Cardiovascular Diseases Flashcards
Main function of the circulatory system
transport of oxygen, nutrients, waste products,
electrolytes, leukocytes, and hormones among the
tissues and organs of the body
What does the circulatory system comprises them?
heart, bv and blood
What are the chambers of the heart?
right and left atrium
right and left ventricle
how does the heart work
collect body from body and lungs and pass it through ventricles which ejects the blood through the body and the lungs
muscles in the heart
myocardium - cardiac muscles that consists of the chamber walls
endocardium - internal lining of the heart
pericardium - double layer membrane enclosing the heart within the pericardial cavity (split into visceral pericardium or epicardium (inner serous layer) and parietal pericardium (outer fibrous layer))
What are the function of valves?
make sure blood only flows in one direction
where is the mitral valves
on left side between the left atrium and left ventricle (has 2 flaps called cusps)
where is the tricuspid valve?
between right atrium and right ventricles named for 3 cusps
What is the pulmonary semilunar valve
between right ventricle to pulmonary artery (one way flow)
Where is the aortic semilunar valve
controls blood flow from the left ventricle to the aorta
What are the pumping cycle of the heart?
diastole (diastolic phase) where the chambers r filling
systole (systolic phase) where the chambers r contracting
How lojng does the cardiac cyle take?
0.8 sec
L coronary artery
L coronary artery begins at aorta (front) and divides into the anterior interventricular coronary artery and circumflex artery (around to the back of heart)
R coronary artery
R Coronary artery branches from the front of the aorta and divides to the right
What is the sinoatrial node (SA node)
the pacemaker of the heart (initiates the impulse for contraction) and passes to ventricles via atrioentricular node
What does the vagus nerve do?
slows heartrate during rest and sleep by secreting acetylcholine
how does the nervous system increase heart rate + when?
during periods of stress, strenuous physical activity, and excitement
releases epinephrine and norepinephrine to excite heart
what is systemic circulation?
distribute oxygenated blood from left ventricle from aorta to the all arteries in body then back to veins to the right atrium (this blood is deoxygenated)
What is pulmonary circulation?
carries deoxygenated blood from the R ventricle, beginning at pulmonary trunk and continuing through smaller arteries to the lungs to be oxygenated and returns the blood through pulmonary veins to the left atrium
What are the partitions known?
interatrial septum and interventricular septum
What are the subdivisions of arteries?
arterioles and the capillaries
What are the smallest veins?
venules
what do arteries, arteroiles, and capillaries look like ?
Arteries - musculsr, thick,strong, elastic, lined with endothelium
Arterioles - smaller, thinner walls, smooth muscle fibers, lined with endothelium, change diameter by constricting or dilating
Capillaries - has lumen as wide as red blood cell, layer of endothelium
Veins look like?
thinner than arteries but lumens r larger
less muscle and elasticity in walls = veins collaspe when empty
have valves to help return blood upward to heart against gravity (particularly in legs)
What is auscultation?
listening for sounds through a stethoscope
what is an electrocardiogram?
electric recording of heart action and aids in diagnosing coronary artery disease, MI, valve disorders, congenital heart diseases, arrhythmias, and heart block
what is echocardiography?
uses high-frequence sound waves to examine size, shape, and motion of heart structures to record heart walve moveet, measure heart chambers and changes in heart chambers
Doppler echocardiography
explore blood-flow patterns and changes in velocity of blood flow within heart and great vessels
allows cardiologist to evaluate valve stenosis or insufficiency
exercise tolerance test
used to diagnose coronary artery disease and other heart disoers (monitors ECG and blood perssure during exercise)
What is cardiac catheterization?
where catheter is passed into the heart through blood vessels to sample blood in each chamber for O2 content and pressure
helps diganose valve disorders or abn shunting of blood
What is an angiocardiogrpahy?
a contrast indicator (dye) is injected into the cardiovascular system which can detect blockage in vessles
what is a coronary arteriography?
employs an injected contrast material that permits imaging of blood vessel function.
What is the leading cause of death in US and world ______ ppl die from it yearly in us
cardiovascular diseases, abt 700,000 ppl yrly
What is hyperlipidemia?
elevated lipids (fats) in the blood
lipids include cholesterol, phospholipids, and triglycerides
What is cholesterol transported by?
lipoproteins
What is low-density lipoprotein (LDL)
major cholesterol carrier in the blood
known as bad cholesterol bc if it accumulates it = a plaque that narrows arteries and impedes blood flow
An estimated ___% of adults older than 20 years of
age in the United States have high levels of LDL.
