Term
| the principle function of the circulatory system is to supply ? and vital metabolic compounds to cells throughout the body, as well as removal of metabolic ? products; ? is a life threatening condition whereby this principal function is compromised |
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Definition
| oxygen; waste; circulatory shock |
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Term
| when circulatory shock is cuased by a severe loss of blodd volume or body water it is called ?; the most distinctive manifestations of hypovolemic shock are ? hypotension and metabolic ? |
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Definition
| hypovolemic shock; arterial; metabolic |
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Term
| metabolic acidosis is a consequence of an accumulation of ? resulting from tissue hypoxia and anaerobic metabolism; if the decrease in arterial blood press is severe and protracted, such hypotension will inevitably lead to severe ? of organs |
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Definition
| lactic acid; hypoperfusion |
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Term
| shock can be categorized by etiology into four major types: ?, ?, ?, and ?; all patients with shock have profound decreases in ? BP; understanding the primary cause of the circulatory abonormality in these respective shock states is invaluable to their management |
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Definition
| hypovolemic, obstructive, cardiogenic, distributive; arterial |
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Term
| ? shock is caused by a loss of intravascular volume either by hemorrhage or fluid loss (dehydration); ? shock is caused by an obstruction that directly compromises inflow or outflow of blood from the heart; ? shock is caused by diminished myocardial contractility which results in decreased cardiac output with an increase an increase in systemic vascular resistance; ? shock is caused by a major decrease in systemic vascular resistance with and increase in cardiac output |
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Definition
| hypovolemic; obstructive; cardiogenic; distributive |
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Term
| hypovolemic shock is considered to be essentially a profound deficit in ?; preload is defined as the volume of blood in the left ventricle at the end of ?; decreased preload results in subsequent decreases in ?, ?, and eventually ?; as such, restoration of ? becomes an over riding goal in the management of hypovolemic shock |
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Definition
| preload; diastole; stroke volume, cardiac output, mean arterial pressure; preload |
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Term
| the total amount of water in a typical 70 kg adult is approximately ? L with ? of those liters being inside of cells (intracellular fluid) and the other ? L being outside the cells (extracellular fluid; interstitial fluid and plasma); circulating blood volume for a normal adult is roughly ? L and is comprised of 2L of ? (intracellular) and 3L of ? (extracellular) |
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Definition
| 42; 28; 14; 5; red blood cells (intracellular); plasma (extracellular) |
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Term
| by definition hypovolemic shock occurs as a consequence of inadequate ? volume to meet the ? and metabolic needs of the body; diminished intravascular volume can result from severe ? or ? bleeding, profound fluid losses from ? sources such as diarrhea or vomiting, or ? losses such as diuretic use, diabetic ketoacidosis, or diabetes insipidus; other sources of intravascular fluid loss can occur through damaged ?, as ween with ?, or via ? leak into the interstitial space or peritoneal cavity as see with edema or ascites and this is referred to as ? spacing |
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Definition
| intravascular; oxygen; internal; external; GI; urinary; sking; burns; capillary; third |
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Term
| hypovolemic shock symptoms begin to occur with decreases in intravascular volume in excess of ? ml or ?% of the circulating blood volume; decreases in preload results in decreases in ?; initially, cardiac output may be partially maintained by a compensatory ?; similarly, reflex increases in ? and myocardial contractility may diminish arterial hypotension; these compensatory responses are mediated by the ? nervous system in an attempt to preserve perfusion to vital organs such as the heart and brain |
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Definition
| 750 ml; 15%; stroke volume; tachycardia; systemic vascular resistance; sympathetic |
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Term
| in hypovolemic shock, the body attempts to maximize its fluid status by decreasing water and sodium excretion through release of ?, ? and ?; BP is maintained by peripheral vasoconstriction mediated by ? relase and the ? system |
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Definition
| ADH, aldosterone, cortisol; catecholamine; renin-angiotensin system |
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Term
| when intravascular volume losses exceed ? ml, the compensatory mechanisms are inadequate while acute losses greater than ? ml are life threatening; in both of these cases there will be decreased cardiac output reulting in diminished delivery of ? to tissues within the body and activation of an acute ? response; oxygen delivery can be further compromised by inadequate blood ? levels due to hemorrhage and/or diminised hemoglobin saturation due to impaired ? |
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Definition
| 1500; 2000; oxygen; inflammatory; hemoglobin; ventilation |
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Term
| decreased delivery of oxygen and other vital nutrients results in diminished production of the energy substrate ?; ? is then produced as a by - product of anaerobic metabolism within tissues throughout the body; ? produced during the stress response from cortisol release is also a contributing factor in the development of lactic acidosis |
