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Pathophysiology > Ch 12 cardio > Flashcards

Ch 12 cardio Flashcards

1
Q

Where is the heat located

A

Mediastinum between lungs

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2
Q

Located in the floor of the right atrium

A

Atrioventricular node

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3
Q

Consists of the right and left branches

A

Bundle of his also known as AV bundle

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4
Q

What are the terminal fibers

A

Perkins fibers

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5
Q

What consists of the sinus rhythm and pacemaker

A

Sing atrial node

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6
Q

What are the parts of a ECG

A

P wave
QRS waves
T wave

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7
Q

What wave of an ECG

Atrial depolarization

A

P wave

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8
Q

What wave of an ECG

Ventricular depolarization

A

QRS wave

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9
Q

What wave of ECG

Ventricular depolarization

A

T wave

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10
Q

What controls heart rate and contraction force

A

Medulla

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11
Q

Detect changes in blood pressure

A

Bark receptors

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12
Q

Where is the baroreceptors located

A

In the aorta and internal carotid arteries

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13
Q

Increases heart rate

A

Sympathetic stimulation

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14
Q

What is another name for the sympathetic stimulation

A

Cardiac accelerator nerve

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15
Q

Decreases heart rate

A

Parasympathetic stimulation

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16
Q

What is another name for the parasympathetic stimulation

A

Vagus nerve

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17
Q

Important site of action for some drugs

A

Sympathetic or beta1 adrenergic receptors

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18
Q

What are the eight factors that increase heart rate

A 
Increased thyroid hormones or epinephrine
Elevated body temperature or infection
Increased environmental temperature
Exertion or exercise
Smoking
Pregnancy
Pain
Stress response
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19
Q

Part of the systemic circulation

Branch of aorta immediately distal to the aortic valve

A

Right and left coronary arteries

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20
Q

Functions as pump for circulating blood

A

Heart

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21
Q

what two things does the left coronary artery divide into

A

left anterior descending or interventricular artery

left circumflex artery

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22
Q

what two things does the right coronary artery branch into

A

right marginal artery

posterior interventricular artery

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23
Q

blood flow through the myocardium is greatest during what and is reduced during what

A

diastole (relaxation)

systole (contraction)

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24
Q

Many small branches extend from the coronary arteries to supply what two things

A

myocardium

endocardium

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25
Q

collateral circulation is what

A

extremely limited

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26
Q

relaxation of the myocardium required for filling chambers

A

diastole

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27
Q

contraction of myocardium provides increase in pressure to eject blood

A

systole

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28
Q

name the steps of the cardiac cycle

A

Atria relaxed (filling with blood) to the AV valves open to blood flows into ventricles to atria contract (remaining blood forced into ventricles) to atria relax to ventricles contract to AV valves close to semilunar valves open to blood into aorta and pulmonary artery to ventricles relax

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29
Q

diastole or systole
atria fills, all valves close
increased atrial pressure opens AV valves, ventricles fill
ventricles empty, ventricles relax, aortic and pulmonary valves close

A

diastole

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30
Q

diastole or systole
atria contract and empty, ventricles are full
ventricles begin contraction, pressure closes AV valves, atria relax
ventricles contract, increased pressure in ventricles, aortic and pulmonary valves open, blood ejected from aorta and pulmonary artery

A

systole

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31
Q

whats the sound?

closure of AV valves

A

Lubb

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32
Q

whats the sound?

closure of the semilunar valves

A

Dub

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33
Q

caused by incompetent valves

A

murmurs

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34
Q

indicates heart rate

A

pulse

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35
Q

difference in rate between apical and radial pulses

A

pulse deficit

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36
Q

what is the equation for cardiac output

A

CO=SV * HR
SV stroke volume
HR heart rate

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37
Q

blood ejected by a ventricle in one minute

A

cardiac output

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38
Q

volume of blood pumped out of ventricle-contraction

A

stroke volume

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39
Q

what varies with the stroke volume

A

sympathetic stimulation and venous return

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40
Q

ability of the heart to increase output in response to increased demand

A

cardiac reserve

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41
Q

amount of blood delivered to heart by venous return

A

preload

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42
Q

forced required to eject blood from ventricles

A

afterload

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43
Q

what is the afterload determined by

A

peripheral resistance in arteries

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44
Q

the number of contractions of the ventricles each minute

A

heart rate

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45
Q

exerted when blood is ejected from ventricles

A

systolic pressure

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46
Q

sustained pressure when ventricles relax

A

diastolic

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47
Q

blood pressure is altered by what

A

cardiac output
blood volume
peripheral resistance to blood flow

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48
Q

changes in blood pressure for sympathetic branch of ANS: increased and decreased

A

increased output: vasoconstriction and increased blood pressure
decreased output: vasodilation and decreased blood pressure

