Cardiac Flashcards
macrophages adhere to vessel walls
then release enzymes and toxic oxygen radicals
that create oxidative stress=oxidized LDL (foam cells)
oxidized LDL further damages vessel walls
pathophysiology of artherosclerosis
how much volume is in the ventricle after dialysis
increase in preload
systolic heart failure is associated with…
activation of the renin angiotensin aldosterone system (RAAS)
best place to hear mitral valve prolapse murmur?
apex- 5th intercostal space at the midclavicular space
where does mitral valve prolapse sound radiate to?
the axilla/back
Clinical manifestations on clinical exam of mitral valve prolapse
mid to late systolic murmur
mid systolic click
biggest risk factor for HTN
African American race
obesity DM Type I & II older age Family Hx ETOH abuse smoking increased Na+ Decreased K+, Mg+, Ca+ artherosclerosis
Risk Factors for HTN
Complication of Uncontrolled HTN
end organ damage (brain, heart, kidneys, eyes)
Main lab to test for end organ damage from HTN in kidneys
urine -micro albumin
Unstable (maintained) angina = _______
clot is not dissolving- MI w/ necrosis
What are you looking for in EKG with suspected MI?
ST elevation (prolonged) Q wave changes (deep, wide) inverted T wave
What is the pain of MI caused by?
ischemia- lack of oxygen- tissue death
Lab result associated w/ MI
increased troponin
increased CK-MB
Why is BP low during an MI?
decreased cardiac output
Why is HR high during an MI?
sympathetic nervous system stimulation
What side of the heart is more likely effected in MI?
left (due to greater workload- pushing blood out into periphery)
crackles/rales breath sounds lactic acidosis dysrythmia hypoxia autonomic nervous system imbalance electrolyte imbalane
Clinical Manifestations of MI
elevation of CK-MBs for MI are seen in ____ hours
2-4
elevation of CK-MBs for MI peak in ____ hours
24
CK-MBs are normal after MI in _____ hours
48-72
leading cause of coronary artery disease and cerebrovascular disease is…
artherosclerosis
release of catecholamines vasoconstriction increase in HR increase in LDL + decrease in HDL (p 1073)
How smoking contributes to coronary artery disease
Blood Flow through Body/Heart
Venous Deoxygenated blood to heart via IVC & SVC Right atria through tricuspid valve R ventricle pulmonic valve pulmonary arteries Lungs (oxygenation of blood occurs) pulmonary veins L atria mitral valve L ventricle aortic valve aorta Body
RAAS and decreased glomerular filtration rate lead to…
fluid retention which increased preload and increased afterload
pressure created in the L ventricle at the end of diastole; volume of blood & stretch in the ventricle after atrial contraction and ventricular filling
*the heart essentially loading up for the next big squeeze during systole.
preload
resistance to ejection during systole; the tension or pressure that must be generated by a chamber of the heart in order to contract and eject blood against resistance
*either vascular resistance or a stenosed aortic valve
afterload
how quickly the ventricle can develop a forceful contraction or contractility
intropy
thickening of the heart muscle secondary to remodeling related to chronic increase in workload.
hypertrophy
______ is increased with:
decreased contractility
excess of plasma volume (too much IV fluid, renal failure, mitral valve disease, loss of contractility d/t MI injury)
preload
________ may improve cardiac output for a while but the increased stretching of the heart muscle eventually will lead to decreased contractility.
increase in preload
_______ is most commonly caused by peripheral vascular resistance (HTN or stenosis of the aortic valve)
increased afterload
_______ results in left ventricle not emptying properly bc of resistance pressure and it works harder to pump the blood forward
increased afterload
Increased afterload leads to left ventricle hypertrophy under the influence of ….
angiotensin-2
catecholamines.
Left sided heart failure may result from ______ heart failure or _______ heart failure
systolic or diastolic
the inability of the heart to generate adequate cardiac output to perfuse tissues (reduced myocardial contractility resulting in a low ejection fraction and reduced intropy during systole).
systolic heart failure
a reduced ventricular compliance during diastole resulting in a ventricle that does not fill effectively (the ejection fraction in this case remains normal)
diastolic heart failure
commonly caused by diffuse hypoxic pulmonary disease or it can result from an increase in left ventricular filling pressure that is reflected back into the pulmonary circulation
right sided heart failure
inability of the heart to meet body requirements for bloodborne nutrients despite adequate blood volume and normal or elevated myocardial contractility
*could be caused by severe anemia
high-output failure
renal failure adds to _____
preload
\_\_\_\_\_\_\_ causes decreased contractility that will lead to: decreased ejection fraction (EF) decreased renal perfusion increased preload increase in renin & angiotensin
viscous cycle of systolic heart failure
most often, \_\_\_\_\_\_ is associated with: An MI in the left ventricle OR systemic HTN OR aortic valve stenosis OR aortic regurgitation
left sided heart failure
\_\_\_\_\_\_\_ Effects of \_\_\_\_\_\_ Heart Failure Dyspnea Orthopnea paroxysmal nocturnal dyspnea cough with sputum production that is pink tinged and frothy Crackles or rales Hypoxemia & cyanosis are late signs
Backward Effects of L sided Heart Failure
\_\_\_\_\_\_\_ Heart Failure is caused by: pulmonary disease pulmonary HTN COPD untreated sleep apnea
Right Sided
most common cause of right sided heart failure
pulmonary edema of L sided heart failure
______ will cause a high afterload on the right ventricle which is trying to push blood into the lung that is affected by the pulmonary HTN
* which will cause right ventricular hypertrophy.
