Cardiac Pathophysiology Flashcards
ischemic heart dieases
coronary artery disease
stable angina
unstable angina
non-modifiable risk factors for CAD
age family hx gender ethnicity genetics
modifiable risk factors for CAD
HYPERLIPIDEMIA HTN smoking DM obesity diet depression/stress
ischemic heart problems
a plumbing issue
atherosclerosis develops in arteries that supply the myocardium causing an artery blockage
artery blockages cause
decreased tissue perfusion
endothelial dysfunction
heart must work harder to pump blood
endothelial dysfunction
vessels become narrowed when they are supposed to dilate
causes of endothelial dysfunction
DM
HTN
HPL
smoking
angina
main symptom of CAD
chest pain
a complete occlusion will result in?
myocardial infartion
symptoms of CAD
dizziness chest pain heart burn irregular heart rate weakness anxiety nausea cold sweats burning sensation
stable angina
flow is diminished by NOT blocked imbalance between o2 supply and demand EXERTION makes it worse REST makes it better lasts 2-5 minutes caused by atherosclerosis
unstable angina
severe and new onset
occurs at REST
last greater than 10 min
crescendo pattern of pain
It is important to _____ the heart being cause of CP _____ exploring non-cardiac causes
exclude; before
common causes of non-cardiac chest pain
Reflux muscle problems ulcer lung problems bone disorders deep breathing emotional distress esophageal rupture
cardiac chest pain presents as
pressure or tightness
diffuse, poorly localized
associated with physical exertion or stress
relieved with rest within minutes
prolonged symptoms may represent an acute MI
non cardiac chest pain presents as
sharp or stabbing well localized, focal positional, spontaneous at rest no predictable relation to exertion last from seconds to days at a time
atypical angina in women
hot, burning, tenderness
not always in the chest
indigestion, heartburn, nausea, weakness/fatigue, dizziness, dyspnea
angina pectoris and pain with MI
CP without exertion may radiate to other areas (neck, jaw, upper abdomen, shoulders, arm) no relieved in 2-5 minutes n/v, soa, diaphoresis risk for MI increased
how do we treat stable angina?
rest and relaxation
nitrates
prevent/treat further atherosclerosis
teach about MI
cardiomyopathy
disease that effects myocardium
can be idiopathic, can be caused by ischemia, HTN, inherited, infections, toxins, myocarditis, auto-immune
LEADS TO HF
what is heart failure
chronic, progressive condition where heart is unable to pump enough blood to meet body’s need.
heart overworked and cant keep up
in heart failure the ____ is weakened and ____ ____ body’s demand, leading to ____
myocardium, cant meet, hospitalization
heart failure results in
decreased CO, Myocardial contractility
increased preload, afterload
major causes of HF
ischemic cardiomyopathy
MI with or without papillary muscle rupture
chronic HTN
COPD
dysrhythmias
valve disorders (mitral insufficiency, aortic stenosis)
PE
Risk factors for HF
HTN (greatest risk) DM men and postmenopausal women have same risk higher incidence in Black/African Americans genetics COPD severe anemia congenital heart defects viruses (causing myocarditis) ETOH/Drugs Kidney problems
major risk factors fo HF
age (65 older most common reason of hospitalization) Black/African American family hx, genetics DM ischemic heart disease obesity THN smoking sedentary
Left sided HF
congestion of LT chambers
Left Ventricle increased in size (LVH)
backflow into pulmonary veins
congestion in lungs
assessment findings in Left sided HF
cough crackles wheezes frothy sputum, possibly blood tinged paroxysmal noturnal dyspnea orthopnea
Right sided HF
often due to COPD with cor pulmonale congested RT chambers Right ventricle hypertrophy backflow into vena cava congestions of Jugular veins, liver, lower extremities
assessment findings in RT sided HF
JVD
dependent edema
WT gain
Hepatosplenomegaly
what is the most common cause of Left Sided HF
poorly controlled HTN
what is the most common cause of Right HF
COPD
pulmonary HTN
reduced ejection fraction ( HFrEF)
Systolic HF
determined by EF <40%
impaired contractile function, increased afterload, cardiomyopathy, mechanical problems
LV loses ability to generate pressure to eject blood
cannot generate SV and lowers CO
LV fails, blood backs up and causes fluid backup and accumulation
Preserved Ejection Fraction (HFpEF)
Diastolic HF
inability of ventricles to relax and fill during diastole
HTN primary cause
LV stiff leading to high filling pressures, leads to decreased SV and decreased CO
reduced CO leads to fluid congestion
EF is normal or only mod. decreased 40-49%
risk factors of HFpEF
female
older age
DM
obestiy
HF mid range EF resembling HFpEF distinct features
older age, female sex
etoh use, potassium levels
AF, lung disease, anemia
HF hospitalization, death, transplant
HF mid range EF resembling HFrEF distinct features
younger age, male sex
CAD, DM, valve disease
High risk of CKD
ventricular remodeling in HF
weakened heart muscle
secretion of Angiotensin II, aldosterone, endothelin,
TNF-alpha, catecholamines, insulin-like
growth factor, and growth hormone
provokes genetic changes, collagen deposits and myocardial fibrosis
ventricular remodeling leads to
enlargement and dilation of LT ventricle
and worsens HF
S3 gallop
low pitched, heard after S2
in adults older than 40 S3 is abnormal and indicative of HF
changes that occur in the development of HF
volume overload
impaired ventricular filling
weakend ventricular muscle
decreased contractility