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49
Q

blood pressure is directly proportional to what

A

blood volume

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50
Q

What does antidiuretic hormone do to blood pressure

A

increases

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51
Q

what does aldosterone do to blood pressure and blood volume

A

increase both

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52
Q

what does renin-angiotensin-aldosterone do to blood pressure and which type of vaso

A

increase

vasoconstriction

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53
Q

What is the equation for blood pressure

A

BP=CO * PR
CO cardiac output
PR peripheral resistance

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54
Q

blood pressure has no change (equation)

A

increase cardiac output and decrease peripheral resistance

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55
Q

blood pressure is elevated (equation)

A

cardiac output has no change and increase peripheral resistance

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56
Q

increased blood pressure (equation)

A

increase heart rate which increases cardiac output and systemic vasoconstriction which increases peripheral resistance

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57
Q

decreased blood pressure (equation)

A

decrease in stroke volume which decreases cardiac output and systemic vasodilation which decreases peripheral resistance

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58
Q

useful in the initial diagnosis and monitoring of dysrhythmias, myocardial infarction, infection , pericarditis

A

electrocardiography

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59
Q

what are the diagnostic tests for cardiovascular function

A 
blood tests
doppler studies
arterial blood gas determination
cardiac catheterization
angiography
exercise stress test
chest x-rays
nuclear imaging
SPECT
tomographic studies
auscultation
echocardiography
electrocardiography
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60
Q

determination of valvular abnormalities or abnormal shunts of blood that cause murmurs

A

auscultation

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61
Q

how is auscultation detected

A

by listening through a stethoscope

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62
Q

used to record heart valve movements, blood flow, and cardiac output function

A

echocardiography

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63
Q

used to assess general cardiovascular

A

exercise stress test

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64
Q

what is used for an exercise stress test

A

bicycle, treadmill, or steps

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65
Q

used to show shape and size of the heart

A

chest x-rays

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66
Q

measures pressure and assesses valve and heart function

A

cardiac catheterization

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67
Q

determines central venous pressure and pulmonary capillary wedge pressure

A

cardiac catheterization

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68
Q

visualization of blood flow in the coronary arteries

A

angiography

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69
Q

checks the current oxygen level and acid-base balance

A

arterial blood gas determination

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70
Q

assess levels of serum triglycerides, cholesterol, sodium, potassium, calcium, and other electrolytes

A

blood test

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71
Q

assess blood flow in peripheral vessels

A

Doppler studies

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72
Q

record sounds of blood flow or obstruction

A

Doppler studies

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73
Q

general treatment measures for cardiac disorders

A 
diuretics
anticoagulants
cholesterol-lowering drugs
digoxin
antihypertensive drugs
adrenergic blocking drugs
angiotensin-converting enzyme inhibitors
vasodilators
beta blockers
calcium channel blockers
dietary modifications
regular exercise program
cessation of smoking
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74
Q

what would dietary modifications for cardiac disorders do for the body

A

to decrease total fat intake
general weight reduction
reduce salt intake

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75
Q

what would regular exercise program for cardiac disorders do for the body

A

increases high-density lipoprotein levels
lowers serum lipid levels
reduces stress levels

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76
Q

what would cessation of smoking for cardiac disorders do for the body

A

decreases risk of coronary disease

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77
Q

what would vasodilators for cardiac disorders do for the body

A

reduction of peripheral resistance

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78
Q

what would beta blockers for cardiac disorders do for the body

A

treatment of hypertension and dysrhythmias

reduction of angina attack

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79
Q

what would calcium channel blockers for cardiac disorders do for the body

A

decrease cardiac contractility
prophylactic against angina
antihypertensives and vasodilators

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80
Q

what would digoxin for cardiac disorders do for the body

A

treatment for heart failure

antidysrhythmic drug for atrial dysrhythmias

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81
Q

what would antihypertensive drugs for cardiac disorders do for the body

A

used to lower blood pressure

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82
Q

what would adrenergic blocking drugs for cardiac disorders do for the body

A

act on SNS centrally or on the periphery

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83
Q

what would angiotensin-converting enzyme inhibitors for cardiac disorders do for the body