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Definition
| ATP; lactic acid; hyperglycemia |
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Term
| protracted tissue hypoxia sets in motion a downward spiral of events leading to organ dysfunction and eventual failure if untreated; relative failure of more than one organ, regardless of etiology, is referred to as the ? (MODS) which definitely needs to be avoided |
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Definition
| multiple organ dysfunction syndrome (MODS) |
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Term
| the overarching goals in treating hypovolemic shock are to restore effective ciruclating ? volume, as well as to manage its ? cause; this is accomplished though the delivery of adequate ? and metabolic substrates such as ? and ? to the tissues throughout the body that will optimally bring about a restoration in organ function and return to homeostasis; evidence of a return to homeostasis is a return to the patient's baseline ? signs, relative normalization of ? test results, and alleviation of the other signs and symptoms of hypovolemic shock |
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Definition
| blood; underlying; oxygen; glucose; electrolytes; vital; laboratory |
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Term
| securing and adequate ? and ventilation is imperative in hypovolemic shock patients consistent with the airway, breathing, and circulation (ABCs) of life support; any compromise in ventilation will only accentuate the tissue ? occurring secondary to inadequate perfusion thus ? intubation and ? ventilation may be needed |
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Definition
| airway; hypoxia; tracheal; mechanical |
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Term
| ? access is also essential for administration of IV fluids and medications; IV access can be accomplished through the placement of ? IV lines or ? with central venous lines if rapid or large volumes of resuscitative fluids are indicated; while primarily facilitating fluid administration, the IV lines provide access for ? samples for obtaining appropriate laboratory tests; placement of an ? catheter is advantageious to allow for accurate and continual monitoring of ?, as well as ? sampling; a ? catheter should also be inserted for ongoing monitoring of urine output |
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Definition
| IV; peripheral; catheters; blood; arterial; blood pressure; ABGs; bladder |
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Term
| baseline laboratory tests that should be done immediately include: ? counts with differentials, serum chemistry profile, ? enzymes, prothrombin and partial thromboplastin times, and serum ?; upon stabilization, placement of a ? artery catheter may be indicated based on the need for more extensive cardiovascular monitoring than is available from noninvasive measures such as vital signs, cardiac rhythm, and urine output; key measured parameters that can be obtained from a PA catheter are the ?, which is a measure of preload, and ? |
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Definition
| complete blood; liver; lactate; pulmonary; pulmonary artery occlusion pressure (PAOP); cardiac output |
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Term
| placement of a PA catheter should be reserved for patients at high risk of ? due to severity of shock or pre-existing medical conditions such as ?; PA catheter use is controversial in broad populations because clinical trials have not shown consistent benefits with their use; use in critically ill patients; an alternate to the PA catheter is placement of a central ? cather that typically resides in the ? to monitor central venous pressure; while these are less ezpensive and more readily placed, they are not particularly accurate in monitoring effective fluid resuscitation |
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Definition
| death; heart failure; venous; superior vena cava; |
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Term
| three therapeutic options are available to clinicians for restoring ciruclating blood volume: ? (electrolyte based solutions), ? (large molecular weight solutions), and ? products; blood products are used only in instances involved ? or severe pre-existing ?, thus leaving ? and ? as the mainstay of therapy in all types of hypovolemic shcok, along with adjunctive ? support; the aggressiveness of fluid resuscitation (rate and volume) will be dictated by the ? of they hypovolemic shock and the underlying cause; warming of all fluids to ?C prior to administration is and important consideration to prevent hypothermia, arrhythmias, and coagulopathy, as they will have a negative impact on the success of the resuscitation effort |
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Definition
| crystalloids; colloids; blood; hemmorhage; anemia; crystalloids and colloids; vasopressor; severity; 37C |
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Term
| conventional, balanced crystalloids are a)fluids with ? composition that approximates plasma, such as ? or b) a total calculated osmolality similar to that of plasma such as ?% sodium chloride also known as ? saline |
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Definition
| electrolyte; Lactated Ringers; 0.9%; normal saline |
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Term
| conventional crystalloids will distribute in normal proportions throughout the ? fluid space upon administration; in other words, expansion of the intravascular space will only increase by roughly 200 to 250 ml for every ? of isotonic crystalloid fluid administered; ? crystalloid solutions such as 3% NaCl or 7.5% NaCl have osmolalities substantially higher than plasma; the effect observed with these fluids is a relatively ? expansion of the intravascular space; by comparison to conventional crystalloids, administration of 250 ml of 7.5% sodium chloride will result in and intravascular space increase of 500 ml; this increase is result of the fluid administered as well as osmotic drawing of ? fluid into the intravascular and interstitial spaces |
