fixed stenoses
- Right coronary artery involvement (spasm)
- What types of drugs are used to treat variant/prinzmetal angina -- acutely or prophylactically?
- Calcium channel blockers and nitrates
- What are two specific drugs that are used to treat variant/prinzmetal angina?
- 1. Cardizem (diltiazem)
2. Verelan (verapamil)
- What are 2 other names for unstable angina?
- Crescendo or preinfarction angina
- What is unstable angina a warning for?
- An impending, irreversible ischemic event
- What does an ECG show for unstable angina?
- Usually, ST segment depression during attacks.
Sometimes, ST segment elevation.
- What are non-drug treatments for someone with unstable angina?
- - hospitalization
- bed rest
- limited activity
- supplemental O2
- What types of drugs are used to treat unstable angina?
- - nitrates
- antiplatelet agents (aspirin)
- anticoagulation therapy:
nonfractionated (NL) heparin or
low molecular weight (fractionated) heparin
- Compared to stable angina, how does unstable angina respond to nitrates.
- Unstable angina does not respond to nitrates as well as stable angina.
- What is the etiology of Acute Myocardial Infarction (AMI or heart attack)?
- Fixed coronary atherosclerotic plaque causing critical stenosis +
acute plaque changes and/or
coronary artery thrombosis
- What are some examples of acute plaque changes?
- - fissuring
- hemorrhage into the plaque
- plaque rupture w/ embolization of debris
- thrombus from fissuring or hemorrhage
- complete occlusion w/angina so bad that it constitutes a heart attack
- What accounts for AMI's in previously asymptomatic patients?
- acute plaque changes
- How is a coronary artery thrombosis formed?
- By plaque fissuring or rupture, exposing platelets to thrombogenic plaque lipids and thrombogenic subendothelial collagen
- How does a coronary artery thrombosis lead to unstable angina?
- It partially occludes a blood vessel.
- How does a coronary artery thrombosis lead to an AMI?
- It completely occludes a blood vessel.
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