Cardiovascular Disorders Flashcards
Where do Atheromatous lesions and subsequent occlusion usually occur?
- Vessel Bifurcations
* Decreased lumen diameter (narrowings)
Steps that cause Atherosclerosis
- Damage to the endothelial cells from mechanical/chemical/inflammation
- Platelet adhesion and clotting
- Smooth muscle cells move from middle layer into lining
- Muscle cells form atheroma in lining
- Atheroma become fibrous and hard
- Vessel narrowed
What can cause deep inflammation?
Chronic gum disease
Lingering UTI’s
Others
How does deep inflammation cause MI’s?
Weakens blood vessels which causes fatty buildups to burst
How can inflammation in patients at risk for heart disease be tested?
- Testing blood for elevated WBC
* Measuring C-reactive protein level
What is C-reactive protein?
A chemical in the blood necessary for fighting injury and infection
Two names for the plaque in Atherosclerosis
- Atheromata
* Atheromatous Lesions
How can C-reactive protein be lowered?
- cholesterol-lowering drugs
- aspirin
- diet/exercise
What are two major effects atherosclerosis has on blood vessels?
- Disrupts inner most lining causing loss of elasticity and increase in formation of clots
- Reduces diameter of vessel lumen
What causes angina?
Imbalance between myocardial O2 demand and supply
Imbalance between myocardial O2 demand and supply causes a buildup of what?
CO2
Lactic Acid
What does a buildup of metabolites (CO2 & lactic acid) in ischemic tissues cause?
Irritates nerve endings and produces anginal pain
What is the most common cause of angina pectoris?
Atherosclerotic disease of coronary arteries
A temporary occlusion caused by vasospasm of a coronary artery with or without atherosclerosis
Prinzmetal’s Angina
What does an I.V. do for the heart?
Increases preload
What creates most dysrhythmias?
Hypoxia
-decreased heart perfusion
Is a bounding pulse fast or slow?
Slow
-increased preload=decreased rate
What are some characteristics of prinzmental’s angina?
- often has ST elevation
- resistant to TX (NTG)
- pain > 10min.
- looks like an MI
- aka “Unstable Angina” or “Preinfarction Angina”
Tachypnea Tachycardia Pale, cool, clammy Delayed cap refill Hypotension ALOC
S/S of decreased Cardiac Output
O- sudden P-exercise, activity stress, big meal Q- pressure, tightness, weight, burn R- substernal, epigastric, may radiate to jaw, neck, shoulder or arm S- mild or moderate T- 3-5 min., rarely past 10min.
Angina Pectoris
Angina Pectoris TX
Calm/ reassure (⬇️O2 demand)
POC
O2 (if
How is stable angina relieved?
Rest
02
NTG
Name some associated S/S of angina
- Anxiety
- SOB
- N/V
- Diaphoresis
What layer does atherosclerotic plaque found?
Tunica Intima
Why does an MI cause CHF
MI= scar tissue=scar tissue doesn’t contract well
Why should caution be used when administering O2 and morphine on a CP Pt?
Morphine and high flow O2 ⬇️ resp. Drive
CP is caused by hypoxia
Name ECG changes w/ an MI (4)
- peaked T waves
- ST elevation
- T wave inversion
- pathologic Q waves
What vein is usually used in a CABG
Saphenous vein
What arteries are used in a CABG?
Internal mammary
Radial artery
Where do most MI’s occur?
Left ventricle
Interventricular septum
Occlusion of the left coronary artery will result in infarction where?
Anterior
Lateral
Septal wall
Occlusion of the right coronary artery will result in infarction where?
Inferior wall (inferior-posterior wall of left ventricle)
What is the most effective tx of unstable angina?
Antiplatelet agents (the thrombus is rich in platelets
Fibrinolytic therapy is not effect and can accelerate occlusion
Occurs as microemboli from a thrombus become lodged in the coronary arteries
Produces minimal damage to myocardium
Non-STEMI
ST depression
T wave abnormalities
Non-STEMI
Thrombus occluded coronary artery for a prolonged period
STEMI
Clot is rich in thrombin
Fibrinolytic stay minimize the size of infarct
What happens to cells in ischemic tissue
As cells begin to lose their electrochemical gradients they begin to swell and depolarize
What response do inferior myocardial infarction show?
Parasympathetic
What response do Anterior myocardial infarction show?
Sympathetic
Name the common fibrinolytic agents (5)
Streptokinase Tissue plasminogen activator (TPA) Tenecteplase Anistreplase Reteplase
How do fibrinolytics work?
Activate the plasma protein plasminogen to dissolve the coronary thrombus
What are the contraindications of fibrinolytic therapy?
Sys BP >180-200 Dia BP >100-110 BP in each arm different by >15 Hx of CNS disease Head/face trauma in 3 weeks Stroke >3hrs or 3 mo. Recent surgery GI bleed Blood thinner, clotting probs Pregnant Serious disease
Acidosis ALOC Cool, clammy, cyanotic, ashen skin Hypoxemia Profound hypotension Crackles Tachycardia or Dysrhythmias Tachypnea
Cardiogenic Shock
Tx of cardiogenic shock
High flow O2 (poss ET) Supine or semi-fowlers if sob IV run NS ECG correct dysrhythmias Consider dopamine
Gradual onset CP ⬇️ BP (late) Ectopy ECG changes JVD (early) Faint or muffled heart sounds SOB Pulsus Paradoxus ST elevation or t wave changes Tachycardia
Cardiac Tamponade
Beck’s Triad
Elevated venous pressure
Hypotension
Distant heart sounds
(Most reliable signs of cardiac tamponade)
Cardiac tamponade tx
Rapid transport IV bolus (if hypotensive)
Causes of aneurysm
Atherosclerotic disease(most common) Infectious disease(syphilis) Traumatic injury HTN Pregnancy Genetic disorders (e.g. Marfan Syndrome)
What causes the weak point in the wall of the aorta?