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Definition
| extracellular; liter; hypertonic; larger; intracellular |
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Term
| hypertonic saline also has the potential for decreasing the ? response; despite these theoretical advantages, data are lacking demonstrating superiority of hypertonic crystalloid solutions compared with isotonic solutions; crystalloids are generally advocated as the initial resuscitation fluid in ? shock because of their availability, low cost, and equivalent outcomes compared to colloids |
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Definition
| inflammatory; hypovolemic |
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Term
| In the absence of ongoing blood loss, administration of ? to ? mls of isotonic crystalloids will normally re-establish baseline vital signs in adult hypovolemic shock patients; selected patients, such as ? patients, may require more aggressive fluid resuscitation, while other patient subsets such as those with ? shock or heart failure may warrant less agressive fluid administration to avoid over-resuscitation; in hemorrhagic shock patients, approximately ? to ? times the shed blood volume of isotonic crystalloids is need for effective resuscitation |
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Definition
| 2,000 to 4,000 mls; burn; cardiogenic; 3 to 4 |
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Term
| side effects from cyrstalloids primarily involve fluid ? and electrolyte disturbances of ?, ?, and ?; dilution of ? factors can also occur resulting in dilutional coagulopathy; two clinically significant reasons lactated ringers is differnt normal saline is than lactated ringers contains ? and has a lower ? content; thus LR has a greater potential than ? to cause ? and/or ?; alternatively NS can cause ? and ?; nevertheless, ther is no clear cut advantage between the two |
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Definition
| overload; sodium, potassium, and chloride; coagulation; potassium; sodium; hyponatremia; hyperkalemia; hypernatremia; hypokalemia |
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Term
| relative ? pressure between the ? lumen and the interstitial space is one of the major determinants of net fluid flow into or out of the circulation; the other major determinant is the relative ? osmotic pressure between the two spaces; administration of exogenous colloids results in and ? in the intravascular colloid osmotic pressure; the effects of colloids on intravascular volume are a consequence of thier relatively ? molecular size, limiting their passage across the capillary membrane in large amounts; alternatively stated, colloids can be thought of as sponges, drawing fluid into the ? space from the ? space |
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Definition
| hydrostatic; capillary; colloid; increase; large; intravascular; interstitial |
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Term
| in the case of isosmotic colloids ?, ?, and ? products, initial expansion of the intravasular space is essentially ?% to ?% of the volume of colloid administered accounting for some leakage of the colloid from the intravascular space; thus, in contrast to isotonic crystalloid solutions that distribute throughout the ? space, the volume of isotonic colloids administered remains relatively confined in the ? space |
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Definition
| 5% albumin, 6% hetastarch, dextran products; 65-75%; extracellular; intravascular |
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Term
| in the case of hyperoncotic solutions such as 25% albumin, fluid is pulled from the ? space into the vasculature resulting in an increase in the intravascular volume that is much ? than the original volume of the 25% albumin that was administered; while theoretically attractive, hyperoncotic solutions should not be used for ? shock since the expansion of the intravascular space is at the expense of depletion of the ? space |
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Definition
| interstitial; larger; hypovolemic; interstitial |
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Term
| with colloids you get immediate expansion of the ? space while with crystalloids you get expansion of the entire ? space; while the debate is not fully resolved, most clinicians today prefer using ? based on their availability and inexpensive costs compared to colloids; generally the major adverse effects associated with colloids are fluid ?, dilutional coagulopathy, and ? reactions |
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Definition
| intravascular; extracellular; crystalloids; overload; anaphylactic |
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Term
| ? products are indicated in hypovolemic shock patients who have sustained blood losses from hemorrhage exceeding ? mls; this is he only setting in which freshly procured whole blood is administered; in virtually all other settings, blood products are given as the individual components of whole blood units (packed red blood cells, fresh frozen plasma, etc.) |
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Definition
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Term
| in hemorrhagic shock, ? can be transfused to increase oxygen carrying capacity in concert with ? solutions to increase blood volume; in patients with documented coagulopathies, ? for global replacement of lose fluids or diuted clotting factors, or ? for patients with severe thrombocytopenia should be administered |
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Definition
| paceked red blood cells (PRBCs); crystalloid; fresh frozen plasma (FFP); platelets |
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Term
| type ? blood or "universal donor blood" is given in emergent cases of hemorrhagic shock; thereafter, blood that has been typed and cross matched with the receipient's blood is given; the traditional threshold for PRBC trasfusion in hypovolemic shock has been a serum hemoglobin of less than ? g/dl and hematocrit less than ?% |
