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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
Q

What is systolic heart failure

A

Myocardial contractility failure

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26
Q

What is diastolic heart failure

A

Increased filling pressure needed to maintain cardiac output

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27
Q

True or False:

Diastolic heart failure is the main form in the elderly

A

True

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28
Q

What happens with diastolic heart failure

A

Impaired starling mechanism which leads to decreased CO, HR, SV, left ventricle filling pressure, increased vascular stiffness, and high BP

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29
Q

What is left sided heart failure

A

CHF left ventricle cannor maintain CO

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30
Q

What is right sided heart failure

A

Right ventricle dysfunction due to pulmonary disease or left sided heart failure

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31
Q

What is another name for right sided heart failure

A

Cor pulmonale

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32
Q

What are risk factors of CHF (4)

A
  1. Hypertension
  2. MI
  3. Other cardiac conditions
  4. Diabetes Mellitus
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33
Q

What is the pathology of left sided heart failure

A

Poor left ventricle output leading to ventricular dilation sympathetic nervous system increases HR and hypertrophy of left ventricle.

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34
Q

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

A

True

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35
Q

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

A

True

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36
Q

True or False:

Right sided heart failure often follows left sided heart failure

A

True

37
Q

What is the pathophysiology of right sided heart failure

A

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
Q

What are the signs and symptoms of left sided heart failure (8)

A
  1. Dyspnea
  2. Weakness/fatigue
  3. Weight gain
  4. Increased HR
  5. Renal changes
  6. Persistent cough
  7. Rales/crackles
  8. Pale/cyanotic
39
Q

What are the signs and symptoms of right sided heart failure (7)

A
  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
Q

How is CHF diagnosed (3)

A
  1. Echocardiogram
  2. ECG
  3. Clinical picture and history
41
Q

How do you treat CHF (5)

A
  1. Diet
  2. Lifestyle changes
  3. Medications
  4. Exercise
  5. Surgical interventions (CABG, valve replacement, or heart transplant)
42
Q

What is a myocardial disease

A

Any disease affecting the heart muscle itself

43
Q

What is myocarditis

A

Inflammation of the heart wall

44
Q

What usually causes myocarditis

A

Bacterial or viral infection

45
Q

What are other causes of myocarditis

A

Inflammation from ischemic heart disease, chest radiation, or drugs

46
Q

What are signs and symptoms of myocarditis (5)

A
  1. Mild continuous chest pain
  2. Palpitaions
  3. Fatigue
  4. Dyspnea
  5. May follow and URI
47
Q

How do you treat myocarditis

A

Treat the underlying cause

48
Q

What is cardiomyopathy

A

Part of a group of conditions affecting the heart contraction/relaxation

49
Q

True or False:

The cause of cardiomyopathy is often unknown and presents in the 20s or 30s

A

True

50
Q

How do you diagnose cardiomyopathy (5)

A
  1. Cardiac catheterization
  2. Echocardiography
  3. Chest x-ray
  4. Blood chemistries
  5. EKG
51
Q

What are the 3 types of cardiomyopathy

A
  1. Dilated
  2. Hypertrophic
  3. Restrictive
52
Q

What is the most common type of cardiomyopathy

A

Dilated cardiomyopathy

53
Q

What are the risk factors for dilated cardiomyopathy (6)

A
  1. Obesity
  2. Long term alcohol use
  3. Systemic hypertension
  4. Smoking
  5. Infection
  6. Pregnancy
54
Q

What is the pathophysiology of dilated cardiomyopathy

A

Myocardial damage resulting in cardiac enlargement

55
Q

What happens with dilated cardiomyopathy

A

There is decreased ejection fraction that results in enlargement and dilation of all chambers eventually progressing to CHF

56
Q

What are the symptoms of dilated cardiomyopathy

A

Similar to heart failure

57
Q

True or False:

There is a 75% death rate within 5 years with cardiomyopathy

A

True

58
Q

True or False:

