Cardiovascular Disorders of the Human Body Pt. 2

Question 1

Coronary Artery Disease

Answer 1

Any vascular disorder that narrows or occludes the coronary arteries
Atherosclerosis is the most common cause

Question 2

Risk factors for CAD

Answer 2

Dyslipidemia
Hypertension
Cigarette smoking
Diabetes mellitus & insulin resistance 
Obesity
Sedentary lifestyle
Atherogenic diet

Question 3

Myocardial ischemia (Ischemic heart disease)

Answer 3

Local, temporary deprivation of the coronary blood supply
Leads to Anaerobic metabolism production of Lactic acid decrease in Myocardial pH  Cell ischemia/death

Can lead to:
Stable angina (decrease in O2, lactic acid buildup)
Prinzmetal angina (vasospastic), when patient is resting
Silent ischemia (asymptomatic, older diabetic women)

Question 4

Acute coronary syndromes (ACS)

Answer 4

Atherosclerotic plaque ruptures and may form a clot Sudden coronary obstruction
Unstable angina
Plaque has ruptured, infarction may follow
Perfusion returns before necrosis
EKG changes (ST depression, T wave inversion)
Cardiac enzymes remain normal

Question 5

Non-ST Elevation Myocardial Infarction

Answer 5

“Time = Muscle”
Subendocardial MI—only involving the layer beneath endocardium
ST depression, T wave inversion
Infarction can extend if thrombus lodges permanently into the vessel
Levine’s Sign: Fist over chest, heart pain

Question 6

ST-Elevated Myocardial Infarction

Answer 6

Infarction through all layers of myocardium, endocardium to epicardium (transmural MI)
ST elevations
Elevated cardiac enzymes
Pain may radiate to jaw, left arm
Treatment: cardiac catheter to break up plaque

Question 7

Stable Plaques

Answer 7

Have thick fibrous caps
Partially block vessels
Do not tend to form clots or emboli

Question 8

Non Stable Plaques

Answer 8

Have thin fibrous caps over large lipid core
Plaque can rupture and cause a clot to form
May completely block the artery
The clot may break free and become an embolus

Question 9

ACS: Clinical Manifestations

Answer 9

Chest pain
Shortness of breath
Feeling of impending doom
Diaphoresis 
Nausea and vomiting
Altered vital signs: going from hypertension to hypo
Cyanosis

Question 10

ACS Diagnosis

Answer 10

Electrocardiogram

Angiogram: cardiac catheter

Elevated CK-MB, Troponin I levels, Myoglobin

Question 11

Dilated Cardiomyopathies

Answer 11

Cardiac hypertrophy & dilatation w/ impaired pumping
Ventricular wall thinning
S&S are r/t heart failure

Question 12

Hypertrophic Cardiomyopathies

Answer 12

Excessive ventricular hypertrophy
Most common cause of sudden cardiac death in the young. Genetic
Disordered muscle fibers → uncoordinated contraction/relaxation→ arrhythmias→ premature death

Question 13

Restrictive Cardiomyopathies

Answer 13

Least common in Western countries
Familial origin?? or r/t endocardial amyloid infiltrations
Excessive rigidity of ventricular walls restricts ventricular filling.
S&S resemble heart failure & constrictive pericarditis.

Question 14

Risk Factors for Cardiomyopathies

Answer 14

Sustained high blood pressure
Valvular disease
Heart tissue damage from a previous heart attack
Chronic rapid heart rate
Metabolic disorders, such as thyroid disease or diabetes
Nutritional deficiencies
Pregnancy
Excessive use of alcohol over many years
Cocaine or certain medications
Viral infections

Question 15

Cardiomyopathy Complications

Answer 15

Thrombosis (Blood clots)

Heart Murmurs (Turbulent blood flow)

Cardiac arrest

Question 16

Cardiomyopathy Treatment

Answer 16

Manage symptoms
Prevent further progression of the disease 
Reduce risk of complications
Implantable defibrillator
Heart transplantation
Lifestyle changes

