alterations- heart Flashcards
what are under the umbrella of atherosclerosis?
peripheral artery disease
coronary artery disease
cerebral artery disease
what are coronary arteries?
arteries on the heart that travel along the epicardial surface (outside layer) and then branch into the myocardium (heart muscle) and then to the endocardium
what is angina?
“chest pain” - is a symptom and diagnosis
- due to ischemia of myocardial cells
- cells temporarily deprived of adequate blood supply
- is due to anything that causes imbalance between myocardial O2 supply and demand
what can cause angina?
1) obstruction:
- vessel spasm
- atherosclerosis (stable plaques)
- atherosclerosis (unstable complicated plaques)
2) other:
- hypotension
- anemia (not enough O2 to the heart
- hypoxemia
- increased demand for O2
manifestations of angina?
Chest pain:
- tends to be SUBSTERNAL (below sternum, center of chest)
- pressure, tightness, squeezing, ache
- “elephant on my chest”
- may radiate to neck, arm, jaw
how is angina pain differ from chest pain from pulmonary origin?
-pulmonary pain tends to be sharper, stabbing, changes with breathing
what are some associated manifestations of angina?
- diaphoresis
- dyspnea
- pallor
- nausea
- vomiting
How does angina differ in women and elderly?
- women have smaller coronary arteries, dont feel it as much, tend not to feel it substernal, overwhelming manifestation is fatigue
What are the three types of angina?
- categories are according to what impairs the blood flow to heart muscle
1) Variant Angina (Prinzmetal’s Angina) -Vessel spasm
2) stable angina (atherosclerosis- stable plaques)
3) unstable angina (atherosclerosis-unstable complicated plaques)
what is variant (prinzmetal) angina?
- vasospasm
- no evidence of coronary artery disease
- due to spasm of coronary artery-cuts off blood flow
- pain is cyclical, often at night (follows sleep-wake pattern)
Tx for varient (prinzmetal) angina?
-treated with calicum channel blocker medications (helps with arteries relax and open up)- will put in angiogram to diagnose (dye in arteries)
what is stable angina?
- narrowing of the vessel lumen because of atherosclerosis = cornonary artery disease
- events that increase myocardial O2 demand can trigger chest pain
- vessels cannot dilate to increase oxygen delivery during exercise or stress (increase myocardial demand)
- pain predictable, relived by rest or nitroglycerin
how can a person manage stable angina?
- reduce risk factors
- nitroglycerin
- may require interventions to open up or bypass obstruction
what falls into the category of unstable angina?
Acute Coronary Syndrome
what is unstable angina?
- also caused by atherosclerosis, but this happens when plaque are unstable (complicated), and tend to crack, bleed, and cause a clot (coronary artery disease)
- there is no warning when clot will crack, can happen at anytime, not related to excercise
- plaque is unstable/ complicated and prone to rupture
what is myocardial infraction?
- a heart attack (death of cardiac muscle cells)
- similar etiology to unstable angina, only difference is time span- takes longer
- plaque is unstable / complicated and prone to rupture, thrombus impedes blood flow
what does prolonged (20 to 30 min) ischemia do to the heart? (irreversible hypoxia)
- cellular death
- scar formation
- surrounding area also affected
what are some manifestations of MI?
- prolonged angina (20-30min) = start getting dead cells
-nausea
-diaphoresis
-pallor
cool, clammy
-tachycardia
-dyspnea
-apprehesnion, feeling of doom (death)
-some have no pain (silent MI)
-in women and elderly: symptoms are more mild
what are diagnostic tools for MI?
-physical assessment
-Electrocardiogram (ECG) changes
if ST is elevated = STEMI
if ST is not elevated= NSTEMI
-Caridac biomarkers (troponin, creatine kinase)- these substances leak into circulations when cell death occurs, when these marksers are elevated, works as an indicator)
what does the ST segment on the electrocardiogram help indicate?
helps to tell how mich the myocardial wall is dead
what are the risk factors for an MI?
diabetes, smoking, hypertension, dyslipidemia
what is included in tertiary prevention for an MI?
- Acetylsaliclic acid (ASA), O2, nitroglycerin, morphine (MONA)
- percutaneous coronary intervention (PCI)
- Medication: fibrinolytics
- Coronary artery bypass surgery
- Asprin: platlet avocation inhibator (prevents clots from getting bigger)
what does the prognosis (likely course of disease) of MI depend upon?
- extent of tissue death
- surrounding tissue
- location (small, distal part of heart isnt as bad)
What are some complications of MI?
- Dysrhythmias
- sudden cardiac death-due to electrical disru[tion in the heart
- heart failure
- cardiogenic shock
- aneruysm of heart wall
- rupture of ventrical wall
- rupture of papillary muscles
- rupture of interventricular septum
what is acute coronary syndrome caused by?
caused by plaque that is unstable /complicated and prone to rupture -> thombus impedes blood flow
is ischemia reversible in unstable angina?
yes
heart muscle is still alive, but hurting
is ischemia reversible in an MI?
no. its irreversible
- there are two types, categorized by ECG changes
- Heart tissue has damage and some death
what are the two things that acute coronary syndrome can turn into?
either unstable angina or an MI
what is the term heart failure used to describe?
used to describe several types of cardiac dysfunction that result in inadequate perfusion of tissues
- linked to hypertension, CAD
- also due to age, renal failure, valvue disease, myocarditis
- 10% of ppl pver age 65 have heart failure
what is left heart failure also known as? whats its ejection fraction?
congestive heart failure
- reduced ejection fraction (% of blood we pump out with every beat)
- problems pumping out blood
- inability of the left ventricle to effectively push oxygenated blood forward into the systemic circulation (aorta)
- increased pulmonary congestion
what is right heart failure?
