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Pathophysiology > Alterations in Cardiac Function > Flashcards

Alterations in Cardiac Function Flashcards

1
Q

What are the etiologies of CAD?

A
  1. thrombus formation
  2. endothelial cell dysfunction
  3. coronary vasospasm
    Caused by atherosclerosis
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2
Q

What are the risk factors for CAD?

A
  1. smoking
  2. obesity
  3. diabetes
  4. hypertension
  5. abnormal lipid levels
  6. genetic predisposition
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3
Q

What is the main objective for treatment against thrombus?

A

to prevent the clot from rupturing by stabilizing the plaque

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4
Q

If the lumen in the coronary artery experiences critical narrowing of the lumen over time or sudden rupture, what are possible results?

A
  1. MI
  2. Sudden cardiac death
  3. heart failure
  4. angina pectoris
  5. cardiomyopathy
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5
Q

If there is insufficient oxygen to meet the demands of cardiac cells what occurs?

A

ischemia

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6
Q

What are the 2 methods cardiac cells meet their oxygen demands?

A
  1. rate of coronary perfusion

2. myocardial workload

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7
Q

What are the 2 subgroups of CAD?

A
  1. Chronic Ischemia

2. Acute Coronary Syndrome (ACS)

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8
Q

Explain the patho of Chronic Ischemia

A

An increase is myocardial workload by increasing, preload, afterload, contractility or heart rate the demand increases. If needs aren’t met this can elude to ischemia (sometimes impairment of perfusion may be present also)

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9
Q

Advanced fibrous plaque is thought to produce intermittent ischemia if _____ or more of the arterial lumen is occluded?

A

75%

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10
Q

When does ACS occur?

A

when sudden obstruction of coronary blood flow results in acute myocardial ischemia (blood to heart muscle is blocked)

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11
Q

What are types of ACS?

A
  1. unstable angina pectoris
  2. MI
  3. dysrhythmias
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12
Q

What are the types of chronic ischemic diseases?

A
  1. stable angina

2. cardiomyopathy

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13
Q

If a patient complains that their chest hurts and it feels as though an elephant is sitting on their chest with an atypical symptoms of fatigue or weakness, what is the causation?

A

angina pectoris

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14
Q

What are the 3 types of angina?

A
  1. stable “classic”
  2. unstable
  3. prinzmetal (variant)
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15
Q

If John says he experiences chest pain during his morning jog but feels fine after resting from his jog, what is the prognosis?

A

stable angina

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16
Q

What is occurring during stable angina(the most common form)?

A

stenosed arteries from atherosclerosis reduces blood flow so these arteries are unable to dilate properly to meet the oxygen demand

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17
Q

Describe Prinzmetal Angina

A

Unpredictable attacks, but not caused pain from exertion and not meeting oxygen demands, but from vasospasms

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18
Q

If John is diagnosed with Prinzmetal angina what would be the treatment? Why?

A

Calcium channel blocker because this prevent the hypercontractility from the vasospasm

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19
Q

If John has angina, what is at risk for?

A

ACS

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20
Q

Compare and contrast unstable angina and MI

A

Both are apart of the ACS by causing chest pain that may be more sever and lasting longer than the other types of angina. in both the plaque ruptures with subsequent acute thrombus development. In unstable angina, occlusion is partial and the clot is dissolved before myocardial tissue death. In an MI, there is complete occlusion and thrombus persist for irreversible damage resulting is myocardial tissue necrosis

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21
Q

What are the 3 biomarkers that detect ACS? What about these biomarkers determined MI?Unstable angina?

A
  1. troponin I
  2. CK-MB
  3. troponin T
    If levels were elevated then MI would be the diagnosis, if not elevated then unstable angina
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22
Q

What are the ways today ACS is detected?

A
  1. ECG

2. STEMI

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23
Q

Nearly all infarcts take place on which side of the heart?

A

left specifically the ventricular wall

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24
Q

If Dr. G diagnosed John with MI, how would Dr. G know this?

A

John suffered from severe crushing, excruciating chest pain that radiated to his arm, should, jaw and back. He also vomited, has SOB, and diaphoresis

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25
Q

What are the 3 methods to treat MI?

