Cardiovascular - Lecture 2 Flashcards
Describe right-sided heart failure
MUST KNOW
Ineffective RV contractility
Failure of RV pumping ability
Decreased CO to lungs
Blood backup into RA & peripheral circulation
Weight gain, peripheral oedema, engorgement of kidneys & other organs
Describe left-sided heart failure
MUST KNOW
Ineffective LV contractility
Failure of LV pumping ability
Decreased CO to body
Blood backup into LA & lungs
Pulmonary congestion, dypsnea, activity intolerance
Pulmonary oedema, right-sided heart failure
What is angina/how does it occur?
MUST KNOW
When cardiac workload & myocardial O2 demands exceed the ability of coronary arteries to supply adequate amount of oxygenated blood - transient myocardial iscemia
Symptoms & Signs of angina
generally not painful, a troublesome ache
discomfort below sternum, may radiate to left shoulder, down inside of left arm, throat, jaw, teeth, upper abdo - never above ears or below umbilicus
What is unstable angina?
MUST KNOW
Any change in angina is unstable & should be taken seriously, suddenly occurring with rest etc
What is myocardial infarction?
MUST KNOW
Myocardial necrosis resulting from abrupt disruption in coronary blood flow to part of the myocardium. Infarcted tissue is permanently dysfunctional & predominantly affects the LV
Valvular Heart Disease - Aortic stenosis-what is it?
MUST KNOW
A narrowing of the aortic valve, obstructing blood flow from the LV to the ascending aorta during systole
Aetiology of aortic stenosis
aortic schlerosis, degenerative aortic valve disease, thickening of aortic valve structures by fibrosis & calcification - over years schlerosis turns into stenosis
Symptoms & signs of aortic stenosis
exertional syncope because cardiac output can’t increase enough to cope with demands
angina
dyspnoea
clinical manifestation of aortic stenosis
aortic regurgitation due to increased pressure load & hypertrophy of LV
carotid & peripheral pulses weaker
systolic BP may be high
hallmark finding is a crescendo-decrescendo ejection murmur, heard at upper L & R sternal borders when a pt. leans forward - murmur becomes louder when stenosis worse
Prognosis of aortic stenosis
50% of deaths occur suddenly when severe
valve replacement for pts. who can tolerate surgery
What is aortic regurgitation? What is it caused by?
MUST KNOW
incompetancy of the aortic valve causing flow from the aorta into the left ventricle during systole
Caused by infective endocarditis, chronic - rheumatic fever
Presentation, symptoms & signs of aortic regurgitation
acute - HF & cardiogenic shock
chronic - asymptomatic for years, progressive exertional dyspnea, palpitations
Signs - as chronic develops - systolic BP goes up, diastolic down, murmur, normal S1, slapping S2, head bobbing,femoral bruit, pulsation of fingernail capilliaries
What is mitral stenosis?
What is it caused by?
MUST KNOW
narrowing of the mitral valve that impedes flow from left atrium to left ventricle
caused by Rheumatic fever almost always
Presentation/signs & symptoms of mitral stenosis
loud S1, murmur increases after valsalva, large LV & increased pressure to compensate, pulmonary venous pressure increases leading to right ventricular failure/tricuspid regurg. leading to LA enlargement & perhaps atrial fibrillation
15-40 years: generally asymtomatic until atrial fibrillation, initial symptoms similar to heart failure, dyspnea
chronic - pulmonary oedema, fatigue
What is pericarditis?
What is it caused by?
MUST KNOW
inflam. of pericardium, often with fluid accumulation
Caused by - infection, MI, trauma, tumours, cancer, metabolic disorders
Clinical presentation - signs & symptoms
Inflammation &/or fluid accumulation
acute - chest pain, maybe dyspnea
cardiac filling impaired leading to low CO, friction rub may be heard
chest pain, dull or sharp sub sternal, may radiate to neck, shoulders (mild to severe) usually aggravated by thoracic motion tachypnea fever chills/weakness
List some causes of chest pain - think of heart & outside of that area….
angina - tight, heavy
myocardial infarction - tight, heavy, more severe than ang.
pericarditis - sharp, raw, worse lying down
aortic dissection - severe, tearing interscapular (stroke..)
respiratory - pleuritic pain - sharp, stabbing, inspir. worse
GO reflux - burning discomfort, worse bending
oesophageal spasm - central chest, can mimic angina
musculoskeletal - costochondritis, rib fracture
dermatolgical - shingles, usually unilateral
Chest pain red flags
tachycardia bradycardia tachypnea hypotension Signs of hypoperfusion - confusion, ashen colour, perspiring a lot shortness of breath new heart murmurs
Common presenting complaint
chest discomfort breathlessness palpitation pre syncope/syncope peripheral oedema
Breathlessness - generally due to 1 of 4 reasons……..
1 - Increased ventilatory demand - exertion, illnes with a fever, hypoxic state, severe anaemia, metabolic acidosis
2 - Decreased ventilatory capacity - pleural effusion, pneumothorax, intrathoracic mass, rib injury or muscle weakness
3 - increased airway resistance - asthma, chronic obstructive pulmonary disease
4 - decreased pulmonary compliance - interstitial fibrosis, pulmonary odema
Could also be left ventricular dysfunction related
