Cardiovascular Diseases and Disorders

Question 1

Coronary Artery Disease (CAD)

Answer 1

ETIOLOGY:

1) risk factors: smoking, stress, obesity, hypertension, diabetes, high cholesterol, sedentary lifestyle, and age
2) atherosclerosis (plaque) OR arteriolosclerosis (degenerative) -> blocked coronary arteries

S/S:
1) asymptomatic -> angina pectoris (chest and left arm pain) -> myocardial infarction (severe chest and left arm pain, nausea)

TREATMENT:

1) ACE inhibitors, ARBs, B-blockers, calcium-channel blockers, thiazide diuretics
2) balloon angioplasty, stent angioplasty, coronary artery bypass graft (CABG) surgery

Question 2

Angina Pectoris

Answer 2

ETIOLOGY:
1) activity -> increased cardiac O2 demand (if CAD-related), vasospasm, tachycardia -> myocardial ischemia

S/S:
1) chest and left-arm pain, dyspnea, arrhythmia

TREATMENT:

1) nitroglycerin tablets
2) lifestyle changes (exercise, low-salt/low-fat diet)

Question 3

Myocardial Infarction (MI)

Answer 3

ETIOLOGY:
1) angina pectoris (vasospasm), CAD -> myocardial ischemia -> cardiac muscle death

S/S:
1) severe chest pain, referred left arm pain, dyspnea, arrhythmia, diaphoresis (sweating), nausea

TREATMENT:

1) aspirin (antiplatelet NSAID), thrombolytic drugs
2) stent/balloon angioplasty OR CABG surgery

BONUS FACTS:
1) patient must take daily aspirin or B-blocker for life

Question 4

Cardiac Arrest

Answer 4

ETIOLOGY:
1) infarction, electrocution, drowning, drug overdose, extreme trauma -> cardiac activity stops

S/S:
1) unresponsive, no pulse, no respiratory effort

TREATMENT:

1) cardiopulmonary resuscitation (CPR) or automated external defibrillator (AED) within 4-6 minutes
2) epinephrine (Adrenalin), lidocaine (antiarrhythmic drug)

Question 5

Takotsubo Cardiomyopathy (Broken Heart Syndrome

Answer 5

ETIOLOGY
1) emotional or physically-straining event -> excessive adrenaline -> temporary left ventricle hypertrophy

S/S:
1) chest and left arm pain, dyspnea

TREATMENT:

1) hospitalization for a few days
2) ACE inhibitors and B-blockers

Question 6

Congestive Heart Failure (CHF)

Answer 6

ETIOLOGY
1) MI, CAD, COPD, arrhythmia, valvular damage, cardiomyopathy, hypertension -> impaired perfusion

S/S:

1) right-sided failure -> peripheral edema, hepatomegaly, splenomegaly
2) left-sided failure -> pulmonary congestion, dyspnea,

TREATMENT:
1) ACE inhibitors, ARBs, aldosterone antagonists, diuretics (reduce caricias workload)

BONUS FACTS:
1) best prognosis associated with acute (MI) CHF

Question 7

Pulmonary Edema

Answer 7

ETIOLOGY:
1) left-sided dysfunction (mitral valve dysfunction, hypertension, arrhythmia, pulmonary emboli) -> excessive pulmonary blood psi

S/S:

1) dyspnea, orthopnea (easier to breath when straight up), tachypnea, bloody sputum
2) tachycardia and possible low blood psi

TREATMENT:

1) bronchodilators
2) nitroglycerin or sodium nitroprusside (IV vasodilators) and diuretics (antihypertensive)
3) Fowler position

Question 8

Cor Pulmonale

Answer 8

ETIOLOGY:

1) COPD (chronic factor) or pulmonary emboli (acute factor) -> increased pulmonary blood pressure -> increased right-heart workload and hypertrophy
2) *hypoxemia -> BM stimulation -> polycythemia -> higher blood psi

S/S:
1) peripheral edema, distended veins, hepatomegaly and splenomegaly

TREATMENT:

1) treat causative factors
2) oxygen supplementation and bronchodilators
3) diuretics (edema), anticoagulants (prevent thrombosis), and phlebotomy (polycythemia)

Question 9

Mitral Stenosis

Answer 9

ETIOLOGY:
1) RHD -> hardening of cusps

S/S:
1) dyspnea, palpitations, fatigue, cyanosis

TREATMENT:

1) anticoagulants, digoxin (antiarrhythmic)
2) balloon valvuloplasty or commissurotomy

Question 10

Mitral Insufficiency

Answer 10

ETIOLOGY
1) MI, mitral valve prolapse, rheumatic fever, endocarditis valve -> mitral valve unable to close

