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Pathophysiology II class notes > Ch. 19 Disorders of Cardiac Function > Flashcards

Ch. 19 Disorders of Cardiac Function Flashcards

1
Q

What are the causes of pericarditis?

A 
Viral
Bacterial
Uremia
Neoplastic
Radiation
Trauma
Drug toxicity
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2
Q

What is constricted pericarditis?

A

When scarring develops due to the healing of pericardial membrane in pericarditis. Doesn’t move/stretch as well = constricted

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3
Q

What is considered acute pericarditis?

A
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4
Q

What are the manifestations of pericarditis?

A 
Decreased cardiac output
Pericardial friction rub
Chest pain 
- precordial
- abrupt onset
- sharp
- scapula pain
- increases with deep breath, cough
- Relief when sitting forward
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5
Q

What is Dressler’s syndrome?

A

A pericardial pain that occurs after a myocardial infarction (usually a week or two later)

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6
Q

What are the causes of pericardial effusion?

A 
Inflammation of pericardium (pericarditis)
Infection elsewhere
Neoplasms
Cardiac surgery
Trauma
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7
Q

What are the causes of pericardial effusion?

A 
Inflammation of pericardium (pericarditis)
Infection elsewhere
Neoplasms
Cardiac surgery
Trauma
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8
Q

What is considered acute pericarditis?

A

less than 2 weeks of symtpoms

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9
Q

What are the manifestations of cardiac tamponade?

A 
Dependent on amount and rapidity
Limits stroke volume and cardiac output - low systolic blood pressure
CNS: change in mentation
Resp: dyspnea, tachypnea
CVS: chest pain, tachycardia
Elevated central venous pressure
Elevated jugular pressure
Circulatory shock
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10
Q

What is Dressler’s syndrome?

A

A pericardial pain that occurs after a myocardial infarction (usually a week or two later)

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11
Q

What is a pericardial effusion?

A

Accumulation of fluid in the pericardial cavity/space.

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12
Q

What are the causes of pericardial effusion?

A 
Inflammation of pericardium (pericarditis)
Infection elsewhere
Neoplasms
Cardiac surgery
Trauma
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13
Q

What is cardiac tamponade?

A

Compression due to fluid or blood. It is the worst case scenario that can happen with fluid building up in the pericardial sac. It is an emergency situation.

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14
Q

What are the causes of cardiac tamponade?

A

Trauma
Myocardial rupture post MI
Cardiac surgery
Aortic dissection

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15
Q

What are the manifestations of stable angina?

A

Precordial/substernal pain, with possible radiation and possible epigastric discomfort. It occurs with exercise/exertion/cold/emotions and is relieved with rest and nitroglycerine.

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16
Q

What assists coronary artery flow?

A

Endothelial cells lining arteries
Diastolic pressure in aorta
Time in diastole

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17
Q

What impairs coronary artery flow?

A

Atherosclerosis is most common

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18
Q

What are the possible symptoms of a silent MI?

A

Hypotension, low body temp, vague complaints of discomfort, mild diaphoresis, stroke-like symptoms, dizziness, sensorium changes

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19
Q

What are the modifiable risks for coronary artery disease?

A 
Hypertension
Hyperlipidemia
Tobacco use
Diabetes
Obesity
Sedentary lifestyle/physical inactivity
Ability to cope with stress
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20
Q

What are some possible causes of acute coronary syndrome?

A 
Unstable plaque, rupturing to form a clot
Thin fibrous cap with fatty core is most unstable
Coronary vasospasm
Atherosclerotic narrowing (progressive)
Inflammation/infection
Surgery
Secondary causes: 
-Anemia
-Fever
-Hypoxemia
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21
Q

What are the manifestations of stable angina?

A

Precordial/substernal pain, with possible radiation and possible epigastric discomfort. It occurs with exercise/exertion/cold/emotions and is relieved with rest and nitroglycerine.

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22
Q

What is variant/prinzmetal angina?

A

d/t spasms of coronary artery
Cause is unclear
Often @ night
Variable symptoms

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23
Q

What is the typical pattern of manifestations of an ST elevation MI?

