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Cardiopulmonary > Cardiovascular Pathophysiology > Flashcards

Cardiovascular Pathophysiology Flashcards

1
Q

Risks factors of heart and cardiovascular disease

A
  • Smoking
  • Physical inactivity
  • Obesity
  • Suboptimal diet
  • HTN
  • Elevated serum total cholesterol: elevated low density lipoprotein or decreased high density lipoprotein
  • Diabetes: family Hx (mother/father <60 years old with cardiovascular event)
  • Age
  • Gender: male risk is higher until females reach menopause then risk is equal
  • Stress
  • Anger and hostility
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2
Q

Describe the difference between the Framingham risk score and the Reynolds risk score

A
  • Framingham: estimation of 10 year cardiovascular disease risk
  • Reynolds: Healthy and without diabetes it is designed to predict your risk of having a future heart attack, stroke, or other major heart disease in the next 10 years
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3
Q

What are the major determinants of arterial blood pressure

A
  • Cardiac output
  • Total peripheral resistance
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4
Q

What are the consequences of HTN

A
  • Cerebral aneurysm or Hemorrhagic CVA (stroke)
  • Retinopathy: arteriolar damage with micro aneurysms & rupture
  • Persistent BP elevation
  • Atherosclerosis
  • Congestive heart failure, atherosclerosis, angina, and/or MI
  • Nephrosclerosis and/or chronic renal failure
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5
Q

Describe the relationship between stroke and atrial fibrillation

A
  • A-fib remains a common & high risk condition for secondary ischemic stroke
  • Clots often form in the L atrial appendage
  • Anticoagulation is usually recommended if the patient has no contraindications
  • Anticoagulation risk must be weighed with risk for hemorrhage and/or fall risk
  • Heart rhythm monitoring for occult A-fib is usually recommended if no other cause of stroke is discovered
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6
Q

What is atherosclerosis

A
  • Fatty deposits (plaque) accumulate inside the artery wall causing blockage of blood flow
  • Plaques are composed of lipid and thrombus
  • Leads to progressive hardening & narrowing or abnormal dilation of the coronary, cerebral, & peripheral arteries
  • Can occur throughout the body in large or small arteries based on disease process
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7
Q

Possible consequences of atherosclerosis

A
  • Partial occlusion of coronary arteries: angina pectoris (ischemic heart disease)
  • Total occlusion of coronary arteries: MI
  • Partial occlusion of carotid/cerebral arteries: transient ischemic attack
  • Total occlusion of carotid/cerebral arteries: cerebrovascular accident (CVA/stroke)
  • Occlusion in the aorta: aneurysm (occlusion, rupture and hemorrhage)
  • Occlusion in the iliac arteries in the legs: peripheral vascular disease (gangrene and amputation)
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8
Q

Describe what printzmetal (vasospastic angina) angina is

A
  • Sclerotic arteries are prone to spasm
  • Vasospastic angina occurs at rest (typically early morning) and is not associated with any preceding increase in myocardial oxygen demand
  • Episodes of chest pain are associated with either transient ST segment elevation of 0.1 mV or depression of 0.1 mV
  • Pain is relieved with nitroglycerin & other vasodilators
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9
Q

What are the usual causes of death and immediate action necessary following a sudden cardiac arrest/death

A
  • Ventricular tachycardia & ventricular fibrillation leading to cessation of cardiac output are usual causes of death
  • Prompt delivery of bystander cardiopulmonary resuscitation with an automatic external defibrillator (AED) and entry into the emergency medical system is best chance of survival
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10
Q

What is commotio cordis

A
  • Abnormal heart rhythm (ventricular fibrillation) & cardiac arrest right after getting hit in the chest
  • Most cases is caused by a baseball, hockey puck, or lacrosse ball hitting the L side of your chest
  • Immediate CPR provides best chance of survival (~59% survival rate)
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11
Q

Define angina

A
  • Substernal pressure caused by an imbalance in the supply & demand of myocardial oxygen
  • Can occur anywhere from the epigastric area to the jaw & is described as squeezing, tightness, or crushing
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12
Q

Symptoms of angina

A
  • Pain is gradual and diffuse
  • Pain accompanied by shortness of breath, nausea, & diaphoresis (sweating)
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13
Q