35
an increase in levels of blood LDL =
increase in risk for heart disease
What are high-density lipoprotein (HDL)
carries abt 1/4 to 1/3 cholesterol
known as good cholestrol bc it carries cholesterol away from arteries and to liver to be eliminated
higher HDl levels =
lower risk of coronary heart disease
fat in the human body is called:
triglycerides
What is hypercolesterolemia + etiology?
abn high levels of blood cholesterol
many types of hyperchoelsterolia have a genetic basis
can also be bc of obesity and diabetes mellitus, high cal diets
diets high in triglycerides and saturated fats =
increased cholesterol syntheisis and ingibit removal of cholesterol from blood
What is arteriosclerosis, etiology, and types?
artery walls thicek and become hard and inflexible bc of calcium deposition = not being able to response to pressure of blood
leads to hypertension
most common cause is atherosclerosis in which fatty material accumuulates within the walls of the artery (smoking can also cause it)
3 tpes: atherosclerosis, Monckeberg arteriosclerosis, arterioscelrosis
What is atheroscleorisis + risk factors + s/s?
the thickening, narrowing, and hardening of arteries
occurs when plaques of cholesterol and lipids form in arterial tunica intima
risk factors: high lipids blood levels, hypercholesterolemia, smoking, hypertension, obesity, and diabetes
responsible for most MIs, cerebral infarction, most r asymptomatic, first symptoms angina pectoris, dizziness, elevated bp and SOB
What are fatty streaks
simplest form of atherosclerosis r thin flat discolorations in arteries that can enlarger and become thicker as they grow in length (present in children and increase in size and number till abt 20)
What are a fibrous atheromatous plaque?
medically important feature of atherosclerosis, charcterized by accumulation of lipids and the formation of scar tissue
begins as a whitish-gray thickening of the innerlinig of an artery (may have a lipd core covered by plaque)
What are the leading risk factors for arterial disease?
cigarette smoking, high blood lipid and cholesterol levels, and hypertension
What is thrombosis?
a clot within a bv that formed bc of ulceration and tubulent blood flow in the region ofthe plaqye
what t is occlusion
when the interior of the artery is narrowed
may result i nchest pain and SOB
what can blocakage of the cartiod arteries result in?
reduce blood supply to brain and cause stroke
WHat is peripheral vascular disease?
hardening of arteries in legs which leads to pain in the muscles of the leg (may even lead to ulcers and infections)
How do diagnose atherosclerosis?
elevated cholesterol, triglyceride, lipid level, hypertension, doppler studies of major vessels show reduced blood flow, ECG, coronary angiography, CT
treatment for atherosclerosis?
controlling bp, reducing blood cholesterol and lipids and exercise, change in diet to reduce saturated fats and foods high in cholesetorl and lipids
antihypertensive and cholesterol-lowering medication (hyperlipidemic)m niacin and lovastatin combo and ezetimibe
What is an important cause for peripheral arterial disease?
atherosclerosis
peripheral arterial disease is most common in which gender and age?
men 70-80 yrs of age
risk factors of peripheral arterial disease
heredity, high-fat diet, smoking, and physical inactivity
most common arteries affect by peripheral arterial disease
femoral and popliteal arteries
What is ischemia?
a loss of blood and oxygen supply
What is Raynaud’s disease?
disorder of arteries in finger and toes where arteries uddenly contract (vasospasm)
s/s r cold and causes white discoloration (blanching), followed by blue discoloration as venous blood remains, finally red or purple, in stressful events, more in women
s/s of peripheral arterial disease
intermittent claudication (primary sign of peripheral artery disease, pain with walking)
thinning of skin and subcutaneous tissue of the lower leg
foot may feel cool to touch, a lower leg pulse may be faint or absent
What can reduced blood flow lead to?
pain, impaired fucntion and tissue necrosis
what is diagnosis for peripherial arterial disease
uses ultrasound and angiography to confirm diagnosis and pintpoint location
how to treat peripheral vascular disease
aimed at prevention of further complication:
walking slowly
avoid injury
blood-thinning agents
severe cases = surgical bypass around clot
risk factors for raynaud symptom + cause
sex, age, stress (highest among young women)
cause is unknown but occurs when exposed to cold or emotional stress (vasospams of small peripheral arteries and arterioles supplying fingers, hand, feet)
what are symptoms of vasospasm
pallor or cyanosis and cold, numb or tingling fingers (color is most notable in fingertips)
may result in nails becoming brittle, skin over fingers becoming thicker, arthritis, ulcers and infection
diagnosis and treatment for raynaud
phyiscal exam + pt histroy of s/s
treatment is aimed at reducing triggers for symptoms and protecting hands from trauma (stop smoking, protect hands from cold, avoid emotional stress, med can help), warmth to affected area, vasodilators, alpha-adrenergic blockers, CCBs
What is aortic aneurysm?
