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Path midterm 2 > alterations- heart > Flashcards

alterations- heart Flashcards

1
Q

what are under the umbrella of atherosclerosis?

A

peripheral artery disease
coronary artery disease
cerebral artery disease

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2
Q

what are coronary arteries?

A

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

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3
Q

what is angina?

A

“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
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4
Q

what can cause angina?

A

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

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5
Q

manifestations of angina?

A

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
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6
Q

how is angina pain differ from chest pain from pulmonary origin?

A

-pulmonary pain tends to be sharper, stabbing, changes with breathing

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7
Q

what are some associated manifestations of angina?

A
  • diaphoresis
  • dyspnea
  • pallor
  • nausea
  • vomiting
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8
Q

How does angina differ in women and elderly?

A
  • women have smaller coronary arteries, dont feel it as much, tend not to feel it substernal, overwhelming manifestation is fatigue
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9
Q

What are the three types of angina?

A
  • 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)
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10
Q

what is variant (prinzmetal) angina?

A
  • 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)
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11
Q

Tx for varient (prinzmetal) angina?

A

-treated with calicum channel blocker medications (helps with arteries relax and open up)- will put in angiogram to diagnose (dye in arteries)

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12
Q

what is stable angina?

A
  • 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
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13
Q

how can a person manage stable angina?

A
  • reduce risk factors
  • nitroglycerin
  • may require interventions to open up or bypass obstruction
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14
Q

what falls into the category of unstable angina?

A

Acute Coronary Syndrome

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15
Q

what is unstable angina?

A
  • 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
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16
Q

what is myocardial infraction?

A
  • 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
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17
Q

what does prolonged (20 to 30 min) ischemia do to the heart? (irreversible hypoxia)

A
  • cellular death
  • scar formation
  • surrounding area also affected
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18
Q

what are some manifestations of MI?

A
  • 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
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19
Q

what are diagnostic tools for MI?

A

-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)

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20
Q

what does the ST segment on the electrocardiogram help indicate?

A

helps to tell how mich the myocardial wall is dead

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21
Q

what are the risk factors for an MI?

A

diabetes, smoking, hypertension, dyslipidemia

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22
Q

what is included in tertiary prevention for an MI?

A
  • 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)
23
Q

what does the prognosis (likely course of disease) of MI depend upon?

A
  • extent of tissue death
  • surrounding tissue
  • location (small, distal part of heart isnt as bad)
24
Q

What are some complications of MI?

A
  • 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
25
Q

what is acute coronary syndrome caused by?

A

caused by plaque that is unstable /complicated and prone to rupture -> thombus impedes blood flow

26
Q

is ischemia reversible in unstable angina?

A

yes

heart muscle is still alive, but hurting

27
Q

is ischemia reversible in an MI?

A

no. its irreversible
- there are two types, categorized by ECG changes
- Heart tissue has damage and some death

28
Q

what are the two things that acute coronary syndrome can turn into?

A

either unstable angina or an MI

29
Q

what is the term heart failure used to describe?

A

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
30
Q

what is left heart failure also known as? whats its ejection fraction?

A

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
31
Q

what is right heart failure?

A
  • high output- something else in body- that causes the body higher demands for blood flow from the heart
  • cannot meet increased body demands
32
Q

what are some manifestations of left heart failure?

A
  • 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
33
Q

what are the body compensatory mechanisms for left heart failure?

A

(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
34
Q

what is right heart failure?

A
  • 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
35
Q

what can cause right heart failure?

A
  • left heart failure
  • COPD
  • congenital heart defects
36
Q

manifestations of right heart failure?

A
  • 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
37
Q

what 3 things does pulmonary edema cause?

A
  • orthopnea
  • paroxymal dyspnea
  • cough with frothy sputum
38
Q

what is the tx for heart failure?

A

-unload the heart (diuretics)
-Decrease heart rate and blood pressure:
Ace inhibators
-beta blockers

39
Q

what is physiological shock?

A
  • impaired tissue perfusion, regardless of cause
  • organ dysfunction
  • syndrome that occurs due to various etiologies
40
Q

what are some causes of shock?

A
  • sodium-potassium pump fails
  • cell membrane permeable
  • cellular edema
  • cell death
41
Q

what are the three types of shock?

A

1) hypovolemic
2) cardiogenic
3) distributive (neurogenic, anaphylactic, and septic)

42
Q

what is hypovolemic shock?

A
  • 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
43
Q

what are some signs and symptoms of hypovolemic shock?

A

-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

44
Q

what is cardiogenic shock?

A
  • impaired contractility = decreased bp = decreased organ perfusion
  • usually due to MI
45
Q

what are some signs and symptoms of cardiogenic shock?

A
  • heart rate goes up
  • increased resp rate
  • decreased bp
  • low level of consciousness
  • decreased urine output
  • cool, pake, decreased cap refill
  • distended jugular vein **
46
Q

What is distributive shock?

A
  • 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
47
Q

what is anaphylactic shock?

A
  • widespread hypersensitivity reaction

- wide blood pressure, really low diastolic, high systolic pressure

48
Q

Signs and symptoms of anaphlactic shock?

A

-hypotension, tachycardia, tachypnea (will die from this if not treated)
-altered LOC
distrubative shock:
-warm, pink skin
-bounding pulses
Anaphylatic:
-wheezing, stridor, edema, hives

49
Q

what is septic shock?

A

systemic reaction to infection (bacteria, virus, fungi)

-massive vasodilation

50
Q

signs and symptoms of septic shock?

A 
- hypotension, tachycardia, tachypnea 
altered LOC 
distrubative shock: 
-warm, pink skin 
-bounding pulse 
Signs of infection: 
-fever, WBC goes up
51
Q

what is neurogenic shock?

A

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
52
Q

what does a loss of sympathetic tone in arterioles lead to?

A

Vasodilation

53
Q

What are some signs and symptoms of neurogenic shock?

A 
-hypotension, tachypnea 
altered LOC 
-distributive shock: 
-warm, pink skin 
-bounding pulse 
-BRADYCARDIA

Path midterm 2 (13 decks)

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