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Clin Med III > Cardiac Pathology Part 5 > Flashcards

Cardiac Pathology Part 5 Flashcards

1
Q

What cause valvular heart disease (3)

A
  1. Congenital deformity
  2. Infection
  3. Disease
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2
Q

What are the 3 types of valvular heart disease

A
  1. Stenosis
  2. Regurgitation/insufficiency
  3. Prolapse
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3
Q

True or False:

Stenosis and prolapse can be mitral or aortic

A

True

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4
Q

True or False:

Valvular heart disease results in an increased cardiac workload and eventually cardiac muscle dysfunction

A

True

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5
Q

What happens with mitral stenosis

A

Blood backs up into the atrium causing fluid to backup into the lungs

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6
Q

True or False:

Mitral stenosis can occur from rheumatic fever

A

True

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7
Q

What are the 3 types of mitral stenosis

A
  1. Mild
  2. Moderate
  3. Severe
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8
Q

What occurs with mild mitral stenosis

A

Asymptomatic

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9
Q

What occurs with moderate mitral stenosis (3)

A
  1. Dyspnea
  2. Fatigue
  3. Decreased CO
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10
Q

What occurs with severe mitral stenosis (6)

A
  1. Pulmonary congestion at rest
  2. Decreased CO
  3. Dyspnea
  4. Right ventricle failure
  5. Fatigue
  6. Orthopnea
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11
Q

What is orthopnea

A

SOB in recumbent position

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12
Q

How do you diagnose mitral stenosis (2)

A
  1. Echocardiography

2. Dopplers

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13
Q

How do you treat mitral stenosis (2)

A
  1. If A-fib with symptoms use medications

2. If uncontrollable pulmonary edema/severe symptoms do surgery

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14
Q

What surgeries are done to address mitral stenosis with uncontrollable pulmonary edema/severe symptoms (3)

A
  1. Valve repair
  2. Replacement
  3. Valvectomy
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15
Q

What are the complications with prosthetic valves (4)

A
  1. Thrombosis
  2. Leaking
  3. Endocarditis
  4. Degeneration
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16
Q

What is mitral regurgitation

A

Insufficiency or incompetence at the mitral valve

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17
Q

What causes mitral regurgitation (5)

A
  1. Valve perforation (ineffective endocarditis)
  2. Dilated cardiomyopathy
  3. Rheumatic disease
  4. Ruptured chordae tendinae
  5. Cardiac tumors
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18
Q

Who is most likely to have mitral regurgitation

A

Females with a low BMI and of older age

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19
Q

What happens with mitral regurgitation

A

There is abnormal closure of the mitral leaflets during LV systole causing blood to go into the LA and aortic valve

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20
Q

What occurs with acute mitral regurgitation

A

Increased LA pressure resulting in pulmonary edema

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21
Q

What occurs with chronic mitral regurgitation

A

Progressive enlargement of the LA

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22
Q

What are the signs and symptoms of mitral regurgitation (5)

A
  1. Often asymptomatic until severe
  2. Exertional dyspnea
  3. Exercise induced fatigue
  4. A-fib
  5. LV failure
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23
Q

How do you diagnose mitral regurgitation (5)

A
  1. Auscultation
  2. Doppler
  3. Echocardiography
  4. Cardiac catheterization
  5. Coronary arteriography
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24
Q