A

block conversion of angiotensin I to angiotensin II

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84
Q

what would diuretics for cardiac disorders do for the body

A

remove excess sodium and/or water

treat high blood pressure and congestive heart failure

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85
Q

what would anticoagulants for cardiac disorders do for the body

A

reduce risk of blood clot formation

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86
Q

what would cholesterol-lowering drugs for cardiac disorders do for the body

A

reduce low-density lipoprotein and cholesterol levels

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87
Q

what is nitroglycerin used for

A

angina attacks and prophylaxis

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88
Q

what is nitroglycerin’s action

A

reduces cardiac workload

peripheral and coronary vasodilator

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89
Q

what are the adverse effects of nitroglycerin

A

dizziness

headache

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90
Q

what are the adverse effects of metoprolol

A

dizziness

fatigue

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91
Q

what is the use of metoprolol

A

hypertension
angina
antiarrhythmic

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92
Q

what is the action of metoprolol

A

blocks beta-adrenergic receptors

slows heart rate

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93
Q

what is the use of nifedipine

A

angina
hypertension
peripheral vasodilator
antiarrhythmic

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94
Q

what is the action of nifedipine

A

calcium blockers

vasodilator

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95
Q

what is the adverse effects of nifedipine

A

dizziness
fainting
headache

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96
Q

what is the adverse effects of digoxin

A

nausea
fatigue
headache
weakness

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97
Q

what is the use of digoxin

A

congestive heart failure and atrial arrhythmias

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98
Q

what is the action of digoxin

A

slows conduction through AV node and increases force of contraction to increase efficiency

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99
Q

what is another name for digoxin

A

lanoxin

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100
Q

what is another name for nifedipine

A

adalat

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101
Q

what is another name for metoprolol

A

lopressor

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102
Q

what is another name for enalapril

A

vasotec

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103
Q

what is the use of enalapril

A

hypertension

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104
Q

what is the action of enalapril

A

ACE inhibitor

blocks formation of angiotensin II and aldosterone

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105
Q

what are the adverse effects of enalapril

A

headache
dizziness
hypotension

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106
Q

what are the adverse effect of furosermide

A

nausea
diarrhea
dizziness

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107
Q

what are the adverse effects of simvastatin

A

digestive discomfort

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108
Q

what are the adverse effects of warfarin

A

excessive bleeding

needs more Vitamin K

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109
Q

what are the adverse effects of ASA

A

gastric irritation

allergy

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110
Q

What is another name for furosemide

A

lasix

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111
Q

what is another name for simvastatin

A

zocor

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112
Q

what is another name for warfarin

A

coumadin

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113
Q

what is another name for ASA

A

aspirin

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114
Q

what is the use of furosemide

A

edema with CHF

hypertension

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115
Q

what is the action of furosemide

A

diuretic increases excretion of water and sodium

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116
Q

what is the use of simvastatin

A

hypercholesteremia

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117
Q

what is the action of simvastatin

A

decreases cholesterol and LDL

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118
Q

what is the use of warfarin

A

prophylaxis and treatment of thromboemboli

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119
Q

what is the action of warfarin

A

anticoagulant interferes with Vitamin K in synthesis of clotting

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120
Q

what is the use of ASA

A

prophylaxis of thromboemboli

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121
Q

what s the action of ASA

A

prevents platelet adhesion

antiinflammatory

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122
Q

what is CAD

A

coronary artery disease

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123
Q

what is IHD

A

ischemic heart disease

124
Q

what is ACS

A

acute coronary syndrome

125
Q

presence of atheromas in large arteries

A

artherosclerosis

126
Q

general term for all types of arterial changes

A

arteriosclerosis

127
Q

degenerative changes in small arteries and arterioles
loss of elasticity
lumen gradually narrows and may become obstructed
cause of increased blood pressure

A

arteriosclerosis

128
Q

plaques consisting of lipids, calcium, and possible clots

related to diet, exercise, and stress

A

atherosclerosis

129
Q

are transported in combination with proteins

130
Q

transports cholesterol from liver to cells

major factor contributing to atheroma formation

A

low density lipoprotein (LDL)

131
Q

transports cholesterol away from the peripheral cells to liver
catabolism in liver and excretion

A

high density lipoprotein (HDL)

132
Q

what type is good cholesterol

133
Q

what type of cholesterol are bad cholesterol

134
Q

what are the eight steps to development of an atheroma

A

dietary intake of cholesterol and triglycerides
chylomicrons absorbed into blood and lymph
lipid uptake by adipose and skeletal muscle cells
remnants to liver
liver synthesizes lipoproteins
LDL transports cholesterol to cells
LDL attaches to LDL receptor in smooth muscle and endothelial tissue
HDL transports cholesterol from cells to liver

