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Clin Med III > 2A: Cardiac Pathologies II > Flashcards

2A: Cardiac Pathologies II Flashcards

1
Q

What is the goal for treating CAD?

A

Halt progression and possible improvement with risk factor modification

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2
Q

What is the definition of an MI?

A

Ischemic event that may result in injury or irreversible tissue death at the myocardium

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3
Q

What are the three signs and symptoms of an MI?

A
  1. ECG changes
  2. Cardiac symptoms
  3. Elevation of cardiac enzymes
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4
Q

What are possible ECG changes with an MI?

A
  1. S-T segment elevation
  2. Inverted T wave
  3. Significant Q wave
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5
Q

How is an MI ruled in or out?

A

Must have 2/3 key symptoms

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6
Q

What are the three zones of infarct of MI?

A
  1. Zone of ischemia
  2. Zone of injury
  3. Zone of infarct
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7
Q

What is the zone of ischemia?

A

Tissue is viable and may not have any damage if infarct doesn’t extend

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8
Q

What is the zone of injury?

A

Viable as long as O2 delivery stays intact. Increasing O2 delivery can save the tissue

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9
Q

What is the zone of infarct?

A

Tissue is O2 deprived and has irreversible damage

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10
Q

What zones can intervention have an effect on?

A

Zone of ischemia and injury

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11
Q

What are the three main cardiac enzymes of interest with an MI?

A
  1. CPK-MB
  2. Troponin
  3. LDH-1
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12
Q

When will CPK-MB increase?

A

0-24 hrs after MI

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13
Q

Why is CPK-MB a marker for MI?

A

Because MB is an isoenzyme that is specific to cardiac tissue

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14
Q

When will troponin increase after an MI?

A

12 hrs - 4 days after

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15
Q

How does LDH-1 indicate MI?

A

Look at the ratio of LDH-1 to LDH-2. If it is greater than 1, suggests MI

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16
Q

What are the two main classifications of MI?

A

Transmural and Subendocardial

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17
Q

What is a transmural MI?

A

Goes into the wall of the myocardium, will see the most wall motion deficits

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18
Q

What is a hypokinetic transmural MI?

A

Decreased wall motion

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19
Q

What is a dyskinetic transmural MI?

A

Unorganized wall motion

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20
Q

What is an akinetic transmural MI?

A

No wall motion

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21
Q

What is a subendocardial MI?

A

Partial thickness infarct

22
Q

How does a subendocardial MI present?

A

Wall motion may be normal and less EKG changes compared to transmural

23
Q

What is the definition of cardiomyopathy?

A

Disease where contraction and relaxation of the cardiac muscles are impaired

24
Q

What are possible causes of cardiomyopathy?

A

Collagen disorder, autoimmune, viral, idiopathic, neurotransmission

25
Q

What are the three types of cardiomyopathy?

A
  1. Dilated cardiomyopathy
  2. Hypertrophy
  3. Restrictive
26
Q

What is dilated cardiomyopathy?

A

Heart wall is floppy, similar to an aneurism

27
Q

What does all cardiomyopathy lead to?

A

Decreased ejection fraction

28
Q

What is hypertrophy cardiomyopathy?

A

Hypercontractile left ventricle

29
Q

What does hypertrophy cardiomyopathy lead to?

A

Increased myocardial O2 demand, rapid ventricular emptying, decrease EF

30
Q

What is restrictive cardiomyopathy?

A

Endocardial scarring that restricts the heart wall distention

31
Q

What are the causes of right sided CHF?

A

Pulmonary HTN, right ventricular infarct

32
Q

What are initial signs of right CHF?

A

Systemic edema with fluid accumulation in the abdomen, liver, and legs

33
Q

What is the primary sign of right CHF, and what should you observe for?

A

LE edema - look for weight gain and jugular vein distension

34
Q

What are causes of left CHF?

A

Resistance from systemic HTN, MV/LV dysfunction secondary to cardiomyopathy or infarct

35
Q

How does left sided CHF initially present?

A

Pulmonary edema

36
Q

What is the primary symptom of left CHF?

A

Dyspnea

37
Q

What are three additional symptoms of left CHF?

A
  1. Tachypnea
  2. Mouth or lung crackles
  3. Orthopnea
38
Q

How does CHF progress?

A

To both sides of the heart

39
Q

What are signs that may indicate right or left sides CHF?

A

S3 heart sound, tachycardia, decreased activity tolerance, weight gain, pulmonary edema

40
Q

Describe NYHA I

A

No limitation to physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or shortness of breath

41
Q

Describe NYHA II

A

Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, shortness of breath, or chest pain

42
Q

Describe NYHA III

A

Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, shortness of breath, or chest pain

43
Q

Describe NYHA IV

A

Symptoms of heart failure at rest. Any physical activity causes further discomfort

44
Q

What is the result of CHF?

A

Low cardiac output (CO)

45
Q

How does the cardiopulmonary system respond to low cardiac output?

A

As if it is a low blood volume problem

46
Q

In what four ways does the body respond to low cardiac output?

A
  1. Retain fluid
  2. Vasoconstriction
  3. Increase stroke force
  4. Increase HR
47
Q

Why is medical intervention necessary for CHF?

A

Control stroke force and reduce vascular pressure and excess fluid to decrease workload on the heart

48
Q

What is a concern with left sided CHF and why?

A

Hypertrophy of the left ventricular wall - has the largest muscle mass with high O2 consumption making it vulnerable to ischemic attack

49
Q

What happens to skeletal muscle and muscle fibers with CHF?

A

Skeletal muscle atrophy and decreased type I fibers leading to decreased endurance

50
Q

Why do muscles have a decreased ability to work with CHF?

A

Decreased skeletal muscle blood flow

51
Q

How does CHF impair skeletal muscle metabolism?

A

Decreased ability to break down O2 for use

52
Q

What is pulmonary edema?

A

Fluid leaks from pulmonary and lymphatic systems interstitially and get into alveoli creating a barrier making gas exchange between capillaries and alveoli difficult

Clin Med III (18 decks)

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