A
  1. Decreasing myocardial oxygen demand
  2. increasing myocardial oxygen supply
  3. monitoring and managing complications
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26
Q

To treat an MI by decreasing myocardial oxygen demand, what is the treatment?

A

rest, HR control, sympathetic antagonists and pain relief

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27
Q

To treat an MI by monitoring and managing complications what is the treatment?

A

continuous ECG monitoring

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28
Q

To treat an MI by increasing myocardial oxygen supple, what is the treatment?

A

Thrombolysis: an enzyme that digests the thrombus
Angioplasty: a ballon that opens the lumen
A shunt
Bypass

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29
Q

What is the primary cause of sudden cardiac arrest?

A

ventricular fibrillation

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30
Q

What are the 3 onsets for valvular disease?

A
  1. inflammation and scarring
  2. calcification
  3. congenital malformations
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31
Q

What are the results of a valvular disease?

A
  1. increased myocardial workload

2 . murmurs

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32
Q

Stenosis

A

“sticky valve” occurs when the valves stick together causing problems opening the valve

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33
Q

Regurgitation

A

“leaky valve” occurs when the valves cannot close completely causing problem closing the valve

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34
Q

Mitral stenosis

A

flow from the left atrium to the left ventricle is impaired, the pressure in the left atrium is greater than the left ventricle; occurs during diastole

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35
Q

What are the results of mitral stenosis?

A

left atrium hypertrophy and enlargement, pulmonary vascular increases, chronic pulmonary hypertension, right ventricular hypertrophy, and right-sided heart failure

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36
Q

SI/Sx of mitral stenosis

A

congestion of blood volume and increased pressure in the left atrium and pulmonary circulation and decreased stroke volume

37
Q

What can the Si/Sx of stenosis also lead to?

A

dyspnea on exertion, paroxysmal nocturnal dyspnea, abnormal breath sounds

38
Q

Mitral regurgitation

A

backflow from the left ventricle to the left atrium during ventricular systole

39
Q

What are the results of mitral regurgitation?

A

the left ventricle must pump a greater volume to compensate for the regurgitant to maintain an effective stroke volume and left-sided hear failure

40
Q

Si/Sx of mitral regurgitation

A

left atrium and ventricle hypertrophy

41
Q

Mitral valve prolapse

A

displacement of the mitral valve leaflet into the left atrium during ventricular systole

42
Q

What can a mitral valve prolapse lead to?

A

infective endocarditis, sudden cardiac arrest and progression to mitral regurgitation

43
Q

aortic stenosis

A

the result of age-related calcification that results in the obstruction of aortic outflow from the left ventricle to the aorta during systole

44
Q

What are the results of aortic stenosis?

A

left-sided heart failure and left ventricular hypertrophy and ischemia

45
Q

Aortic regurgitation

A

during diastole the aortic valves allows blood to backflow into the left ventricle

46
Q

Causes of aortic regurgitation

A

abnormal aortic valve

47
Q

Results of aortic regurgitation

A

left ventricle hypertrophy and left-sided heart failure

48
Q

What are the 2 types of endocardial diseases?

A

rheumatic heart disease and infective endocarditis

49
Q

Rheumatic heart disease

A

an acute inflammatory disease that follows an infection from Beta hemolytic strep occurs mainly in children

50
Q

Si/Sx of rheumatic heart disease

A

fever, sore throat, joint inflammation, and truncal rash

51
Q

Infective Endocarditis

A

invasion and colonization if microorganisms with resulting inflammation

52
Q

What are the 2 types of myocardial diseases?

A
  1. myocarditis

2. cardiomyopathy

53
Q

myocarditis

A

characterized as inflammation, leukocyte infiltration, and necrosis of cardiac cells

54
Q

Causes of myocarditis

A

viral, microbial, immune-mediated diseases, physical agents

55
Q

What are the 4 types of cardiomyopathy?

A
  1. normal
  2. dilated
  3. hypertophic
  4. restrictive
56
Q

Dilated cardiomyopathy

A

ventricular dilation leading to weakness and cardiac failure

57
Q

What is dilated cardiomyopathy related to?

A

alcohol toxicity, pregnancy, postviral myocarditis and genetic abnormality

58
Q

Hypertrophic cardiomyopathy

A

thickened septum and ventricular muscle mass leading to idiopathic hypertrophic subaortic stenosis; the left ventricle is more affected than the right

59
Q

Restrictive cardiomyopathy

A

the rarest form in which a stiff, fibrotic ventricle with impaired diastolic filling

60
Q

What are the results of restrictive cardiomyopathy?