A

Crushing/constricting pain; usually abrupt
- Substernal with radiation to left arm, jaw, neck
Epigastric distress/nausea
Palpitations
Cool, clammy skin
Short of breath
Anxiety

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24
Q

What are the possible symptoms of a silent MI?

A

Hypotension, low body temp, vague complaints of discomfort, mild diaphoresis, stroke-like symptoms, dizziness, sensorium changes

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25
Q

What are the results of myocardial ischemia/necrosis?

A

Decreased contractile force

  • Decreased cardiac output
  • Decreased coronary artery perfusion
  • Increased pulmonary vasculature pressure

Interruption of conduction
- Dysrhythmias

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26
Q

What are some possible causes of acute coronary syndrome?

A 
Unstable plaque, rupturing to form a clot
Thin fibrous cap with fatty core is most unstable
Coronary vasospasm
Atherosclerotic narrowing (progressive)
Inflammation/infection
Surgery
Secondary causes: 
-Anemia
-Fever
-Hypoxemia
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27
Q

What are the manifestations of unstable angina?

A

With pre-diagnosis of “stable angina”
Occurs at rest (or minimal exertion)
Lasts >20 minutes

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28
Q

What is an ST elevation MI?

A

Ischemic death of myocardial tissue

29
Q

What are the possible complications of an acute MI?

A 
Arrhythmias – most common cause of sudden death
Reinfarction 
Heart failure
Pericarditis
Embolic CVA or Pulmonary embolus
Valve deformities
Septal rupture
LV wall aneurysms/rupture
Cardiogenic shock
Dressler syndrome
30
Q

How quickly does cell death occur in an MI?

A

15-20 minutes

31
Q

What are the results of myocardial ischemia/necrosis?

A

Decreased contractile force

  • Decreased cardiac output
  • Decreased coronary artery perfusion
  • Increased pulmonary vasculature pressure

Interruption of conduction
- Dysrhythmias

32
Q

What are three serum biomarkers that indicate an MI?

A

Troponin
Myoglobin
Creatine Kinase MB (CK-MB)

33
Q

What are treatments for acute MI?

A

Oxygen
Pain relief
Reperfusion
Coronary artery bypass graft

34
Q

What are some methods of reprofusion during an acute MI?

A

Fibrinolytics (clot busters)
Percutaneous transluminal coronary angioplasty (PTCA)
Stents

35
Q

What are the possible complications of an acute MI?

A 
Arrhythmias – most common cause of sudden death
Reinfarction 
Heart failure
Pericarditis
Embolic CVA or Pulmonary embolus
Valve deformities
Septal rupture
LV wall aneurysms/rupture
Cardiogenic shock
Dressler syndrome
36
Q

What are cardiomyopathies?

A

Problems with the muscle of the heart.

37
Q

What is an idiopathic cardiomyopathy?

A

A heart muscle disorder with an unknown cause.

38
Q

What is hypertrophic cardiomyopathy?

A

Unexplained genetic ventricular septal thickening.

39
Q

What are the effects of hypertrophic cardiomyopathy?

A

Poor diastolic filling
LV outflow obstruction
Left ventricular hypertrophy
Disruption of normal conduction pathways

40
Q

What are the manifestations of hypertrophic cardiomyopathy?

A

Variable manifestations

Decreased stroke volume d/t impaired diastolic filling
  - Dyspnea
  - Chest pain
  - Syncope post exertion
Atrial fibrillation
Lethal ventricular arrhythmias
41
Q

What is endocarditis?

A

Any infection of the inner lining of the heart.

42
Q

What are the typical characteristics of endocarditis?

A

Usually staphylococcus aureus
Vegetative
Involvement of mitral & aortic valves most common
Acute: relatively healthy individual
Sub-acute/chronic: history of valve abnormalities

43
Q

What are the risk factors for endocarditis?

A

Infection elsewhere
Dental surgery/other surgery, IV drug use/contaminants
Immunodeficiency/immunosuppression
Valve prolapse (sudden or congenital)

44
Q

What are the manifestations of endocarditis?

