cardiac patho - E3

Question 1

what area is the most concerning to get clogged for people w/ CAD

Answer 1

left anterior descending artery because it is the power house of the heart and determines perfusion to body
“widow maker”

Question 2

CAD

Answer 2

the arteries branching off the aorta get clogged d/t atherosclerosis

Question 3

do you have to have a heart attack to be able to have coronary artery disease

Answer 3

no, you can have CAD w/o having a heart attack but the disease can cause a heart attack

Question 4

non modifiable risk factors for CAD

Answer 4

age, family hx, gender (men early years then equal post meni), ethnicity (AA), genetics

Question 5

modifiable risk factors for CAD

Answer 5

HTN, cigarette smoking, diabetes, obesity/inactivity, diet, HDL, depression/stress

Question 6

CAD etiology

Answer 6

atherosclerosis develops in the arteries supplying the myocardium causing the arteries to be blocked -> the damage causes decreased tissue perfusion and endothelial dysfunction (+the heart has to work harder than it is supposed to)

Question 7

endothelial dysfunction

Answer 7

vessels become narrowed when they are supposed to dilate caused by DM, HTN, HDL, smoking
huge problem when paired w/ blocked arteries

Question 8

when the heart doesn’t get the blood and oxygen it is supposed to -> what does it look like

Answer 8

angina
-can be asym
-chest pain, heart burn, irregular HR, weakness, anxiety, dizziness, cold sweat, nausea
if it becomes completely blocked -> MI

Question 9

stable angina

Answer 9

coronary blood flow is diminished but not fully blocked -> sx occurs on exertion & relieved w/ rest

Question 10

what to do if having a stable angina episode

Answer 10

stop activity & sit down (to decrease oxygen demand on the heart), take nitrate, call 911 if pain does not go away

Question 11

what areas are associated w/ the heart that needed to be ruled not cardio before looking into other non cardiac problems

Answer 11

left arm, jaw, left shoulder, diaphoresis, pallor

Question 12

what does cardiac pain present as

Answer 12

-pressure or tightness
-diffused, poorly localized
-associated w/ physical exertion or stress
-relieved w/ rest, prolonged could mean MI

Question 13

what does non cardiac pain present as

Answer 13

-sharp or stabbing
-focal, well localized
-could be positional, spontaneous at rest
-no predictable relation to physical exertion
-can lasts seconds to days

Question 14

atypical angina in women

Answer 14

-discomfort: hot, burning, tender
-location: not always the chest
-other: indigestion, heart burn, nausea, fatigue, lightheadedness, dyspnea

Question 15

pain associated w/ a MI

Answer 15

-chest pain not brought on by exertion that can radiate
-pain not relieved in 2-5 mins
-N/v, SOA, diaphoresis

Question 16

cardiomyopathy

Answer 16

disease that affects the myocardium that is usually idiopathic and can be caused by ischemia, htn, inherited disorders, infections, toxins, myocarditis, & autoimmune disorders that can lead to heart failure

Question 17

dilated cardiomyopathy

Answer 17

r/t ischemic problems, valve problems, alc/drugs, post/peri pts, heart failure issues & infections -> leads to heart failure w/ reduced ejection fraction

Question 18

hypertrophic cardiomyopathy

Answer 18

r/t htn causing the muscle to become enlarged -> leads to decreased ejection fraction and high risk of deadly arrhythmias and sudden cardiac death

Question 19

restrictive cardiomyopathy

Answer 19

r/t amyloid disease, the ventricles becoming resistant to filing & the muscle stops working / hardens -> leads to a right sided heart failure

Question 20

what is heart failure

Answer 20

a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen

Question 21

heart failures results in

Answer 21

decreased cardiac output, decreased myocardial contractility, increased preload & increased after load

Question 22

development of HF -> pathological changes that occur

Answer 22

-volume overload bc heart isn’t pumping effectively & you get a fluid back up
-impaired ventricular filling (which occurs during diastole aka in between the contraction)
-weakened ventricular muscle
-decreased ventricular contractile function (the squeeze during systole)

Question 23

etiology of HF

Answer 23

r/t repeated ischemic episodes (unstable angina or MIs), chronic htn, DM, copd (rvf), dysrhythmias, valve disorders (mitral insuf, aortic stenosis), pulm embolus (rvf)

Question 24

if a person has left sided heart failure, where does the back up of blood occur

Answer 24

into pulmonary circulation

Question 25

if a person has right sided heart failure, where does the back up of blood occur

Answer 25

into systemic circulation

Question 26

left sided heart failure symptoms

Answer 26

-cough, crackles, wheezes
-frothy sputum (possibly blood tinged)
-paroxysmal nocturnal dyspnea
-orthopnae (tripod position to breath)
-cyanosis, tachycardia, restlessness

Question 27

right sided heart failure symptoms

Answer 27

JVD, dependent edema (lower extremities), weight gain & anorexia, hepatosplenomegaly (enlarged spleen & liver)

Question 28

what is right sided heart failure most often caused by ; left sided

Answer 28

COPD ; HTN

Question 29

ejection fraction

Answer 29

the amount of blood pumped out of the left ventricle w/ each squeeze , normal is 55-65%

Question 30

Heart Failure: reduced ejection fraction (HFrEF) [systolic HF]

Answer 30

-EF <40% (seen on echo)
-caused by impaired contractile function, increased afterload, cardiomyopathy, & mechanical problems
-the left ventricle loses ability to generate pressure to eject blood & the weakened muscle cannot generate stroke volume which lower CO -> LV fails, blood backs up, caused fluid backup & accumulation

Question 31

Heart Failure: preserved ejection fraction (HFpEF) [diastolic HF]

Answer 31

-EF will be normal or mod decrease (40-49%)
-inability of the ventricles to relax & fill (ineffective muscle) during diastole caused by chronic HTN
-LV is stiff & noncompliant leading to high filling pressures which leads to decrease stroke volume & decreased CO -> fluid congestion

Question 32

ventricular remodeling in HF

Answer 32

a weakened heart muscle causing the heart to secrete molecular substances like angtiotensin II, aldosteron, andothelin, TNF alpha, epi & norepi, insulin like growth factor & growth hormone -> supposed to be protective but overtime provoke genetic changes, apoptosis, &hypertrophy of cardiac myocytes + as well as collagen deopsits & myocardial fibrosis which all worsen HF by causing enlargement & dilation

Question 33

S3 gallop in HF

Answer 33

-low pitch
-heard after S2 during rapid filing of the ventricle in the early part of diastole
fluid left in the ventricle after contraction