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Definition
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Term
| traditional risks from allogenic blood product administration include hemolytic and nonhemolytic transfusion reactions and transmission of ? infections in contaminated blood; recent large studies have also shown that transfusions are associated with higher ? possibly because of adverse immune and inflammatory effects; reasearch is ongoing pertaining to red blood cell ? and the use of recombinant activated factor ? |
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Definition
| bloodborne; mortality; substitutes; VII |
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Term
| ? is the term used to describe any pharmacologic agent that can induce arterial vasoconstriction through stimulation of the ? adrenergic receptors; while replenishment of inravascular volume is undoubtedly the cornerstone of hypovolemic shock therapy, use of vasopressors may be warranted as a temporary measure in pations with profound ? or evidence of ? dysfunction in the early stages of shock; typically, vasopressors are used ? with fluid administration |
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Definition
| vasopressor; alpha 1; hypotension; organ; concurrently |
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Term
| ? or ? may be preferred over ? because epinephrine has an increased potential for causing cardiac ? and impaired ? circulation; in cases involving concurrent heart fail;ure, an inotropic agent such as ? may be needed in addition to the use of a vasopressor |
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Definition
| dopamine; norepinephrine; arrhythmias; splanchnic; dobutamine |
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Term
| vasopressors have very ? half lives; the dose should be started low and ? upwards; once ? is normal titrate the vasopressor downward; main adverse effects are too much ? resulting in poor perfusion of organs and potential to induce ?; monitoring of endo organ function such as adequate ? output should also be used to monitor therapy |
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Definition
| short; titrated rapidly; BP; vasoconstriction; arrhythmias; urine |
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Term
| ? which typically accompanies hypovolemic shock as a consequence of tissue hypoxia is best treated by reversal of the ? cause; administration of ? agents such as ? has not been shown to have any beneficial effects and may actually worsen the condition; also want to prevent stress related mucosal disease in the GI tract and the most common agents are ? and ?; also want to prevent ? events by using LMWH or heparin; patients with adrenal insufficiency should receive appropriate ? replacement therapy such as ? |
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Definition
| lactic acidosis; underlying; alkalizing; sodium bicarbonate; H2 receptor antagonists; PPIs; thromboembolic; glucocorticoid; hydrocortisone |
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Term
| ischemic heart disease is also called ? or ?; the term ischemic refers to a decreased supply of ? blood, in this case to the heart muscle; IHD is caused by the narrowing of one or more of the major ? arteries that supply blood to the heart most commonly due to ? plaques |
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Definition
| coronary heart disease; coronary artery disease; oxygenated; coronary; atherosclerotic |
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Term
| IHD results from an imbalance between myocardial oxygen ? and oxygen ?; common clinical manifestations of IHD include ? angina and the ? of unstable angina, non ST segment elevation myocardial infarction, and ST segment elevation myocardial infarction |
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Definition
| supply; demand; chronic stable; acute coronary syndroms (ACSs) |
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Term
| ? is the most common symptom of IHD and is discomfort in the chest that occurs when the blood supply to the myocardium is compromised; ? angina is defined as a chronic and predictable occurence of chest discomfort due to transient myocardial ischemia with physical exertion or other conditions that increase oxygen demand |
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Definition
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Term
| the major epicardial coronary arteries are the left ?, left ?, left ?, and right ?; ? involving one or more of the major coronary arteries or their principal branches is the major cause of angina; ? at the site of an atherosclerotic plaque may contribute to angina by further restricting blood sypply to the distal myocardium; less commonly, vasospasm in the coronary arteries with no or minimal athersclerotic disease can produce angina and even precipitate ACS and this type of vasospasm is referred to as variant or ? angina |
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Definition
| main; anterior descending; circumfles; coronary arteries; atherosclerosis; vasospasm; Prinzmetal |
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Term
| ?, ?, ? and ? are associated with endothelial dysfunction and potentiate atherosclerosis of the coronary arteries; the risk of IHD increases twofold for every ? mm Hg increment in systolic blood pressure and up to eightfold in the presence of ?; ? is related to hypertension, abdominal obesity, dyslipidemia, and insulin resistance and increases the risk of developing IHD and related complications by twofold |
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Definition
| hypertension, dyslipidemia, diabets, cigarette smoking; 20; diabetes; |
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Term
| increases in heart rate, cardiac contractility, and left ventricular wall tension increase the rate of ? (MVO2); ventricular wall tension is a function of ?, ?, and ?; physical exertion ? MVO2 and commonly precepitates symptoms of angina in patients with significant coronary atherosclerosis; medications that reduce heart rate, cardiac contractility, and ventriculr wall tension are commonly prescribed to prevent ischemic symptoms in chronic stable angina |