How do you treat mitral regurgitation

A

Surgery either through repair or replacement

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25
What is mitral valve prolapse
Variations in mitral valve shape or structure
26
True or False: | Mitral valve prolapse can occur due to and autonomic dysfucntion
True
27
True or False: | There is a genetic component to mitral valve prolapse
True
28
What happens with mitral valve prolapse
Valve leaflets bulge back into the LA during ventricular systole which eventually can lead to mitral regurgitation
29
True or False: | Mitral valve prolapse is often not diagnosed until young adulthood
True
30
What are the signs and symptoms of mitral valve prolapse (8)
1. Fatigue not associated with exercise 2. Stress 3. Dyspnea 4. Deconditioning 5. Swelling 6. Sleep disturbances 7. Abnormal perspiration 8. Chest pain
31
True or False: | Mitral valve prolapse is most often noted during physical exam
True
32
How do you treat mitral valve prolapse (6)
1. Beta blockers 2. Exercise prescription 3. Avoidance of caffeine 4. Alcohol 5. Cigarettes 6. Prophylactic antibiotic before invasive procedures
33
What does mitral valve prolapse progress to (5)
1. Mitral valve regurgitation 2. Increased LA and LV size, 3. A-fib 4. Pulmonary hypertension 5. CHF
34
What is aortic stenosis
Progressive calcification or deformity of valve associated with aging
35
What cause aortic stenosis (5)
1. Obese 2. Sedentary 3. Smoking 4. High cholesterol 5. Age
36
What are the signs and symptoms of aortic stenosis once severe (5)
1. LV failure 2. Angina 3. Exertional syncope 4. Systolic ejcetion murmur on ausculation 5. Decreased CO
37
How do you diagnose aortic stenosis (4)
1. Echo-doppler 2. ECG 3. X-ray 4. Ausculation
38
How do you treat aortic stenosis (2)
1. Surgery | 2. Prophylactic antibiotics
39
What surgeries can be done to address aortic stenosis (2)
1. Valve replacement | 2. Balloon valvuloplasty
40
What is aortic regurgitation
Aortic blood leaks back into the LV which results in enlargement and thickening of the LV eventually causing LV failure
41
What causes aortic regurgitation (5)
1. Rheumatic fever 2. Congenitally changed bicuspid valve 3. Infective endocarditis 4. Hypertension 5. Ankylosing spondylitis
42
What are the signs and symptoms of aortic regurgitation (6)
1. Asymptomatic 2. Exertional dyspnea 3. Fatiuge 4. Excessive perspiration 5. Paroxysmal Nocturnal Dyspnea 6. Pulmonary edema
43
How do you diagnose aortic regurgitation (2)
1. Echocardiography with doppler | 2. Aortography
44
How do you treat aortic stenosis (4)
1. Surgery 2. Vasodilators 3. Diuretics 4. Digoxin
45
What is endocarditis
Endocardial infection usually including the heart valves
46
What valves are usually affected with endocarditis (3)
1. MV 2. Aortic 3. Tricuspid
47
True or False: | Endocarditis is due to bacteria
True
48
What happens with endocarditis
Inflammation to cardiac endothelium that destroys connective tissue that can embolize leading to infarcts and spread of the infection
49
What are the signs and symptoms of endocarditis (9)
1. Immediate or delayed 2. Valvular dysfunction 3. Neurologic symptoms 4. Fever 5. Cardiac murmur 6. Petechiae (red dotting of skin) 7. Arthalgia 8. Arthritis 9. Myalgias
50
How do you diagnose endocarditis (3)
1. Blood cultures 2. Lab tests 3. Echocardiography
51
How do you treat endocarditis (2)
1. Antibiotics | 2. Surgery
52
True or False: | Treatment of endocarditis can cause CHF or emboli
True
53
What is rheumatic fever caused by
Strep A bacteria (strep throat)
54
True or False: | Rheumatic fever can affect all layers of the heart including the valves
True
55
What are the signs and symptoms of rheumatic fever (2)
1. Fever | 2. Joint pain
56
What is pericarditis
Pericardial inflammation
57
What causes pericarditis (8)
1. Drug induced 2. Autoimmune 3. Post MI 4. Renal failure 5. S/P open heart surgery 6. Radiation therapy 7. Hepatitis 8. HIV 9. Neoplastic pericarditis
58
What are the signs and symptoms of pericarditis (9)