Hypertrophic cardiomyopathy is an inherited genetic disorder

A

True

59
Q

What is the pathophysiology of hypertrophic cardiomyopathy

A

Excessive left ventricle and septal hypertrophy with normal to above normal contractility and rigid myocardium

60
Q

What does the rigid myocardium caused by hypertrophic cardiomyopathy result in

A

No rest during diastole leading to decreased diastolic function and decreased blood flow to the ventricles

61
Q

What are the signs and symptoms of hypertrophic cardiomyopathy (2)

A
  1. Asymptomatic which leads to sudden death

2. Dyspnea that increases with strenuous exercise

62
Q

What is restrictive cardiomyopathy

A

Myocardial fibrosis that leads to hypertrophy and defective myocardial relaxation

63
Q

What is the pathophysiology of restrictive cardiomyopaathy

A

Endocardial fibrosis/scarring of the ventricles leads to rigidity which impairs diastolic filing

64
Q

What are the signs and symptoms of restrictive cardiomyopathy (5)

A
  1. Signs of decreased cardiac output
  2. CHF
  3. Initially decreased exercise tolerance
  4. Fatigue
  5. SOB
65
Q

What is the treatment of cardiomyopathy (4)

A
  1. Cardiac resynchronization
  2. Biventricular pacing
  3. Beta blockers or calcium channel blockers
  4. Heart transplant
66
Q

How many classes are there in the NYHA functional classification of heart disease

A

4

67
Q

What is class 1 of the NYHA functional classification of heart disease

A

Cardiac disease without physical limitations or symptoms with ordinary activity

68
Q

What is class 2 of the NYHA functional classification of heart disease

A

Slight physical limitations or fatigue, palpitations, dyspnea, angina with ordinary activity

69
Q

What is class 3 of the NYHA functional classification of heart disease

A

Marked physical limitations with symptoms arising with less than ordinary activity

70
Q

What is class 4 of NYHA functional classification of heart disease

A

Discomfort with all activity with symptoms at rest

71
Q

What is an arrhythmia

A

Disturbance of the cardiac nervous system

72
Q

How are arrhythmias classified

A

Based on rhythm and rate

73
Q

What are the rhythm descriptors for arrhythmias (3)

A
  1. Flutter
  2. Fibrilation
  3. Premature contractions
74
Q

What are the rate descriptors for arrhythmias (2)

A
  1. Tachycardia

2. Bradycardia

75
Q

What puts you at risk for arrhythmias (2)

A
  1. Congenital

2. Myocardial hypertrophy

76
Q

What is the rate of tachycardia

A

More than 100 bpm

77
Q

What is tacycardia

A

Increased sympathetic stimulation due to increased O2 demands usually asymptomatic

78
Q

What is the rate of bradycardia

A

Less than 60 bpm

79
Q

What is bradycardia

A

Occurs with vagal stimulation or sinus node disease can be asymptomatic or fatigue, dyspnea, syncope, dizzness, angina, or diaphoresis

80
Q

How do you do you treat bradycardia

A

Atropine or a pacemaker

81
Q

True or False:

Bradycardia can be normal in some people

A

True

82
Q

How do you diagnose arrythmias (3)

A
  1. Holter monitoring
  2. Cardiac event monitoring
  3. Transesophageal echocardiography (TEE)
83
Q

How do you treat arrhythmias (4)

A
  1. Cardioversion
  2. Radiowave ablation
  3. Pacemakers
  4. Implantable cardioverter defirbilator (ICD)
84
Q

What is cardioversion

A

Restoring normal cardiac rhythm spontaneously, with electrical defibrillation or meds

85
Q

What is radiowave ablation

A

A catheter sends current to destroy the site of the arrhythmia

86
Q

True or False:

Radiowave ablation is used with some tachycardias and can destroy the ehart’s conducting system

A

True

87
Q

What is a pacemaker

A

Battery powered stimuli that initiates a heartbeat

88
Q

What is an implantable cardioverter defibrillator

A

A device that shocks the heart into a normal rhythm

Clin Med III (9 decks)

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