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Definition
| myocardial oxygen consumption; blood pressure, lef ventricular end diastolic volume, ventricular wall thickness; increases; |
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Term
| reductions in coronary blood flow secondary to ? plaques, ?, or ? formation decrease mycardial oxgyen supply; becase the coronary arteries fill during ?, tachycardia can also reduce coronary perfusion and myocardial ocygen supply (atherosclerotic plaques are the main resons in chronic stable angina) |
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Definition
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Term
| the hallmark feature in the pathophysiology of chronic stable angina is an established ? plaque that impedes coronary blood flow to the extent that myocardial oxygen ? can no longer meet increases in myocardial oxygen ?; with ACS, the hallmark is atherosclerotic plaque ? with the formation of a ?; prinzmetal or variant angina results from spasm of a cornary artery in the absense of significant ?; variant angina usually occurs at ? in the early morning hours; while the vasospasm is generally transient, is some instances vasospasm may persist long enough to ? the myocardium; patients with variant angina are typically ? than those with chronic stable angina and often do not posses the classic risk factors for IHD |
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Definition
| atherosclerotic; supply; demand; rupture; thrombus; atherosclerosis; rest; infarct; younger |
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Term
| precipitants to variant angina include ? smoking, ? use, ?, and exposure to ? temperatures; the treatments of chronic stable angina and variant angina are different so it is important to be able to distinguish between the two |
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Definition
| cigarette; cocaine; hyperventilation; cold |
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Term
| chronic stable angina should be distinguished from unstable angina since the latter is associated with a greater risk of ? and ? and requires more ? treatment |
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Definition
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Term
| a resting ? is indicated in all patients with angina like symptoms; patients with ? elevation are at the highest risk of death and need interventions in order to restore blood flow to the myocardium as quickly as possible; can also use ? tests to test patients for IHD; 50% of patients who have a normal ECG at rest will develop ECG changes with exercise on a treamil; ? is a pharmacologic stressor used in patients who are unable to exercise; dobutamine increases ? demand by stimulating the ? receptor, leading to increases in heart rate and contractility |
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Definition
| ECG; ST segment; stress; dobutamine; oxygen; beta 1 |
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Term
| ? and ? are coronary vasodilators commonly combined with radionuclide myocardial perfusing imaging; these agents ? coronary blood flow in vessels free of disease, but not in diseased vessels |
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Definition
| adenosine; dipyridamole; increase |
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Term
| ? is considered the gold standard for the diagnosis of IHD; coronary angiography is indicated when ? test results are abnormal or symptoms of angina are ? controlled; angiography involves ? insertion, usually into the ? artery, and advancement into the aorta and into the coronary arteries; ? medium is injected through the catheter into the coronary arteries allowing visualization of the coronary anatompy; contrast medium must be used cautiously with adequate hydration in patients with pre-existing ? disease |
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Definition
| coronary angiography; stress; poorly; catheter; femoral; contrast; renal |
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Term
| both ? and ? are believed to provide vasculoprotective effects and in addition to ?, have been shown to reduce the risk of acute coronary events as well as mortality in patients with IHD; ? may be used in patients who cannot tolerate ACE inhibitors because of side effects; ? have been shown to decrease morbidity and improve survival in patients who have suffered an MI |
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Definition
| HMG CoA reductase inhibitors (statins); ACE inhibitors; aspirin; ARBs; beta blockers |
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Term
| therapies to alleviate and prevent angina are aimed at improving the balance between myocardial oxygen ? and ?; since angina usually results from increased myocardial oxygen ? in the face of a relatively ? reduction in oxygen supply, drug treatment is primarily aimed at ? oxygen demand |
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Definition
| demand and supply; demand; fixed; decreasing |
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Term
| short acting ? are indicated to acutely relieve angina, ?, ?, and long acting ? are traditionally used to reduce the frequency of angina and improve ? tolerance; in most patients with IHD, the most effective treatments to improve myocardial oxygen supply are ? mechanical interventions such as percutaneous coronary intervention (PCI) and coronary arter bypass graft (CABG) surgery |
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Definition
| nitrates; beta blockers, calcium channel blockers, nitrates; exercise; invasive |
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Term
| ? may exacerbate pre-existing ?; beta blockers are not absolutely contraindicated in bronchospastic disease, but should be avoided in patients with poorly controlled symptoms; while patients often require combination antianginal therapy, there is a potential pharmacodynamic drug interaction with the concurrent use of ? and ? CCBs since both drug classes slow electrical conduction through the ? node and serious ? or ? may result with their concomitant use |