What is the primary physiologic difference between unstable and chronic stable angina

A
  • Absence of an increase in myocardial oxygen demand to provoke the syndrome
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14
Q

What are the most common warning signs of heart attack

A
  • Uncomfortable pressure, fullness, squeezing or pain in the center of the chest (prolonged)
  • Pain that spreads to the throat, neck, back, jaw, shoulders, or arms
  • Chest discomfort with lightheadedness, dizziness, sweating, pallor (unhealthy pale appearance), nausea, or shortness of breath
  • Prolonged symptoms unrelieved by antacids, nitroglycerin, or rest
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15
Q

Describe chronic stable angina

A
  • Well established level of onset & is the result of not enough blood supply to meet the metabolic demand
  • Usually can alleviate symptoms by reducing the intensity slightly or by taking sublingual nitroglycerin
  • Metabolic demand = rate pressure product = Heart rate x Systolic BP
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16
Q

Differentiate the different types/causes of chest pain

A
  • Stable angina: tightness/pressure anywhere above the waist with exertion activity & diminishes with rest or nitroglycerin
  • Unstable angina: chest discomfort that is accelerating in frequency or severity that may occur at rest but doesn’t result in myocardial necrosis
  • Vasospastic angina (printzmetal): Chest discomfort with ST segment depression or elevation occurring at rest typically early morning
  • Musculoskeletal chest wall pain: pain/discomfort that is increased with palpation over chest wall
  • Pulmonary/Pleuritic: discomfort/pain sharp in nature that changes with breathing
  • Bronchospasm: exertion ally related or induced by cold relieved by bronchodilator or stopping activity
  • Vascular: sudden onset, constant, pleuritic pain with SOB
  • Gastrointestinal: prolonged epigastric discomfort usually related to food intake; relieved by antacid
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17
Q

What does CHEST PAIN stand for to indicate an acute coronary syndrome

A
  • Chest pain
  • High sensitivity
  • Early care
  • Share
  • Testing
  • Pathways
  • Accompanying
  • Identify
  • Noncardiac
  • Structured
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18
Q

What is the preferred blood test for in evaluation of patients with chest pain

A
  • Troponins
  • Troponins may become elevated within 2-3 hours after myocardial injury
  • High sensitivity cardiac Troponin reference range: women = <14; men = <22
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19
Q

Vital signs recommendations to stop PT for acute coronary syndrome/MI patients

A
  • Unable to comfortably speak
  • RR >40
  • Onset of S3 heart sound
  • HR decrease >10 bpm
  • SBP decrease >10 mmHg
  • MAP increase >10 mmHg
  • SpO2 <90% or a decrease ≥4%
  • New onset or worsening of cardiac dysrhythmia
  • Return of pre-MI angina like pain
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20
Q

Vital signs for initiation of PT intervention for stable angina/ECG/down trending toponin

A
  • RR <30 (able to speak comfortably)
  • Resting HR <120 bpm
  • MAP a minimum of 60 mmHg
  • SpO2 >90%
  • SBP <110 mmHg
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21
Q

Diagnosis criteria for a non-STEMI

A
  • Signs and symptoms of cardiac ischemia (chest pain or equivalent) and positive myocardial biomarkers (troponin)
  • New pathologic Q wave on the ECG often does not develop
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22
Q

Relationship between Q-wave and STEMI

A
  • Patient with a STEMI develops a Q-wave on the ECG in the subsequent 24-48 hrs & previously was defined as Q-wave or transmural infarctions
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23
Q

What is a NSTEMI

A
  • Type of MI that happens when a part of your heart is not getting enough oxygen
  • Usually occurs due to partial coronary artery blockage or blockage in a branch off of your main coronary artery
  • Some electrical pattern changes visible but often not distinctive
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24
Q

What clinical indications could require a percutaneous coronary intervention (PCI)

A
  • Acute STEMI
  • Non ST elevation acute coronary syndrome (NSTE-ACS)
  • Unstable angina
  • Stable angina
  • Anginal equivalent (dyspnea, arrhythmia, dizziness or syncope)
  • High risk stress test findings
  • Critical coronary artery stenosis is indicated fro PCI but no for coronary artery bypass surgery (CABG)
25
Q

