CardioPulmonary Pathology Flashcards
Angina Pectoris
- p! in chest, jaw, or L arm 2ndary to temp/localized ischemia (usually from atherosclerosis)
- dyspnea
- indegestion
- dizziness, syncope and anxiety
- Causation: cold/windy weather, PA, stress
- results in changes of left venticular fxn on ECG
- Medications:
- nytroglycerins etc
Coronary Artery DIsease
an atherosclerotic dx process that narrows the lumen of the CA resulting in ischemia to the myocardium (leading cause of death in US today)
- clinical manifestions: ischemia, infarction, sudden death and heart failure
- main syndromes include angina, MI and <3 failure
Cor Pulmonale
Failure or hypertrophy of the R ventricle resulting from disorders of the lungs, pulm vessels or chest wall
- lung pathology produces pulmonary artery HTN that creates a problem for R ventricle
- usually chronic but may be acute and reversible
Congestive Heart Failure
results from failure of the heart to maintain adequate circulation of the blood to meet systemic demands
- decreased CO
- elevated end diastoliv values
- tachycardia
- contractile deficiency (SV, F)
- impaired ventricular function
Treatment
- best rest, diuretics, sodium restriction etc
Medications:
- Digitalis - increase pumping ability, decrease HR
- Diuretics - decrease fluid, pre/afterload, control HTN
Left Sided Heart Failure (forward)
Inadequate L ventricle to pump into system
- undue tachycardia
- intolerance to cold
- increased pulm art pressure/edema
- DOE
- dry cough
- orthopnea, PND
- Pulmonary Rales, wheezing
- fatigue
Right sided Heart Failure (backward)
Inadequate R ventricle reduces venous return
- increased pulm art swelling/edema
- peripheral edema (ankle swelling)
- venous hypertension and stasis
- weight gain
- fullness in abdomen
- fatigue
Myocardial Infarction
Ischemic myocardial necrosis usually resulting from abrupt reduction coronary blood supply (atherosclerosis, thrombus, spasm, cocaine)
- symptoms similar to angina, not relieved w/ medication
- pt usually restless, pale, diaphoretic, and cool
Treatment
- relieve stress, reduce cardiac work
Medications:
- depend on damage
Postural Tachycardia Syndrome
sustained HR increased greater than or equal to 30 bpm within 10 minutes of standing (40 in teenagers)
Ischemic Cardiac Chest Pain
(angina or MI)
- diffuse
- retrosternal
- “tightness”
- achiness
- Anginal Scale 1+ to 4+
- associated w/ dyspnea, syncope, anxiety etc
- can refer to:
- shoulders, back, arms, neck or jaw
- p! from back = AAA
Asthma
increased reactivity of the trachea and bronchi to various stimuli causing widespread narrowing of the airways due to inflammation, smooth muscle constriction, and increased secretions.
Signs/Symptoms:
- wheezing cough
- dry or productive mucoid sputums
- anxiety w/ severe bronchospasm may restrict airflow to the point of no wheezing
- chest wall is symmetrically decreased
Treatments
- bronchodilators prior to exercise/cold exposure
- decreased activity if environment is unfavorable
- medications, oral or IV steriods (prednisone) and nebulizer or inhaler.
Bronchitis
Chronic inflammation of the tracheobronchial tree with cough and sputum production lasting at least 3 months for 2 consecutive years
signs/symptoms
- wheezing or rhonci breath sounds
- productive mucoid or purulent sputum with infection
- may have fever
Treatment
- bronchopulmonary hygiene if indicated
- positions of relaxation
- paced breathing
- endurance exercise
- patient education
- smoking cessation
Cystic Fibrosis
A genetically inherited dx, characterized by thickening of secretions of all exocrine glands, leading to obstruction. May present as obstructive, restrictive or mixed
Signs/symptoms
- frequent infections : staph aureus, pseudomonas aeruginosa
- inability to weight gain
- positive sweat electrolyte test
- rales, wheezing
- productive of large mucoid, mucopurulent or purulent sputum
- may have hemoptysis
Treatment
- percussion, vibration, shaking and postural drainage up to several times per day (acute) or will develop pneumonia
- suction in severe cases
- endurance exercises
Emphysema
Permanent abnormal enlargement and destruction of air spaces distal to terminal bronchioles. May develop following smoking history with chronic cough and sputum production
Signs/Symptoms
- barreled chest
- use of accessory muscles of ventilation
- decreased breath sounds w/w/o wheezing
- dyspnea
Treatment
