Cardiology Flashcards
What is an Aneurysm?
Ballooning of vessels exacerbated by certain disease processes affecting the endothelium—most common at weaker sites, bifurcations.
Where are the 3 main sites for aneurysm?
-Cerebral
-thoracic
-abdominal
What are the 3 DeBakey classification of aortic aneurysm?
(Type I, II, III)
The DeBakey classification divides dissections into 3 types, as follows:
Type I involves the ascending aorta, aortic arch, and descending aorta
Type II is confined to the ascending aorta
Type III is confined to the descending aorta distal to the left subclavian artery
Describe Arteriosclerosis
Arteriosclerosis occurs when the blood vessels become thick and stiff due to excessive uptake of cholesterol into the endothelium
What is atherosclerosis?
Atherosclerosis is characterized by patchy intimal plaques (atheromas) that encroach on the lumen of medium-sized and large arteries; the plaques contain lipids, inflammatory cells, smooth muscle cells, and connective tissue. Risk factors include dyslipidemia, diabetes, cigarette smoking, family history, sedentary lifestyle, obesity, and hypertension
define hypertension
Hypertension is sustained elevation of resting systolic blood pressure (≥ 130 mm Hg), diastolic blood pressure (≥ 80 mm Hg), or both
What’s the Main Difference Between Peripheral Artery Disease (PAD) vs. Peripheral Venous Disease (PVD).
PAD means you have narrowed or blocked arteries -PVD, on the other hand, refers to problems with veins.
PAD symptoms
-Coldness in one of the lower leg/foot
-Leg numbness or weakness
-No pulse or a weak pulse in the legs
-Painful cramping (claudication) in one or both of the legs
-Shiny skin on the legs
-Skin color changes on the legs
-Sores on the toes, feet or legs that won’t heal
-Hair loss or slower hair growth on the legs
Primary hypertension
Hypertension with no known cause (primary; formerly, essential, hypertension) is most common.
Secondary hypertension
Hypertension with an identified cause (secondary hypertension) is usually due to sleep apnea, chronic kidney disease, primary aldosteronism, diabetes, or obesity
Whatis Endocarditis?
Endocarditis, sometimes called infective endocarditis (IE) is an infection of the inner lining of the heart and may include the heart chambers, one or more heart valves or the septum.
What causes endocarditis?
The most common bacterial causes of infections are:
Viridans Streptococci
Staphylococcus Aureus
What are some predisposing Risk Factors of Endocarditis:
Artificial heart valves
Previous history of endocarditis
Heart valves damaged by rheumatic fever
Congenital heart or heart valve defects
Hypertrophic cardiomyopathy
Intravascular catheters
Recent dental work
Intravenous drug use
What are some signs/symptoms of endocarditis?
-Fever
-Rigors: An acute onset of uncontrollable shivering and chills. It may be accompanied by profuse diaphoresis and elevated temperature.
-Petechiae (tiny purple or red spots on the skin, sclera or mouth)
-Osler’s nodes (red, painful nodes on the pads of the fingers & toes)
-Janeway lesions (red, painless skin spots on the palms & soles)
-Splinter hemorrhages (small areas of bleeding under the nails)
what is petechiae
-tiny purple or red spots on the skin, sclera or mouth
seen in endocarditis
what are Janeway lesions
-red, painless skin spots on the palms & soles
seen in endocarditis
what are Osler’s nodes
-red, painful nodes on the pads of the fingers & toes
seen in endocarditis
What are some ECG changes seen in endocarditis?
-Increased PR interval
-Conduction abnormalities
-Low QRS voltage
-ST elevation
-Atrioventricular dissociation including atrioventricular blocks with accelerated junctional escape rhythms
-Heart blocks including first degree and complete heart block
-Ventricular tachycardia
-Supraventricular tachycardia
What is Pericarditis?
Pericarditis is inflammation of the pericardium.
What does the pericardium consist of?
the pericardium consists of two layers – the visceral pericardium which is attached to the myocardium and the parietal pericardium that envelops the heart. The two layers are continuous with each other in that the visceral pericardium folds over itself at the origin of the great vessels creating a sac in which the heart is contained.
How much fluid is normally in the pericardium?
Typically, a small amount of fluid (about 25 ml) is found in this potential space. It acts as a lubricant as the two layers slide against each other while the heart beats.
what happens during pericarditis?
inflammation of the pericardium, the layers can thicken and more fluid that is typically found in the pericardial space can accumulate. This can cause a pleural effusion or if the accumulation of fluid is acute it can progress to cardiac tamponade and present with becks triad
What is Becks Triad?
– muffled heart sounds, jugular vein distention and hypotension.
Dressler Syndrome
an immune system response that occurs as a result of damage to cardiac tissue after myocardial infarct or cardiac surgery. It is also called post-myocardial infarction syndrome or postcardiac injury syndrome
findings for pericarditis?