Absolute contraindications for Fibrinolysis use in ST elevation MI

A
  • Any prior ICH
  • Known structural cerebral vascular lesion
  • Known malignant intracranial neoplasm
  • Ischemic stroke with 3 months except acute ischemic stroke within 3 hours
  • Suspected aortic dissection
  • Active bleeding or bleeding diathesis (excluding menses)
  • Significant closed head or facial trauma within 3 months
26
Q

Criteria for Type 1 MI

A
  • Symptoms of acute myocardial ischemia
  • New ischemic ECG changes
  • Development of pathological Q-waves
  • Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology
  • Identification of a coronary thrombus by angiography including intracoronary imaging or by autopsy
27
Q

What is a Type 1 MI

A
  • Plaque rupture/erosion with occlusive thrombus
  • Plaque rupture/thrombus with non-occlusive thrombus
28
Q

Criteria of Type 2 MI

A
  • Symptoms of acute myocardial ischemia
  • New ischemic ECG changes
  • Development of pathological Q-waves
  • Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology
29
Q

What is a Type 2 MI

A
  • Atherosclerosis & oxygen supply/demand imbalance
  • Vasospasm or coronary microvascular dysfunction
  • Non-atherosclerotic coronary dissection
  • Oxygen supply/demand imbalance alone
30
Q

What is a Type 3 MI

A
  • AKA sudden cardiac death
  • Ventricular tachycardia & ventricular fibrillation leading to cessation of cardiac output
  • Irreversible brain damage starts within 4-6 min from a lack of blood flow to the brain
  • Prompt delivery of bystander resuscitation with AED & entry into the emergency medical system is their best chance of survival
31
Q

Any 1 of the following criteria meets the diagnosis for prior or silent/unrecognized MI

A
  • Pathological Q-waves with or without symptoms in the absence of non-ischemic causes
  • Imaging evidence of loss of viable myocardium in a pattern consistent with ischemic etiology
  • Pathological findings of a prior MI
32
Q

Criteria for Type 4a MI

A
  • New ischemic ECG changes
  • Development of new pathological Q-waves
  • Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology
  • Angiographic findings consistent with a procedural flow-limiting complication such as coronary dissection, occlusion of a major epicardial artery or a side branch occlusion/thrombus, disruption of collateral flow, or distal embolization
33
Q

What is a Type 4b MI

A
  • Stent/scaffold thrombus associated with percutaneous coronary intervention
  • Acute = 0-24 hrs
  • Subacute = >24 hrs to 30 days
  • Late = >30 days to 1 yr
  • Very late = >1 yr after stent/scaffold implantation
34
Q

What is a Type 4c MI

A
  • Restenosis associated with percutaneous coronary intervention
  • In-stent restenosis or restenosis following balloon angioplasty in the infarct territory
  • Defined as focal or diffuse restenosis or a complex lesion associated with a rise and/or fall of cTn values
35
Q

Criteria for a Type 5 MI

A
  • Happens after a CABG surgery
  • Development of new pathological Q-waves
  • Angiographic documented new graft occlusion or new native coronary artery occlusion
  • Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology
36
Q

Wells Score/Criteria for DVT

A
  • Active CA (ongoing tx, within last 6mo, or palliative)
  • Paralysis, paresis, or recent plaster immobilization of LE
  • Recently bedridden for ≥3 days or major surgery within 12 wks requiring general/regional anesthesia
  • Localized tenderness along distribution of deep venous system
  • Entire leg swollen
  • Calf swelling at least 3cm larger than asymptomatic side
  • Pitting edema confined to symptomatic leg
  • Collateral superficial veins (nonvaricose)
  • Previously documented DVT
  • Alternative diagnosis at least as likely as DVT (-2 points from score)
  • DVT likely = ≥2 points
  • DVT unlikely = <2 points
37
Q

What is the Constans criteria for DVT in UE

A
  • CVC or pacemaker
  • Localized pain
  • Unilateral swelling
  • Alternative diagnosis likely (-1 point from score)
  • DVT UE likely = ≥2 points
  • DVT UE unlikely = ≤1 point
38
Q

