Cardiovascular Flashcards
What is myocarditis
An inflammatory disease of the myocardium (muscle layer of the heart) that can range from a mild disorder to a lethal condition.
What does the inflammation in myocarditis cause
degeneration and necrosis of cardiac myocytes.
what is common in myocarditits
conduction disruption
most common cause of myocarditis
Coxsackie viruses A and B
what is pericarditis
When the pericardium undergoes inflammation, fluid accumulates in the pericardial space.
fluid in pericarditis is called
pericardial effusion
What is cardiac tamponade
fluid accumulates to high levels of 200 mL or greater
compresses the heart
causing a condition called cardiac tamponade.
In cardiac tamponade,
heart chambers are restricted by the surrounding pericardial fluid so they cannot stretch and fill with blood
signs of acute pericarditis
Chest pain; sharp and worsens with deep breathing
Fever
Dyspnea
Pericardial friction rub: scratching sound can be heard through the stethoscope
ECG findings of ST elevations
Beck’s triad
Symptoms of cardiac tamponade
Beck triad:
hypotension
JVD
muffled heart sounds
Pulsus paradoxus occurs in 70% to 80% of patients with cardiac tamponade
what is pulsus paradoxus
Pulsus paradoxus is exhibited by a decrease in systolic blood pressure of 10 mm Hg or more with inspiration.
Pericarditis Tx
NSAIDs / ASA / Corticosteroids (+/-) / Colchicine \+Typically for gout \+Recently for pericarditis refractory to NSAIDs
Patho of Aneurysms
Hypertension weakens the walls of arteries, increasing development of bulges in arterial walls called aneurysms.
Aneurysms cause what
turbulent blood flow and are suceptible to rupture
what may be heard of aneurysms
Bruits
what are the most common areas for aneurysm
Aorta
Cerebral arteries
What are some common aneursyms
Abdominal aortic aneurysm
+ above or below renal artery
Thoracic aortic aneurysm
Cerebral
What are some variations of aneurysms
Dissecting aortic aneurysm
false (psudo) aneurysm
what is a saccular aneurysm
Saccular (balloon shaped)
Involves only one part of circumference
Wide neck
What is a fusiform aneurysm
Entire circumference of vessel
Gradual/progressive dilatation
Potentially extensive involvement
what are Berry Aneursyms
Subtype of saccular
Small neck
Located at bifurcation
Common Location:
Circle of Willis
What is a False (Psudo) aneurysm
Localized dissection or tear in inner artery wall
Type of hematoma
Complication of vascular interventional procedures
Presentation of Abdominal Aortic Aneurysm
Auscultation of a bruit over the abdominal aorta suggests the presence of an aneurysm.
If a pulsatile mass is evident in the abdomen during inspection or light palpation, deep palpation should not be performed until the possibility of AAA is ruled out.
Biggest complication of aneurysms
RUPTURE
What is a dissecting aneurysm
Layers of the wall of the artery are separated and blood enters the region.
Manifestations of Aortic Dissection
severe, tearing pain
Early stages
Blood pressure is elevated
Later stages
BP may be unobtainable
Syncope, hemiplegia, paralysis of lower extremities
Cardiovascular collapse -> shock -> death
Aortic Dissection emergency Pharm
beta blockers
nitrates
What does aortic dissection need RIGHT AWAY
surgery - minutes count
Printzmetal’s Variant Angina =
Coronary Artery Vasospasm (Supply Ischemia)
Chronic stable angina =
fixed stenosis (Demand Ischemia)
Unstable Angina =
Thrombus (Supply Ischemia)
3 conditions in Acute coronary syndromee
unstable angina
non ST elevation MI - NSTEMI
ST Elevation MI - STEMI
define unstable angina
new or changing chest pain caused by ischemia
define NSTEMI
non-ST segment elevation myocardial infarction
define STEMI
ST segment elevation myocardial infarction
Cuase of Prinzmetal angina
Coronary artery spasm
Underlying cause??
Endothelial dysfunction
characteristics of prinzmetal angina
Unique features
CAD may or may not be present
Onset timing
Rest, minimal exertion, night
Specific ECG changes
Elevated ST segment
unstable plaque in ACS with
size of lipid core
inflammation
smooth muscle cells
Size of lipid core?
Large
Inflammation?
Active
Smooth muscle cells?
Proliferation into intima
Are cardiac enzymes elveated in unstable angina?