abnormal dilation of the aorta that results from weakness in the aorta wall that can be caused by an inherited disorder, hypertension, atherosclerosis, or inflammation and infection of the artery
How are aneurysms described?
by their location, size, shape and origin
what r the shape of aortic aneurysms known as and what are they?
fusiform - uniform shaped, tapered at both ends, symmetrical dilation
saccular - appears as an outpouhcing of a portion of the aoritc wall
where do aneurysms usually occur
in abd below kidney (abdominal aortic aneurysm)
in chest cavity (thoracic aneurysm)
cereberal (brain) aneurysm is less common
what is the danger of an aneurysm?
the tendency to increase in size and rupture = hemorrphage
how to diagnose and treat an aneurysm?
diagnose - bruit heard on ausculation, rupture, ultrasound imaging, ECG, CT, MRI
treat - surgical repair before they leak or rupture, catheter-based stent grafts (after integrity of aortic wall has been breached, immediate surgical intervention to repair the rupture, usually with synthetic graft)
What is hypertension?
high bp (arterial bp is measure of force of blood against the arterial walls)
What is the highest ideal pressure for healthy adullts
(systolic) less than 120
(diastolic) less than 80
What is the blood pressure for hyper tension?
greater than 140/90 in at least 3 measures
what is prehypertension??
120-139
80-89
Abt __% of adult population world wide has hypertension
most common CV disorder with abt 20%
Risk factors for hypertension?
advancing age, sedentary lifestyle, excess weight, and
excessive dietary salt and alcohol consumption, family histroy of Hypertension, AA ancestery
What is essential hypertension?
primary hypertension which is a sustained increase in systolic and diastolic bp
what is secondary hypertension?
elevated bp as a result from some other disease likekidney disease
What are the s/s of hypertensions
headache, dizziness, agitation
epistaxis
lightheadness
syncope
development of CV disease
What are common symptoms in pt with CV disease?
- chest pain
- dyspnea on exertion
- tachynpean
- palpitaitons
- cyanoisis
- edema
- fatigue
- synocope
What is coronary artery disease?
0 involving arteries supplying myocardiam (arteries become narrowed bc of atherosclerotic deposits over tiem, causign temporary cardiac ischemia and eventually MI)
- casued by fat-containing plaque in lumen of coronary arteries resultin in atherosclerosis and subsequent narrowing of lumen (myocardium must ahve an adequate blood supply to function)
s/s of coronary artery disease?
- 1st symtpom is pain of angina pectoris
- if advanced: severe pain of MI as burning, squeezing, crushing, radiating to arm, neck or jaw as result from diminsiehd blood flow and lower oxygen saturation
- nausea and vomiting
- weakness
- changes r often on pt ECG
- pt may be asymptomatic
ppl at high risk for CAD:
- those with genetic predisposition
- older than 40
- men (slightly more than women0
- postmenopausal women
- Caucasians
- history of smoking
- residence in urban society
- presence of hypertension
- dabetes
- obesity
- history of elevated serum cholesterol
-reduced HDL - sedentary lifestyle
- stress
how to diagonse coronary atery disease
diagnose -usually no chest pain from atherosclerosis until coronary arteries r about 75% occluded
- collateral circulation often develops to suply tissue with needed Oxygen and nutrients
- ECG = ischemia and possibly arrhytmias
- treadmill testing, thallium or Cardiolite scanning, CT, stress echocardiography, cardiac catheterization, angiography, electron bean computerized testing
how to treat coronary artery disease
- aimed to restore adequate blood flow to myocardium
- vasodilators
- angioplasty w/ balloon or stention
- hyolipidemic drugs
- angiotensin- converting enzyme (ACE) inhibitor
- angiotensin receptor blockers (ARBs)
- calcium channel blockers (CCBs)
- thiazide diuretics
- vasodilators
- beta-blockers and anticoagulants
- CABG (coronary artery bypass surgery)
What is cardiac arrest + etiology?