What is the Geneva clinical prediction rule for pulmonary embolism (PE)

A
  • Age >65 y/o
  • Previous DVT or PE
  • Surgery within 1mo
  • Active malignant condition
  • Unilateral lower limb pain
  • Hemoptysis
  • Heart Rate ≥95 bpm
  • Pain on lower limb deep venous palpation & unilateral edema
39
Q

Based on the medication given for a DVT/PE how long after administration is it safe to mobilize

A
  • LMWH: 3-5 hrs check with medical team; >5hrs mobilize
  • Fondaparinux: 2-3hrs check with medical team; >3hrs mobilize
  • UFH: >24hrs check with medical team
  • DOAC: 2-3hrs check with medical team; >3hrs mobilize
40
Q

Criteria for HAS-BLED bleeding risk with anti-coagulation therapy

A
  • HTN uncontrolled: >160 mmHg systolic
  • Abnormal renal failure: dialysis, transplant, Cr >2.26 mg/dL or >200 umol/L
  • Abnormal liver function: cirrhosis or bilirubin
  • Stroke: prior Hx of stroke
  • Bleeding: prior major bleeding or predisposition to bleeding
  • Labile INR: (unstable/high INR) time in therapeutic range <60%
  • Elderly: age >65 y/o
  • Drug or alcohol usage history (≥8 drinks/wk)
  • Guidelines advise stopping anticoagulation if the HAS-BLED score is ≥4 and cannot be modified
41
Q

Describe how HTN, CAD, or Cardiac dysrhythmias can cause congestive heart failure

A
  • HTN: increased arterial pressure leads to L ventricular hypertrophy & increased energy expenditure
  • CAD (myocardial ischemia): dysfunction of L/R ventricle as result of injury, scar formation & decreased contractility may occur as well as reduced relaxation
  • Cardiac dysrhythmias: extremely rapid or slow cardiac arrhythmias impair the functioning ventricles
42
Q

Describe how renal insufficiency, cardiomyopathy, or heart valve abnormality can cause congestive heart failure

A
  • Renal insufficiency: causes fluid overload
  • Cardiomyopathy: contraction/relaxation or myocardial muscle fibers are impaired
  • Heart valve abnormality: valvular stenosis or incompetent valves cause myocardial hypertrophy & a decrease in ventricular distensibility with mild diastolic dysfunction
43
Q

Describe how pericardial effusion, pulmonary HTN, or pulmonary embolism can cause congestive heart failure

A
  • Pericardial effusion: injury to pericardium leads to pericarditis & progress to peripheral effusion & cardiac compression as fluid fills the pericardial sac
  • Pulmonary HTN: elevated pressures in pulmonary artery leads to increased after load for R ventricle & overtime to R ventricular failure
  • Pulmonary embolism: severe hypoxemia may result from embolism blocking a mod-large amount of lung increasing pulmonary artery pressures
44
Q

Describe how SCI or age related changes can cause congestive heart failure

A
  • SCI: transaction of the cervical spinal cord prevents the sympathetic driven changes necessary to maintain cardiac performance
  • Age related changes: decrease in cardiac output by altered contraction/relaxation of cardiac muscle
45
Q

What are the references ranges for BNP and pro-BNP

A
  • Substance made by the heart & used in the diagnosis/stratification of patients with heart failure
  • BNP <100
  • Pro-BNP <300
  • BNP >400: heart failure is likely
46
Q

Common drugs that cause orthostatic hypotension

A
  • Diuretics
  • Alpha Adrenoceptor Blockers for benign prostatic hypertrophy
  • Beta blockers (-lol’s)
  • ACE inhibitors (-pril)
  • Calcium channel blockers (-pine/-azem)
  • Angiotensin II receptor blockers (-tan)
  • Insulin, Levodopa, & Tricyclic antidepressants
47
Q

Describe the relationship between CHF and pulmonary HTN

A
  • Pulmonary HTN = mean pulmonary artery pressure ≥20 mmHg
  • A damaged or failing L heart can also lead to Pulmonary HTN as elevated L sided filling pressures bc of a weakened L ventricle beginning to passively back up into the pulmonary system increasing pressures in the pulmonary circulation
48
Q