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Definition
| beta blockers; bronchospasm; beta blockers; non dihydropyridine; AV; bradycardia; heart block |
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Term
| ? is the single preventable cause of IHD and IHD related death; smoking may also attenuate the antianginal effects of ? therapy; weight loss, through caloric restriction and increased physical activity, should be encouraged in patients who have a BMI greater than ?; should limit fat intake to less than ?% of total caloric consumption; limit cholesterol intake to less than ? mg/day; limit consumption of ? and ? fat to less than 7% of total calories; consume at least two servings of ? per week (alternatively patients may take ?); comsume at least 6 servings of grains, 5 servings of fruits and vegetables, and 2 servings of nonfat or lowfat dairy products per day; consider adding ? sterols and/or ? fiber to lower LDL cholesterol; limit daily sodium intake to ? g for blood pressure control; moderate intensity anaerobic activity such as brisk walking idealy for ? to ? minutes every day |
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Definition
| cigarette; drug; 25; 30%; 200; saturated; trans; fish; omega 3 fatty acids; plant; viscous; 2.4g; 30 to 60 minutes |
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Term
| when drug therapy fails or if extensive coronary atherosclerosis is present, ? is often perfomed to restore coronary blood flow, relieve symptoms, and prevent adverse cardiac events; patients with one or more critical coronary stenoses (greater than ?% occlusion of the coronary lumen) detected during coronary angiography may be candidates for PCI |
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Definition
| percutaneious coronary intervention (PCI); 70% |
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Term
| the two drugs used in drug eluding stens are ? and ? to prevent restenosis; ? is necessary upon placement of a stent (bare metal or drug eluding) until the stent becomes endothelialized; as an alternative to PCI, ? surgery, or open heart surgery, may be performed if the patient is found to have extensive coronary atherosclerosis (generally greather than 70% occlusion of ? or more coronary ateries); this surgery is typically last resort |
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Definition
| paclitaxel; sirolimus; antiplatelet therapy; coronary artery bypass graft (CABG); 3 |
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Term
| a major component of any IHD treatment plan is control of modifiable risk factors such as ?, ?, and ?; treatment of ? is critical for both primary and secondary prevention of IHD related cardiac events; a LDL cholesterol goal of less than ? mg/dl whould be implemented for all patients with documented IHD or IHD risk equivalents such as diabetes or other vascular disease |
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Definition
| hypertension, diabetes, dyslipidemia; dyslipidemia; 100 mg/dl |
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Term
| ? or other LDL lowering therapy is indicated along with ? modifications in patients with cardiovascular disease or diabetes and multiple cardiovascular risk factors, regardless of baseline LDL cholesterol levels; intensity of LDL lowering therapy should be sifficient to decrease LDL cholesterol by ? to ? percent; goal LDL levels in patients with known clinical cardiovascular disease of diabetes plus one or more cardiovascular risk factors is less than ? mg/dl |
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Definition
| statins; lifestyle modifications; 30 to 40%; 70 mg/dl |
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Term
| goal blood pressure in patients with IHD is less than ? mm Hg with consideration of reducing blood pressure to less than ? mm Hg in patients with left ventricular dysfunction or heart failure; because of their cardioprotective benefits, ? and ? either alone or in combination, are appropriate for most patients with both hypertension and IHD |
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Definition
| 130/80; 120/80; beta blockers; ACE inhibitors |
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Term
| ? play a major role in the pathophysiology of ACS; specifically, platelets adhere to the site of atherosclerotic plaque ? where they become activated, aggregate, and stimulate thrombus formation and ACS; ? is a potent platelet activator; ? inhibits cyclooxygenase, an enzyme responsible for the productiong of thromboxane, thereby inhibiting ? activation and aggregation |
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Definition
| platelets; rupture; thromboxane; aspirin; platelet |
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Term
| in patients with stable or unstable angina, ? has been consistently shown to reduce the risk of major adverse cardiac events, particularly MI; ? therapy with aspirin should be considered for all patients without contraindications, particularly in patients with a history of MI (dose of 75 to 162 mg daily are recommended in patients with or at risk for IHD); if aspirin is contraindicated or is not tolerated by the patient, other antiplatelet agents such as ? should be considered |
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Definition
| aspirin; antiplatelet; clopidogrel |
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Term
| dual antiplatelet therapy with ? and ? is recommended following PCI with stent placement to prevent stent thrombosis priot to stent endothelialization; ? is the thienopyridine drug of choice; antiproliferative drugs in drug eluting stents delay ? of the stent and thus a longer period of combination antiplatelet therapy is recommended for drug eluting stents compared to bare metal stents to prevent thrombosis; recent guidelines recommend dual 1antiplatelet therapy for at least ? month after bare metal stent placement and at least ? months after drug eluding stent placement |
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Definition
| aspririn and thienopyridine; clopidogrel; endothelialization; 1; 12; |