135
Q

nonmodifiable risk factors for atherosclerosis

A

age (more common after 40)
gender
genetic or familial factors

136
Q

modifiable risk factors for atherosclerosis

A

obesity
sedentary lifestyle
cigarette smoking
diabetes mellitus
poorly controlled hypertension
combination of oral contraceptives and smoking
combination of high cholesterol and high blood pressure

137
Q

diagnostic tests of atherosclerosis

A

serum lipid levels

138
Q

treatment of atherosclerosis

A

weight loss
increase exercise
lower total serum cholesterol and LDL levels by dietary modification
reduce sodium intake
control chronic disorders (hypertension and diabetes)
cessation of smoking
antilipidemic drugs
surgical intervention, such as coronary artery bypass grafting

139
Q

what does a total occlusion cause in the heart

A

myocardial infarction

140
Q

what does a partial occlusion cause in the heart

A

angina pectoris

141
Q

what does a partial occlusion cause in the brain

A

transient ischemic attack

142
Q

what does a total occlusion cause in the brain

A

cerebrovascular accident

143
Q

what causes an occlusion, rupture, and hemorrhage

144
Q

what causes gangrene and amputation

A

peripheral vascular disease

145
Q

occurs when there is a deficit of oxygen to meet myocardial needs

A

angina pectoris

146
Q

what are the different patterns that chest pain may occur

A

classic or exertional angina
variant angina
unstable angina

147
Q

what occurs in a variant angina

A

vasospasm occurs at rest

148
Q

what occurs in an unstable angina

A

prolonged pain at rest and may precede myocardial infarction

149
Q

decreased oxygen supply means what two things

A

decreased activity

pain

150
Q

attacks vary in severity and duration but become more frequent and longer as disease progresses
recurrent, intermittent brief episodes of substernal chest pain

A

angina pectoris

151
Q

what triggers angina pectoris

A

physical or emotional stress

152
Q

angina pectoris is relieved by what

A

rest and administration of coronary vasodilators

153
Q

primarily acts by reducing systemic resistance, decreasing the demand for oxygen

A

nitroglycerin

154
Q

what are the emergency treatments for angina

A

rest, stop activity
patient seated in administer oxygenupright position
administration of nitroglycerin
check pulse and respiration

155
Q

occurs when coronary artery is totally obstructed
vasospasm is cause in a small percentage
part of thrombus may break away, forming embolus

A

myocardial infarction

156
Q

what is the most common cause of a myocardial infarction

A

atherosclerosis

157
Q

what may obstruct the artery in a myocardial infarction

A

thrombus from atheroma

158
Q

what determines the damage of a myocardial infarction

A

size and location of the infarct

159
Q

what are the warning signs of a heart attack

A

feeling of pressure, heaviness, or burning in chest
sudden shortness of breath, weakness, fatigue
hypotension, rapid pulse
nausea, indigestion
anxiety and fear
pain may occur and can be crushing, radiating, and substernal

160
Q

what are the diagnostic tests of a myocardial infarction

A

changes in ECG
serum enzyme and isoenzyme levels
serum levels of myosin and cardiac troponin are elevated
serum electrolyte levels may be abnormal
leukocytosis, elevated C-reactive protein and erythrocyte sedimentation rate common
arterial blood gas measurements may be altered in severe cases
pulmonary artery pressure measurements

161
Q

at what time are the serum levels high: CPK-MB, AST, and LDH-1

A

LDH-1: 72 hours
AST: 48 hours
CPK-MB: 24 hours

162
Q

what are complications of myocardial infarction

A 
sudden death
cardiogenic shock
CHF
rupture of necrotic heart tissue (ventricular aneurysm)
thromboembolism
163
Q

