Cardiopulmonary pathologies Flashcards
1
Q
Aneurysm
A
- abnormal dilation of a blood vessel, usually an artery.
- Common sites include the thoracic and abdominal aorta and vessels within the brain.
*Etiology - Congenital defect; weakness in the wall of the vessel often due to chronic hypertension; connective tissue disease (e.g., Marfan syndrome); trauma; infection.
*Signs and symptoms - Variable based on the site. Aortic aneurysms are usually asymptomatic, but may include generalized abdominal or low back pain. Abdominal aortic aneurysms may cause pulsations near the navel. A cerebral aneurysm. can cause a sudden and severe headache, nausea and vomiting, stiff neck, seizure, loss of consciousness, and double vision.
- Treatment - Antihypertensive medications may be recommended for hypertension. Surgery is recommended to repair large aortic aneurysms and consists of replacing the aneurysm with a synthetic fabric graft. Two surgical options for ruptured brain aneurysms are surgical clipping and endovascular coiling.
2
Q
Angina Pectoris
A
- Inadequate blood flow and oxygenation of the heart muscle mostly due to coronary artery disease.
- Signs and symptoms -
pressure, heaviness, fullness, squeezing, burning or aching behind the sternum, but may also be felt in the neck and back, jaw, shoulders, and arms.
Could be - The sensation may be associated with difficulty breathing, nausea or vomiting, sweating, anxiety or fear (anginal equivalents). It is typically triggered by exertion or strong emotion and subsides with rest. - Treatment - supplemental O2, nitroglycerin, long-acting nitrates, beta blockers, and calcium channel blockers….or angioplasty
3
Q
Types of Angina
A
- Stable angina - Occurs at a predictable level of exertion, exercise or stress and responds to rest or nitroglycerin.
- Unstable angina - Usually is more intense, lasts longer, is precipitated by less exertion, occurs spontaneously at rest, is progressive, or any combination of these features.
- Prinzmetal (variant) angina - Occurs due to coronary artery spasm most often associated with coronary artery disease.
4
Q
Atherosclerosis
A
- Slow progressive accumulation of fatty plaques on the inner walls of arteries. Over time the plaque can restrict blood flow, causing a blood clot.
- Etiology
- May begin with damage or injury to the inner wall of the artery from hypertension, high cholesterol, smoking or diabetes.
- Fatty plaques made of cholesterol and other cellular waste products build up at the site of the injury and harden, narrowing the artery and impeding blood flow (Fig. 6-6).
- Signs and symptoms
- Coronary arteries: angina pectoris may result.
- Cerebral arteries: affected, numbness or weakness of the arms or legs, difficulty speaking or slurred speech, or drooping face muscles may result.
- Peripheral arteries: intermittent claudication may result.
- Treatment
- Lifestyle changes, medications, and surgery may be recommended.
- Lifestyle changes include smoking cessation, regular exercise, healthy diet, and stress management.
- Medications may include antihypertensive, antiplatelet, and antilipidemic agents.
- Surgical procedures may include: angioplasty, endarterectomy, and bypass surgery.
5
Q
Cardiomyopathy
A
- group of conditions that affect the myocardium, impairing the ability of the heart to contract and relax.
- Three types of cardiomyopathy are dilated, hypertrophic. and restrictive.
- Etiology - many causes of cardiomyopathy, including coronary artery disease and valvular heart disease.
*Signs and symptoms
- None during early stages.
- As the condition progresses, signs and symptoms include breathlessness with exertion or even at rest; swelling of the legs, ankles and feet; bloating of the abdomen due to fluid buildup; fatigue; irregular heartbeat; dizziness, lightheadedness and fainting.
6
Q
Types of cardiomyopathy treatments
A
- Dilated cardiomyopathy - Common medications include
ACE inhibitors, beta blockers, digoxin, and diuretics. Surgical intervention may include a biventricular pacemaker or an implantable cardioverter-defibrillator for patients at risk for serious arrhythmias. - Hypertrophic cardiomyopathy - Medications to slow the heart rate and stabilize its rhythm. Common medications include Lopressor and calcium channel blockers. If medications are unsuccessful, surgical interventions may include septal myectomy (removal of the thickened interventricular septum); septal alcohol ablation (destruction of the interventricular septum by alcohol injection); pacemaker implantation; and implantable cardioverter-defibrillator.
- Restrictive cardiomyopathy - Medications focus on improving symptoms and may include diuretics, antihypertensives, and antiarrhythmics. In severe cases, surgical options include a ventricular assist device or a heart transplant.
7
Q
Chronic Venous Insufficiency
A
- Veins and valves in the lower extremity are damaged and cannot keep blood flowing toward the heart. This causes the veins to remain filled with blood.
- Etiology - Weak or damaged valves inside the veins. Risk factors include age, female gender, obesity, pregnancy, and prolonged sitting or standing.
- Signs and symptoms - Leg swelling, varicose veins, aching, heaviness or cramping, itching, redness or skin ulcers of the legs and ankles.
- Treatment - Compression stockings and elevation of the legs help decrease chronic swelling. Varicose vein stripping may be performed for cases with persistent leg pain or skin ulcers due to poor circulation.
8
Q
Cor Pulmonale
A
aka pulmonary heart disease
- refers to hypertrophy of the right ventricle caused by altered structure or function of the lungs.
