Cardiac Conditions Flashcards by Khient Leonard Limpag

Cardiac Disease in Heart Muscle

Coronary Artery Disease
Myocardial Infarction
Pericarditis
Congestive Heart Failure
Aneurysms

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Cardiac Disease in Heart Valves

Rheumatic Fever
Endocarditis
Mitral Valve Prolaps
Congenital Anomalies

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Cardiac Disease in Cardiac Nervous System

Arrhythmias
Tachycardia
Bradycardia

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CARDIOPULMONARY PATHOPHYSIOLOGY is due to the following processes:

Obstruction or restriction of arterial lumen
Inflammation
Diilation or distention

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Hyperlipidemia predisposes to many cardiopulmonary diseases. Metabolic abnormalities presenting as:

High Serum Cholesterol
High LDL
High Triglycerides
Low HDL

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Statin therapy can cause dose-dependent statin-induced:

Myalgia and Myopathy

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Myopathy Signs and Sx

Muscle Soreness
Muscle Pain
Muscle Weakness
Dyspnea

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Myalgia Signs and Sx

Elevated CK Levels

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Both Myopathy and Myalgia Signs and Sx

Unexplained Fever
Nausea
Vomiting
Liver Impairment

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Liver Impairment Signs and Sx

Spider Angiomas
Palmar Erythema
Asterixis
Nail Bed Changes
Skin Changes
Dark Urine
Ascites
Bilateral CTS

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Risk Factor for Statin-Induced Muscular Sx

Age of 80
Small body frame
Polypharmacy
Alcohol Abuse
Kidney/Liver Dse

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Signs and Symptoms of Myositis

Muscle aches and pain
Unexplained Fever
Nausea
Dark Urine
Vomiting

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Risk Factors of CAD: Modified Factors

Physical Inactivity
Obesity
Tobacco Smoking
Cholesterol
High BP
Diabetes
Deviated Serum

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Risk Factors for CAD: Non modifiable risk factors

Postmenopausal (Female)
Family Hx
Age (65 or older)
Race
Male Gender

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Risk Factors for CAD (SHAPPO)

Stress
Hormonal Status
Alcohol Consumption
Personally
Peripheral Vascular Disease
Obesity

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Progressive Hardening of the arteries which is common in LE, kidney and brain

Atherosclerosis

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Made up of fats, calcium, and fibrous scar tissues that line and narrow in the arterial lumen

Plaque Formation

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T or F:
Narrowing-> Occlusion-> Ischemia-> Necrosis

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Clot formation over the plaque due to slowing of blood flow

Thrombus

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A clot that is dislodged and travels into different parts of the body.

Embolus

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T or F: CAD
Angina-> Myocardia Ischemia-> Myocardial Infarction

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Occlusion of the coronary artery leading to ischemia and necrosis of the myocardial tissue

Myocardial Infarction

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Another name for your MI

Acute Coronary Syndrome

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Results from a sudden decrease in coronary perfusion or an increase in myocardial demand without adequate blood supply which leads to death in the myocardium

Myocardial Infarction

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In MI, NSTEMI and STEMI means?

1. Non-ST- Elevated MI- good prognosis c medications but depends if refractory 2. ST Elevated MI- actual necrosis which needs surgery

Zones of Infarct

1. Zone of Ischemia 2. Zone of Hypoxic Injury 3. Zone of Infarction

Zone of Ischemia

Reversible- T-wave inversion

Zone of Hypoxic Injury

Reversible if with collateral circulation; ST Elevation

Zone of Infarction

Irreversible; Abnormal Q

Cardiac Enzymes Associated With Myocardial Injury and Infarction

1. Creatine Kinase- Myocardial Band 2. Lactic Dehydrogenase LDH 3. Troponin 4. Myoglobin

Normal, Minor, Major, & Peak Levels of CK-MB in MI

0-3%, 5%, 10% 14-36 hours

Normal, Minor, Major Dysfunction of Lactic Dehydrogenase LDH in MI

100-225 mL or 127 IU, 300-750 mL, >1,000 mL

Normal, Minor, Major Dysfunction of Troponin I

0-0.2 mg/mL, 5mg/mL, greater than or equal to 10 mg/mL, 24-36 hours

Normal, Minor, Major Dysfunction of Myoglobin

<100 ng/mL, 200 ng/mL, greater than or equal to 500 ng/mL

T or F: CK-MB quickly appears and disappears during MI, Troponin I elevates and is longer lasting