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Term
| ? are the preferred drugs to achieve LDL cholesterol goals based on their potency in lowering LDL cholesterol and efficacy in preventing cardiac events; this is important in both ? and ? prevention of IHD related events; the four statins shown to reduce morbidity and mortality associated with IHD include ?, ?, ?, ? |
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Definition
| statins; primary; secondary; lovastain, pravastain, simvastatin, atovastain |
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Term
| statins also do many other things to stabilize atherosclerotic plaques and contribute to cardiovascular risk reduction such as promote larger, less ? particles, improve ? function, prevent or inhibit ?, etc |
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Definition
| atherogenic; endothelial; inflammation |
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Term
| to control risk factors and prevent major adverse cardiac events, ? therapy should be considered in all patients with IHD, particularly in those with elevated LDL cholesterol or diabetes; statins are potent lipid lowering agents, possess non lipid lowering effects that may provide additional benefits to patients with IHD, and have been shown to reduce morbidity and mortality in patients with IHD; based on these benefits, statins are generally considered the drugs of choice in patients with dyslipidemias; moreover, based on evidence that statins improve outcomes in patients with IDH and normal LDL cholesterol concentration, statins should be considered in all patients with IHD at high risk of major adverse cardiac events, regardless of baseline LDL cholesterol |
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Definition
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Term
| ? is a neurohormone produced in the kidney and is a potent ? and stimulates the production of ?; in the absence of contraindications, ? should be considered in all patients with IHD, particularly those who also have hypertension, diabetes mellitus, chronic kidney disease, left ventricular dysfunction, history of MI, or any combination of these; additionally, ACE inhibitors should also be considered in patients at high risk for developing IHD; ? may be used in patients with indications for ACE inhibitors but who cannot tolerate them due to side effects such as ? |
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Definition
| angiotensin II; vasodilatory; aldosterone (sodium and water retention which increases ventricular wall tension); ACE inhibitors; ARBs; chronic cough |
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Term
| side effects of ACE inhibitors and ARBs include ?, deterioration in ? function, and rarely ?; serum potassium increases are secondary to ? inhibition and are more likely in the presense of pre existing renal impairment, diabetes, or concomittant therapy with ?, ? supplements, or potassium sparing ? |
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Definition
| hyperkalemia; renal; angioedema; aldosterone; NSAID; potassium; diuretics |
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Term
| short acting ? are first line treatment to terminate acute episodes of angina; all patients with a history of angina should have ? nitroglycerin tablets or spray to relieve acute ischemic episodes; nitrates undergo biotransformation into ?; nitric oxide leads to increased intracellular concentrations of ?, and ultimately to smooth muscle ?; nitraties primarily cause venodilation leading to reductions in ?; the resultant decrease in ventricular volume and wall tension leads to decreased myocardial oxygen demand; at higher concentrations, nitrates may also cause arterial dilation and cause a reduction in ?; in addition to reducing oxygen demand, nitrates increase myocardial oxygen ? by dilating the epicardial coronary arteries and collateral vessels, as well as relieving vasospasm |
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Definition
| nitrates; sublingual; nitric oxide; cGMP; relaxation; preload; afterload; supply |
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Term
| at the onset of an angina attack, a 0.3 to 0.4 mg dose of nitroglycerin (tablet or spray) should be administered sublingually, and repeated every ? minutes until symptoms resolve; sitting or standing enhances venous ? and the effectiveness of nitroglycerin; sublingual nitroglycerin can also be used to prevent ? induced angina; in this case, the patient should use sublingual nitroglycerin 2 to 5 minutes prior to an activity known to cause angina, with the effects persisting for approximately ? minutes; ? has a longer half life with antianginal effects last up to 2 hours |
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Definition
| 5; pooling; effor; 30 minutes; isosorbide dinitrate |
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Term
| the use of short acting nitrates alone, without concomitant long acting antiaginal therapy, may be acceptable for patients who experience angina symptoms once every ? days; however, for patients with more frequent attacks, long acting antianginal therapy with ?, ? or long acting ? is recommended; don't use nitrates with ED meds |
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Definition
| few; beta blockers; calcium channel blockers; nitrates |
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Term
| the ? position is generally preferred when using nitroglycerin because the drug may cause dizziness; call 911 if symptoms are unimproved or worsen 5 minutes after the ? dose; the drugs traditionally used to prevent ischemic symptoms are ?, ? and ?; these drugs exert their antianginal effects by improving the balance between myocardial oxygen supply and demand; these drugs decrease the frequency of angina and delay the onset of angina during ?; there is no evidence that any of these agents prevent ACS or improve survival in patients with chronic stable angina; ? is a newer molecular entity indicated for the treatment of chronic stable angina in patients unresponsive to traditional antianginal medications; ? therapy with 2 or three antianginal drugs is often needed |