A

decreased CO and left-sided heart failure

61
Q

Pericardial diseases

A

are sequelae of other disorders such as systemic infection, trauma, metabolic derangement or neoplasia

62
Q

What can a pericardial effusion lead to?

A

cardiac temponade

63
Q

Pericardial effusion

A

nonimflammatory fluid in the pericardial sac

64
Q

Cardiac temponade Si/Sx

A

reduced stroke volume and increase in heart rate

65
Q

Explain Beck’s triad

A

hypotension, muffled heart sounds, and distended jugular veins are a result of cardiac temponade; this occurs from a reduced cardiac filling and heart compression

66
Q

Pericarditis

A

acute or chronic inflammation of the pericardium presenting as chest pain, ever leukocytosis, malaise, and tachycardia (friction rub)

67
Q

Congenital heart disease

A

an abnormality of the heart that is present from birth

68
Q

What are the 4 types congenital heart diseases?

A
  1. atrial septal defect
  2. ventriclular septal defect
  3. patent ductus arteriosus
  4. coarctation of the aorta
69
Q

T/F Congenital heart disease is the most common hear disorder in children

A

T

70
Q

What are the 2 primary pathologies of congenital hear disease?

A
  1. shunts

2. obstruction

71
Q

What are the 2 types of shunts?

A
  1. right to left

2. left to right

72
Q

Right to left shunt

A

allows deoxygenated blood from the right atrium to enter the left side and systemic circulation without first passing through the lungs

73
Q

Left to right shunt

A

allows oxygenated blood from the left-side to be recirculated through the lungs

74
Q

An infant with a right to left shunt generally have some degree of what?

A

cyanosis

75
Q

An infant with a left to right shunt generally have some degree of what?

A

acyanosis

76
Q

Atrial Septal Defect

A

occurs in the foramen ovale which in the long-term increase in pulmonary hypertension, right ventricular hypertrophy, and a reversal of a shunt to a right to left pattern

77
Q

Ventricular Septal Defect

A

The most common; typically located in the the membranous septum occurs when the shunt is left to right because pressure in the left side is greater than the right

78
Q

What is the result of ventricular septal defect?

A

increase in pulmonary blood flow, pulmonary hypertension, and right ventricular hypertrophy may lead to shunt reversal

79
Q

Patent Ductus Arteriosus

A

since the pressure is higher in the aorta than the pulmonary artery, the oxygenated blood flows from the aorta to the pulmonary artery

80
Q

What is the result of patent ductus arteriosis?

A

pulmonary hypertension and can lead to right sided heart failure

81
Q

Coarctation of the aorta

A

narrowing of the aorta vessels impeding blood flow results in upper extremities having an elevated blood pressure and lower extremities having a lower blood pressure and weak pulses

82
Q

What are the results of coarctation of the aorta?

A

congestive heart failure, intracranial hemorrhage or aortic rupture

83
Q

What are the 4 types of cyanotic defects?

A
  1. Tetralogy of fallot
  2. Transposition of the Great Arteries
  3. Truncus Arteriosus
  4. tricupsid atresia
84
Q

Tetralogy of Fallot 4 charactersitics

A
  1. ventricular septal defect
  2. aorta positioned above the ventricular septal opening
  3. pulmonary stenosis
  4. right ventricular hypertrophy
85
Q

Why does tetralogy of fallot result on cyanosis?

A

the overriding aorta receives deoxygenated blood from the right side of the heart and oxygenated blood from the left side

86
Q

Transposition of the great arteries

A

the aorta rises from the right ventricle and the pulmonary artery rises from the left ventricle; not compatible with life

87
Q

Truncus Arteriosus

A

failure of the pulmonary artery and aorta to separate resulting in the formation of one large vessel that receives blood from both the right and left ventricle

88
Q

What is the result of truncus arteriosus

A

pulmonary hypertension and right ventricular hypertrophy and systemic cyanosis

89
Q

Tricupsid atresia

A

absence of the tricupsid valve due to underdevelopment of the right ventricle and atrial septal defect

Pathophysiology (19 decks)

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