What are the treatments of a myocardial infarction

A 
reduce cardiac demand
oxygen therapy
analgesics
anticoagulants
thrombolytic agents may be used
tissue plasminogen activator
medication
164
Q

what are the medications to treat myocardial infarction

A

dysrhythmias
hypertension
CHF
cardiac rehabilitation begins immediately

165
Q

for monitoring the conduction system that detects abnormalities

A

electrocardiography

166
Q

what are deviations from normal cardiac rate or rhythm caused by

A

electrolyte abnormalities, fever, hypoxia, stress, infection, drug toxicity

167
Q

reduction of the efficiency of the heart’s pumping cycle

A

cardiac dysrhythmias

168
Q

pacemaker of the heart and rate can be altered

169
Q

regular but slow heart rate

A

bradycardia

170
Q

regular rapid heart rate

A

tachycardia

171
Q

marked by altering bradycardia and tachycardia

A

sick sinus syndrome

172
Q

often requires a mechanical pacemaker

A

sick sinus syndrome

173
Q

what are the three atrial conduction abnormalities

A

atrial flutter
atrial fibrillation
premature atrial contractions

174
Q

extra contraction or ectopic beats
irritable atrial muscle cells outside conduction pathway
palpitations

A

premature atrial contractions

175
Q

atrial heart rate of 160 to 350 beats a minute

AV node delays conduction (ventricular rate slower)

A

atrial flutter

176
Q

rate over 350 beats a minute
causes pooling of blood in the atria
thrombus formation is a risk

A

atrial fibrillation

177
Q

what degree block: conduction delay between atrial and ventricular contractions

178
Q

what degree block: every second to third atrial beat dropped at AV node

179
Q

what degree block: no transmission from atria to ventricles

total blockage

180
Q

conduction excessively delayed or stopped at AV node or Bundle of His

A

heart block

181
Q

What are different ventricular conduction abnormalities

A

bundle branch block
ventricular tachycardia
ventricular fibrillation
premature ventricular contractions

182
Q

interference with conduction in one of the bundle branches

A

bundle branch block

183
Q

likely to reduce cardiac output as reduced diastole occurs

A

ventricular tachycardia

184
Q

muscle fibers contract independently and rapidly

cardiac standstill occurs if not treated immediately

A

ventricular fibrillation

185
Q

additional beats from ventricular muscle cell or ectopic pacemaker
may lead to ventricular fibrillation

A

premature ventricular contractions

186
Q

what is the effect of bradycardia

A

stroke volume increased

possibly reduced cardiac output

187
Q

what is the effect of tachycardia

A

possibly reduced cardiac output

188
Q

what is the effect of atrial flutter

A

less filling time

often reduced cardiac output

189
Q

what is the effect of fibrillation

A

no filling, no output- cardiac standstill

190
Q

what is the effect of premature ventricular contractions

A

may induce fibrillation

191
Q

what is the effect of bundle branch block

192
Q

what is the effect of first heart block

193
Q

what is the effect of second heart block

A

periodic decrease in output

194
Q

what is the effect of a total heart block

A

marked decrease in output, causing syncope

195
Q

what is used to treat cardiac dysrhythmias

A

antidysrhythmic drugs
SA nodal problems or total heart block require pacemaker
defibrillator may be implanted for conversion of ventricular fibrillation

196
Q

asystole

A

cardiac arrest

197
Q

cessation of all heart activity means

A

no conduction of impulses

flat EKG

198
Q

what are reasons of cardiac arrest

A 
excessive vagal nerve stimulation
potassium imbalance
cadiogenic shock
drug toxicity
insufficient oxygen
respiratory arrest
blow to heart
199
Q

heart is unable to pump out sufficient blood to meet metabolic demands of the body

A

congestive heart failure

200
Q

when heart cannot maintain pumping capability for CHF (2)

A

cardiac output or stroke volume decreases

backup and congestion develop as coronary demands for oxygen and glucose are not met

201
Q

why does cardiac output or stroke volume decrease (4)

A

less blood reaches the various organs
decreased cell function
fatigue and lethargy
mild acidosis develops

202
Q

How does backup and congestion develop as coronary demands for oxygen and glucose are not met (2)

A

output from ventricle is less than the inflow of blood

congestion in venous circulation draining into the affected side of the heart

203
Q

what are the effects of CHF left side

A

left ventricle weakens and cannot empty
decreased renal blood flow stimulates renin-angiotensin and aldosterone secretion
high pressure in pulmonary capillaries leads to pulmonary congestion or edema

204
Q

what are the effects of CHF right side

A

right ventricle weakens and cannot empty
decreased renal blood flow stimulates renin-angiotensin and aldosterone secretion
increased venous pressure results in edema in legs and liver and abdominal organs
very high venous pressure causes distended neck vein and cerebral edema

205
Q

what are the three compensation mechanisms of CHF

A

tachycardia
cutaneous and visceral vasoconstriction
daytime oliguria

206
Q

what are the four forward effects of CHF

A

decreased blood supply to tissues, general hypoxia
fatigue and weakness
dyspnea and shortness of breath
exercise and cold intolerance

