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BPK 140 Chapter 4: Chapter 4 Textbook Notes

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whitebeetle807
28 Jan 2019
School
Simon Fraser University
Department
Biomedical Physio & Kines
Course
BPK 140
Professor
Rajiv K

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Document Summary

Chapter 4 cardiovascular disease and diabetes textbook notes. Cardiovascular disease- refers to disease of the heart (cardio) and blood vessels (vascular) Coronary arteries- blood vessels that supply the heart muscle itself with blood. Coronary artery disease- atherosclerosis of the coronary arteries. Risk factors for cardiovascular disease: prevention of diseases that have a lengthy silent onset is done with epidemiologically. Framingham heart study- examined more than 5 000 residents; people with certain characteristics were more likely to contract and die from cardiovascular disease. Age- risk of cvd increases with age. Sex- cvd used to affect more males than females, but has changed. Heredity- if you or a close relative have had cvd already, you are more likely to suffer from cvd in the future. Ethnicity- canadians of african, hispanic, & south asian heritage; due to higher rates of obesity and diabetes in these subgroups.

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Related Questions

1. Which of the following is the correct sequence of bloodflow?

a. heart --> atery --> arteriole --> capillary -->vein --> venule --> heart

b. heart --> vein --> venule --> capillary -->arteriole --> artery --> heart

c. heart --> artery --> arteriole --> capillary -->venule --> vein --> heart

d. heart --> artery --> venule --> capillary -->arteriole --> vein --> heart

e. heart--> artery --> capillary --> arteriole -->venule --> vein --> heart

2. What are the functions of the elastic fibers that are foundin the walls of ateries? (there may be more than one answer)

Select one or more:

a. they allow the artery to stretch and then recoil back to itsoriginal shape as blood is forcegully pumped from the heart intothe arteries

b. they allow arteries to lengthen as the volume of blood in thearteries increase

c. they help maintain a steady blood pressure during thedifferent phases of heart contraction

d. they smooth out the walls of the arteries to preventturbulent blood flow

3. Which of the following are functions of the lymphatic system?(there may be more than one answer)

Select one or more:

a. help fight infections and cancer

b. allows excess interstitial fluid (fluid found between thecells in your tissues) to get dumped back into your blood

c. brings large molecules from fat digestion into thebloodstream so that they can be processed and stored

d. all of the above are functions of the lymphatic system

4. Which of the following blood vessels bring newly oxygenatedblood from the blood vessels in the lungs back to the heart so thatthe heart can pump it to the rest of the body?

Select one:

a. aorta

b. inferior vena cava

c. pulmonary vein

d. pulmonary artery

5. Which of the following mechanisms help blood fight gravity sothat, for instance, it can return from blood vessels in your feetback into your heart? (there may be more than one answer)

Select one or more:

a. breathing allows the pressure in your chest to decrease andallow blood to flow up towards your heart

b. as you walk, the skeletal muscles in your legs contract andsqueeze the veins; since veins have valves, blood flows up anddoesn't backflow back down

c. the force of blood flowing out of the heart and into thearteries pushes all of the blood along, causing blood to return tothe heart

d. precapillary sphincters open to allow blood to flow backtowards the heart

6. The tricuspid and bicuspid/mitral valves prevent backflow ofblood from the atria into the ventricles.

Select one:

True

False

7. The following sequence represents the correct order of bloodflow through the heart:

inferior and superior vena cava --> right atrium --> rightventricle --> pulmonary artery --> lungs --> pulmonaryvein --> left atrium --> left ventricle --> aorta

Select one:

True

False

8. Capillaries are as wide as one red blood cell.

Select one:

True

False

9. The purpose of the coronary arteries is to bring oxygenatedblood to the walls of the heart so that the muscles in the heartwalls can contract.

Select one:

True

False

10. Vasodilation refers to the narrowing of blood vessels.

Select one:

True

False

QuestionGroup: #37 CNS

Assigned as

Homework

37

Which parts of the brain contribute to our social behavior?

A

Orbitofrontal cortex

B

Mirror neurons

C

Amygdala

D

All of these are correct

Answered

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QuestionGroup: #38 CNS2

Assigned as

Homework

38

Part of the explanation of long term memory is which of the following?

A

Long term potentiation between neurons and muscle cells

B

Long term potentiation between neurons

C

Short term translation

D

Long term transcription

Answered

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QuestionGroup: #39 PNS

Assigned as

Homework

39

The somatic component of the peripheral nervous system has which of the following characteristics?

A

It controls the smooth muscle in the blood vessels so that blood vessels can vasoconstrict or vasodilate

B

It controls the autonomic nervous system so it indirectly controls heart rate

C

It controls your skeletal muscle so you can answer this question by pushing on the keyboard

D

It controls the smooth muscle in your intestinal tract so it controls peristalsis

Answered

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QuestionGroup: #40 Smooth/skeletal

Assigned as

Homework

40

Which of the following is NOT a part of a skeletal muscle cell?