- Etiology - Pulmonary hypertension from chronically increased resistance in the pulmonary circulation.
- Signs and symptoms - The cardinal symptom is progressive shortness of breath, especially with exertion. Other signs and symptoms are fatigue, palpitations, atypical chest pain, swelling of the lower extremities, dizziness, and syncope.
- Treatment - Supplemental oxygen sufficient to maintain Sa02> 90% and/or Pa02 > 60 mm Hg. General measures include diuretics and anticoagulation.
9
Q
Coronary Artery Disease (CAD)
A
- blockage of the coronary arteries due to atheromatous plaques which reduces the blood flow
- typically starts as damage or injury to the coronary artery
- S&S - degree of stenosis required to show symptoms varies by O2 demand. Around 70% occlusion can feel Angina, SOB
- Treatment -
- Aggressive modification of atherosclerosis risk factors
- Drug therapy includes: antiplatelet agents (aspirin, clopidogrel), ACE inhibitors, angiotensin II receptor blockers, and statins.
- High risk for mortality: Percutaneous angioplasty and CABG
- Cardiac catherization with coronary angiography with contrast with x-ray provides the most accurate info regarding location and severity of CAD.
10
Q
Risk factors of CAD
A
HTN
DM
Obesity
CKD
Elevated cholesterol
Triglyceride levels
Family hx
Modifiable risk factors: smoking, inactivity, alcohol abuse, and stress.
11
Q
Deep Vein Thrombosis (DVT)
A
- blood clot forms in 1 or more of deep veins
- if the clot breaks loose and travels to the lungs it can cause a pulmonary embolism
- Etiology: Risk of DVT
- prolonged bed rest
- inherited blood clotting disorder
- injury or surgery of the veins
- pregnancy
- cancer
- birth control or hormone replacement therapy
- overweight/obese
- smoking
- S&S: ~50% are asymptomatic
- swelling, pain, redness, wearmth in the affected leg
- Treatment - try and prevent it. Anticoagulant and thrombolytic. “Filter” in vena cava to prevent clot from reaching lungs.
Compression stockings
12
Q
Endocarditis
A
- inflammation of the endothelium that lines the heart and cardiac valves. Can progress to destroy valves and lead to death
- Etiology - bacteria entering the blood stream ( catheters, needles, dental procedures, gum disease, sexually transmitted disease, or irritable bowel disease.
More at risk if have damaged heart valve, artificial heart valves, or heart defect. - S&S - fatigue, SOB, fever, chills, heart murmur, weight loss, blood in urine, and skin petechiae.
- Treatment - antibiotics. Potentially replace the heart valve
13
Q
Congestive Heart Failure
A
- progressive condition where the heart can’t maintain a normal cardiac output to meet the body’s demands for blood and oxygen.
- ventricles dilate and weaken to the point that the heart can’t pump efficiently.
- will back up in the body and lungs
- S&S: SOB, fatigue, weakness, swelling of the legs, feet and abdomen; rapid or irregular heart beat, persistent cough or wheezing, weight gain from fluid retention.
- It is a symptoms of a pathology. This pathology needs to be addressed to help the symptoms.
14
Q
R heart failure
A
- associated with systemic venous congestion
- dependent edema
- can get venous jugular distention
15
Q
L heart failure
A
- pulmonary venous congestion
16
Q
Heart Murmur
A
- abnormal swishing or whoosing sound
- Etiology -
Innocent: due to activity, pregnancy, fever, anemia
Abnormal: from damaged or narrow heart valve or hole in heart’s walls. Rheumatic fever, endocarditis, calcified valves, and mitral valve prolapse. - S&S -
Innocent: None
Abnormal: cyanosis, limb edema, SOB, enlarged neck veins, weight gain, chest pain, dizziness, and fainting. - Treatment - depends on the underlying cause.
- Meds: digoxin, anticoagulants, diuretics, and other antihypertensive agents.
- Surgical: valve replacement or patching.
17
Q
Hypertension
A
- blood pressure is persistently elevated
- can cause damage to the arteries which increases the risk of more serious comorbidities such as CVA or MI
- African descent, men, post-menopausal women, and family hx of HTN.
- Different classes of HTN
- Symptoms may not be recognized until BP becomes dangerously high – HA, confusion, visual changes, fatigue, arrhythmia, or tinnitus.
- Treatment:
- Risk reduction through lifestyle changes
- diuretics, beta-blocker, calcium channel blockers, and ACE inhibitors.
18
Q
Myocardial Infarction (MI)
A
- coronary artery is severely reduced or cut off completely. Causes irreversible necrosis.
- From ruptured atherosclerotic plaque or blood clot that blocks the flow.
Uncommon cause is spasm of coronary artery. - S&S:
Chest discomfort with pressure,
squeezing or pain;
shortness of breath;
discomfort in the upper body including the arms, shoulder, neck or back;
nausea/vomiting,
dizziness, sweating, and palpitations.
Impending sense of doom - Treatment -
- Medications acute MI: anticoagulants and thrombolytic agents, pain relievers, antihypertensives, and cholesterol-lowering medications.
- Surgical procedures: coronary angioplasty with stenting or coronary artery bypass surgery.