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Definition
| seated; first; BBs; CCBs; nitrates; exercise; ranolazine; combination |
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Term
| beta blockers decrease myocardial oxgyen ?; beta blockers can also decreas oxgyen demand by lowering ?; beta blockers have no effect on myocardial oxygen ?; beta blockers with ? activity actually agonize beta receptors cause less of a reduction and heart rate and therefore less of a reduction in myocardial oxygen demand and should not be used in patients with IHD (acebutolol, labetolol, penbutolol, pindolol); want resting heart rate to be between ? and ? beats per minute; maximum heart rate with exercise of ? bpm or ? bpm above the resting heart rate |
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Definition
| demand; blood pressure; supply; intrinsic sympathomimetic; 50 to 60 bpm; 100 bpm; 20 |
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Term
| beta blockers are first line therapy for preventing ischemic symptoms, particularly patients with a history of ?; in the absence of contraindications, beta blockers are preferred because of their potential cardioprotective effects; specifically, beta blockers may prevent cardiac arrhythmias by decreasing the rate of spontaneous depolarization of ectopic pacemakers; specific beta blockers associated with mortality reduction in clinical trials include ?, ?, and ?; beta blockers are contraindicated in patients with severe ? or ? conduction defects; beta blockers should be used with particular caution in combination with other agents that depress AV conduction such as ?, ?, and ?; beta ? selective agents are preferred in patients with asthma or COPD however this selectivity is ? dependent; all beta blockers may mask the tachydardia and tremor that commonly accompany episodes of ? in diabetes and ? beta blockers can may alter glucose metabolism and slow recovery from hypoglycemia in insulin dependent diabetes but beta blockers should not be avoided in patients with diabetes; beta blockers should be used cautiously in patients with ? as they are negative inotropic agents; beta blockers should not be discontinued abruptly |
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Definition
| MI; metoprolol; carvedilol; propranolol; bradycardia; AV nodal; digoxin; diltiazem; verapamil; beta 1; dose; hypglycemia; non selective; heart failure; |
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Term
| calcium channel blockers inhibit calcium entry into vascular ? muscle and ? cells resulting in the inhibition of the calcium dependent process leading to muscle ?; inhibition of calcium entry into the vascular smooth muscle leads to systemic vasodilation and reductions in ?; inhibition of calcium entry into the cardiac cells leads to reductions in cardiac contractility; thus, CCBs reduce myocardial oxygen ? by lowering both wall tension (through the reductions in afterload) and cardiac contractility; in addition, the ? CCBs ? and ? further decrease myocardial oxygen demand by slowing conduction through the AV node and lowering heart rate; in contrast, ? CCBs (nifedipine in particular) are potent vasodilators that can cause ? mediated increases in heart rate; because of their negative chronotropic effects, verapamil and diltiazem are generally more effective antianginal agents than the dihydropyridine CCBs; in addition to decreasing oxygen demand, all CCBs increase myocardial oxygen ? by dilating coronary arteries thus increasing coronary blood flow and relieving vasospasm |
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Definition
| smooth; cardiac; contraction; afterload; demand; nondihydropyridine; diltiazem; verapamil; dihydropyridine; baroflex; supply |
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Term
| in randomized, controlled, clinical trials, CCBs were as effective as ? at preventing ischemic symptoms; CCBs are recommended as initial treatment in IHD when ? are contraindicated or not tolerated; in addition, CCBs may be used in ? with beta blockers when initial treatment is unsuccessful; want to use ? acting CCBs in treatment of ischemia; ? and ? are the only CCBs which have less inotropic effects and appear to be safe in patients with left ventricular systolic dysfunction |
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Definition
| beta blockers; beta blockers; combination; long acting (short acting should be avoided); amlodipine; felodipine |
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Term
| the major limitation of nitrate therapy is the development ? with continuous use; the loss of antianginal effects may occur within the first ? hours of continuous nitrate therapy; long acting nitrate products are available in ? and ? dosage forms; the most effective method to avoid tolerance and maintain the antianginal efficacy of nitrates is to allow a daily nitrate free interval of at least ? to ? hours; nitrates do not provide portection from ischemia during the nitrate free period therefore the nitrate free period should occur when the patient is least likely to experience angina; genrally angina is less common druing the ? hourse when the patient is sleeping and myocardial oxygen demand is ?; monotherapy with nitrates for the prevention of ischemia should generally be ?; reflex increases in sympathetic activity and heart rate with resultant increases in myocardial oxygen ? may occur secondary to nitrate induced venodilation and also because patients are unprotected during the nitrate free interval; ? and ? are dosed to proved 24 hour protection from ischemia; treatment with long acting ? should be added to baseline therapy with either a ? or ? or a combination of the two (beta blocker and long acting nitrates are a very good combination); nitrates cause venodilation so can get ? hypotension with their use but not a big deal |
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Definition
| tolerance; 24; oral and transdermal; 8 to 12 hours; hours; decreased; avoided; demand; beta blockers; calcium channel blockers; nitrates; BB; CCB; postural |
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