- pursed lip breathing
- education about disease
- endurance exercises
Restrictive Diseases
- Alterations in pleura
- fibrotic changes w/in pulmonary pleura associated w/:
- idiopathic pulmonary fibrosis
- asbestos
- radiation pneumonitis
- oxygen toxicity
- fibrotic changes w/in pulmonary pleura associated w/:
- Alterations in Chest Wall
- restricted motion of bony thorax:
- ankylosing spondylitis
- arthritis
- scoliosis
- pectus excavatum
- chest wall burns
- scleroderma
- restricted motion of bony thorax:
- Alterations in neuromuscular system
- decreased muscular strength results in an inability to expand rib cage
- MS
- MD
- Parkinson’s
- SCI
- Stroke
- decreased muscular strength results in an inability to expand rib cage
Flail Chest
2(+) fractures in two or more adjacent ribs, usually due to blunt trauma
- Signs/symptoms
- shallow breathing
- crepitation during ventilation over site
- paradoxical mvmnt of flail section
- inspiration: pulled inward
- expiration: moves outward
- treatment
- gentle breathing exercises
- splinting
- pain management
- proper positioning
Pneumothorax
air enters pleural space, causing the lung to collapse due to a loss of NEGATIVE pressure
- Signs/symptoms
- decreased or absent breath sounds
- dry cough
- may have local or referred pain
- trachial deviation AWAY from affect side
- hyperresonant and tympanic percussion
- Treatment
- chest tube
- pulls air/fluid out of pleural space
- restores negative pressure and lung inflation
- chest tube must remain properly attached to pt at all times
- chest PT is precaution in the area of the tube
- chest tube
Tuberculosis TB
infection spread by aerosolized droplets from an untreated infected host. after 2 weeks medication renders host noninfectious. (increased incidence in HIV population)
- Signs/Symptoms
- slight nonproductive cough
- hemoptysis
- low-grade fever
- dyspnea
- chest wall pain
- possible chest x-ray changes
- Treatment
- medications to eliminate infection
- isolation reduces spread of infection
Pulmonary Edema
Excessive seepage of fluid from pulmonary vascular system into the interstitial space. (LVF, aortic valve disease, mitral valve disease, inhalation of toxic fumes or narcotic overdose)
- Signs/symptoms
- DOE or PND
- Fatigue
- Pink frothy sputum
- positive chest x-ray
- crackles
- treatment
- medication, including O2 and diuretics
- reduction of salt intake
- bed rest (head elevated)
Pulmonary Emboli
Thrombus from peripheral venous system, lodges in pulmonary artery with subsequential obstruction of blood flow to the lungs
- signs/symptoms
- without infarction: tachypnea, anxiety, restlessness, rales (crackles), wheezing, decreased breath sounds
- with infarction: chest pain, hemoptysis, pleural friction rub, fever, postive chest x-ray
- treatment
- low-dose heparin
- analgesics
- pulmonary vasodilators
COPD
airflow limitation that is not fully reversible, progressive and associated with abnormal inflammatory response of the lungs to noxious stimuli
- Stage 1
- FEV1/FVC < 70%
- FEV1 >/= 80% of predicted
- w or w/o chronic symptoms
- Stage 2
- FEV1/FVC < 70%
- 50% < FEV1 < 80% predicted
- SOB on exertion
- Stage 3
- FEV1/FVC < 70%
- increased SOB, dec exercise capacity, and exacerbations of their disease
- Stage 4
- FEV1/FVC < 70%
- FEV1 < 30% of predicted,
- impaired quality of life
Risk Factors for CVD
Modifiable and Non-Modifiable
Non-Modifiable
- Age (men >45, women >55)
- Fam hx (1 deg relative male
- Race (african american)
- Gender (men>women pre menopause)
Modifiable
- Cholesterol (>200 total)
- Diabetes (HgA1C>7%)
- Diet
- HTN
- obesity
- sedentary
- tobacco
Enzyme Changes Associated with MI
- rise and fall of cardiac troponin (I or T* and one:
- sx of ischemia
- new ST changes on ECG
- pathological Q waves on ECG
- new loss of myocardium and/or new wall motion abnormality
- evidence of intracoronary thrombus via catheterization or autopsy
- elevation of CK or CPK levels
Serum Enzymes Associated with Death of Cardiac Cells
Creatine phosphate (CPK)
lactate dehydrogenase (LDH)
Serum glutamate oxalate transaminase (SGOT)
Cardiopulmonary Responses to water immersion
- changes are result of hydrostatic pressure and include a cephalod redistribution of blood flow
- both SV and CO will increase, while HR stays the same or slightly decreases
- Hydrostatic pressure on the chest challenges expansion, which can decrease inspiratory reserve and FVC