- high output- something else in body- that causes the body higher demands for blood flow from the heart
- cannot meet increased body demands
what are some manifestations of left heart failure?
- agitation confusion, altered LOC
- tachycardia and tachpnea
- eventually lethargic and coma
- weak pulse
- cyanotic, cool
- slow capillary refill
- low bp
- crackles in lungs
- dyspnea, possible nocturnal dyspnea
- cough
- sputum (frothy, pink)
- decreased urine output
- more blood pools in left ventricle and eventually left atrium = lots of fluid back up into lungs, end up with water congestion in lungs = pulmonary edema
what are the body compensatory mechanisms for left heart failure?
(at first they are helpful)
- Heart rate increases
- Artery size is smaller, body does this because it wants to maintain blood pressure (eventually this is harmful)
- RAAS, ADH (helps to increase blood pressure)
- reabsorption of sodium and water - helps initally, eventually harmful
what is right heart failure?
- inability of right ventricle to effectively push de-oxygenated blood forward into the pulmonary circulation
- less blood flow in lungs = hypoxemia
- all of the veins that drain into the right atrium will become congested, feet will become edemic
- veins from liver and spleen will become congested (they become bigger)
- congestion + swelling of gut = nausea, lose appetitie
- jugular vein will become distended (budge)
- weight gain (because of fluid retension)
- back up of blood into systemic veins
what can cause right heart failure?
- left heart failure
- COPD
- congenital heart defects
manifestations of right heart failure?
- backwards congestion into liver, spleen, peripheral tissue
- edema in feet and legs
- hepatomegaly
- splenomegaly
- anorexia
- distended jugular vein
- weight gain (caused by accumulation of fluid)
- hypoexmia (oxygenated blood not effectively pumped into pulmonary circulation)
- fatigue
what 3 things does pulmonary edema cause?
- orthopnea
- paroxymal dyspnea
- cough with frothy sputum
what is the tx for heart failure?
-unload the heart (diuretics)
-Decrease heart rate and blood pressure:
Ace inhibators
-beta blockers
what is physiological shock?
- impaired tissue perfusion, regardless of cause
- organ dysfunction
- syndrome that occurs due to various etiologies
what are some causes of shock?
- sodium-potassium pump fails
- cell membrane permeable
- cellular edema
- cell death
what are the three types of shock?
1) hypovolemic
2) cardiogenic
3) distributive (neurogenic, anaphylactic, and septic)
what is hypovolemic shock?
- decreased circulating blood volume = decreased bp = decreased organ perfusion (aka, shock)
- either bleeding, or causes evaportation (burn victoms)
- loss of whole blood, plasma, or interstitial fluid
what are some signs and symptoms of hypovolemic shock?
-heart rate goes up
-increased resp rate
-decrease in bp
-low levels of conciousness (restlessness)
-decreased urine output
-cool, pale, weak pulse
-slow cap refill
-less circulating blood = flat jugular veins***
Tx: fluids, replace blood, stop cause of bleedin
what is cardiogenic shock?
- impaired contractility = decreased bp = decreased organ perfusion
- usually due to MI
what are some signs and symptoms of cardiogenic shock?
- heart rate goes up
- increased resp rate
- decreased bp
- low level of consciousness
- decreased urine output
- cool, pake, decreased cap refill
- distended jugular vein **
What is distributive shock?
- vasodilation -> decreased BP -> decreased organ perfusion
- warn, pink skin
- bounding pulse
- drop in bp because of massive systemic vasodilation, pressure inside blood vessels decreases
- subcategories include anaphylatic, spetic, and neurogenic
what is anaphylactic shock?
- widespread hypersensitivity reaction
- wide blood pressure, really low diastolic, high systolic pressure
Signs and symptoms of anaphlactic shock?
-hypotension, tachycardia, tachypnea (will die from this if not treated)
-altered LOC
distrubative shock:
-warm, pink skin
-bounding pulses
Anaphylatic:
-wheezing, stridor, edema, hives
what is septic shock?
systemic reaction to infection (bacteria, virus, fungi)
-massive vasodilation
signs and symptoms of septic shock?
- hypotension, tachycardia, tachypnea altered LOC distrubative shock: -warm, pink skin -bounding pulse Signs of infection: -fever, WBC goes up
what is neurogenic shock?
Due to spinal cord injury*
- located at or above the 6th thoracic vertebrae
- this interupts sympathetic functioning
- this causes the arteries to dilate
- this impairment in sympathetic functioning causes a low heart rate
what does a loss of sympathetic tone in arterioles lead to?
Vasodilation
What are some signs and symptoms of neurogenic shock?
-hypotension, tachypnea altered LOC -distributive shock: -warm, pink skin -bounding pulse -BRADYCARDIA
