Cardiac Pathophysiology Flashcards by Megan Foley

ischemic heart dieases

coronary artery disease
stable angina
unstable angina

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non-modifiable risk factors for CAD

age
family hx
gender
ethnicity
genetics

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modifiable risk factors for CAD

HYPERLIPIDEMIA
HTN
smoking
DM
obesity
diet
depression/stress

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ischemic heart problems

a plumbing issue

atherosclerosis develops in arteries that supply the myocardium causing an artery blockage

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artery blockages cause

decreased tissue perfusion
endothelial dysfunction
heart must work harder to pump blood

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endothelial dysfunction

vessels become narrowed when they are supposed to dilate

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causes of endothelial dysfunction

DM
HTN
HPL
smoking

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angina

main symptom of CAD

chest pain

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a complete occlusion will result in?

myocardial infartion

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symptoms of CAD

dizziness
chest pain
heart burn
irregular heart rate
weakness
anxiety
nausea
cold sweats
burning sensation

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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

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unstable angina

severe and new onset
occurs at REST
last greater than 10 min
crescendo pattern of pain

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It is important to _____ the heart being cause of CP _____ exploring non-cardiac causes

exclude; before

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common causes of non-cardiac chest pain

Reflux
muscle problems
ulcer
lung problems
bone disorders
deep breathing
emotional distress
esophageal rupture

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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

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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

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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