(ECG and auscletating)
-pericardial rub
-Sinus tachycardia is common
- Lead II may present with Spodick’s Sign
-Widespread concave ST elevation and PR depression throughout most of the limb leads (I, II, III, aVL, aVF) and precordial leads (V2-6)
-Reciprocal ST depression and PR elevation in lead aVR and//or V1
What is Spodick’s sign?
Downsloping TP segment seen as an early ECG manifestation in ~80% of patients with pericarditis, best visualized in leads II and the lateral precordial leads
Spodick’s sign ECG image
Additional S/S of pericarditis?
-acute onset of sharp chest pain that may radiate into the neck or shoulders, neck or back
-The pain may decrease when the patient is sitting up and worsen when the patient is lying down or breathing deeply.
-Patient may also present with fever, weakness, palpitations or shortness of breath
-The patient may develop a pericardial tamponade depending on fluid accumulation around the heart (Beck’s triad)
-A 12 lead may show “global ischemia” – ST changes in all leads
Pericarditis is thought to be often caused by viral or bacterial infections
How is pericarditis treated?
Pericarditis can be treated with NSAIDs (Follow local treatment guidelines in the prehospital setting)
S/S of endocarditis?
Physical and ECG
-Symptoms often appear slowly (over days or weeks or months) or they can appear quickly (acute endocarditis)
-fever, chest pain, cough, shortness of breath
-Chest pain is often made worse with breathing and is a vague symptom – (Patient may complain of another presenting symptom and chest pain as an aside)
-The ECG node may show AV nodal conduction abnormalities (heart blocks)
What is Myocarditis?
an inflammatory disease of the myocardium. It occasionally can extend to the epicardium and pericardium.
What Contributes to the Incidence of Myocarditis?
Often the cause of myocarditis cannot be determined but viral infections are the most common culprit.
What are the Signs and Symptoms Associated with Myocarditis?
The initial presentation may include prodromal flu-like symptoms including respiratory and gastrointestinal symptoms
Cough
Dyspnea
Vomiting
Myalgia
Fever
ECG findings in myocarditis?
-Sinus tachycardia is the most common ECG change noted along with non-specific ST segment and T wave changes
-Prolonged QRS
-QT prolongation
-Diffuse T wave inversion
-Ventricular arrhythmias
-AV conduction defects
What are some ecg findings in the acute phase of myocarditis?
Diffuse ST-segment elevation occurs in the acute phase of the disease. Patients with delayed presentation or recurrent disease may have diffusely inverted T waves or low-voltage QRS complexes.
what is Valvular stenosis?
the valves stiffen and their opening becomes narrow and prevents blood from flowing properly
What is Valvular prolapse?
occurs when the leaflets that form the valve do not close properly or fall back onto themselves.
What is Valvular regurgitation?
occurs when valves malfunction and blood flows backwards through a valve.
What can valcular heart disease lead to ?
Valvular heart disease can lead to ventricular hypertrophy or heart failure.
Describe tricuspid valve stenosis
-Affects blood flowing from the right atrium to the right ventricle
-Can lead to right atrial hypertrophy
-Affects blood pressure within the right ventricle, compromising forward pulmonary circulation
-It may also cause right ventricular atrophy.
Describe pulmonary valve stenosis
-Affects blood flowing from the right ventricle to the pulmonary arteries and to the lungs
-Right ventricular workload is increased as a result compromising oxygenation of the blood by the lungs.
-Right ventricular pressure also increases.
Describe mitral valve stenosis
-affects the blood flow from the left atrium to the left ventricle
-this affects flow to the systemic circulation, organ perfusion can be affected resulting in decreased oxygenation of organs which can manifest as fatigue and dyspnea.
-Mitral valve stenosis can result in blood remaining in the left atrium. —-This can result in left atrial enlargement.
- decreased forward flow of blood also puts patients at risk for pulmonary edema.
Describe aoritic valve stenosis
Aortic valve stenosis causes left ventricular stroke volume to be affected and a drop in blood pressure can occur.
The increased workload on the left side of the heart can result in ventricular hypertrophy decreasing cardiac function.
what is a valvular Prolapse
Valvular prolapse occurs when valve leaflets do not align properly, allowing leaks, flipping back on themselves or forming a bulge. This leads to uneven closure and may lead to blood’s backflow, disrupting forward blood flow.
Congenital Causes of valvular disease?
-Congenital valvular heart disease
-Bicuspid aortic valvular disease
-Marfan’s Syndrome
aquired cases of valvular disease?
-Rheumatic fever
-Infective endocarditis
-Radiation therapy
-Degenerative changes
Other cases of valvular disease?
Coronary artery disease
Myocardial infarction
Cardiomyopathies
Metabolic disorders
Cardiac tumors
Some medications
What are three different forms of aneurysms?
fusiform, saccular, and pseudo.
The aortic valve is responsible for maintaining normal ___________ . It closes during __________ to do this.
blood pressure, diastole