A

S&S of systemic infection
Heart sound changes
Symptoms related to embolism

45
Q

What are some complications of endocarditis?

A

Emboli (lung, renal, brain, etc)
Valve dysfunction
Arrhythmias

46
Q

What are some causes of valvular disorders?

A 
Congenital
Trauma
Ischemic damage
Degenerative changes
Inflammation
47
Q

How are valvular disorders diagnosed?

A

Auscultation
Doppler Echo
Ultrasound

48
Q

What are the treatments for valvular disorders?

A 
Preventative
APA 
Symptoms
Percutaneous valvuloplasty
Surgery
49
Q

What is mitral valve stenosis?

A

Fibrous, stiff tissue, often causing chordae tendineae to shorten
Incomplete opening obstructs blood flow

50
Q

What are the causes of mitral valve stenosis?

A

Rheumatoid factor

Congenital

51
Q

What causes rheumatic heart disease?

A

It is caused by rheumatic fever which occurs after streptococcal pharyngitis. It affects one or all layers of the heart.

52
Q

What are the manifestations of mitral valve stenosis?

A

Chest pain, weakness, fatigue, palpitations

53
Q

What are the complications that can arise from mitral valve stenosis?

A

Arrhythmias (atrial fibrillation, atrial tachycardias)

Mural thrombi (thrombus in the heart)

54
Q

What is mitral valve reguritation?

A

Incomplete closing of the mitral valve that causes some blood to return to the left atrium during systole.

55
Q

What are the causes of mitral valve regurgitation?

A

RHD
Chordae tendineae or papillary muscle rupture
Left ventricular hypertrophy dilates orifice
Mitral valve prolapse

56
Q

What are the manifestations of mitral valve regurgitation?

A

It is a slow process = compensation
Pulmonary congestion
Pansystolic murmur
Left atrial and left ventricular hypertrophy

57
Q

What are the potential complications of mitral valve regurgitation?

A

Atrial fibrillation

Thrombus

58
Q

What is mitral valve prolapse?

A

Leaflets of the mitral valve enlarge, become “floppy”

59
Q

What disorders are associated with mitral valve prolapse?

A

Marfan’s syndrome and osteogenesis imperfecta

60
Q

What are the manifestations of mitral valve prolapse?

A

“snap”
Asymptomatic
Chest pain, dyspnea

61
Q

What are the potential complications that can arise from mitral valve prolaplse?

A

Mitral valve regurgitation
Atrial fibrillation
Thrumbus

62
Q

What is aortic valve stenosis?

A

Narrowing causing resistance to ejection

63
Q

What are the causes of aortic valve stenosis?

A

Congenital or acquired
More common in males
Active inflammation

64
Q

What are the manifestations of aortic valve stenosis?

A 
Loud systolic ejection murmur OR split 2
Chest pain
Dyspnea
Syncope
Heart failure (LV hypertrophy)
65
Q

What is aortic valve regurgitation?

A

Scarring of leaflet and/or enlarged orifice

Blood flow back into the left ventricle during diastole

66
Q

What are the causes of aortic valve regurgitation?

A 
RHD
Ideopathic aortic dilation
Congenital
Endocarditis
Marfan's
HTN
Trauma
67
Q

What are the manifestations of chronic aortic valve regurgitation?

A

Blowing sound over valve
Widening pulse pressure
Karotkoff sounds persist to zero!
Tachycardia or water-hammer pulse (bounding pulse)
“Pouding” of heart when lying down
Eventually orthopnea, dyspnea, paroxysmal nocturnal dyspnea

68
Q

What are the causes of acute aortic regurgitation?

A

Acute endocarditis
Trauma
Aotric dissection

69
Q

What are the manifestations of acute aortic regurgication?

A

Acute happens quickly, so no time to compensate
Extreme rise in left ventricular end diastolic pressure = pulmonary edema
Decreased coronary artery perfusion
Dysrhythmias = lethal

Pathophysiology II class notes (15 decks)

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