NO
Theory of Plaque Rupture
Increased SNS activity / ↑ BP, HR, & force of contraction / ↑ force of coronary artery blood flow / ↑ force exerted against injured endothelium / Plaque Rupture! / Platelets adhere to ruptured plaque / Release substances that 1) attract more platelets and 2) contribute to vasospasm / Thrombus Formation
contributing factores to SNS increase
psychological stress
exercise
circadian rhythms
S/S of MI
Diaphoresis Dyspnea Extreme anxiety Levine’s sign (fist to chest) Pallor Retrosternal crushing chest pain that radiates to shoulder, arm, jaw, or back Weak pulses
What is acute MI
Ruptured plaque + thrombus
Why is there an infarction?
Blood flow disruption is prolonged
OR
Blood flow disruption is total
ECG changes? ______
Cardiac enzymes elevated? troponin levels increase with infarction but should decrease when relieved
In Acute MI myocardial cells suffer
irreversible ischemic necrosis and will not function properly again
How are MIs classified
STEMI
NSTEMI
by ECG findings
Process from ischemia to infarction
What is ischemia?O2 deficiency
/
Importance of adenosine triphosphate (ATP)
Main energy source for cell function Myocardial cells can not store ATP = need continuous source / Irreversible injury occurs within 30 min.- 4 hr / Tissue necrosis begins by 4 hours / Necrotic tissue is cleared away by 1-2 weeks / Tough fibrous scar tissue replaces necrotic tissue by 6 weeks / Infarction? Tissue death
3 zones of Heart damage
Infarction = necrosis
- mi,dead cells
- beyond hope of revocery but can stop it from increasing
Injury
- some recovery possible
- can still perfuse it and restore it to become viable
- not dead yet
Ischemia
-full recovery possible
interventions to prevent patient to extend size of the infarction
Increase O2
decrease heart demand
extent of damage of ACUTE MI is influenced by 3 factors
Location or level of occlusion in the coronary artery
Length of time that the coronary artery has been occluded
Heart’s availability of collateral circulation.
what is the left anterior descending Artery
The LAD artery supplies the left ventricle
Most commonly involved in myocardial infarction.
Initial Tx of Acute MI
Oxygen Morphine * Aspirin Nitroglycerin Beta-blocker (if no contradictions)**
Thrombolytic agent *** if patient is eligible. Ideally, thrombolytic agents are used within 4-6 hours of the beginning of the MI.
Immediate STEMI Pharm
Oxygen Increase 02 delivery to ischemic myocardium / Aspirin Suppresses platelet aggregation Decreases mortality Chew first dose / Morphine Decreases pain Reduces preload and afterload Helps preserve ischemic tissue / Beta Blocker (only if not contradicted) Reduce HR and contractility (reduce oxygen demand) Reduces pain, infarct size, and mortality / Nitroglycerin Reduces preload and afterload, limits infarct size Does not reduce mortality
STEMI Fibrinolytic therapy DRUG
Alteplase (tPA)
Alteplase (tPA) MOA
Dissolves clot by converting plasminogen into plasmin
ADV/DISAdv of Alteplase
Advantages?
Most effective
Disadvantages?
Works best within 30 – 70 minutes
A/E of Alteplase
Bleeding
Alteplase is always given with
heparin and antiplatelet therapy
what is Nitroglycerine used for
Severe hypotension
Particularly with other nitrates
Do not aminister WHAT with Nitroglycerine
Do not administer with sildenafil (ViagraR)
Risk of severe hypotension
what is myocardial stunning
Rapid restoration of blood flow to the myocardium also contributes to injury
what is myocardial stunning caused by
oxidized free radicals generated by WBCs and the cellular response to restored blood flow.
Key info about MI
Acute MI is the leading cause of death in the United States and in other industrialized nations throughout the world.
Hesitation and delayed request for emergency care are major causes of death because of MI.
Survival rates for treated patients with acute MI are 90% to 95% in the United States.
Approximately 50% of individuals who suffer an MI are younger than 65 years old.
Persons with diabetes and those older than age 65 often suffer silent, asymptomatic MI.
Key info about MI
Acute MI is the leading cause of death in the United States and in other industrialized nations throughout the world.
Hesitation and delayed request for emergency care are major causes of death because of MI.
Survival rates for treated patients with acute MI are 90% to 95% in the United States.
Approximately 50% of individuals who suffer an MI are younger than 65 years old.
Persons with diabetes and those older than age 65 often suffer silent, asymptomatic MI.
Interventions for reperfusion
Angioplasty and atherectomy
Angioplasty and stent placement
Coronary artery bypass graft (CABG)
