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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
Q

What is mitral valve prolapse

A

Variations in mitral valve shape or structure

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26
Q

True or False:

Mitral valve prolapse can occur due to and autonomic dysfucntion

A

True

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27
Q

True or False:

There is a genetic component to mitral valve prolapse

A

True

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28
Q

What happens with mitral valve prolapse

A

Valve leaflets bulge back into the LA during ventricular systole which eventually can lead to mitral regurgitation

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29
Q

True or False:

Mitral valve prolapse is often not diagnosed until young adulthood

A

True

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30
Q

What are the signs and symptoms of mitral valve prolapse (8)

A
  1. Fatigue not associated with exercise
  2. Stress
  3. Dyspnea
  4. Deconditioning
  5. Swelling
  6. Sleep disturbances
  7. Abnormal perspiration
  8. Chest pain
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31
Q

True or False:

Mitral valve prolapse is most often noted during physical exam

A

True

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32
Q

How do you treat mitral valve prolapse (6)

A
  1. Beta blockers
  2. Exercise prescription
  3. Avoidance of caffeine
  4. Alcohol
  5. Cigarettes
  6. Prophylactic antibiotic before invasive procedures
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33
Q

What does mitral valve prolapse progress to (5)

A
  1. Mitral valve regurgitation
  2. Increased LA and LV size,
  3. A-fib
  4. Pulmonary hypertension
  5. CHF
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34
Q

What is aortic stenosis

A

Progressive calcification or deformity of valve associated with aging

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35
Q

What cause aortic stenosis (5)

A
  1. Obese
  2. Sedentary
  3. Smoking
  4. High cholesterol
  5. Age
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36
Q

What are the signs and symptoms of aortic stenosis once severe (5)

A
  1. LV failure
  2. Angina
  3. Exertional syncope
  4. Systolic ejcetion murmur on ausculation
  5. Decreased CO
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37
Q

How do you diagnose aortic stenosis (4)

A
  1. Echo-doppler
  2. ECG
  3. X-ray
  4. Ausculation
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38
Q

How do you treat aortic stenosis (2)

A
  1. Surgery

2. Prophylactic antibiotics

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39
Q

What surgeries can be done to address aortic stenosis (2)

A
  1. Valve replacement

2. Balloon valvuloplasty

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40
Q

What is aortic regurgitation

A

Aortic blood leaks back into the LV which results in enlargement and thickening of the LV eventually causing LV failure

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41
Q

What causes aortic regurgitation (5)

A
  1. Rheumatic fever
  2. Congenitally changed bicuspid valve
  3. Infective endocarditis
  4. Hypertension
  5. Ankylosing spondylitis
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42
Q

What are the signs and symptoms of aortic regurgitation (6)

A
  1. Asymptomatic
  2. Exertional dyspnea
  3. Fatiuge
  4. Excessive perspiration
  5. Paroxysmal Nocturnal Dyspnea
  6. Pulmonary edema
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43
Q

How do you diagnose aortic regurgitation (2)

A
  1. Echocardiography with doppler

2. Aortography

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44
Q

How do you treat aortic stenosis (4)

A
  1. Surgery
  2. Vasodilators
  3. Diuretics
  4. Digoxin
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45
Q

What is endocarditis

A

Endocardial infection usually including the heart valves

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46
Q

What valves are usually affected with endocarditis (3)

A
  1. MV
  2. Aortic
  3. Tricuspid
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47
Q

True or False:

Endocarditis is due to bacteria

A

True

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48
Q

What happens with endocarditis

A

Inflammation to cardiac endothelium that destroys connective tissue that can embolize leading to infarcts and spread of the infection

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49
Q

What are the signs and symptoms of endocarditis (9)

A
  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
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50
Q

How do you diagnose endocarditis (3)

A
  1. Blood cultures
  2. Lab tests
  3. Echocardiography
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51
Q

How do you treat endocarditis (2)

A
  1. Antibiotics

2. Surgery

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52
Q

True or False:

Treatment of endocarditis can cause CHF or emboli

A

True

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53
Q

What is rheumatic fever caused by

A

Strep A bacteria (strep throat)

54
Q

True or False:

Rheumatic fever can affect all layers of the heart including the valves

A

True

55
Q

What are the signs and symptoms of rheumatic fever (2)

A
  1. Fever

2. Joint pain

56
Q

What is pericarditis

A

Pericardial inflammation

57
Q

What causes pericarditis (8)

A
  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
Q

What are the signs and symptoms of pericarditis (9)

A
  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
Q

How do you diagnose pericarditis (8)

A
  1. History
  2. Auscultation
  3. Chest x-ray
  4. ECG
  5. Lab studies
  6. CT
  7. MRI
  8. Echocardiography
60
Q

How do you treat endocarditis (4)