What are the signs and symptoms of CHF

A
  • Dyspnea (difficult/labored breathing)
  • Tachypnea
  • Paroxysmal nocturnal dyspnea
  • Orthopnea (SOB when lying flat)
  • Peripheral edema
  • Cold, pale, & possibly cyanotic extremities
  • Weight gain
  • Hepatomegaly (enlargement of liver)
  • Jugular venous distention (act of swelling)
  • Rales (crackles)
  • Tubular breath sounds & consolidation
  • Prescience of an S3 heart sound
  • Sinus tachycardia
  • Decreased exercise tolerance or physical work capacity
49
Q

Describe the differences b/w HFrEF and HFpEF

A
  • HFrEF (HF with reduced ejection fraction): result of low cardiac output at rest or during exertion, systolic dysfunction, resting ejection fraction <40%, impaired contraction of ventricles during systole causing a low stroke volume
  • HFpEF (HF with preserved ejection fraction): impaired relaxation of L ventricle & passive L ventricle compliance resulting in stiffness & increased diastolic pressures, resting EF ≥50%
50
Q

Describe the classes of HF

A
  • Class I: no limitation in physical activity, no fatigue, palpitations, or dyspnea due to ordinary physical activity
  • Class II: slight limitation in PA; fatigue, palpitations, or dyspnea caused by ordinary PA
  • Class III: marked limitation of PA, less than ordinary PA cases fatigue, palpitations, or dyspnea
  • Class IV: symptoms at rest; unable to do any PA without symptomology
51
Q

Comorbidities that impact patients with CHF

A
  • COPD
  • Anemia
  • Diabetes
  • Renal dysfunction
  • Sleep disordered breathing
  • Obesity
52
Q

Symptoms that may indicate an adjustment in medications & therefore warrants communication with the physician in CHF patients

A
  • Weight gain of 2-3 lbs in 24hrs
  • Increased cough
  • Peripheral edema
  • Increase in shortness of breath with activity
  • Orthopnea: increase in the number of pillows needed
53
Q

Symptoms that indicate overt decompensation & an immediate visit to the emergency department or physician office in patients with CHF

A
  • Shortness of breath at rest
  • Unrelieved chest pain
  • wheezing or chest tightness at rest
  • Paroxysmal nocturnal dyspnea: requiring to sit in chair to sleep
  • Weight gain or loss of more than 5lbs in 3 days
  • Confusion
54
Q

What is dilated cardiomyopathy

A
  • Dysfunction of myocardial mitochondria leads to a lack of energy necessary for proper cardiac function causing the heart to be a less effective pump
  • Ineffective pumping increases L ventricular end diastolic volume & pressure which dilate the L ventricle
  • LV is unable to contract/relax properly in response to increased workload preventing myocardial hypertrophy but producing ineffective systolic function
55
Q

What is hypertrophic cardiomyopathy

A
  • Diastolic dysfunction impairs filling of ventricles during diastole
  • Increase in L ventricular end diastolic pressure & eventually L arterial, pulmonary artery, & pulmonary capillary pressures leading to a hyper contractile LV
  • High risk of sudden cardiac death
56
Q

What is restrictive cardiomyopathy

A
  • Cardiomyopathy of diastolic dysfunction & frequently unimpaired contractile functiion
57
Q

What is Takotsubo cardiomyopathy (AKA broken heart syndrome)

A
  • Condition is usually the result of severe emotional or physical stress such as a sudden illness, loss of a loved one, serious accident, or a natural disaster such as an earthquake
  • Most common in women ages 58-75 y/o
  • Most people recover with no long-term heart damage
58
Q

what causes valvular stenosis

A
  • Blocked valves
  • Calcifications
59
Q

Symptoms of a heart valve disease

A
  • Pain, tightness, or pressure in the chest
  • Lightheadedness or dizziness
  • Shortness of breath
  • Rapid fluttering heartbeat
  • Fainting
  • Difficulty sleeping or sitting up
  • Swollen ankles or feet
  • Difficulty walking short distances
  • Not engaging in activities you once did

Cardiopulmonary (9 decks)

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