Right sided Heart Failure
\_\_\_\_\_\_ Effects of \_\_\_\_\_\_ Heart Failure: hepatomegaly ascites splenomegaly anorexia subcutaneous edema JVD
Backward Effects of Right Sided Heart Failure
\_\_\_\_\_\_\_ Effects of \_\_\_\_\_ Heart Failure: fatigue oliguria tachycardia faint pulses restlessness confusion anxiety
Forward Effects of BOTH Left and Right Sided Heart Failure
Common causes of \_\_\_\_\_\_\_: Anemia- Decreased oxygen carrying capacity of blood Septicemia- vasodilation and a fever Hyperthyroidism Beriberi (thiamine deficiency)
High Output Heart Failure
diffuse inflammatory disease caused by delayed immune response to infection by group A, beta hemolytic streptococcus
rheumatic heart disease
an example of antibody-antigen reaction, a type 3 hypersensitivity and it takes a while to occur
rheumatic heart disease
causes rigidity and deformity of the valve cusps or shortening and fusion of the chordae tendinae; valvular stenosis or regurgitation will result.
rheumatic heart disease
causes rigidity and deformity of the valve cusps or shortening and fusion of the chordae tendinae; valvular stenosis or regurgitation will result.
rheumatic heart disease
in rheumatic heart disease, mitral and aortic valves are affected in _____ % of cases
20
a distinctive truncal rash
never seen on the face
o appears as pink or red macules (flat spots) or papules (small lumps)
o spreads outward in a circular shape
o As the lesions advance, the edges become raised and red and the center clears
o lesions are not itchy or painful and sometimes go unnoticed by the patient.
Erythema maginatam in rheumatic heart disease
failure of the valve to open completely resulting in extra pressure work (afterload) for the heart
stenosis
inability of the valve to close completely resulting in extra volume work (preload) for the heart
regurgitation
most common cause of the valvular disorders in rheumatic fever
mitral stenosis
_____are more often affected with mitral stenosis
women
Sounds/Location of _________:
low, pitched rumbling decrescendo diastolic murmur
best heard over the apex with radiation to the left axilla.
may hear an opening snap when the stenosed valve is forced open
mitral stenosis
_______ can lead to chronic pulmonary HTN, right ventricular hypertrophy, and right sided heart failure.
mitral valve stenosis
When the _____ valve is stenosed, the atria cannot force this blood through, so volume increases in the left atria and the back flow is to the lungs
mitral
Common causes of _______:
o mitral valve prolapse
o rheumatic heart disease
mitral regurgitation
Pathophysiology of _______:
o Back flow of the blood from the L ventricle to the L atrium during ventricular systole
o left atrium and L ventricle dilate
o Hypertrophy due to the extra volume occurs
o can lead to left side heart failure & eventually biventricular failure
Mitral Regurgitation
Sound/Location of ________:
o high-pitched, loud, pansystolic, blowing murmur
o heard best at the apex with radiation to the back and axilla
Mitral Regurgitation
displacement, ballooning, or billowing of the mitral valve leaflets into the left atrium during a ventricular systole
Mitral Valve Prolapse
Most common valve disorder in the U.S.
Mitral Valve Prolapse
______ are more often affected with Mitral Valve Prolapse
Women
_______ may be due to genetic or environmental effects on the heart valve during the 5th or 6th week of gestation when the individual is still an embryo
Mitral Valve Prolapse
Sound/Location of _______:
midsytolic click or midsystolic murmur that may progress to a regurgitant murmur over time or it may stay the same
Mitral Valve Prolapse
Clinical Manifestation of _______:
o Typically asymptomatic
o If these patients are symptomatic, they will complain of palpitations
o May have rhythm abnormalities, dizziness, fatigue, dyspnea, chest pain, depression, or anxiety (prone to panic attacks)
Mitral Valve Prolapse
very common valvular disorder affecting about 2% of adults who are older than 65.
aortic stenosis
Pathophysiology of _______:
o Predominant cause is age related calcium deposits on the aortic cusp.
o Other causes congenital bicuspid valve and inflammation secondary to rheumatic heart disease.
o Results in obstruction of aortic outflow from the left ventricle in the aorta during systole.
o Left ventricular hypertrophy will develop d/t high afterload left sided heart failure
aortic stenosis
Sound/Location of ______:
o crescendo-decresendo systolic murmur during ventricular systole with prominent S4
o heard best at the second intercostal space on the right at the sternal border and it radiates to the neck.
