Chapter 18 Exam 3 Flashcards

1
Q

Unstable Angina enzymes*

A
  • no cardiac enzymes created, but chest pain will be very strong
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2
Q

Angina Pectoris*

A
  • chest pain associated with intermittent myocardial ischemia
  • no permanent damage occurs to the heart
  • crackles/rales are indicative of left side congestion, they are bubbling and rattling of buildup of fluid in the lungs
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3
Q

3 patterns of Angina Pectoris *

A
  • stable, unstable, and prinzmetal
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4
Q

Nitroglycerin*

A

dilates the coronary arteries

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5
Q

Stable Angina *

A
  • most common
  • characterized by stenoic atherosclerotic coronary vessels
  • relived by rest and nitroglycerin
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6
Q

Unstable or crescendo angina*

A
  • can progress to acute ischemia

- very similar to nonSTEMI heart attack, only difference is absence of serumbiomarker troponin

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7
Q

Prinzmetal/Variant angina*

A
  • unpredictable
  • vasospastic
  • caused by coronary artery occlusions
  • calcium channel blocking agents used for treatment
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8
Q

Acute Coronary Syndrome*

A
  • Myocardial infarction (MI) or unstable angina

- ECG and biomarkers used for diagnosis

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9
Q

ACS ECG changes*

A
  • t wave inversion or s wave depression
  • ST elevation in case of a heart attack; also known as STEMI (st elevation; myocardial infarction)
  • Q wave means old heart attack
  • T wave inversion with biomarkers is a nonSTEMI
  • segment depression means ischemia
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10
Q

Treatment of ACS with drugs*

A
  • antiplatelets and statin drugs are the best thing for ACS with nonSTEMI/unstable angina
  • reperfusion therapy is best thing for ACS with STEMI
  • morphine, oxygen, nitrates, and aspirin together treat acs
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11
Q

Acute occulsion*

A
  • blockage in an artery, vein, or within the heart
  • can cause a range of cellular events depending on the availability and adequacy of collateral blood flow, relative workload, & length of time that flow is interrupted
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12
Q

Diagnosis of ACS*

A

depends on

  • signs and symptoms
  • electrocardiographic changes
  • elevatioins of specific marker proteins in the blood
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13
Q

Signs and symptoms of ACS*

A
  • sever crushing, excruciating chest pain that may radiate to the arm, shoulder, jaw, or back
  • nausea
  • vomiting
  • diaphoresis (sweating)
  • shortness of breath
  • diabetics and elderly may not have pain due to neuropathy
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14
Q

More ACS info: Asymptomatic MI *

A
  • lasts more than 15 min and is not relieved by rest or nitroglycerin
  • can be asymptomatic MI (silent MI) which is typical in women, the elderly, and patients with diabetic neuropathies
  • ECG for asymptomatic includes st segment elevation, large Q waves, and inverted T waves
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15
Q

ACS serum marker changes*

A
  • myoglobin
  • lactate dehydrogenase
  • creatine kinase
  • increased CK-MB and troponin I and T
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16
Q

ACS Treatment Steps

A
  • Decreasing myocardial oxygen demand (rest, heart rate control, pain relief, afterload reduction)
  • Increasing myocardial oxygen supply (thrombolysis, angioplasty, coronary bypass grafting)
  • Monitoring and managing complications (early detection and management of dysrhthmias and conduction disorders, continuous ECG monitoring)
  • beta blockers are given
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17
Q

Sudden Cardiac Arrest

A
  • also called sudden cardiac death
  • unexpected death from cardiac causes within 1 hour of symptom onset
  • lethal dysrhythmia is usually primary case
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18
Q

Chronic Ischemic Cardiomyopathy

A
  • heart failure develops insiduously due to progressive ischemic myocardial damage
  • typically have history of angina or MI
  • appears to be a consequence of slow, progressive apoptotic death of myocytes from chronic ischemia
  • more common in older adults
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19
Q

Endocardial and Valvular Disease

A

endocardial & valvular structures may be damaged by:
- inflammation and scarring
- calcification
- congenital malformations
causes altered hemodynamics of the heart and increase myocardial workload
- will include stenosis. regurgitation, and prolapse

20
Q

Stenosis

A

failure of the calve to open completely results in extra pressure work for the heart

21
Q

Regurgitation (insufficiency)

A

inability of a valve to close completely results in extra volume work for the heart

22
Q

Mitral Stenosis*

A
  • blood flow from the left atrium to left ventricle is impaired during ventricular diastole
  • increased pressure of the left atrium leads to atrial chamber enlargement and hypertrophy
23
Q

Results of Mitral Stenosis *

A
  • chronic pulmonary hypertension
  • right ventricular hypertrophy
  • right sided heart failure
24
Q