True

The most common cause of infarction

Coronary Thrombosis

Other Factors that causes MI

○ Coronary artery spasm ○ Platelet aggregation ○ Embolism ○ Aortic stenosis ○ Thrombus from RHD or prosthetic valves ○ Endocarditis ○ Aortic spasm

Complications of MI

○ Pump failure ○ Hypovolemia ○ Cardiogenic shock ○ Arrhythmias ○ Sinus bradycardia ○ Free wall rupture ○ Recurrent chest discomfort ○ Pericarditis

Cardiac Arrest

○ Sudden loss of consciousness ○ No normal breathing ○ No signs of circulation ○ No movement or coughing

If patient has a cardiac arrest, what should you do?

1. CPR 2. AED

Prodromal Symptoms of MI

1. Pallor 2. Profuse Perspiration 3. Nausea and Vomiting

Heart Attack Symptoms in Women: One month before a heart attack

1. Unusual fatigue 2. Sleep disturbance 3. Dyspnea 4. Indigestion or GERD 5. Anxiety 6. Heart racing 7. Arms weak/heavy

Heart Attack Symptoms in Women: During a heart attack

1. Dyspnea 2. Weakness 3. Unusual Fatigue 4. Cold Sweat 5. Dizziness 6. Nausea 7. Arms weak/heavy

Inflammation of the pericardium affecting the parietal and visceral layers

Pericarditis

Clinical Signs and Sx of Pericarditis

1. Substernal pain 2. Difficulty in swallowing 3. Pain referred by leaning forward or sitting upright 4. Pain relieved or reduced by holding your breath 5. Pain aggravated by movement associated with deep breathing (laughing, coughing, deep inspiration) 6. Hx of fever, chills, weakness, or heart disease 7. Cough 8. Lower extremity edema

Symptoms of Pericardial Effusion

1. Chest Pain 2. SOB 3. Compression of Near Structures

Cardiac Tamponade Beck's Triad

1. Hypotension 2. Distended Jugular Veins 3. Muffle Heart Sounds

Sudden fluid accumulation and pericardium cannot adjust to the dramatic increase in pressure

Acute Pericardial Tamponade

Causes of Acute Pericardial Tamponade

1. Chest Trauma 2. Ruptured Aorta 3. Ruptured of Ventricle After Heart Attack

What is the other known word for CHF?

Cardiac Insufficiency or Cardiac Decompensation

The heart is unable to pump blood effectively thus cannot meet the metabolic needs of the body. Ventricular Failure

CHF

Pathophysiological Processes Commonly Leading to Heart Failure

1. Disease processes directly impairing myocardial contractility 2. Disease processes increasing afterload 3. Disease processes increasing preload 4. Disease processes impairing ventricular filling

Causes of Cardiac Muscle Dysfunction

1. Hypertension 2. CAD 3. Cardiac Dysrhythmias 4. Valve Abnormalities 5. Pericardial Pathology 6. Cardiomyopathies

Increased peripheral arterial pressure contributes to increased afterload and pathological hypertrophy of the left ventricle.

Hypertension

Acute injury to myocardial tissue damages ventricular contractility causing systolic dysfunction. Scar formation seen in infarcted tissue alters relaxation and may lead to diastolic dysfunction.

CAD

Normal electrical conduction through the heart allows for normal mechanical contraction of the ventricles. Altered electrical conduction alters the mechanical activity of the ventricles exacerbating heart failure

Cardiac Dysrhythmias

Cardiac valve pathology (stenosis or regurgitation) causes structural changes to the chamber behind the valve resulting in cardiac muscle dysfunction and failure.