207
Q

what is the first sign of CHF in children

A

feeding difficulties

failure to gain weight or meet developmental guidelines

208
Q

what are four signs of CHF in children

A

short sleep periods
tripod position to play
cough, rapid grunting respirations, flared nostrils, wheezing
often a third heart sound is present

209
Q

radiographs for CHF in children shows what

A

cardiomegaly and presence of absence of fluid in lungs

210
Q

arterial blood gases are used to measure what in CHF in children

211
Q

structural defects in the heart that develop during the first eight weeks of embryonic life

A

cardiac anomalies

212
Q

septal defects
valvular defects
detected by the presence of heart murmurs

A

congenital heart disease

213
Q

depending on the direction of shunting in congenital heart defects can be

A

acyanotic or cyanotic

214
Q

what are the seven signs and symptoms of large congenital heart defects

A 
pallor
tachycardia
dyspnea on exertion
squatting position
clubbed fingers
intolerance for exercise and exposure to cold weather
delayed growth and development
215
Q

signs of congenital heart defects what does a squatting position do

A

appears to modify blood flow

216
Q

True or false severe defects are often diagnosed at birth and others may not be detected for some time

217
Q

what are the five different examination techniques of congenital heart defects

A 
radiography
diagnostic imaging
cardiac catheterization
echocardiography
electrocardiography
218
Q

what is the most common congenital heart defect

A

ventricular septal defect

219
Q

congenital heart defect hole in the heart; opening in the interventricular septum

A

ventricular septal defect

220
Q

what are the three things that happen with untreated ventricular septal defects

A

pressure usually higher in left ventricle
shunt from left to right
acyanotic condition unless respiratory condition increases pressure in right ventricle

221
Q

usually affect aortic and pulmonary valves
may be classified as stenosis or valvular incompetence
mitral valve prolapse

A

ventricular septal defect

222
Q

abnormally enlarged and floppy valve leaflets

A

mitral valve prolapse

223
Q

failure of valve to close completely

blood regurgitates or leaks backward

A

stenosis or valvular incompetence

224
Q

surgical repair of ventricular septal defect

A

mechanical or animal tissue

225
Q

occurs because shunt bypasses the pulmonary circulation

226
Q

most common cyanotic congenital heart condition

alters pressures in heart and alters blood flow

A

tetralogy of fallot

227
Q

what are the four abnormalities of tetralogy of fallot

A

involves heart as well as joints
VSD
dextroposition of the aorta
right ventricular hypertrophy

228
Q

acute systemic inflammatory condition
may result from an abnormal immune reaction
can occur a few weeks after an untreated infection
involves heart as well as joints
usually occurs in children ages 5 to 15 years old

A

rheumatic fever

229
Q

rheumatic fever may be complicated by what

A

infective endocarditis and heart failure in older adults

230
Q

what untreated infections could cause rheumatic fever

A

group A beta hemolytic streptococcus

231
Q

acute stage of rheumatic fever

A

inflammation of the heart
myocarditis
pericarditis
endocarditis and incompetent heart valves

232
Q

other sites of inflammation that have to do with rheumatic fever

A

large joints
erythema marginatum
nontender subcutaneous nodules
involuntary jerky movement of the face, arms, legs

233
Q

signs and symptoms of rheumatic fever

A

low-grade fever, leukocytosis, malaise, anorexia, fatigue, tachycardia, heart murmur, abdominal pain

234
Q

what diagnostic tests are used for rheumatic fever

A

heart function test
electrocardiography
ASO titer

235
Q

what treatments are used for rheumatic fever

A

prophylactic antibacterial agents

anti-inflammatory agents

236
Q

subacute infective endocarditis

A

streptococcus viridans

may interfere with opening and closing of valves

237
Q

acute infective endocarditis

A

staphylococcus aureus

238
Q

factors that predispose to endocarditis infection

A

bactermia
reduced host defenses
presence of abnormal valves in heart

239
Q

increasing fatigue, anorexia, cough, and dyspnea

A

insidious onset

240
Q

subacute endocarditis has what onset

241
Q

how is endocarditis treated

A

antimicrobial drugs for several weeks often IV

242
Q

sudden, marked onset, spiking fever, chills, drowsiness, heart valves badly damaged

A

acute endocarditis

243
Q

signs of infective endocarditis

A

new heart murmurs, low grade fever or fatigue, anorexia, splenomegaly, congestive heart failure in severe cases

244
Q

simple inflammation of the pericardium
chest pain
effusion may develop
can be secondary

