Ch. 19 Disorders of Cardiac Function Flashcards
What is Pericardial Effusion?
- build up of fluid in pericardial sac
- threatens compression of the heart
- sudden accumulation of fluid may compress the heart and cause it to stop (tamponade)
What is a cardiac Tamponade?
when the cardiac sac is way over stretched putting pressure on the heart
causes:
- trauma
- surgical (iatrogenic)-common after heart surgery
- pericarditis
What is Pericarditis?
- inflammation and fluid in the pericardium
- usually infectious exudate
what are the S/S associated with pericarditis?
- chest pain
- rub heard on auscultation
- ECG changes
- fatigue, shortness of breath, other vital symptoms
Pericarditis can lead to what?
Pericardial Effusion if the fluid builds up alot
what is the normal fluid volume in the pericardial sac?
2-3 tablespoons
a very large pericardial effusion can hold up to how much fluid?
1-2 liters
what happens with a very large pericardial effusion?
-the heart is pretty much suffocated and contraction does not perform well
what are the causes of Pericardial Effusion?
-inflammation (Pericarditis) because the pericardium gets inflamed and releases exudate
what causes pericarditis?
- mainly viral infections: CMV, HIV
- bacterial, fungal, parasitic
- cancer
- heart attack
- injury to the mitochondria (surgical, trauma, car accident,)
What is the heart surrounded by?
the pericardium
what is the pericardium and what does it do?
- thin 2 layered sac surrounding the heart
- in-between the 2 layers there is a fluid that acts as padding from the beating
- shields the heart from infection and malignancy
What are the S/S of a cardiac Tamponade?
- 20mmHg drop in systolic blood pressure during respirations
- harder to see with BP cuff so usually there is a line that is inserted in the artery that reaches the heart and monitors.
- heart monitor will look normal but there will be no pulse
Why will the heart monitor look normal with a cardiac Tamponade even though there is no pulse?
-the heart is still sending the electrical signals but it is not beating because it has no room too
what is the treatment for a cardiac Tamponade?
- stick a needle in the cardiac sac if there is a suspicion
- if there is no fluid, oh well you were wrong
- if there is fluid, drain it and then go immediately to OR to fix
What is angina?
- a SYMPTOM
- chest pain, discomfort in the area of the heart due to lack of O2
- may radiate to the arm, neck, jaw
- can feel like indigestion
What is CAD and what can it lead to?
-build up of plaque in the coronary arteries or atherosclerosis of the coronary arteries
- angina
- Myocardial infarction (MI)
What causes an MI?
- occurs when a coronary artery is totally obstructed leading to prolonged ischemia and cell death or infarction, of the heart wall
- most common cause is atherosclerosis usually with thrombus attached
- common cause of disability and death
- majority 65 years old and older
what may an MI ultimately lead to?
-heart failure, arrhythmia, or sudden death
how many deaths are caused by MIs?
1 in 5
what are some MAJOR risk factors for MI?
- smoking
- elevated blood pressure
- elevated LDL cholesterol
- low HDL cholesterol
- diabetes mellitus
- metabolic syndrome
What are some EMERGING risk factors for MI?
- prothrombotic state (higher risk for throwing clots)
- proinflammatory state
- insulin resistance
what are some UNDERLYING risk factors for MI?
- high fat diet
- obesity
- physical inactivity
- family history
What are the 3 types of Acute Coronary Syndrome (ACS)?
- angina
- STEMI
- NONSTEMI
When does Angina Pectoris occur?
occurs when there is a deficit of oxygen for the heart muscle. May occur when the heart is working more than usual or when supply of oxygen is impaired
What is Chronic Stable Angina?
- fixed coronary obstruction, seen with increased demands of myocardium, exercise induced and resolves with rest
- emotional stress and cold can trigger episodes
What is Acute Unstable Angina?
- unexpected, emergency
- sudden change in normal pattern of angina
- something happened like a clot
- can occur without knowledge of Stable Angina
Which type of angina is a warning sign of MI?
acute Unstable angina
what is given to people with Chronic Stable Angina?