Valve Abnormalities

Pericarditis (fluid in the pericardial space) with resultant cardiac tamponade compresses the ventricles leading to cardiac muscle dysfunction and heart failure.

Pericardial Pathology

Damage to the myocardial cells from various pathological processes alters the systolic and/or diastolic function of the ventricles

Cardiomyopathies

LEFT-SIDED CHF SYMPTOMS

● Dyspnea predominated ● Left-sided S3/S4 gallop ● Bilateral basilar rales ● Pleural effusions ● Pulmonary edema ● Orthopnea, paroxysmal nocturnal dyspnea

RIGHT-SIDED CHF SYMPTOMS

● Fluid retention predominates ● Right-sided S3/S4 gallop ● JVD ● Hepatojugular reflux ● Peripheral edema ● Hepatomegaly, ascites

NYHA / New York Heart Association Functional Classification: No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation or dyspnoea

CLASS 1

NYHA / New York Heart Association Functional Classification: Slight limitation of physical activity. Comfortable at rest but ordinary physical activity results in fatigue, palpitation or dyspnoea.

CLASS 2

NYHA / New York Heart Association Functional Classification: Marked limitation of physical activity. Comfortable at rest but less than ordinary activity results in fatigue, palpitation or dyspnoea.

CLASS 3

NYHA / New York Heart Association Functional Classification: Unable to carry out any physical activity without discomfort. Symptoms at rest. If any physical activity is undertaken, discomfort is increased.

CLASS 4

ACCF/AHA Stages of Heart Failure : At high risk for HF but without structural heart disease or symptoms of HF. RF for Hypertension

Stage A

ACCF/AHA Stages of Heart Failure: Structural heart disease but without signs or symptoms of HF. LV Dysfunction & LV Hypertrophy

STAGE B

ACCF/AHA Stages of Heart Failure: Structural heart disease with prior or current symptoms of HF. Most forms of chronic HF

STAGE C

ACCF/AHA Stages of Heart Failure: Refractory HF requiring specialized interventions. Advanced/End stage HF

STAGE D

● Abnormal function of the heart muscle ● Presents with dyspnea and worsened by exertion (Dilated, Restrictive, Hypertrophic) ● Treatment is Beta Blockers

Cardiomyopathy

Pathophysiology of Cardiomyopathy

1. Impaired Systolic Function 2. Impaired Ventricular Filling 3. Septum Hypertrophy

An abnormal dilation in the wall of an artery, vein, or the heart due to the weakening of the vessel or heart wall as a result of: ○ Trauma/Weight-lifting/Thoracic Surgery ○ Congenital vascular disease ○ Infection ○ Atherosclerosis

Aneurysms

Aneurysms is the result of:

○ Trauma/Weight-lifting/Thoracic Surgery ○ Congenital vascular disease ○ Infection ○ Atherosclerosis

Common aneurysm can be found at?

Abdominal Aorta, proximal to renal arteries then the cerebral vascular system

Types of Aneurysm

1. Thoracic Aneurysms 2. Abdominal Aortic Aneurysms 3. Peripheral Arterial Anuerysms

● Common in hypertensive men aged 40-70 years ● May occur in the ascending arch or descending aorta ABOVE the diaphragm

Thoracic Aneurysms

● Most common site is the popliteal artery ● Can lead to ischemic symptoms of the area ● Presents with an easily palpable pulse

Peripheral Aneurysms

● 4x more common than thoracic aneurysms ● Most common site is just below the kidney (below the renal arteries

Abdominal Aortic Aneurysms

a tear develops between two layers of the intima causing blood to flow between the 2 layers than through the lumen

Aortic Dissection

Impairment of the heart valves due to disease, congenital deformity or infection

Valvular Heart Disease

● Narrowing or constriction that prevents the valve from opening fully ● Due to growths, scars or abnormal deposits on the leaflets

Stenosis

● Valves do not close properly and cause blood to flow back into the heart chamber

Regurgitation

● Only affects the MITRAL VALVE ● Enlarged valve leaflets bulge backward into the left atrium