- sudden, unexpected cessation of cardiac activityy
- pt is unresponsive w/ no respiratory effort and no palpable pulse
- caused by anoxia (absnece of oxygen to tissue) or interruption of electrical stimuli (can be caused by respiratory arrest, arrhythmias, MI, electrocution, drowning, severe trauma, massive hemorrhage, drug overdose)
how to diagnose and treat cardiac arrest/
diagnose - absnece of respiratory effort and lack of palpable pulse, ECG = ventricular fibrillation or asystole
treat - ZCPR within 4-6 min of cardiac arrest, AEC, epinephrine, isoproterenol or dobutamine, antiarrhytmic drugs
What is therapeutic hypothermia?
- after cardiac arrest pt often have bad outcome howevere studies ahve shown cooling pt immediately after cardiac arrest can improve neurologic outcome and quite possibly decrease mortality
- cool to 91F w/ cooling blankets, ice, caardiopulmonary bypass for 18-24 hrs and then rewarming slowly by less than 1 degree an our
What is broken heart syndrome?
- aka takotsubo cardiomyopathy
- occur when heart’s pumping function is abnormal (can result when there is a temporary problem in a single area or region of heart)
- indv experience chest pain and SOB after stressful or exciting even
- thought to be caused by surge of stress hormones (preceded by powerful emotional or physical incident)
- left ventricle temproarily enlargesand doesnt pump properly
how to diangose and treat broken heart syndrome?
diagnose- arteries arent obstructed, blood flow may be reduced, chest xray may not show abn size or shape, ECG (changes from normal rhythm) and echocardigraphy may show enlarged left ventricle, coronary angiography to rule out arterial blockage, lungs will be evaluated for pulmonary edema, bp, blood tests = no MI
treat - stay in hospital until MRI can rule out, then beta-blockers, ACE inhibitors and/or diuretics
how to diagnose and treat hypertension?
diagnose - elevated bp readings (systolic over 140 and diastolic over 90) and track for a while, careful, complete med history, physical exam, lab eval
treat - diuretics, ACE inhibitors, ARBs, vasodilators, CCBs, limit sodium, dietary managements, wt reduction, exercise, reduction of stressful situations and cessation of smoking
What is malignant hypertension, s/s, etiology, and how to diagnose and treat
- life-threatening, severe form of hypertension
- s/s r severe headache, blurred vision, dyspnea
- etiolgoy is unknown
- diagnose w/ notable bp elevation (if v. severe 200+/120+)
= treat w/ IV vasodilators, monitor bp
What is pericarditis, etiology, and what can it result in (worst case scenario)?
- acute or chronic inflammation of pericardium, the sac enclosing and protecting the heart (blood or inflammtory exudate is relassed into pericardial sac)
- is idiopathic or consequence of inflammation or infection elsewhere in the body (other causative agents r viruses, bacteria, trauma, rheumatic fevere, mlignatn neoplastic disease, MI)
- acutre inflammation can cause adhesions btwn pericardium and heart, loss of elasticity, fibrous calcifications of visceral membrane, interfering with heart’s abiltiy to contrract normally
s/s of pericarditis?
- s/s r fever, malaise, chest pain that fluctuates with inspiration or heartbeat, dyspnea, chills, anxious, feeling “pounding heart”, detecable friction rub or grating sound, tachycardia
diagnose and treat pericarditis?
diagnose - blood studies t oidentify causative organism, elevated WBC, ESR, cardiac enzyme levels, ECG (pericardial fluid and thickened pericardium)
treat - antibiotic treatment and surgical drainage or aspiration, complete bed rest, administration of analgesics, antipyretics and NSAIDS, corticosteroids
What is rheumatic heart disease, s/s?
- cardiac manifestations that occur after rheumatic fever
- s.s r acutre endocarditiis, which leads to chornic cardiac involvement, stenosis of valves, particularly mitral and aoritic valves, dynspnea, tachycardia, edema, nonproductive couhg and cardiac murmurs
- after rheumatic fever vegetations may become enlarged or valves may become scarried, causing stenosis
diagnose and treat rheumatic heart disease?
diagnose - history of rheumatic fever, cardiac murmurs, ECG show vegetations or resulting damage to valves
treat - aimed at reducing srtenosis of valves, relieve stenosis, replace valve, good dental hygein, prophylactic antiobiotics
What is valvular heart disease + diagnose and treat?
- acquired or congenital disorder that can involve any ofthe 4 valves of heart
- can occur in ofrm of either insufficiency or stenosis
- insufficinecy (failure of valves to close completely, allowing blood to forced back int previous chamber and increases heart workload (stenosis, hardneing of cusps of valves that prevents complete opening of valves impedes blood flow to next chamber
- mostly valve
- diagnose w/ ECG, chest radiographic studies, echo, cardiac catherization
- treat w/ digiitalis or quindine for arrhythmias and antibiotic prophylaxis
What is mitral stenosis + s/s?