- a nitroglycerin supplement
- these are potent vasodilators
What lifestyle changes we suggest for those who suffer from Angina?
- get HDL up
- get LDL down
- stop smoking
- exercise regularly/mall walkers
- stop doing what whatever triggers the angina
What are some medications that can be given to patients who suffer from angina?
- nitroglycerin supplements to dilate blood vessels during an angina episode
- different types to control the underlying problem
ex: cholesterol medication that lowers cholesterol
what are our goals for angina?
- reduce pain
- prevent MI
What is a STEMI?
- a type of acute coronary syndrome (ACS)
- “ST” wave is elevated during an MI, looks like a “RIP gravestone”
- MORE SEVERE type of heart attack
- large amount of heart muscle is being damaged
- TOTAL BLOCKAGE
What is a NONSTEMI?
- a type of acute coronary syndrome(ACS)
- “ST” wave is not elevated during an MI, normal
- only partially blocked
- still getting some profusion to the heart
sudden death from an MI is most likely do to?
acute ventricular arrhythmia
- monitor looks like fast zigzag
- heart just gyrates and doesn’t actually pump
What are the warning signs of a Heart Attack (MI)?
- feeling of pressure, heaviness, or burning in chest, especially with increased activity
- shortness of breath, sweating, weakness, fatigue
- nausea, indigestion
- anxiety and fear “Feeling of Doom”
what are some diagnostic tests used to identify an MI?
- EKG : can see if it’s STEMI v NONSTEMI
- Serum enzymes & isoenzymes : heart muscle has specific enzymes so if cells die these will show up in the blood levels
- cardiac catheterization: line in femoral artery that runs to the heart, dye is injected and images (xrays) are taken to locate the blockage
What is a CABG?
- coronary artery bypass graft
- they get the graft from vessels in the leg; the heart cannot build collateral vessels but the leg can
- graft a bypass around the block
what is a Stent?
- looks like a pen spring
- inserted into the affected coronary artery to keep it open
2 to 3 days after an MI what might happen?
- the necrosis in the area becomes inflamed and very irritable
- might see dysrhythmias on the EKG
What are the 3 types of Primary Cardiomyopathy?
- Genetic-HCM
- Mixed- DCM or RCM
- Aquired-Myocarditis or Takostubo
Hypertrophic Cardiomyopathy (HCM)
- Genetic form of ACS
- area of myocardium becomes thickened (hypertrophied) for no apparent reason
Dilated Cardiomyopathy (DCM)
- mixed form of ACS
- increased left ventricular wall thinning
- less contractility as heart gets bigger (its floppy)
- may benefit from a pacemaker
Restricted Cardiomyopathy (RCM)
- mixed form of ACS
- walls become rigid
- heart is restricted from filling with blood
Myocarditis
- acquired form of ACS
- inflammation of the heart muscle
- usually caused by a VIRUS
- often asymptomatic
- may develop chest pain, fever, dyspnea or tachycardia
Takotsubo
-broken heart syndrome
Endocarditis
- microbial infection that affects the ENDOTHELIUM and the VALVES
- predisposing factors : rheumatic heart disease or valvular disease
- murmur develops due to vegetative(abnormal growth inside the heart) valve destruction
Endocarditis and Rheumatic Heart Disease (RHD) are both complications of what?
septicemia
why?
-vegetation (microbe growth) from infection will grow inside the heart as it passes through the heart in the blood
Stenosis
narrowing of the orifice of valve
Regurgitation
valves are not completely closing, so the blood will flow back into the chamber of which it just came
What types of Mitral Valve Disorders are there?
- stenosis
- regurgitation
- prolapse
What types of Aortic Valve Disorders are there?
- stenosis
- regurgitations: causes drop in diastolic blood pressure which can cause decreased coronary profusion
Prolapse
- heart valves leaflets are thickened sticking out into the other chamber
- can cause: regurgitation, heart failure, cardiac arrest