aortic stenosis
Clinical Manifestations of_____:
o syncope, fatigue, and angina
aortic stenosis
incompetent aortic valve that allows blood to leak back from the aorta into the left ventricle during diastole caused by abnormal aortic valve or aortic root dilation that may be congenital or acquired due to rheumatic heart disease, atherosclerosis, or the over use of diet pills
aortic regurgitation
______ leads to fluid overload in the left ventricle during diastole, hypertrophy, and dilation with eventual left sided heart failure
aortic regurgitation
Sound/Location of______:
o high-pitched decrescendo blowing diastolic murmur during the ventricular diastole
o heard best at the sternal border of the right 2nd, 3rd, or 4th intercostal space and it may radiate to the neck
aortic regurgitation
Clinical Manifestations of \_\_\_\_\_\_: high systolic blood pressure low diastolic blood pressure (wide pulse pressure) palpitations
aortic regurgitation
where to listen for mitral stenosis
diastolic murmur over the apex with radiation to the axilla
where to listen for mitral regurgitation
pansystolic, blowing murmer over the apex with radiation to the axilla
where to listen to mitral valve prolapse
apex
where to listen for aortic stenosis
Second ICS on the right at the sternal border and radiates to the neck
where to listen for aortic regurgitation
Best: diastolic murmur at 2nd ICS
Sternal border 2nd, 3rd or 4th ICS and may radiate to the neck
where to listen for aortic regurgitation
Sternal border 2nd, 3rd or 4th ICS and may radiate to the neck
autosomal dominant that can be passed within in a family
Familial hypercholesterolemia
Autosomal recessive disorder that is identified in blacks on chromosome 22 and associated with HTN and kidney disease
Apolipoprotein L1 gene variants
Autosomal recessive disorder that results in familial HDL deficiency
Familial apolipoprotein A1-deficiency
genetic disorder due to channelopathies (abnormalities or variants in gene coding for ion channels)
arrythmias
autosomal recessive disorder resulting in high LDL and triglycerides
Familial hyperlipidemia
measures artherosclerotic plaque related to inflammation
c reactive protein
condition of pale lower extremities when elevated and dark red extremities when dangled present in peripheral artery disease
rubarbed
PAD is relieved with…
rest
pain on ambulation seen with PAD
intermittent claudication
any debris picked up on the venous side of the circulatory system will first go into….
right side of the heart
the 6 P’s of acute arterial occlusion
o Pallor o Pain o Paresthesia o Paralysis (due to lack of oxygen) o Polar (cold skin) o Pulselessness
late sign of arterial occlusion would be a _______
painful arterial ulcer
embolus leaving the ______ ventricle will cause an ischemic stroke.
left
embolus leaving the _____ ventricle will cause an pulmonary embolism
right
caused by altered connective tissue proteins, increased proteolytic enzyme activity, and decreased transforming growth factor B in the vein walls.
varicose veins
caused by obesity, pregnancy, right heart failure, and prolonged standing that produces varicose veins, chronic venous insufficiency, and possibly obstruction of the deep veins with a thrombus (DVT)
Venous Disorder
obstruction of _______ causes edema, venous stasis ulcers, and pain.
deep veins
arise when there is inadequate venous return that leads to venous HTN, circulatory stasis, tissue hypoxia, and inflammatory reaction in the vessels that leads to fibrous sclerotic remodeling of the skin and ulceration
venous stasis ulcers
triad of factors that contribute to deep vein thrombosis including venous stasis, venous endothelial damage and inflammation, and hypercoagulable states such as pregnancy
Virschow’s Triad
lab test for DVT
D-dimer
caused by systemic disease or specific identifiable pathology/condition that raises the peripheral vascular resistance, cardiac output, or both and is most common in infant and preschool children.
Secondary HTN
secondary HTN in children is commonly caused by:
coarctation of the aorta
renal disease
Systolic BP above 160 with a variable diastolic BP > or equal to 95/100/110 that is seen more often in people older than 65. The wide (increased) pulse pressure (the difference between systolic and diastolic) is due to reduced vascular compliance of the large arteries; specifically, aortic stiffening.
Isolated Systolic HTN
Inhereited defects of ______:
o Renal sodium excretion
o Insulin & insulin sensitivity
o Activity of the sympathetic nervous system
o renin-angiotensin-aldosterone system (RAAS)
o cell membrane sodium and calcium transport
HTN
increases in troponin I and T are seen in ____ hour after MI
2-4
increases in troponin I and T will be elevated for ______ days after MI
7-10
source of the Q wave seen on EKG in MI, release of CK-MB and troponin before cells die and become silent
total ischemia
epi-centers for cardiac arrythmias due to an abnormal ion flux
partially ischemic cells
_______ will cause an increase in myocardial workload because of the increased heart rate and blood pressure and contractility of the heart
sympathetic nervous system
diastolic murmur heard best at 2nd ICS
aortic regurgitation
Systolic Murmurs
MR Peyton Manning AS MVP
mitral regurg, physiological, aortic stenosis, mitral valve prolapse
Diastolic Murmurs
ARMS
aortic regurg, mitral stenosis
most common cause of increased afterload
HTN
when endothelial cells are injured, what contributes to artherosclerosis?
cells unable to make normal amount of vasodilating cytokines