Prolapse

CLINICAL SIGNS AND SYMPTOMS OF VALVULAR HEART DISEASE

○ Easy fatigue ○ Dyspnea ○ Palpitation (subjective sensation of throbbing, skipping, rapid or forcible pulsation of the heart) ○ Chest pain ○ Orthopnea or paroxysmal dyspnea ○ Syncope ○ Pitting edema

SYSTOLE

● Left ventricle EMPTIED ● Passage of blood from ventricle to Aorta/Pulmonary Artery ● VALVES OPEN: Semilunar Valves ● VALVES CLOSED: Atrioventricular Valves

DIASTOLE

● Left ventricle FILLED UP ● Passage of blood from Atrium to Ventricles ● VALVES OPEN: Atrioventricular Valves ● VALVES CLOSED: Mitral Valves

If there is a problem in opening the valves in stenosis? What will happen?

● Aortic and Pulmonic Valve - SYSTOLIC ● Mitral and Tricuspid Valve - DIASTOLIC

If there is a problem in closing the valves in regurgitation? What will happen?

● Aortic and Pulmonic Valve - DIASTOLIC ● Mitral and Tricuspid Valve - SYSTOLIC

● Commonly seen in kids ● An infection caused exclusively by group A Streptococci bacteria

Rheumatic Fever

2 most common symptoms of RF

1. Fever 2. Joint Pains

Most common cause of heart disease in children in developing countries

Rheumatic Heart Disease

The most typical initial clinical presentation of RHD

1. Sore throat 2. Painful Migratory Joint pain after 2-3 weeks

CLINICAL SIGNS AND SYMPTOMS of Rheumatic Fever

○ Migratory arthralgias ○ Subcutaneous nodules on extensor surfaces ○ Fever and sore throat ○ Carditis ○ Flat, painless skin rash (short duration) ○ Weakness, malaise, weight loss, and anorexia ○ Acquired valvular disease

○ May occur 1-3 months after strep infection and always AFTER polyarthritis ○ Rapid, purposeless, non repetitive movements that may involve all muscles EXCEPT the EYES

Rheumatic Chorea (St. Vitus' Dance)

Criteria for Rheumatic Fever

Joint pain (migratory) Myocarditis Nodules (subcutaneous), Erythema marginatum, Sydenham Chorea (St. Vitus Dance)

Hard, painless, non-pruritic, mobile nodules over bony prominence and extensor surfaces

Subcutaneous Nodules

Annular, evanescent eruptions with erythematous serpiginous borders and central clearing

Erythema Marginatum

● Bacterial or fungal infection of the heart causing inflammation of the cardiac endothelium and damaging the tricuspid, aortic or mitral valves ● May be caused by bacteria entering the bloodstream from a remote area of the body OR ● As a result of abnormal growths (vegetations) on the surfaces of artificial valves

Infective Endocarditis

Infective Endocarditis is common in patients c:

○ Previous valvular damage ○ Infection during users ○ Post-cardiac surgical patients ○ Invasive diagnostic procedures

● CLINICAL SIGNS AND SYMPTOMS OF INFECTIVE ENDOCARDITIS

○ Arthralgia ○ Arthritis ○ Musculoskeletal symptoms ○ Low back/sacroiliac pain ○ Myalgias ○ Petechiae/splinter hemorrhages ○ Constitutional symptoms ○ Dyspnea, chest pain ○ Cold and painful extremities

most common musculoskeletal symptoms

Arthralgia

Most commonly affected site in Infective Endocarditis

Shoulder > Knee > Hip > Wrist > Ankle > MTT > MCP > AC joints

Duke's Criteria for Infective Endocarditis

Fever Roth Spot Osler Node Murmur Janeway Lesions Anemia Nail Bed Hemorrhage Emboli

Small, tender, palpable, erythematous lesions on the pads of the fingers and toes

Osler Nodes

Painless, hemorrhagic nodular lesions in the palms and soles, may ulcerate

Janeway Lesions

Definite Endocarditis

○ 2 major criteria ○ 1 major criteria + 3 minor criteria ○ 5 minor criteria