A

acute pericarditis

245
Q

pericarditis may be secondary to

A

open heart surgery, myocardial infarction, rheumatic fever, systemic lupus erythematosus, cancer, renal failure, trauma, viral infection

246
Q

what does it mean for effusion in pericarditis

A

large volume of fluid accumulates in pericardial sac

leads to distended neck veins, faint heart sounds, pulsus paradoxus

247
Q

what are the five effects of pericardial effusion

A 
fluid around heart compresses heart wall
heart cannot expand to fill
backup into systemic circulation
decreased blood flow to lungs
decreased output to body
248
Q

Results in formation of adhesions between the pericardial membranes
Fibrous tissue ten results from tuberculosis or radiation to the mediastinum
Limiting movement of the heart during diastole and systole reduced cardiac output
Inflammation or infection may develop from adjacent structures
Causes fatigue, weakness, abdominal discomfort

A

Chronic pericarditis

249
Q

Cause by systemic venous congestion

A

Chronic pericarditis

250
Q

Arrhythmias has to do with

A

Myocarditis

251
Q

Valve damage has to do with

A

Endocarditis

252
Q

Effusion has to do with

A

Pericarditis

253
Q

High blood pressure
Often undiagnosed
Sometimes classified as systolic and diastolic

A

Hypertension

254
Q

What age group may hypertension occur

A

Any age group

255
Q

Hypertension is what type of disease

A

Arterial disease

256
Q

What individuals are more common to have hypertension

A

African ancestry

257
Q

Essential hypertension
Idiopathic
Increase in arteriolar vasoconstriction
Over long period of time there is damage to arterial walls

A

Primary hypertension

258
Q

What is the blood pressure for primary hypertension

A

Consistently above 140/90

259
Q

How does primary hypertension damage arterial walls

A

Blood supply to involved area is reduced

Ischemia and necrosis of tissues with loss of function

260
Q

Results from renal or endocrine disease, pheochromocytoma, or SNS chain of ganglia
Underlying problem must be treated to reduce blood pressure

A

Secondary hypertension

261
Q

Benign tumor of the adrenal medulla

A

Pheochromocytoma

262
Q

Uncontrollable, severe, and rapidly progressive form with many complications
Diastolic pressure is extremely high

A

Malignant or resistant hypertension

263
Q

What are the areas most frequently damaged by hypertension

A

Kidneys
Heart
Brain
Retina

264
Q

What are the five predisposing factors of hypertension

A

Incidence increases with age
Men affected more frequently and more severely
incidence in women increases after middle age
Genetic factors
Sodium intake, excessive alcohol intake, obesity, smoking, prolonged or recurrent stress

265
Q

What are the initial signs of hypertension

A

Fatigue, malaise, sometimes morning occipital headache

266
Q

What are the five steps to treat essential hypertension

A 
Lifestyle changes
Reduction of sodium intake
Weight reduction
Reduction of stress
Drugs like diuretics, ACE inhibitors, drug combinations
267
Q

Hypertension is frequently what in early stages

A

A symptomatic

268
Q

Disease in arteries outside the heart

Increased incidence with diabetes

A

Peripheral vascular disease and atherosclerosis

269
Q

Diagnostic tests for peripheral vascular disease and atherosclerosis

A

Blood flow assessed by Doppler studies and arteriography

Plethysmograph you measures the size of limbs and blood volume in organs or tissues

270
Q

Most common sites of peripheral vascular disease and atherosclerosis

A

Abdominal aorta
Carotid arteries
Femoral and iliac arteries

271
Q

Signs and symptoms of peripheral vascular disease atherosclerosis

A

Increasing fatigue and weakness in the legs
Intermittent claudication (leg pain) associated with exercise caused by muscle ischemia
Sensory impairment like tingling, burning, numbness
Peripheral pulses distal to occlusion become weak
Appearance of skin of the feet and legs change; marked by pallor or cyanosis, skin dry and hairless, toenails thick and hard

272
Q

Treatment of peripheral vascular disease atherosclerosis

A

Maintain control of blood glucose level
Reduce body mass index
Reduce serum cholesterol level
Platelet inhibitors or anticoagulant medication
Cessation of smoking
Increase activity and exercise
Maintain dependent position for legs-improves arterial perfusion
Peripheral vasodilators
Observe skin for breakdown and treat promptly
If gangrene develops, amputation is required

273
Q

Localized dilation and weakening of arterial wall
Develops from a defect in the medial layer
Has three different shapes

