Mastering GNRS 555: Get Ready for
Exam 3
What is CO? - How much blood we are pushing. Affected by heart rate, contractility,
conductivity
What is SVR (systemic vascular resistance)? - Affected by vessel diameter.
Vasoconstriction makes the BP higher.
What does the sympathetic nervous system do to blood vessels? - Dilate/constrict
What do neurohormonal (angiotensin, norepinephrine) do to the blood vessels? -
Constrict (fight/flight)
What do prostaglandins and nitric oxide do to the blood vessels? - Dilate
What does endothelin do to the vessels? - Constrict
What are statistics for hypertension? What gender has greater prevalence, race/
ethnicity, who has greater control over BP? - -Men have higher prevalence than
women
-Non-Hispanic black adults have the highest prevalence (54%)
-Non-Hispanic white adults have the highest BP control (among those recommended
to take medication)
Which of the following is the most effective lifestyle modification that affects the BP?
A. Exercise
B. Stop smoking
C. Sodium restriction
D. Weight loss - D. Weight loss (if we have less weight on the body, that is fewer
blood vessels the body has to make; decreasing BP)
What is a normal change that occurs in the valves as we age? - Arteriosclerosis (can
be exacerbated with smoking)
What valves are most likely to be affected as we age? - Mitral and aortic
What happens in the conduction system as we age? - Pacemaker cells reduce in
number so it takes longer for depolarization to go through the heart
What happens to the left ventricle as we age? - It increases in size and stiffness due
to it being the powerhouse of the heart. Decreased speed of early diastolic filling due
to fibrotic changes
What are aorta/large artery changes as we age? - Thickening, less distensible
arteries, systolic BP increases to compensate, SVR (systemic vascular resistance)
increases
,What happens to baroreceptors as we age? - They become less sensitive to
pressure changes (orthostatic hypotension and postprandial hypotension (feeling
sleepy after a large meal because blood gets sent to stomach))
What is atherosclerosis? - Soft deposits of fat that harden with age. Not normal! Can
cause MI, increased BP
Who has the highest incidence of CAD? - White men
What is chronic stable angina? - Myocardial ischemia, caused by oxygen
supply/demand mismatch. Episodic pain lasting a few minutes, provoked exertion or
stress, relieved by rest and nitroglycerin (vasodilator)
What is unstable angina? - Rupture of unstable plaque, exposing thrombogenic
surface. New onset angina or chronic that increases, lasts more than 10 minutes and
does not go away, occurs at rest with minimal exertion
What is Prinzmetal's angina? - Occurs at rest, triggered by smoking or substances
What is microvascular angina? - Ischemia related to microvascular disease affecting
the small, distal branches of the coronary arteries. triggered by ADLs, more common
in women
What is done if CAD is suspected? - -History and physical
-ECG
-Chest x-ray
-Stress test
-Echocardiogram
-Coronary angiogram
-Electron beam computed tomography
-Labs -lipids, C-reactive protein
What is MI? - Abrupt stoppage of blood flow through coronary artery from a
thrombus caused by platelet aggregation (irreversible cell death)
What do the different zones mean?
-Zone of necrosis
-Zone of injury
-Zone of ischemia - -Tissue is dead
-Cells are losing oxygen and they will die if nothing is done, might get some function
back
-Area where oxygen is being lost (looks like NSTEMI)
What is the best marker of MI? - Troponin; detectable within 4-6 hours, peak at 10-
24 hours, can be detected for 10-14 days
What are creatine kinase and C-reactive protein used to detect? - Inflammation, they
are non-specific
, What do beta blockers do? - Decrease HR and cardiac workload, prevent
remodeling of the heart. They end in -olol
What affect does morphine have? - Can act as a vasodilator
What is PCI (percutaneous coronary intervention)? - It is an alternative to surgery,
insertion of stent or balloon, open the blocked artery within 90minutes of arrival to
facility
What is Thrombolytic therapy? - Breaks up clots, rapid administration of thrombolytic
to dissolve the thrombus and reperfuse heart muscle, the patient will eventually need
to have PCI (complication: bleeding)
Is every episode of chest pain of cardiac origin? - No, but we are going to treat it as
an MI until proven otherwise
How do you differentiate chest pain of cardiac origin from chest pain of non-cardiac
origin based on clinical presentation?
A. Cardiac chest pain is constant
B. Cardiac chest pain increases with inspiration - A. Cardiac chest pain is constant
True or False? When a patient presents with chest pain, you should assume it is of a
cardiac origin until that can be ruled out. - True
Based on Mr. Cameron's presentation (possible MI), which diagnostic test should
you do FIRST?
A. ECG
B. Serum troponin
C. Chest x-ray
D. Echocardiogram - A. ECG (it is the fastest)
-Mr. Cameron indicated that his pain is in the middle of his chest and radiates to his
left arm. It is about 6/10. He added that this was not the first time he had this pain.
He said that the pain usually starts a few minutes after gardening or climbing stairs
and is relieved by rest. Angina is suspected.
-What type of angina did Mr. Cameron just describe? - Stable
What is the most important risk factor for developing CAD in women? - Age
Many women experience atypical angina, what are the symptoms? - Indigestion,
pain between the shoulders, aching jaw, choking sensation with exertion.
Based on the pathophysiology of Mr. Cameron's condition (stable angina), his
coronary artery is blocked by:
A. 30%
B. 50%
C. 70% - C. 70%
The occlusion/obstruction of coronary arteries are determined using:
A. Echocardiogram
Exam 3
What is CO? - How much blood we are pushing. Affected by heart rate, contractility,
conductivity
What is SVR (systemic vascular resistance)? - Affected by vessel diameter.