Signs and symptoms of Mitral Stenosis *

A
  • low pitched, rumbling diastolic murmur
  • opening snap (sound)
  • atrial dysrhythmias
  • atrial clots
  • exertional dyspnea
25
Mitral Regurgitation*
- backflow of blood from left ventricle to the left atrium during ventricular systole - mitral valve should snap open and then close, but it does not snap closed and the blood experiences backflow
26
Results of Mitral Regurgitation *
- left atrium and ventricle dilate and hypertrophy due to the extra volume - may lead to left sided heart failure
27
Signs and symptoms of Mitral Regurgitation*
- high pitched, pansystolic blowing murmur - giant V waves - chronic weakness and fatigue
28
Mitral Valve Prolapse*
- displacement (ballooning) of the mitral valve leaflets into the left atrium during ventricular systole - women are affected more than men - typically asymptomatic
29
Signs ad symptoms of Mitral Valve Prolapse *
- Midystolic click or systolic murmur - palpitations - rhythm abnormalities - diziness - fatigue - dyspnea - chest pain - or depression and anxiety
30
Aortic Stenosis
- predominant cause is age related calcium deposits on the aortic cusps - results in obstruction of the aortic outflow from the left ventricle into the aorta during systole
31
Signs and Symptoms of Aortic Stenosis
- left ventricle hypertrophy may result in ischemia and left sided heart failure - crescendo-decrescendo murmur during ventricular systole with prominent S4 (s3 follows s2, S4 proceeds S1, s4 is indicative of a stiff left ventricle) - syncope - fatigue - angina
32
Aortic Regurgitation
- incompetent aortic valve allows blood to leak back from the aorta into the left ventricle during diastole - causes include abnormal aortic valve or aortic root dilation - leafs to left ventricular hypertrophy and dilation with eventual left sided heart failure
33
Signs and symptoms of Aortic Regurgitation
- high pitched blowing murmur during ventricular diastole - high systolic blood pressure - diastolic blood pressure usually low - palpitations
34
Rheumatic Heart Disease
- acute inflammatory disease that follows infection with group a beta hemolytic streptococci - damage is due to immune attack on individuals own tissues - damage occurs in CT of joints, heart, and skin - occurs mainly in children
35
Signs and symptoms of Rheumatic Heart Disease
- fever - sore throat - joint inflammation - involuntary movements (sydenham chorea) - distinctive truncal rash
36
Infective endocarditis
- invasion and colonization of endocardial structures by microorganisms with resulting inflammation - vegetations - most common bacteria are strep and staph - Can be acute (poor prognosis) or subacute (predisposing risk factors typically present)
37
Myocarditis
- inflammatory disorder of the heart muscle characterized by necrosis and degeneration of myocytes - clinical course is acute or stormy with recovery or death from cardiac failure occurring weeks to months after onset of symptoms
38
Cardiomyopathy
- classified by cause or functional impairment - primary: dysfunction or unknown cause - Secondary: known cause - Functional classifications: dilated, hypertrophic, restrictive
39
Dilated Cardiomyopathy
- cardiac failure associated with dilation of one or both ventricular chambers - can be related to alcohol toxicity, pregnancy, postviral myocarditis, or genetic abnormality - slow progression of biventricular heart failure with low ejection fraction ( ejection fraction less than 40% is heart failure
40
ICD
Implantable Cardioverter Defribrillator
41
Hypertrophic Cardiomyopathy
- thickened, hyperkinetic ventricular muscle mass - septum may be affected, leading to idiopathic subaortic stenosis - caused by a genetic abnormality - can be asymptomatic or show signs of dyspnea and angina
42
Restrictive Cardiomyopathy
- Rarest form - stiff, fibrotic, rigid, noncompliant ventircle with impaired diastolic filling - mosy commonly associated with amyloidosis - decreased cardiac output and left sided heart failure can result - exerrcise intolerance, dyspnea, and weakness
43
Pericardial Diseases
Typically sequelae of other disorders such as - systemic infection - trauma - metabolic derangement - neoplasia
44
Pericardial Effusion
- accumulation of noniflammatory fluid in the pericardial sac - composition of usual fluids includes serous, serosanguineous, chylous(fatty), and blood
45
Cardiac Tamponade
- when fluid accumulation in the pericardial sac is large/sudden it can lead to external compression of the heart chambers such that filling is impaired (basically a medical emergency in which there is a sudden build up of fluid in the lungs)
46
Manifestations of Cardiac Tamponade and treatment
- reduced stroke volume - compensatory increases in heart rate - pulsus paradoxus - jugular venous distension - Beck's Triad - Treatment is pericardiocentesis
47
Pericarditis
- acute or chronic inflammation of the Pericardium