A

Aortic aneurysm

274
Q

Aortic aneurysm

Bulging wall on the side

275
Q

Aortic aneurysm

Circumferential dilation along a section of artery

276
Q

Aortic aneurysm

Develops when there is a tear in the intima of the wall and blood continues to dissect or separate tissues

A

Dissecting aneurysm

277
Q

Causes of aortic aneurysm

A

Atherosclerosis
Trauma
Syphilis and other infections
Congenital defects

278
Q

Signs and symptoms of aortic aneurysm

A

Bruit may be heard on auscultation
Pulse may be felt on palpation of abdomen
Frequently asymptomatic until they become large or rupture

279
Q

A rupture in aortic aneurysm may lead to what

A

Moderate bleeding but usually causes severe hemorrhage and death

280
Q

Diagnostic tests of aortic aneurysm

A

Radiography
Ultrasound
Cut scanning
Mir

281
Q

What is the treatment of aortic aneurysm

A

Maintain blood pressure at normal level
Prevent sudden elevations caused by exertion
Prevent stress, coughing, constipation
Surgical repair

282
Q

Irregular, dilated, tortuous areas of superficial veins
Familial tendency
Increased body mass index, parity, and weight lifting are risks

A

Varicose veins

283
Q

In the legs varicose veins do what and appear as

A

May develop from defect or weakness In Vein walls or valves

Appear as irregular, purplish, bulging structures

284
Q

Treatment of varicose veins

A

Keep legs elevated, support stockings

Restricted clothing, crossing legs to be avoided

285
Q

Thrombus development in inflamed vein

A

Thrombophlebitis

286
Q

Thrombus forms spontaneously without prior inflammation; attached loosely

A

Phlebothrombosis

287
Q

What are the factors for thrombus development

A

Stasis of blood or sluggish blood flow
Endothelial injury
Increased blood coagulant lite

288
Q

Signs and symptoms of thrombophlebitis and phlebothrombosis

A

Often unnoticed
Aching, burning, tenderness in affected legs
Systemic signs like fever, malaise, leukocyte sis

289
Q

What is a complication of thrombophlebitis and phlebothrombosis

A

Pulmonary embolism

290
Q

What is the treatment of thrombophlebitis and phlebothrombosis

A

Preventive measures like exercise and elevating legs
Anticoagulant therapy
Surgical intervention

291
Q

Loss of circulating blood volume

A

Hypovolemic shock

292
Q

Inability of heart to maintain cardiac output to circulation

A

Cardiogenic shock

293
Q

Changes in peripheral resistance leading to pooling of blood in the periphery

A

Distributive, vasogenic, neurogenic, septic, anaphylactic shock

294
Q

Vasodilation owing to severe infection, often with gram-negative bacteria

A

Septic or endotoxins

295
Q

Loss of blood or plasma

A

Hypovolemic

296
Q

Decreased pumping capability of the heart

A

Cardio genie

297
Q

Vasodilation owing to loss of sympathetic and vasomotor tone

A

Vasogenic

Neurogenic or distributive

298
Q

Systemic vasodilation and increased permeability owing to severe allergic reaction

A

Anaphylactic

299
Q

Early manifestations of shock

A 
Anxiety
Tachycardia
Pallor
Light-headedness
Syncope
Sweating
Oliguria
300
Q

Compensation mechanisms of shock

A

SNS and adrenal medulla stimulated- increase heart rate, force of contraction, systemic vasoconstriction
Renin secretion increases
Increased ADH secretion
Secretion of glucocorticoids
Acidosis stimulates increased respiration

301
Q

With prolonged shock what happens

A

Cell metabolism is diminished, waste not removed and leads to lower pH

302
Q

Complications of shock

A

Acute renal failure
Shock lung, or adult respiratory distress syndrome
Hepatic failure
Paralytic ileum, stress or hemorrhagic ulcers
Infection or septicemia
Disseminated intravascular coagulation
Depression of cardiac function

303
Q

Compensation manifestations in shock

A 
Tachycardia
Cool, pale, moist skin
Oliguria
Thirst
Rapid respiration so
304
Q

Progressive manifestations of shock

A

Lethargy, weakness, faintness

Metabolic acidosis secretion

305
Q

Emergency treatment for shock

A 
Place patient in a supine position
Cover and keep warm
Call for assistance
Administer oxygen if possible
Determine underlying cause and treat if possible such as using an epipen for anaphylaxis or applying pressure for bleeding

Pathophysiology (4 decks)

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