- hardening of cusps of mitral valve that prevents complete and normal opening of valve for passage of blood from L atrium into L ventricle
- s/s r exertional dyspnea and fatigue, cough and palpitations, hemoptysis, cyanotic
how to diagnose and treat mitral stenosis?
diagnose - can be insidious or acutre, cardiac murmur (diastolic murmur), Echocardiography
treat - limit sodium, diuretucs, anticoagulants, atrial fibrillation = digoxin, surgical intervention w/ comissurotomy to free up valve and allow adequate blood flow (can be done nonsurgically with balloon valvuloplasty
What is mitral insufficiency, s/s and etiology?
- mitral valve fails to close completely and allows blood from L ventricle to flow back into L atrium
- s/s r dyspnea and fatigue, heart murmur as blood leaks back into L atrium
- may be caused by scar tissue from inflammation and vegetations (from endocarditis), rheumatic fever, mitral valve prolaspe (MVP), CAD, or MI, or cardiac dilation
how to diagnose and treat mitral insuffiency?
diagnose - thorough pt history (hisotry of sore thraot or rheumatic fever), physical exam = murmur, echo = insufficiency, ECG, chest radiography, cardiac catherization
treat - bed rezst, oxygen therapy, antibiotics, surgical repair or replacement
what is mitral valve prolapse, s/s, and etiology
benign condition
one or more cusps of mitral valve protrude back into left atrium during ventricular contraction
- most pt r asympomatic, some experience chest pain, dyspnea, dizziness, fatigue, syncope, severe anxity
- caused by abnormally long or short tendinease, malfunctioning papillary muscles, regurgitation of blood during Left ventricular systole = rushing, gurgling cardiac murmur
how to diagnose and treat mitral valve prolapse
diagnose - typical click-murmur syndrome on ausculation, Echo, premature ventricular cnotract (PVC) r detected
treat - for asymptomatic pt dont need treatment, those who experience discomfort and anxirty r treated with beta-blockers, advised to av void caffeine, smoking and large, heavy maeals
What are blood vessel composed of (3 layers)
- tunica intima, tunica media, tunica externa
- lining of vessel lumen, tunica intima: is composed of smooth, thin endothelium allowing minimal friction with flowing blood
- tunica media: composed of smooth muscle and elastic tissue that r under control of sympathetic nervous system (allows constriction or dilation of vessel walls and changes in bp) (more in arteries to compensate for strong bp under which arteries must function)
tunica externa: is made of connective tissue and support and protect vesslels
WWhat hat is Monckeberg arteriosclerosis?
- aka medial calcific sclerosis
- involves arterial tunica media
- destruction of muscle and elastic fibers along with calcium deposits
What is an aneurysm + etiology?
- weakening and resulting local dilation of wall of an artery
- common cause is buildup of atherosclerotic plaque, can be trauma, infection or inflammation, and congential tendencies
s/s of aneurysm?
- either insidious or sudden and acute
- based on location, size and extent of dilation
- discovered during physical exam when abd is palpated, abdominal radiographic study
- abd or back pain
- pulsating mass is observed in abd
- leakage from wall of artery or sudden rupture of weak area
What is phlebitis, s/s, etiology, diagnose and treat?
- inflammation of a vein, most often in lower legs
- s/s r pain and tenderness in affected area, swelling, redness, warmth, tender, cordlike mass under skin, affects tunica intima, resulting in formation of clots (thrombophlebitis)
- cause is unknown (venous stasis, obesity, blood disorders, injury and surgery)
- clinical picture and history
- treat w/ analgesics, dont massage affected tender area bc can form clots or emboli
What is thromboplebitis, s/s, etiology?
-result of inflammation of a vein with formation fo a thrombus on vessel wall
- interferes w/ blood flow, resulting in edema, as with phlebitis, pain, swelling, heaviness, warmth, chills and fever
- caused by venous stasis, blood disroders that cause a hypercoagulable state and injury tto venous wall
diagnose and treat thromboplebitis?
diagnose - gross edema in 1 leg, tender to palpation, radiographic venography and ultrasonography
treat - immobilize to prevent thrombus from spreading and dislodgint to become an embolus, heparin to prevent clot from enlarging and antibiotics (usually resolves itself, if not surgical intervention to ligate affected vessel)
