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Clin Med III > Cardiac Pathology Part 4 > Flashcards

Cardiac Pathology Part 4 Flashcards

1
Q

What is another name for percutaneous transluminal coronary angiolasty (PTCA)

A

Balloon angioplasty or percutaneous coronary iintervention

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2
Q

What is a percutaneous transluminal coronary angioplasty

A

Cardiac catheterization lab under local anesthesia where an angiography is used to place an inflated balloon in a coronary artery to decrease blood pressure increasing blood flow

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3
Q

What are the 2 types of stents

A
  1. Normal stents

2. Drug eluting stents

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4
Q

What is a stent

A

Metal or wire mesh that holds open a vessel

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5
Q

How much does a stent decrease re-stenosis rate

A

Down to 25%

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6
Q

What is a drug eluting stent

A

Slow release drug is put on the stent to prevent tissue regrowth and restenosis

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7
Q

What is an endartectomy

A

Exposing and removing the stenotic plque

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8
Q

What is an embolectomy/thrombectomy

A

Removing an embolus or thrombus

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9
Q

What is a coronary artery bypass graft

A

An open heart surgery to re-route occluded vessels by harvesting a vessel from a donor site (either an artery or vein)

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10
Q

True or False:

A coronary artery bypass graft is the treatment of choice for left main or all three main coronary artery occlusion

A

True

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11
Q

What makes choosing an artery more beneficial than a vein for a coronary artery bypass graft

A

They are less likely to re-occlude

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12
Q

What are the common donor sites for a coronary artery bypass graft (3)

A
  1. Saphenous veins
  2. Left internal mammary artery
  3. Radial artery
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13
Q

What is the artery of choice for a CABG

A

Left internal mammary artery

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14
Q

When are the saphenous veins used for a CABG

A

When many grafts are needed

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15
Q

What are the pros of performing a CABG surgery off-pump (7)

A
  1. Decreased complications
  2. Decreased bleeding
  3. Decreased risk of post-op a-fib
  4. Decreased risk of infection
  5. Decreased risk of cognitive impairment
  6. Faster recovery
  7. Decreased risk of hypoxemia to brain
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16
Q

What are the cons of perfomring a CABG surgery off pump (3)

A
  1. Newer procedure with no long term data
  2. More difficult surgery
  3. Increased risk of repeat surgery
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17
Q

When is minimally invasive CABG surgery performed

A

For one or two vessel involvement

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18
Q

What are indications for a heart transplant (2)

A
  1. Ischemic coronary heart disease

2. Severe/advanced heart failure

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19
Q

Who are candidates for a heart transplant

A

Patients with limited survival without surgery

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20
Q

What is the surgical process of a heart transplant

A

Removal of the recipients heart except atrial wall followed by implanting of the donor heart in the atria and an anastomoses is formed between the aorta and pulmonary artery

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21
Q

True or False:

Occasionally the recipient heart will be left intact

A

True

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22
Q

What are the complications of a heart transplant (5)

A
  1. Organ rejection/infection
  2. Acute right ventricle failure
  3. Complications associated with cyclosporine use (osteoporosis or chronic arthritis) to prevent rejection
  4. Transplant CAD
  5. Cancer
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23
Q

What is heart failure

A

The heart cannot pump enough blood to meet the body’s needs secondary to cardiac valves or the myocardium