Degenerative changes in the MEDIAL layer (cystic medial necrosis)
What is the most common site for an abdominal aortic aneurysm?
The area below the renal arteries and
above the branch of the common iliac arteries
Rupture of an aneurysm begins with a tear in what layer?
Intima
What is more deadly a tear with bleeding into the retroperitoneal space or peritoneal cavity?
Peritoneal cavity
What s/s does a rupturing aneurysm have?
Syncope
Hypotension
Bradycardia (despite loss of blood)
What causes the bradycardia in an aortic aneurysm tear?
Stimulation of vagus nerve which is wrapped around the aorta. Stretches when it tears causing stimulation. Bradycardia is present despite hemorrhagic shock.
How to asses a pulsating mass
No aggressive palpation
Auscultation (similar to systolic murmur or bruit)
Where does blood move when there is a tear in the Intima
Between the Intima and adventitia
Resulting in a hematoma
Where do dissecting aortic aneurysms usually occur?
Ascending Aorta
Once dissection begins what can happen
It can extend distally or proximally
Can involve all of thoracic, abd and tributaries, coronary arteries, carotid and subclavian vessels
What happens to blood flow bypassing a dissection?
Reduced
Dissection can cause what complications due to reduced blood flow
Syncope
Stroke
Absent or reduced pulses
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve
Infection caused by a bacterium entering the blood
Iv drug use, central line, dental surgery, weakened heart valves
Hx of rheumatic (strep) fever or valvular disease at high risk
Endocarditis (infection of endocardium)
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve
Infection caused by a bacterium entering the blood
Iv drug use, central line, dental surgery, weakened heart valves
Hx of rheumatic (strep) fever or valvular disease at high risk
Endocarditis (infection of endocardium)
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve
Infection caused by a bacterium entering the blood
Iv drug use, central line, dental surgery, weakened heart valves
Hx of rheumatic (strep) fever or valvular disease at high risk
Endocarditis (infection of endocardium)
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve
Infection caused by a bacterium entering the blood
Iv drug use, central line, dental surgery, weakened heart valves
Hx of rheumatic (strep) fever or valvular disease at high risk
Endocarditis (infection of endocardium)
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve
Infection caused by a bacterium entering the blood
Iv drug use, central line, dental surgery, weakened heart valves
Hx of rheumatic (strep) fever or valvular disease at high risk
Endocarditis (infection of endocardium)
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve
Infection caused by a bacterium entering the blood
Iv drug use, central line, dental surgery, weakened heart valves
Hx of rheumatic (strep) fever or valvular disease at high risk
Endocarditis (infection of endocardium)
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve
Infection caused by a bacterium entering the blood
Iv drug use, central line, dental surgery, weakened heart valves
Hx of rheumatic (strep) fever or valvular disease at high risk
Endocarditis (infection of endocardium)
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve
Infection caused by a bacterium entering the blood
Iv drug use, central line, dental surgery, weakened heart valves
Hx of rheumatic (strep) fever or valvular disease at high risk
Endocarditis (infection of endocardium)
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve
Infection caused by a bacterium entering the blood
Iv drug use, central line, dental surgery, weakened heart valves
Hx of rheumatic (strep) fever or valvular disease at high risk
Endocarditis (infection of endocardium)
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve
Infection caused by a bacterium entering the blood
Iv drug use, central line, dental surgery, weakened heart valves
Hx of rheumatic (strep) fever or valvular disease at high risk
Endocarditis (infection of endocardium)
Claudication
Cramp like pain
Where do almost all emboli originate?
The heart
What are the most common sites of embolic occlusions?
Abdominal aorta Common femoral artery Carotid artery Brachial artery Mesenteric artery
Pain in both hips or lower limbs
Occlusion of the Terminal portion of abdominal aorta
Pain in buttocks or hip on one side
Occlusion of iliac artery
Claudication in the calf
Occlusion of femoral artery
Severe abd pain
Occlusion of mesenteric artery
Pain in extremity that may be severe and sudden or absent (paresthesia) Pallor, mottled or cyanotic distal Distal lowered skin temp ⬇️sensory and motor Distal absent pulse Bruit over site Slow cap refill distal
Acute arterial occlusion
What acute arterial occlusion is most likely to cause shock?
Mesenteric artery occlusion
Pain Edema Warmth Erythema or bluish discoloration Tenderness
DVT
What valves are most frequently affected by valvular disease?
Mitral
Aortic
What can valvular disease do to the heart?
Enlarge and thicken it
resulting in loss of elasticity and increase risk of pulmonary embolism or stroke
List 4 effects of aortic stenosis
- Narrowing of aortic valve limits blood leaving the ventricle
- Left ventricular hyperthrophy
- Decreased CO
- Incomplete atrial emptying
Heart Valve:
•less blood flows through
•no back flow
Valve Stenosis
Heart Valve:
•blood flows freely
•blood regurgitates backward through leaky valve
Incompetent Valve