1. Pleuretic chest pain 2. Worse with lying down 3. Respiratory movements 4. Constrictive pericarditis (fibrotic, thickened pericardium constricting the heart) 5. Progressive dyspnea 6. Fatigue 7. Weakness 8. Peripheral edema 9. Ascites (fluid in abdomen)
59
How do you diagnose pericarditis (8)
1. History 2. Auscultation 3. Chest x-ray 4. ECG 5. Lab studies 6. CT 7. MRI 8. Echocardiography
60
How do you treat endocarditis (4)
1. Digitalis 2. Diuretics 3. Na+ restriction 4. Surgery
61
What surgeries can be done for endocarditis (2)
1. Pericardiectomy | 2. Pericardiocentesis
62
What is an aneurysm
Vessel wall dilates greater than 50% and balloons
63
What are causes of an aneurysm (4)
1. Trauma 2. Congenital vascular disease 3. Infection 4. Atherosclerosis
64
What happens with an aneurysm
Plaque formations occur leading to vessel wall erosion which causes weak thin layers of necrotic muscle and fibrous tissue
65
What are the signs and symptoms of an aneurysm (5)
1. Pain 2. Dyspnea 3. Cough 4. Ischemic symptoms 5. MI
66
True or False: | Symptoms of an aneurysm are dependent on the size and position
True
67
When is rupture most common size when an aortic artery aneurysm ruptures
5 cm
68
True or False: | An aortic artery aneurysm (AAA) has flank and back pain
True
69
How is an AAA diagnosed (8)
1. Pulsating mass 2. Radiography 3. Ultrasound 4. Echocardiography with doppler 5. CT 6. MRI 7. Arteriorgraphy 8. Aortography
70
How do you treat an aneurysm
Surgery
71
What is the surgery for an aneurysm
Endoluminal stent graft
72
What is Peripheral Artery Disease PAD
Arterial occlusive disease
73
What causes PAD (6)
1. Atherosclerosis 2. Smoking 3. Diabetes 4. Males 5. Hypertension 6 Low HDL
74
What are the signs and symptoms of PAD (5)
1. Intermittent claudication 2. Medium-large vessels are affected 3. Symptoms are distal to the occlusion 4. Signs of ischemia 5. Silent (asymptomatic)
75
What are the signs and symptoms of intermittent claudication (5)
1. Pain 2. Aching 3. Cramping 4. Weakness 5. All decrease with rest
76
What muscles does intermittent claudication occur in (3)
1. Calf 2. Glutes 3. Quads
77
What distance of walking is mild moderate and severe intermittent claudication
Mild: 2+ blocks Moderate: 1 block Severe: .5 or less blocks
78
How do you diagnose PAD (3)
1. History 2. Ankle brachial index 3. Ultrasound
79
How do you treat PAD (4)
1. Prevention 2. Low does aspirin 3. Meds 4. Revascularization surgery
80
What are the 5 P's
Pain, Pallor, Pulselessness, Paresis, Paresthesias
81
What is a thrombophlebitis
Partial/complete occlusion of a vein by a thrombus
82
What is a superficial thrombophlebitis
Often secondary to varicose veins and are self limiting and not serious
83
Where is a superficial thrombophlebitis normally located
Saphenous vein
84
What is a deep thrombophlebitis
DVT in the calf or proximally in the popliteal, femoral, iliac or inferior vena cava
85
What causes a thrombophlebitis (3)
1. Venous stasis 2. Hypercoagulability 3. Venous wall injury
86
How does a thrombophlebitis form
Endothelial injury leads to thrombosis formation which can eventually embolize
87
What are signs and symptoms of DVT (7)
1. 50% are initially asymptomatic 2. Dull ache 3. Tightness 4. Pain 5. Swelling 6. Slight fever 7. Increased skin temperature
88
How do you diagnose a DVT (2)
1. Doppler ultrasound | 2. Venous duplex scanning
89
How do you prevent a DVT (4)
1. Early ambulation 2. Anticoagulants 3. Elastic stockings 4. Pneumatic pressure devices
90
How do you treat a DVT (4)
1. Anticoagulants 2. Elastic stockings 3. Heat/elevation 4. Avoid prolonged sitting/standing
91
When is ambulation ok after treating a DVT
Adequate anticoagulation with an INR (international normalized ratio) ratio of 2.0 to 3.0 (usually after 48 hours)
92
What are varicose veins
Abnormal venous dilation that leads to vessel twisting and turning, valve incompetence, and increased risk of thrombosis
93
What cause varicose veins (5)
1. Inherited 2. High venous pressure 3. Obesity 4. Heart failure 5. Constipation
94
What happens with a varicose vein
One way venous valves become incompetent or veins become more elastic leading to distention
95
What are signs and symptoms of varicose veins (6)