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24
Q

What are the 4 types of heart failure

A
  1. Systolic
  2. Diastolic
  3. Left sided
  4. Right sided
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25
What is systolic heart failure
Myocardial contractility failure
26
What is diastolic heart failure
Increased filling pressure needed to maintain cardiac output
27
True or False: | Diastolic heart failure is the main form in the elderly
True
28
What happens with diastolic heart failure
Impaired starling mechanism which leads to decreased CO, HR, SV, left ventricle filling pressure, increased vascular stiffness, and high BP
29
What is left sided heart failure
CHF left ventricle cannor maintain CO
30
What is right sided heart failure
Right ventricle dysfunction due to pulmonary disease or left sided heart failure
31
What is another name for right sided heart failure
Cor pulmonale
32
What are risk factors of CHF (4)
1. Hypertension 2. MI 3. Other cardiac conditions 4. Diabetes Mellitus
33
What is the pathology of left sided heart failure
Poor left ventricle output leading to ventricular dilation sympathetic nervous system increases HR and hypertrophy of left ventricle.
34
True or False: With left sided heart failure the right side of the heart continues to pump blood leading to pulmonary edema because the left side of the heart is over filled with blood due to decreased ejection of blood
True
35
True or False: Because there is less blood passing through the kidneys with left sided heart failure there is sodium and water retention to increase blood volume which leads to tissue edema
True
36
True or False: | Right sided heart failure often follows left sided heart failure
True
37
What is the pathophysiology of right sided heart failure
Poor right ventricle output leads to peripheral edema and venous congestion causing the kidneys to retain fluid due to signals of low blood volume in the body leading to edema in tissue
38
What are the signs and symptoms of left sided heart failure (8)
1. Dyspnea 2. Weakness/fatigue 3. Weight gain 4. Increased HR 5. Renal changes 6. Persistent cough 7. Rales/crackles 8. Pale/cyanotic
39
What are the signs and symptoms of right sided heart failure (7)
1. Dependent edema 2. Jugular vein distention 3. Abdominal pain 4. Liver involvement may lead to cirrhosis, ascites, or jaundice 5. Weight gain 6. Cyanosis 7. Anxiety
40
How is CHF diagnosed (3)
1. Echocardiogram 2. ECG 3. Clinical picture and history
41
How do you treat CHF (5)
1. Diet 2. Lifestyle changes 3. Medications 4. Exercise 5. Surgical interventions (CABG, valve replacement, or heart transplant)
42
What is a myocardial disease
Any disease affecting the heart muscle itself
43
What is myocarditis
Inflammation of the heart wall
44
What usually causes myocarditis
Bacterial or viral infection
45
What are other causes of myocarditis
Inflammation from ischemic heart disease, chest radiation, or drugs
46
What are signs and symptoms of myocarditis (5)
1. Mild continuous chest pain 2. Palpitaions 3. Fatigue 4. Dyspnea 5. May follow and URI
47
How do you treat myocarditis
Treat the underlying cause
48
What is cardiomyopathy
Part of a group of conditions affecting the heart contraction/relaxation
49
True or False: | The cause of cardiomyopathy is often unknown and presents in the 20s or 30s
True
50
How do you diagnose cardiomyopathy (5)
1. Cardiac catheterization 2. Echocardiography 3. Chest x-ray 4. Blood chemistries 5. EKG
51
What are the 3 types of cardiomyopathy
1. Dilated 2. Hypertrophic 3. Restrictive
52
What is the most common type of cardiomyopathy
Dilated cardiomyopathy
53
What are the risk factors for dilated cardiomyopathy (6)
1. Obesity 2. Long term alcohol use 3. Systemic hypertension 4. Smoking 5. Infection 6. Pregnancy
54
What is the pathophysiology of dilated cardiomyopathy
Myocardial damage resulting in cardiac enlargement
55
What happens with dilated cardiomyopathy
There is decreased ejection fraction that results in enlargement and dilation of all chambers eventually progressing to CHF
56
What are the symptoms of dilated cardiomyopathy
Similar to heart failure
57
True or False: | There is a 75% death rate within 5 years with cardiomyopathy
True
58
True or False: | Hypertrophic cardiomyopathy is an inherited genetic disorder
True
59
What is the pathophysiology of hypertrophic cardiomyopathy
Excessive left ventricle and septal hypertrophy with normal to above normal contractility and rigid myocardium
60
What does the rigid myocardium caused by hypertrophic cardiomyopathy result in
No rest during diastole leading to decreased diastolic function and decreased blood flow to the ventricles
61
What are the signs and symptoms of hypertrophic cardiomyopathy (2)
1. Asymptomatic which leads to sudden death | 2. Dyspnea that increases with strenuous exercise
62
What is restrictive cardiomyopathy
Myocardial fibrosis that leads to hypertrophy and defective myocardial relaxation
63
What is the pathophysiology of restrictive cardiomyopaathy
Endocardial fibrosis/scarring of the ventricles leads to rigidity which impairs diastolic filing
64
What are the signs and symptoms of restrictive cardiomyopathy (5)
1. Signs of decreased cardiac output 2. CHF 3. Initially decreased exercise tolerance 4. Fatigue 5. SOB
65
What is the treatment of cardiomyopathy (4)
1. Cardiac resynchronization 2. Biventricular pacing 3. Beta blockers or calcium channel blockers 4. Heart transplant
66
How many classes are there in the NYHA functional classification of heart disease
4
67
What is class 1 of the NYHA functional classification of heart disease
Cardiac disease without physical limitations or symptoms with ordinary activity
68
What is class 2 of the NYHA functional classification of heart disease
Slight physical limitations or fatigue, palpitations, dyspnea, angina with ordinary activity
69
What is class 3 of the NYHA functional classification of heart disease
Marked physical limitations with symptoms arising with less than ordinary activity
70
What is class 4 of NYHA functional classification of heart disease
Discomfort with all activity with symptoms at rest
71
What is an arrhythmia
Disturbance of the cardiac nervous system
72
How are arrhythmias classified
Based on rhythm and rate
73
What are the rhythm descriptors for arrhythmias (3)
1. Flutter 2. Fibrilation 3. Premature contractions
74
What are the rate descriptors for arrhythmias (2)
1. Tachycardia | 2. Bradycardia
75
What puts you at risk for arrhythmias (2)
1. Congenital | 2. Myocardial hypertrophy
76
What is the rate of tachycardia
More than 100 bpm
77
What is tacycardia
Increased sympathetic stimulation due to increased O2 demands usually asymptomatic
78
What is the rate of bradycardia
Less than 60 bpm
79
What is bradycardia
Occurs with vagal stimulation or sinus node disease can be asymptomatic or fatigue, dyspnea, syncope, dizzness, angina, or diaphoresis
80
How do you do you treat bradycardia
Atropine or a pacemaker
81
True or False: | Bradycardia can be normal in some people
True
82
How do you diagnose arrythmias (3)
1. Holter monitoring 2. Cardiac event monitoring 3. Transesophageal echocardiography (TEE)
83
How do you treat arrhythmias (4)
1. Cardioversion 2. Radiowave ablation 3. Pacemakers 4. Implantable cardioverter defirbilator (ICD)
84
What is cardioversion
Restoring normal cardiac rhythm spontaneously, with electrical defibrillation or meds
85
What is radiowave ablation
A catheter sends current to destroy the site of the arrhythmia
86
True or False: | Radiowave ablation is used with some tachycardias and can destroy the ehart's conducting system
True
87
What is a pacemaker
Battery powered stimuli that initiates a heartbeat
88
What is an implantable cardioverter defibrillator
A device that shocks the heart into a normal rhythm

Clin Med III (9 decks)

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