Cardio A/P Pt 2

Question 1

Define Acute Pericarditis:

Answer 1

acute inflammation of the pericardial membranes,
fibrotic process - roughening

Question 2

symptoms/signs Acute Pericarditis:

Answer 2

● symptoms: precipitating fever; sudden onset, severe
retrosternal chest pain; worsening with breathing and laying
down
● signs: fever, tachycardia, cardiac friction rub at apex and left
sternal border, ECG changes (PR depression, ST elevation)

Question 3

Define Pericardial Effusion:

Answer 3

fluid in pericardial sac can occur with pericarditis

Question 4

what are the two types of causes of pericardial effusion

Answer 4

● Exudate (inflammatory): acute pericarditis, autoimmune
disorders, infection
● Transudate (serous): heart failure, overhydration,
hypoproteinemia

Question 5

signs/symptoms of Pericardial Effusion:

Answer 5

● Classic symptoms: dyspnea on exertion, dull chest pain
● signs: muffled heart sounds, x-ray water bottle

Question 6

tamponade:

Answer 6

pressure exerted by
pericardial fluid that equals or exceeds diastolic pressure in the
heart

interferes with atrial filling, increases venous
pressure/congestion, decreases ventricular filling (decreased
SV, decreased CO)

Question 7

Acute Rheumatic Fever (ARF)

Answer 7

● delayed, exaggerated systemic inflammatory disease

○ results from an autoimmune response to group A beta-
hemolytic streptococcus (GABHS) pharyngitis (strep

throat)- not skin

symptoms
○ Acute: fever, lymphadenopathy, polyarthritis- red
swollen joint- large joint, chorea- involuntary
movement of face, tongue, arms, erythema
marginatum- rash on neck

Question 8

prevention Acute Rheumatic Fever (ARF)

Answer 8

○ antibiotics within 9 days of GABHS (group A beta-
hemolytic streptococcus)
○ completion of ABX therapy for GABHS
○ untreated-> scarring/deformity of cardiac structures->
rheumatic heart disease (RHD)

Question 9

Relationship between Acute Rheumatic Fever and Rheumatic Heart Disease

Answer 9

if Acute Rheumatic Fever left untreated- carditis (endo, myo, peri)- scar
the heart valves, result = rheumatic heart disease

Question 10

rheumatic heart disease

Question 11

Heart Failure:

Answer 11

heart is unable to generate adequate cardiac output, causing
inadequate tissue perfusion/increased diastolic filling pressures

Question 12

Define:
■ Ejection Fraction

Answer 12

the fraction of blood ejected from the ventricles

Question 13

Ejection Fraction values

Answer 13

● normal is 50-70%
● failure is below 40%

Question 14

what is HFrEF

Answer 14

Left Heart Failure (congestive) (Systolic (can’t pump hard enough)

People with HFrEF, AKA systolic heart failure, have an EF that is 40–50% or lower. People with HFpEF, AKA diastolic heart failure, do not have much of a change in their ejection fraction.

Question 15

contractility (ischemia)

Answer 15

○ MI most common cause of decreased contractility
○ ventricular remodeling
○ when contraction is decreased, SV decreases, LVEDV
increased= dilation of the heart and increased preload
○ treatment- myocardial oxygenation (nitrates,
morphine), surgical

Question 16

afterload (hypertension)

Answer 16

○ result of increased peripheral vascular resistance
○ pumping against pressure leads to hypertrophy of
myocardium
○ with more myocardium= more oxygen demand= higher
risk of ischemia

Question 17

preload (high fluid volume)

Answer 17

○ increases with decreased contractility or increased
blood volume
○ some increased preload can increase CO but too much
stretch over time leads to dysfunction
○ treatment- diuretics, salt restriction

Question 18

Symptoms of LHF related to pulmonary vascular congestion

Answer 18

● backwards effect: fluid filled alveoli impair gas exchange
○ due to pulmonary edema
■ dyspnea, cyanosis, pink/frothy sputum,
orthopnea, crackles, pulmonary effusion

Question 19

Symptoms of LHF related to inadequate
systemic perfusion

Answer 19

decreased sv- blood flow, decreased ejection
fraction, all systems affected by tissue ischemia, fatigue, edema, decreased urinary output, oliguria, angina, S3- rapid ventricular
filling