A

Motor neurons

B

Nuclei

C

Sarcomeres

D

Actin

E

Myosin

Answered

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QuestionGroup: #41 Cardio

Assigned as

Homework

41

Which part of the circulatory system has the highest pressure?

A

Veins

B

Capillaries

C

Arteries

D

Aorta

Answered

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QuestionGroup: #42 Cardio2

Assigned as

Homework

42

Where do the electrical signals originate in your heart?

A

SA node

B

Internodal tracts

C

His-Purkinje System

D

AV node

Answered

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QuestionGroup: #43 Blood pressure

Assigned as

Homework

43

There was a horrific traffic accident and you run to help the victims. You feel a pulse from his carotid artery ,however the medic comes along and gets no blood pressure as he measures it from the arm. He claims the victim is dead. You think which of the following?

A

Medic is not correct since it is the difference between heart rate and blood pressure that determines life. No heart rate only means tha the sympathetics have stopped vasoconstricting the blood vessels.

B

Medic is correct since it is common to not have a blood pressure of 120/80 and no pulse due to stress as was discussed in class.

C

Medic is incorrect since there is a pulse. This means the person is still alive.

D

Medic is correct since there is no blood pressure there is no life.

Answered

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QuestionGroup: #44 Blood pressure2

Assigned as

Homework

44

Which side of the capillary bed has the higher oncotic pressure?

A

venous and lymph

B

arterial and lymph

C

lymph

D

venule side

E

arterial side

Answered

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QuestionGroup: #45 Capillaries

Assigned as

Homework

45

If the hydrostatic pressure is higher in the interstitial space rather than the capillary, which of the following will occur?

A

(2),(3)

B

(1),(2),(3)

C

(3) Decreased hydrostatic pressure in the arterial end of the capillary

D

(2) Decreased hydrostatic pressure in the venous end of the capillary

E

(1) No change in the hydrostatic pressure since this pressure is maintained regardless of external pressures.

Answered

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QuestionGroup: #46 Respiration/ ventilation

Assigned as

Homework

46

The left atrium is damaged and is generating a great resistance to blood coming from pulmonary vein. What happens due to this pressure?

A

Back up of blood in the pulmonary artery which causes pulmonary capillary edema

B

Generation of back flow into the inferior vena cava

C

Generation of coronary artery edema

D

Back up of blood in the pulmonary vein which causes pulmonary capillary edema

Answered

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QuestionGroup: #47 Respiration/ventilation 2

Assigned as

Homework

47

Edema in the pulmonary circulation refers to which of the following?

A

additional fluid in the trachea

B

additional interstitial fluid

C

additional surfactant

D

additional capillary fluid

E

additional intracellular fluid

Answered

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QuestionGroup: #48 Cell communication

Assigned as

Homework

48

What is the definition of a signaling pathway?

A

All the proteins in the nucleus

B

All the cell molecules in the mitochondria

C

A group of genes that control mitosis

D

A specific chemical pathway that is activated by the ligand/receptor complex.

Answered

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QuestionGroup: #49 Hormone/ menstruation

Assigned as

Homework

49

Which hormone directly causes ovulation?

A

Follicle stimulating hormone

B

Lutenizing hormone

C

Progesterone

D

Estrogen

E

All of these

Medical History:
A 31 yr old man, a two pack per day smoker, presented to the emergency department complaining of sudden-onset, 10/10 crushing substernal chest pain associated with shortness of breath and diaphoresis that began 30 min prior to arrival. He had no previous history of cardiovascular disease.
Physical exam: Height 192 cm, weight 153.8 kg, BMI 41.6 kg · m–2 (class III obesity); blood pressure 178/101 mmHg, pulse 75 beats · min–1, respiratory rate 20 breaths · min–1, temperature 36.7 ∞C; normal heart sounds, lungs clear to auscultation, normal peripheral pulses
Electrocardiogram: Normal sinus rhythm, rate 72 beats · min–1; ST-segment elevation V1-V4
Chest radiograph: Normal Blood work: Elevated cTn and CK-MB; glucose normal; blood lipids: total cholesterol 200 mg · dl–1, HDL-C 45 mg · dl–1, LDL-C 134 mg · dl–1, triglycerides 104 mg · dl–1
Chest CT: No evidence of aortic dissection Echocardiogram: Left ventricular ejection fraction 45%, hypokinesis of the anteroseptal wall, borderline left ventricular enlargement, normal diastolic function, normal cardiac valves

Diagnosis:
Acute anterior wall STEMI.

