cardiac patho - E3 Flashcards
what area is the most concerning to get clogged for people w/ CAD
left anterior descending artery because it is the power house of the heart and determines perfusion to body
“widow maker”
CAD
the arteries branching off the aorta get clogged d/t atherosclerosis
do you have to have a heart attack to be able to have coronary artery disease
no, you can have CAD w/o having a heart attack but the disease can cause a heart attack
non modifiable risk factors for CAD
age, family hx, gender (men early years then equal post meni), ethnicity (AA), genetics
modifiable risk factors for CAD
HTN, cigarette smoking, diabetes, obesity/inactivity, diet, HDL, depression/stress
CAD etiology
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)
endothelial dysfunction
vessels become narrowed when they are supposed to dilate caused by DM, HTN, HDL, smoking
huge problem when paired w/ blocked arteries
when the heart doesn’t get the blood and oxygen it is supposed to -> what does it look like
angina
-can be asym
-chest pain, heart burn, irregular HR, weakness, anxiety, dizziness, cold sweat, nausea
if it becomes completely blocked -> MI
stable angina
coronary blood flow is diminished but not fully blocked -> sx occurs on exertion & relieved w/ rest
what to do if having a stable angina episode
stop activity & sit down (to decrease oxygen demand on the heart), take nitrate, call 911 if pain does not go away
what areas are associated w/ the heart that needed to be ruled not cardio before looking into other non cardiac problems
left arm, jaw, left shoulder, diaphoresis, pallor
what does cardiac pain present as
-pressure or tightness
-diffused, poorly localized
-associated w/ physical exertion or stress
-relieved w/ rest, prolonged could mean MI
what does non cardiac pain present as
-sharp or stabbing
-focal, well localized
-could be positional, spontaneous at rest
-no predictable relation to physical exertion
-can lasts seconds to days
atypical angina in women
-discomfort: hot, burning, tender
-location: not always the chest
-other: indigestion, heart burn, nausea, fatigue, lightheadedness, dyspnea
pain associated w/ a MI
-chest pain not brought on by exertion that can radiate
-pain not relieved in 2-5 mins
-N/v, SOA, diaphoresis
cardiomyopathy
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
dilated cardiomyopathy
r/t ischemic problems, valve problems, alc/drugs, post/peri pts, heart failure issues & infections -> leads to heart failure w/ reduced ejection fraction
hypertrophic cardiomyopathy
r/t htn causing the muscle to become enlarged -> leads to decreased ejection fraction and high risk of deadly arrhythmias and sudden cardiac death
restrictive cardiomyopathy
r/t amyloid disease, the ventricles becoming resistant to filing & the muscle stops working / hardens -> leads to a right sided heart failure
what is heart failure
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
heart failures results in
decreased cardiac output, decreased myocardial contractility, increased preload & increased after load
development of HF -> pathological changes that occur
-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)
etiology of HF
r/t repeated ischemic episodes (unstable angina or MIs), chronic htn, DM, copd (rvf), dysrhythmias, valve disorders (mitral insuf, aortic stenosis), pulm embolus (rvf)
if a person has left sided heart failure, where does the back up of blood occur
into pulmonary circulation
if a person has right sided heart failure, where does the back up of blood occur
into systemic circulation
left sided heart failure symptoms
-cough, crackles, wheezes
-frothy sputum (possibly blood tinged)
-paroxysmal nocturnal dyspnea
-orthopnae (tripod position to breath)
-cyanosis, tachycardia, restlessness
right sided heart failure symptoms
JVD, dependent edema (lower extremities), weight gain & anorexia, hepatosplenomegaly (enlarged spleen & liver)
what is right sided heart failure most often caused by ; left sided
COPD ; HTN
ejection fraction
the amount of blood pumped out of the left ventricle w/ each squeeze , normal is 55-65%
Heart Failure: reduced ejection fraction (HFrEF) [systolic HF]
-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
Heart Failure: preserved ejection fraction (HFpEF) [diastolic HF]
-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
ventricular remodeling in HF
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
S3 gallop in HF
-low pitch
-heard after S2 during rapid filing of the ventricle in the early part of diastole
fluid left in the ventricle after contraction
