Cardiac Conditions Flashcards
Cardiac Disease in Heart Muscle
- Coronary Artery Disease
- Myocardial Infarction
- Pericarditis
- Congestive Heart Failure
- Aneurysms
Cardiac Disease in Heart Valves
- Rheumatic Fever
- Endocarditis
- Mitral Valve Prolaps
- Congenital Anomalies
Cardiac Disease in Cardiac Nervous System
- Arrhythmias
- Tachycardia
- Bradycardia
CARDIOPULMONARY PATHOPHYSIOLOGY is due to the following processes:
- Obstruction or restriction of arterial lumen
- Inflammation
- Diilation or distention
Hyperlipidemia predisposes to many cardiopulmonary diseases. Metabolic abnormalities presenting as:
- High Serum Cholesterol
- High LDL
- High Triglycerides
- Low HDL
Statin therapy can cause dose-dependent statin-induced:
Myalgia and Myopathy
Myopathy Signs and Sx
Muscle Soreness
Muscle Pain
Muscle Weakness
Dyspnea
Myalgia Signs and Sx
Elevated CK Levels
Both Myopathy and Myalgia Signs and Sx
Unexplained Fever
Nausea
Vomiting
Liver Impairment
Liver Impairment Signs and Sx
Spider Angiomas
Palmar Erythema
Asterixis
Nail Bed Changes
Skin Changes
Dark Urine
Ascites
Bilateral CTS
Risk Factor for Statin-Induced Muscular Sx
Age of 80
Small body frame
Polypharmacy
Alcohol Abuse
Kidney/Liver Dse
Signs and Symptoms of Myositis
Muscle aches and pain
Unexplained Fever
Nausea
Dark Urine
Vomiting
Risk Factors of CAD: Modified Factors
Physical Inactivity
Obesity
Tobacco Smoking
Cholesterol
High BP
Diabetes
Deviated Serum
Risk Factors for CAD: Non modifiable risk factors
Postmenopausal (Female)
Family Hx
Age (65 or older)
Race
Male Gender
Risk Factors for CAD (SHAPPO)
Stress
Hormonal Status
Alcohol Consumption
Personally
Peripheral Vascular Disease
Obesity
Progressive Hardening of the arteries which is common in LE, kidney and brain
Atherosclerosis
Made up of fats, calcium, and fibrous scar tissues that line and narrow in the arterial lumen
Plaque Formation
T or F:
Narrowing-> Occlusion-> Ischemia-> Necrosis
T
Clot formation over the plaque due to slowing of blood flow
Thrombus
A clot that is dislodged and travels into different parts of the body.
Embolus
T or F: CAD
Angina-> Myocardia Ischemia-> Myocardial Infarction
T
Occlusion of the coronary artery leading to ischemia and necrosis of the myocardial tissue
Myocardial Infarction
Another name for your MI
Acute Coronary Syndrome
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
In MI, NSTEMI and STEMI means?
- Non-ST- Elevated MI- good prognosis c medications but depends if refractory
- ST Elevated MI- actual necrosis which needs surgery
Zones of Infarct
- Zone of Ischemia
- Zone of Hypoxic Injury
- 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
- Creatine Kinase- Myocardial Band
- Lactic Dehydrogenase LDH
- Troponin
- 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?
- CPR
- AED
Prodromal Symptoms of MI
- Pallor
- Profuse Perspiration
- Nausea and Vomiting
Heart Attack Symptoms in Women: One month before a heart attack
- Unusual fatigue
- Sleep disturbance
- Dyspnea
- Indigestion or GERD
- Anxiety
- Heart racing
- Arms weak/heavy
Heart Attack Symptoms in Women: During a heart attack
- Dyspnea
- Weakness
- Unusual Fatigue
- Cold Sweat
- Dizziness
- Nausea
- Arms weak/heavy
Inflammation of the pericardium
affecting the parietal and visceral layers
Pericarditis
Clinical Signs and Sx of Pericarditis
- Substernal pain
- Difficulty in swallowing
- Pain referred by leaning forward or sitting upright
- Pain relieved or reduced by holding your breath
- Pain aggravated by movement associated with deep breathing (laughing, coughing, deep inspiration)
- Hx of fever, chills, weakness, or heart disease
- Cough
- Lower extremity edema
Symptoms of Pericardial Effusion
- Chest Pain
- SOB
- Compression of Near Structures
Cardiac Tamponade Beck’s Triad
- Hypotension
- Distended Jugular Veins
- Muffle Heart Sounds
Sudden fluid accumulation and pericardium cannot adjust to the dramatic increase in pressure
Acute Pericardial Tamponade
Causes of Acute Pericardial Tamponade
- Chest Trauma
- Ruptured Aorta
- 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
- Disease processes directly impairing myocardial
contractility - Disease processes increasing afterload
- Disease processes increasing preload
- Disease processes impairing ventricular filling
Causes of Cardiac Muscle Dysfunction
- Hypertension
- CAD
- Cardiac Dysrhythmias
- Valve Abnormalities
- Pericardial Pathology
- 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
- Impaired Systolic Function
- Impaired Ventricular Filling
- 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
- Thoracic Aneurysms
- Abdominal Aortic Aneurysms
- 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
- Fever
- Joint Pains
Most common cause of heart disease in children in
developing countries
Rheumatic Heart Disease
The most typical initial clinical presentation of RHD
- Sore throat
- 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