A
  1. Digitalis
  2. Diuretics
  3. Na+ restriction
  4. Surgery
61
Q

What surgeries can be done for endocarditis (2)

A
  1. Pericardiectomy

2. Pericardiocentesis

62
Q

What is an aneurysm

A

Vessel wall dilates greater than 50% and balloons

63
Q

What are causes of an aneurysm (4)

A
  1. Trauma
  2. Congenital vascular disease
  3. Infection
  4. Atherosclerosis
64
Q

What happens with an aneurysm

A

Plaque formations occur leading to vessel wall erosion which causes weak thin layers of necrotic muscle and fibrous tissue

65
Q

What are the signs and symptoms of an aneurysm (5)

A
  1. Pain
  2. Dyspnea
  3. Cough
  4. Ischemic symptoms
  5. MI
66
Q

True or False:

Symptoms of an aneurysm are dependent on the size and position

A

True

67
Q

When is rupture most common size when an aortic artery aneurysm ruptures

A

5 cm

68
Q

True or False:

An aortic artery aneurysm (AAA) has flank and back pain

A

True

69
Q

How is an AAA diagnosed (8)

A
  1. Pulsating mass
  2. Radiography
  3. Ultrasound
  4. Echocardiography with doppler
  5. CT
  6. MRI
  7. Arteriorgraphy
  8. Aortography
70
Q

How do you treat an aneurysm

A

Surgery

71
Q

What is the surgery for an aneurysm

A

Endoluminal stent graft

72
Q

What is Peripheral Artery Disease PAD

A

Arterial occlusive disease

73
Q

What causes PAD (6)

A
  1. Atherosclerosis
  2. Smoking
  3. Diabetes
  4. Males
  5. Hypertension
    6 Low HDL
74
Q

What are the signs and symptoms of PAD (5)

A
  1. Intermittent claudication
  2. Medium-large vessels are affected
  3. Symptoms are distal to the occlusion
  4. Signs of ischemia
  5. Silent (asymptomatic)
75
Q

What are the signs and symptoms of intermittent claudication (5)

A
  1. Pain
  2. Aching
  3. Cramping
  4. Weakness
  5. All decrease with rest
76
Q

What muscles does intermittent claudication occur in (3)

A
  1. Calf
  2. Glutes
  3. Quads
77
Q

What distance of walking is mild moderate and severe intermittent claudication

A

Mild: 2+ blocks
Moderate: 1 block
Severe: .5 or less blocks

78
Q

How do you diagnose PAD (3)

A
  1. History
  2. Ankle brachial index
  3. Ultrasound
79
Q

How do you treat PAD (4)

A
  1. Prevention
  2. Low does aspirin
  3. Meds
  4. Revascularization surgery
80
Q

What are the 5 P’s

A

Pain, Pallor, Pulselessness, Paresis, Paresthesias

81
Q

What is a thrombophlebitis

A

Partial/complete occlusion of a vein by a thrombus

82
Q

What is a superficial thrombophlebitis

A

Often secondary to varicose veins and are self limiting and not serious

83
Q

Where is a superficial thrombophlebitis normally located

A

Saphenous vein

84
Q

What is a deep thrombophlebitis

A

DVT in the calf or proximally in the popliteal, femoral, iliac or inferior vena cava

85
Q

What causes a thrombophlebitis (3)

A
  1. Venous stasis
  2. Hypercoagulability
  3. Venous wall injury
86
Q

How does a thrombophlebitis form

A

Endothelial injury leads to thrombosis formation which can eventually embolize

87
Q

What are signs and symptoms of DVT (7)

A
  1. 50% are initially asymptomatic
  2. Dull ache
  3. Tightness
  4. Pain
  5. Swelling
  6. Slight fever
  7. Increased skin temperature
88
Q

How do you diagnose a DVT (2)

A
  1. Doppler ultrasound

2. Venous duplex scanning

89
Q

How do you prevent a DVT (4)

A
  1. Early ambulation
  2. Anticoagulants
  3. Elastic stockings
  4. Pneumatic pressure devices
90
Q

How do you treat a DVT (4)

A
  1. Anticoagulants
  2. Elastic stockings
  3. Heat/elevation
  4. Avoid prolonged sitting/standing
91
Q

When is ambulation ok after treating a DVT

A

Adequate anticoagulation with an INR (international normalized ratio) ratio of 2.0 to 3.0 (usually after 48 hours)

92
Q

What are varicose veins

A

Abnormal venous dilation that leads to vessel twisting and turning, valve incompetence, and increased risk of thrombosis

93
Q

What cause varicose veins (5)

A
  1. Inherited
  2. High venous pressure
  3. Obesity
  4. Heart failure
  5. Constipation
94
Q

What happens with a varicose vein

A

One way venous valves become incompetent or veins become more elastic leading to distention