1. Dilated twisted veins 2. Brown pigmented skin 3. Ankle swelling 4. LE ulcers 5. Aching and heaviness of legs 6. LE cramping
96
True or False: | Symptoms of varicose veins are relieved with elevation
True
97
How do you diagnose varicose veins (3)
1. Visual inspection 2. Palpation 3. Doppler ultrasound
98
How do you treat moderate varicose veins (3)
1. Periodic rest 2. Promote circulation 3. Elastic stockings
99
How do you treat severe varicose veins
Surgery
100
What are the surgeries for severe varicose veins (4)
1. Venous ligation and stripping 2. Radiofrequency sealing 3. Sclerotherapy 4. Laser therapy
101
What is another name for chronic venous insufficiency
Venous stasis
102
What is chronic venous insufficiency
Prolonged inadequate venous return due to damage of the venous valves
103
True or False: | Chronic venous insufficiency often follows a DVT
True
104
True or False: | Chronic venous insufficiency can lead to venous ulcers
True
105
What does chronic venous insufficiency do
The damaged/destroyed venous valves causes increased venous pressure and decreased venous return causing venous pooling and decreased O2 distally which leads to cell death, necrosis, and poor healing
106
What are the signs and symptoms of chronic venous insufficiency (7)
1. Edema 2. Red-brown skin pigmentation 3. Thin 4. Shiny 5. Dry 6. Cyanotic skin 7. Ulceration (often above medial malleolus)
107
How do you diagnose venous insufficiency (2)
1. History | 2. Physical exam
108
How do you treat venous insufficiency (3)
1. Compression 2. Rest 3. Elevation
109
What is Raynuad's disease
Intermittent small artery/arteriole constriction leads to changes in pallor, cyanosis, and temperature
110
What causes Raynuad's disease (3)
1. Cold temp 2. Anxiety 3. Excitement
111
What are the signs and symptoms of Raynaud's disease (4)
1. Numbness 2. Stiffness 3. Decreased sensation 4. Aching
112
True or False: | For patients with Raynaud's disease they develop thickened fingertip skin and brittle nails
True
113
How do you diagnose Raynaud's disease (2)
1. Clinical presentation | 2. PMH
114
How long does the PMH have to have no change to diagnose Raynaud's disease
2 years
115
How do you treat Raynuad's disease (6)
1. Prevent/limit vasospasm 2. Avoid triggers 3. Protective skin care 4. Hand warming 5. Movement 6. Vasodilators
116
When do congenital heart defects develop and present
Develop in first trimester and presents at birth
117
What is a cyanotic congenital heart defect
Obstructed blood flow to lungs or mixing of blood within the heart chamber
118
What is an acyanotic congenital heart defect
Abnormal opening leading to right to left shunting
119
What are the 3 cyanotic heart defects
1. Tetralogy of Fallot 2. Tricuspid atresia 3. Transposition of the great vesels
120
What 4 things occur to cause tetralogy of Fallot
1. Pulmonary stenosis 2. Ventricular septal defect 3. Aortic communications with both ventricles 4. RV hypertrophy
121
What is tertralogy of Fallot
Oxygen poor blood flows out of the heart to the entire body
122
What are the signs and symptoms of tetralogy of Fallot (4)
1. Cyanotic 2. Easily fatigued 3. Poor growth 4. Frequent respiratory infections
123
What is transposition of the great vessels
Pulmonary artery leaves the LV and aorta leaves the RV
124
What is tricuspid atresia
The tricuspid valve does not develop
125
What are the acyanotic heart defects (5)
1. Ventricular septal defect 2. Atrial septal defect 3. Patent ductus arteriosus 4. Aoric stenosis 5. Coarctation of the aorta
126
What is ventricular septal defect
Abnormal opening between RV and LV causing blood to flow from LV to RV
127
What is atrial septal defect
Abnormal opening between RA and LA causing blood to flow from LA to RA
128
What is patent ductus arteriosus
Fetal ductus arteriosus does not close within first few weeks of life causing L to R shunting of aorta to pulmonary artery
129
What is aortic stenosis
Narrowing of the aortic valve prior to the aorta
130
What is coarctation of the aorta
Narrowing/obstruction of flow in descending thoracic aorta

Clin Med III (9 decks)

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