Question 17

Stenosis

Answer 17

Failure of valve leaflets to open properly

Question 18

Regurgitation

Answer 18

Failure of valve to close properly permitting backflow of blood

Question 19

Murmurs

Answer 19

Characteristic sound of turbulent blood flow through a diseased valve

Question 20

CHF

Answer 20

#1 reason to be admitted to the hospital
Can be caused by: Cardiomyopathies - #1 cause
Coronary insufficiency: CAD 
Myocardial infarction
Valvular heart disease
Regurgitant valvular disease
Constrictive pericarditis

Question 21

Manifestations of Heart Failure

Answer 21

Effects of impaired pumping
Compensatory responses to decreased CO
Effects of decreased renal blood flow RAA pathway
Effects of the sympathetic nervous system
Natriuretic peptides: inhibits renin, angiotensin, aldosterone

Question 22

Left Heart Failure (CHF)

Answer 22

Impaired pumping of blood
Decrease in Cardiac Output:
Anxiety, Confusion, Impaired Memory, Fatigue & activity intolerance
Leads to congestion in pulmonary circulation
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
Pulmonary edema

Question 23

Right heart failure

Answer 23

Can result from an increase in left ventricular filling pressure that is reflected back into the pulmonary circulation  
Impairs pulmonary circulation
Systemic venous accumulation
Peripheral edema
Weight gain – weigh pt daily
Visceral congestion (liver, spleen, GI tract)
JVD
Cor pulmonale

Question 24

Treatment for CHF

Answer 24

Pharmacologic treatment
Treatment of reversible causes
Restriction of salt intake
Cardiac rehabilitation
Surgical repair of heart valves

Question 25

John complains of severe shortness of breath, and has fluid in his lungs. He has tachycardia, increased diastolic blood pressure, pale moist skin, and says he feels weak, dizzy, and anxious all the time
Which are due to the sympathetic nervous system?
Which side of his heart do you think is failing?

Answer 25

(anxiety, increased BP, tachycardia)

Left (fluid in the lungs)

Question 26

Pulmonary Edema

Answer 26

Capillary fluid moves into alveoli
Lung becomes stiffer
Harder to inhale…dyspnea/air hunger
Less gas exchange in alveoli
Crackles
Frothy sputum
Hemoglobin not completely oxygenated → cyanosis

Question 27

Which of the following is the most dramatic symptom of left heart failure, can be life-threatening, and is characterized by capillary fluid moving into the alveoli?

Answer 27

Pulmonary edema

Question 28

Varicose Veins

Answer 28

Veins in which blood has pooled with blood
Appear distended, tortuous, and can be palpable
Usually in the saphenous vein
Increased intra-abdominal pressure causes gradual venous distention

S/S:
Edema & aching of the lower extremities
Edema subsides w/ elevation of legs

Stretch calf muscles

Question 29

Chronic venous insufficiency

Answer 29

Inadequate venous return cause by damage to the vein, valves leaflets, and muscle pumps
Causes: Varicose veins, Valvular incompetence, DVT’s

Leads to:
Tissue congestion
Edema
Impaired tissue nutrition
Brown pigmentation of skin (hemosiderin deposits)
Stasis dermatitis & Venous stasis ulcers – advanced venous insufficiency

Question 30

Venous thrombosis (DVT)

Answer 30

Thrombus in a vein causing obstruction of venous flow causing an inflammatory response in the vessel wall.
Strongly associated with chronic venous insuff.
PREVENTION IS KEY!!!
Factors: Venous stasis, Venous endothelial damage, Trauma, surgery, SCI

Hypercoagulable states
Oral contraceptives
Hematological malignancy
Pregnancy/ Postpartum

Question 31

Superior Vena Cava Syndrome

Answer 31

Progressive occlusion of the SVC that leads to venous distention in the upper extremities and head
Leading cause: Bronchogenic cancer

Question 32

Treatment for SVC

Answer 32

Malignant disorders
Radiation therapy; surgery; chemotherapy; administration of diuretic, steroidal, and anticoagulant agents

Nonmalignant causes
Bypass surgery using various grafts, thrombolysis (both locally and systemically), balloon angioplasty, and placement of intravascular stents