Treatment:
1. Emergent cardiac catheterization (began 46 min after initial presentation to the hospital): total occlusion of the proximal left anterior descending (LAD) coronary artery, mild diffuse narrowing of the circumflex and right coronary arteries. The LAD occlusion was treated with thrombectomy, percutaneous coronary angioplasty, and placement of a drug-eluding stent, with good result.
2. Medical treatment: Aspirin, heparin, intravenous nitroglycerin, clopidogrel, abciximab, atorvastatin, carvedilol, lisinopril, nicotine patch.
3. Nicotine dependence consultation.
4. Referral to outpatient cardiac rehabilitation. Complications: None Hospital dismissal: Occurred approximately 48 h after admission; appointments made to see primary physician and to begin outpatient cardiac rehabilitation program in 5 d; follow-up blood work, ECG, and cardiology appointment in 8 wk Dismissal medications: Carvedilol, aspirin, clopidogrel, lisinopril, nicotine patch, simvastatin

Outpatient Exercise Test Results (Performed 8 D after Hospital Dismissal)
8.0 min duration (treadmill), normal blood pressure and electrocardiographic responses, peak heart rate 164 beats · min–1, V.O2peak = 3.04 L · min−1 (20.8 ml ∑ kg−1 ∑ min−1; 47% of expected), no angina reported
Exercise Prescription:
Outpatient cardiac rehabilitation program: Began 5 d after hospital dismissal; initial evaluations included assessments of neuromuscular function (normal), depression (normal), and potential sleep apnea (abnormalBerlin questionnaire, abnormal overnight oximetry resulted in referral for a sleep consultation); meeting with registered dietitian.
Exercise prescription: Goals included weight loss, increased aerobic and muscular fitness; frequency of three supervised sessions per week in cardiac rehabilitation facility plus three or four independent sessions per week (total frequency of six or seven sessions each week); average intensity using target heart rate 130 to 140 beats · min–1 (60-70% heart rate reserve), RPE 12 to 14; high-intensity intervals (to begin 2 wk after starting cardiac rehabilitation) using RPE 17, heart rate <160 beats · min–1; duration initially set at 10 to 15 min (not including warm-up, cool-down, strength training), gradually increasing to 45 to 60 min per session; types of exercise to include outdoor or treadmill walking, elliptical trainer; resistance training (to begin 2 wk after starting cardiac rehabilitation) using free weights and weight machines, initially one set of 8 to 15 slow repetitions, exercises for the major muscle groups, two or three sessions per week; lifestyle or general physical activity including walking short distances during the day, yard work, physical activity at work (return to work as restaurant equipment installer 4 wk after myocardial infarction).

Outcomes from 11 WK of Cardiac Rehabilitation Program
Medication compliance: Excellent (self-report) Exercise training: Frequency six or seven sessions per week (two or three supervised sessions per week); aerobic exercise duration 50 to 60 min per session; aerobic interval training two or three sessions per week (initially treadmill grade walking for 30 s progressing to slow jogging on treadmill for up to 4 min, three to five high-intensity intervals per session); resistance training two or three sessions per week, two or three sets of 8 to 15 repetitions, major muscle groups. Body weight: Stopped eating fast food and desserts, had more fruit, vegetables, poultry, fish; weight loss = 20.8 kg (BMI still excessive, 33.8 kg · m–2). Repeat cardiopulmonary exercise test: 10.5 min duration (treadmill), normal blood pressure and electrocardiographic responses, peak heart rate 162 beats · min–1, V.O2peak = 4.16 L · min−1 (31.2 ml ∑ kg−1 ∑ min−1; 71% of expected), 37% increase in V.O2peak (L · min−1), no angina reported. Tobacco use: One or two cigarettes daily. Blood pressure: 126/80 mmHg. Blood lipids: Total cholesterol 126 mg · dl–1, HDL-C 33 mg · dl–1, LDL-C 80 mg · dl–1, triglycerides 65 mg · dl–1. Recommendations: Stop smoking; continue medications, exercise program, and heart-healthy eating habits; continue efforts for weight loss; return appointment with cardiac rehabilitation team in 3 mo.

Discussion:
This patient was extremely young and was fortunate to realize the importance of promptly seeking medical attention with the onset of symptoms. His hospital course included standard diagnostic testing for acute myocardial infarction with subsequent timely coronary angiography with PCI of the infarct-related artery. Fortunately he did not develop serious complications and was discharged from the hospital after only 2 d. He enrolled in outpatient cardiac rehabilitation 1 wk after his MI. Of concern, he was markedly obese and may have had obstructive sleep apnea based on his abnormal Berlin questionnaire; he was referred for further evaluation in the Sleep Clinic. His course during rehabilitation was very favorable, and he did not experience post-infarction angina. He was successful in exercise and weight loss and demonstrated a remarkable increase in aerobic capacity. His challenge will be to continue taking his medications, stop smoking completely, eat a healthy diet, maintain his exercise program, and control his other coronary risk factors.

Questions:
1. What were this patient’s coronary risk factors?

2. What clinical tests were used to make the diagnosis of an acute ST-segment elevation anterior wall myocardial infarction?

3. What classes of cardiovascular medications were prescribed for this patient?

4. Compare the two cardiopulmonary exercise tests for this patient. What were the similarities? What were the differences?

5. Review the patient’s exercise prescription and program. Were the established goals achieved? Would you alter the exercise program in any fashion?

6. How effective was the patient in controlling his coronary risk factors by the time he completed 11 wk in the outpatient cardiac rehabilitation program?

7. What is his most important remaining coronary risk factor?

8. What component of the recommendations given to him at the completion of 11 wk of cardiac rehabilitation will potentially help him in sustaining his efforts at secondary prevention?