S/S:
1) dyspnea, heart murmur, fatigue

TREATMENT:

1) treat causative factors (antibiotics, antifungals)
2) surgical valvular repair or replacement

Question 11

Mitral Valve Prolapse (MVP)

Answer 11

ETIOLOGY:
1) abnormally long or short chordae tendineae AND/OR malfunctioning papillary muscles -> mitral valve cusp bulges back when closing

S/S:
1) asymptomatic OR fatigue, dyspnea, syncope

TREATMENT:

1) usually no treatment is needed, lifestyle changes encouraged
2) beta-blockers

Question 12

Arrhythmia

Answer 12

ETIOLOGY:
1) other cardiac diseases, certain drugs -> electrical impulse error in SA or AV nodes

S/S:

1) tachycardia, bradycardia, heart block (atria/ventricles beat independently), atrial fibrillation, or ventricular fibrillation
2) fatigue, dizziness, syncope

TREATMENT:

1) treat causative factors, cease drug use
2) cardiac ablation if bradycardia
3) implantable cardioverter-defibrillator (ICD) if tachycardia

Question 13

Cardiomyopathy

Answer 13

ETIOLOGY:

1) Dilated: viral infection, chronic alcoholism, autoimmunity -> myocardial degeneration
2) Hypertrophic: congenital factors -> enlarged ventricles -> obstruction
3) Restricted: myocardial insult -> fibrosis -> stiff myocardium

S/S:

1) dyspnea, fatigue, tachycardia, chest pain
2) (right-sided) peripheral edema, distended veins hepatomegaly, splenomegaly
3) (left-sided) dyspnea, orthopnea, tachypnea, bloody sputum

TREATMENT:
1) ACE inhibitors, B-blockers, CCBs (antihypertensive and antiarrhythmic)

BONUS FACTS:
1) worst prognosis associated with restrictive cardiomyopathy

Question 14

Pericarditis

Answer 14

ETIOLOGY
1) inflammation or infection (rheumatic fever, bacteria, viruses) -> exudate enters serous fluid, pericardial adhesions, visceral pericardial calcification -> reduced cardiac output

S/S:

1) chest pain, tachycardia, dyspnea, “friction rub” during auscultation
2) fever, malaise, chills

TREATMENT:

1) treat causative factors
2) NSAIDs, antipyretics, analgesics, corticosteroids
3) surgical resection of adhesions or calcifications

Question 15

Cardiac Tamponade

Answer 15

ETIOLOGY
1) visceral or parietal pericardial blood vessel damaged -> blood fills pericardial sac -> impaired beating of heart

S/S:

1) cyanotic above nipple line
2) (shock) altered state of consciousness, weak and rapid pulse, tachypnea, cold, polydipsia, shakiness, pupil dilation

TREATMENT:
1) pericardiocentesis (needle-shunting blood from sac)

Question 16

Myocarditis

Answer 16

ETIOLOGY:
1) pathogenic infection (viral, bacterial, fungal, protozoal) or toxic agents (cocaine, chronic alcoholism, radiation) -> myocardial inflammation

S/S:

1) arrhythmia, palpitations, dyspnea
2) fatigue, fever, malaise

TREATMENT:

1) treat causative factor
2) analgesics, NSAIDs, corticosteroids
3) digoxin (antiarrhythmic) and ACE inhibitors

Question 17

Endocarditis

Answer 17

ETIOLOGY:
1) bacterial (Staphylococcus A, Group A streptococcus, or E. coli) or fungal sepsis -> endocardial and valvular infection -> septic emboli transported through arterial circulation

S/S:

1) fever, fatigue, weakness, chills, night sweats, anorexia
2) ischemia of extremities

TREATMENT:

1) treat causative factors (antifungals, antibiotics)
2) antipyretics, anticoagulants
3) surgical repair of valves

Question 18

Rheumatic Fever

Answer 18

ETIOLOGY:
1) group A beta-hemolytic Streptococcal infection -> autoantibodies produced -> systemic inflammation (can include cardiac tissues)

S/S:
1) fever, weakness, malaise, weight loss, anorexia, polyarthritis, edema

TREATMENT:
1) complete course of penicillin, antipyretics, anti-inflammatory drugs

Question 19

Rheumatic Heart Disease (RHD)

Answer 19

ETIOLOGY:
1) group A beta-hemolytic Streptococcal infection -> valvular vegetation/autantibodies produced -> valvular scarring and stenosis

S/S:
1) cardiac murmurs, tachycardia, dyspnea, cough, possible CHF

TREATMENT:

1) prophylactic penicillin
2) surgical valvular repair or replacement

Question 20

Shock

Answer 20

ETIOLOGY:
1) hypovolemic (hemorrhaging), anaphylactic, septic (bacterial infection), cardiogenic (arrhythmia, MI, valvular disease), neurologic (emotional distress, other insult), or metabolic (acidosis) -> inadequate blood perfusion -> ischemia of vital organs

S/S:

1) altered state of consciousness, weak and rapid pulse, tachypnea, low blood pressure
2) polydipsia, pupil dilation, shakiness

TREATMENT:

1) CABs, control any bleeding (if hemorrhagic), epinephrine (if anaphylactic)
2) place in supine position, elevate legs above heart, keep warm
3) vasodilators OR vasoconstrictive drugs (if cardiogenic)

BONUS FACTS:
1) worse prognosis associated with cardiogenic shock

Question 21

Essential (Primary) Hypertension

Answer 21

ETIOLOGY:
1) (risk factors) family history, stress, type A personality, high-fat/salt diet, obesity, sedentary lifestyle -> high blood psi -> blood vessel damage

S/S:

1) asymptomatic OR headaches, epistaxis syncope, worsened visual acuity
2) blood pressure >140/90 mmHg

TREATMENT:
1) ACE inhibitors, ARBs, CCBs, thiazide diuretics (antihypertensives)

BONUS FACTS:
1) blood psi of 120-139/80-89 mmHg considered “pre-hypertensive”

Question 22

Malignant Hypertension

Answer 22

ETIOLOGY:
1) idiopathic OR extreme stress -> extremely high blood psi

S/S:

1) severe headache, syncope, blurry vision
2) blood psi ≥ 200/120 mmHg

TREATMENT:
1) sodium nitroprusside (IV vasodilator)

BONUS FACTS:
1) extreme risk of cerebrovascular accident (CVA)

Question 23

Thromboangiitis Obliterans (Buerger’s Disease)

Answer 23

ETIOLOGY
1) chronic smoking -> blood vessel inflammation and thrombus -> complete obliteration -> infarction to surrounding areas

S/S:
1) intense pain, possible ulcers or gangrene

TREATMENT:

1) cease smoking, Buerger-Allen exercises
2) amputation of gangrenous tissues

Question 24

Aneurysm

Answer 24

ETIOLOGY:
1) atherosclerosis, trauma, inflammation, infection -> weakening and dilation of blood vessel

S/S:

1) (before rupture) asymptomatic, possible palpable lump, bruit murmur
2) (if large vessel and ruptures) hemorrhagic shock

TREATMENT:
1) catheter stent graft, artery bypass graft surgery

Question 25

Phlebitis

Answer 25

ETIOLOGY:
1) linked to obesity, surgery, or trauma

S/S:
1) tenderness, warmth, swelling

TREATMENT:
1) analgesics (just symptomatic)

Question 26

Thrombophlebetis

Answer 26

ETIOLOGY
1) deep venous phlebitis, hypercoagulable blood disorders, trauma -> formation of thrombus

S/S:
1) tenderness, swelling, edema, chills, fever

TREATMENT:
1) immobilize area,
heparin (anticoagulant)

Question 27

Emboli

Answer 27

ETIOLOGY:
1) blood clot, air bubble, fat globule, or chunk of tissue -> lodged in vessel -> ischemia to surrounding areas

S/S:

1) (if peripheral artery affected) localized pain, coldness, numbness
2) (if large artery affected) nausea, dizziness, syncope, shock

TREATMENT:
1) streptokinase (thrombolytic drug), heparin (anticoagulant)

Question 28

Varicose Veins

Answer 28

ETIOLOGY:
1) inactivity -> no milking action of veins -> blood pool (distention) and places stress on veins -> permanent valvular damage

S/S:
1) dull sensation, leg cramps at night -> stabbing pain, noticeably distended veins

TREATMENT:
1) compression stockings, sclerotherapy, ligation, vein stripping, or laser ablation

Question 29

Atherosclerosis

Answer 29

ETIOLOGY:

1) RISK FACTORS: family history, obesity, sedentary lifestyle, high-fat diet, smoking
2) lipids and cholesterol in blood -> fatty streaks -> atherosclerotic fatty deposit -> risk of thrombus and infarction

S/S:
1) asymptomatic -> high blood pressure, syncope, dyspnea

TREATMENT:

1) lifestyle changes
2) lovastatin (hyperlipidemic drug)

Question 30

Raynaud’s Disease

Answer 30

ETIOLOGY:
1) cold weather, emotional events, or smoking tobacco -> arteriole vasospasm

S/S:

1) white discoloration (blanching) -> blue discoloration -> red discoloration when circulation restored
2) possible (although uncommon) digital ulceration

TREATMENT:

1) apply warmth
2) vasodilators, alpha-adrenergic blockers, CCBs (side effects may outweigh benefits)