Vasoconstriction makes the BP higher.
What does the sympathetic nervous system do to blood vessels? - Dilate/constrict
What do neurohormonal (angiotensin, norepinephrine) do to the blood vessels? -
Constrict (fight/flight)
What do prostaglandins and nitric oxide do to the blood vessels? - Dilate
What does endothelin do to the vessels? - Constrict
What are statistics for hypertension? What gender has greater prevalence, race/
ethnicity, who has greater control over BP? - -Men have higher prevalence than
women
-Non-Hispanic black adults have the highest prevalence (54%)
-Non-Hispanic white adults have the highest BP control (among those recommended
to take medication)
Which of the following is the most effective lifestyle modification that affects the BP?
A. Exercise
B. Stop smoking
C. Sodium restriction
D. Weight loss - D. Weight loss (if we have less weight on the body, that is fewer
blood vessels the body has to make; decreasing BP)
What is a normal change that occurs in the valves as we age? - Arteriosclerosis (can
be exacerbated with smoking)
What valves are most likely to be affected as we age? - Mitral and aortic
What happens in the conduction system as we age? - Pacemaker cells reduce in
number so it takes longer for depolarization to go through the heart
What happens to the left ventricle as we age? - It increases in size and stiffness due
to it being the powerhouse of the heart. Decreased speed of early diastolic filling due
to fibrotic changes
What are aorta/large artery changes as we age? - Thickening, less distensible
arteries, systolic BP increases to compensate, SVR (systemic vascular resistance)
increases
,What happens to baroreceptors as we age? - They become less sensitive to
pressure changes (orthostatic hypotension and postprandial hypotension (feeling
sleepy after a large meal because blood gets sent to stomach))
What is atherosclerosis? - Soft deposits of fat that harden with age. Not normal! Can
cause MI, increased BP
Who has the highest incidence of CAD? - White men
What is chronic stable angina? - Myocardial ischemia, caused by oxygen
supply/demand mismatch. Episodic pain lasting a few minutes, provoked exertion or
stress, relieved by rest and nitroglycerin (vasodilator)
What is unstable angina? - Rupture of unstable plaque, exposing thrombogenic
surface. New onset angina or chronic that increases, lasts more than 10 minutes and
does not go away, occurs at rest with minimal exertion
What is Prinzmetal's angina? - Occurs at rest, triggered by smoking or substances
What is microvascular angina? - Ischemia related to microvascular disease affecting
the small, distal branches of the coronary arteries. triggered by ADLs, more common
in women
What is done if CAD is suspected? - -History and physical
-ECG
-Chest x-ray
-Stress test
-Echocardiogram
-Coronary angiogram
-Electron beam computed tomography
-Labs -lipids, C-reactive protein
What is MI? - Abrupt stoppage of blood flow through coronary artery from a
thrombus caused by platelet aggregation (irreversible cell death)
What do the different zones mean?
-Zone of necrosis
-Zone of injury
-Zone of ischemia - -Tissue is dead
-Cells are losing oxygen and they will die if nothing is done, might get some function
back
-Area where oxygen is being lost (looks like NSTEMI)
What is the best marker of MI? - Troponin; detectable within 4-6 hours, peak at 10-
24 hours, can be detected for 10-14 days
What are creatine kinase and C-reactive protein used to detect? - Inflammation, they
are non-specific
, What do beta blockers do? - Decrease HR and cardiac workload, prevent
remodeling of the heart. They end in -olol
What affect does morphine have? - Can act as a vasodilator
What is PCI (percutaneous coronary intervention)? - It is an alternative to surgery,
insertion of stent or balloon, open the blocked artery within 90minutes of arrival to
facility
What is Thrombolytic therapy? - Breaks up clots, rapid administration of thrombolytic
to dissolve the thrombus and reperfuse heart muscle, the patient will eventually need
to have PCI (complication: bleeding)
Is every episode of chest pain of cardiac origin? - No, but we are going to treat it as
an MI until proven otherwise
How do you differentiate chest pain of cardiac origin from chest pain of non-cardiac
origin based on clinical presentation?
A. Cardiac chest pain is constant
B. Cardiac chest pain increases with inspiration - A. Cardiac chest pain is constant
True or False? When a patient presents with chest pain, you should assume it is of a
cardiac origin until that can be ruled out. - True
Based on Mr. Cameron's presentation (possible MI), which diagnostic test should
you do FIRST?
A. ECG
B. Serum troponin
C. Chest x-ray
D. Echocardiogram - A. ECG (it is the fastest)
-Mr. Cameron indicated that his pain is in the middle of his chest and radiates to his
left arm. It is about 6/10. He added that this was not the first time he had this pain.
He said that the pain usually starts a few minutes after gardening or climbing stairs
and is relieved by rest. Angina is suspected.
-What type of angina did Mr. Cameron just describe? - Stable
What is the most important risk factor for developing CAD in women? - Age
Many women experience atypical angina, what are the symptoms? - Indigestion,
pain between the shoulders, aching jaw, choking sensation with exertion.
Based on the pathophysiology of Mr. Cameron's condition (stable angina), his
coronary artery is blocked by:
A. 30%
B. 50%
C. 70% - C. 70%
The occlusion/obstruction of coronary arteries are determined using:
A. Echocardiogram