95
Q

What are signs and symptoms of varicose veins (6)

A
  1. Dilated twisted veins
  2. Brown pigmented skin
  3. Ankle swelling
  4. LE ulcers
  5. Aching and heaviness of legs
  6. LE cramping
96
Q

True or False:

Symptoms of varicose veins are relieved with elevation

A

True

97
Q

How do you diagnose varicose veins (3)

A
  1. Visual inspection
  2. Palpation
  3. Doppler ultrasound
98
Q

How do you treat moderate varicose veins (3)

A
  1. Periodic rest
  2. Promote circulation
  3. Elastic stockings
99
Q

How do you treat severe varicose veins

A

Surgery

100
Q

What are the surgeries for severe varicose veins (4)

A
  1. Venous ligation and stripping
  2. Radiofrequency sealing
  3. Sclerotherapy
  4. Laser therapy
101
Q

What is another name for chronic venous insufficiency

A

Venous stasis

102
Q

What is chronic venous insufficiency

A

Prolonged inadequate venous return due to damage of the venous valves

103
Q

True or False:

Chronic venous insufficiency often follows a DVT

A

True

104
Q

True or False:

Chronic venous insufficiency can lead to venous ulcers

A

True

105
Q

What does chronic venous insufficiency do

A

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
Q

What are the signs and symptoms of chronic venous insufficiency (7)

A
  1. Edema
  2. Red-brown skin pigmentation
  3. Thin
  4. Shiny
  5. Dry
  6. Cyanotic skin
  7. Ulceration (often above medial malleolus)
107
Q

How do you diagnose venous insufficiency (2)

A
  1. History

2. Physical exam

108
Q

How do you treat venous insufficiency (3)

A
  1. Compression
  2. Rest
  3. Elevation
109
Q

What is Raynuad’s disease

A

Intermittent small artery/arteriole constriction leads to changes in pallor, cyanosis, and temperature

110
Q

What causes Raynuad’s disease (3)

A
  1. Cold temp
  2. Anxiety
  3. Excitement
111
Q

What are the signs and symptoms of Raynaud’s disease (4)

A
  1. Numbness
  2. Stiffness
  3. Decreased sensation
  4. Aching
112
Q

True or False:

For patients with Raynaud’s disease they develop thickened fingertip skin and brittle nails

A

True

113
Q

How do you diagnose Raynaud’s disease (2)

A
  1. Clinical presentation

2. PMH

114
Q

How long does the PMH have to have no change to diagnose Raynaud’s disease

A

2 years

115
Q

How do you treat Raynuad’s disease (6)

A
  1. Prevent/limit vasospasm
  2. Avoid triggers
  3. Protective skin care
  4. Hand warming
  5. Movement
  6. Vasodilators
116
Q

When do congenital heart defects develop and present

A

Develop in first trimester and presents at birth

117
Q

What is a cyanotic congenital heart defect

A

Obstructed blood flow to lungs or mixing of blood within the heart chamber

118
Q

What is an acyanotic congenital heart defect

A

Abnormal opening leading to right to left shunting

119
Q

What are the 3 cyanotic heart defects

A
  1. Tetralogy of Fallot
  2. Tricuspid atresia
  3. Transposition of the great vesels
120
Q

What 4 things occur to cause tetralogy of Fallot

A
  1. Pulmonary stenosis
  2. Ventricular septal defect
  3. Aortic communications with both ventricles
  4. RV hypertrophy
121
Q

What is tertralogy of Fallot

A

Oxygen poor blood flows out of the heart to the entire body

122
Q

What are the signs and symptoms of tetralogy of Fallot (4)

A
  1. Cyanotic
  2. Easily fatigued
  3. Poor growth
  4. Frequent respiratory infections
123
Q

What is transposition of the great vessels

A

Pulmonary artery leaves the LV and aorta leaves the RV

124
Q

What is tricuspid atresia

A

The tricuspid valve does not develop

125
Q

What are the acyanotic heart defects (5)

A
  1. Ventricular septal defect
  2. Atrial septal defect
  3. Patent ductus arteriosus
  4. Aoric stenosis
  5. Coarctation of the aorta
126
Q

What is ventricular septal defect

A

Abnormal opening between RV and LV causing blood to flow from LV to RV

127
Q

What is atrial septal defect

A

Abnormal opening between RA and LA causing blood to flow from LA to RA

128
Q

What is patent ductus arteriosus

A

Fetal ductus arteriosus does not close within first few weeks of life causing L to R shunting of aorta to pulmonary artery

129
Q

What is aortic stenosis

A

Narrowing of the aortic valve prior to the aorta

130
Q

What is coarctation of the aorta

A

Narrowing/obstruction of flow in descending thoracic aorta

Clin Med III (9 decks)

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