chapter 19 Flashcards
Disorders of Cardiac function (5)
- Coronary Artery Disease
- Endocardial and Valvular Disorders
- Disorders of the Pericardium
- Cardiomyopathies
- Heart Disease in Infants and Children
Coronary Artery Disease
- atherosclerosis blocks coronary arteries
- ischemia causes: angina, heart attack, cardiac arrythmias, conduction deficits, heart failure, death.
most common cause of coronary artery disease
atherosclerosis
stable plaques
cause ischemia and some problems
unstable plaques
soft, mushy necrotic core that are easily broke off.
- lead to thrombosis formation
- can create ischemia in coronary vessels (Heart Attack, changes in conduction fo the heart, angina, death)
angina
chest pain
Acute Coronary Syndromes
things that cause reduced blood flow to muscle cells of the heart
how do you diagnose acute coronary syndromes?
ECG changes
- T wave inversion
- ST segment is depressed or elevated
- Abnormal Q wave
ischemia disrupts which wave of an ECG the most?
ST wave
- disrupts the repolarization process of ST. makes a shorter action potential, less time in between depolarization and repolarization.
PQRST wave
P-
QRS-
T-
P- Atrial Depolarization
QRS- Ventricular Depolarization
T- Ventricular Repolarization
serum cardiac markers
- Creatine Kinase- (CK-MB) specific to cardiac muscle
- Troponin- TnI and TnT specific to cardiac muscle
- Myoglobin- not specific to cardiac muscle
Cardiac Panel
tests the serum cardiac markers (proteins)
- creatine kinase (CK-MB)
- Troponin ( TnI and TnT)
- Myoglobin
Creatine Kinase (CK-MB)
- specific to only heart cardiac muscle cells
- shows up 4-8 hours after damage
- if specifically present in blood, can say the heart is damaged.
Troponin (Tnl and TnT)
- can tell if troponin is coming from damaged heart cells vs damaged muscle cells. (Tnl and TnT)
- can stay high from 3 hours-10 days
Myoglobin
found in cardiac and skeletal muscle (nonspecific marker)
- if paired with Tnl, TnT, or CK-MB you can say its myocardial cell death
- shows up in 1 hour
Unstable Aginga
less severe form of ischemia; no serum biomarkers
- cardiac cells haven’t diet
- from formation of stable plaques! not going to break off and kill you.
NSTEMI- non stemi myocardial infarction
- non ST MI
- result of atherosclerotic heart disease specifically formation of STABLE PLAQUE.
- occurs at rest and lasts 20 minutes, pain is severe an d new onset.
- TREATMENT: Nitroglycerin (vasodilator)
- No elevation of ST- complex on ECG
- presence of serum biomarkers
STEMI
- ST elevation myocardial infarction
- transmural: loss of supply to endocardium, myocardium, epicardium ( all 3 layers of heart)
- Subendocardial: loss to inner 1/3 to 1/2 of ventricular wall. only affects part of the cardiac wall.
Transmural means:
all 3 layers of the heart have lost blood supply
STEMI is not relieve by ___
Nitroglycerin
STEMI symptoms:
- chest pain: severe, crushing, constrictive
- Sympathetic NS response: GI distress, Tachycardia, Anxiety, vasoconstriction, nausea, vomiting
- Hypotension and shock- weakness in arms and legs
STEMI- Plan of action
- Reperfusion Therapy
- 12-lead ECG assessment- STEMI or NSTEMI?
- Pharmaceutical therapy
- Reestablishment of blood flow
Pharmaceutical therapy for STEMI
- Pain management: Morphine
- Anticoagulants and O2- Aspirin
- Sympathetic NS antagonists (slow HR)
the most important thing you can do when PT has a stemi
- reestablish blood flow
Complications of Acute Myocardial Infarctions
- heart failure
- thromboemboli (stroke)
- ventricular aneurysms (^ shockable rhythm)
Chronic Stable Anging (chest pain)
- imbalance in blood supply and the heart’s O2 demands
- Pain is similar to ACS but: occurs with exertions
* recurrent
* relieved with nitroglycerin
chronic stable angina’s get worse with ___
anything that ^ oxygen demand
- stress
- exercise
- cold
chronic stable angina diagnosis and treatment:
D: pain history, risk factors, imaging/ECG, labwork
T: lifestyle modification, drugs (beta blockers, vasodilators, calcium channel blockers)
ischemic heart disease is characterized by ____ which is associated with stable plaques.
stable angina
____ is characterized by plaques with platelets stuck to them (likely to form a thrombus); they cause a range of acute coronary syndromes.
Unstable Angina
__ and __ open during systole and close during diastole
Bi and Tricuspid Valves
___ and __ valves open during diastole and close during systole
AV and PV
Valve defects: 2
stenosis
regurgitation
Stenosis
- the valve won’t open all the way.
- it’s harder to force blood through it.
- will hear murmur of blood shooting through the narrow opening when the valve is open.
Regurgitation
- the valves won’t close all the way.
- it leaks when “closed”
- will hear a murmur of blood leaking back through when the valves should be closed.
valve defects most commonly show up :
on the left side of the heart : mitral (bicuspid) valve
Mitral valve disorders: 2
- Mitral valve regurgitation: goes back into left atrium
- Mitral valve prolapse: result of valves that become enlarged and lose some of their structural rigidity. too big and floppy so they swing back and forth instead of closing and opening properly.
Aortic Valve Disorders (2)
- Aortic Valve Stenosis- calcification means ^ hypertrophy of left side
- Aortic Valve Regurgitation- valve doesn’t close properly
when someone has an aortic valve disorder, they __-
- have difficulty breathing, chest pain and discomfort
- become really aware of their heartbeat when lying down. making it hard for them to sleep.
stenosis creates ___ pressure in aorta which means it’s not pumping enough blood to other areas of the body.
decreased pressure
Lub
Dub
Lub- closing AV valves, called S1
Dub- closing SV valves, called S2
Pericarditis
inflammation of the pericardium- release of inflammatory exudate into pericardial space
Symptoms of pericarditis
- Sharp, radiating pain- made worse by inhaling or coughing
- Responsive to NSAIDS- asprin/tylenol make it go away
- Fever w/pericardial friction
Most chest pain can be treated using this acronym
MONA Morphine Oxygen Nitroglycerin Aspirin
Pericarditis Diagnosis and Treatment
D- evaluate pain (sharp or compressed)
Auscultation- usually in neck, back, or abdomen
ECG- ST shape and distance diff than MI
Lab Testing: cardiac panel (inflam. precursors)
T- bacterial: antibiotic
viral: NSAIDS, steroid, but most often you ride it out.
Inflammation of the pericardium may restrict the heart’s movement due to:
- Serous exudate filling the pericardial cavity (pericardial effusion)
- Fibrous scar tissue making the pericardium stick to the heart (constrictive pericarditis)
Pericardial Effusion
- accumulation of fluid in the pericardial cavity
- inhibits chamber in heart filling
- ECG shows “dampened signals
- treatment is focused on fluid removal
Fluid removal for Pericardial Effusion
- Diuretics
- NSAIDS
- Pericardiocentesis- stick needle in chest, pull fluid out
Cardiac Tompanade
- pericardial effusion on steroids*
- have so much fluid in pericardial sac that its pushing on the heart and it can’t pump.
- signs: jugular vein distention, lowered systolic BP
- may hear muffled heart sounds (bc of fluid) ^ HR
Consequences of pericardial effusion
- BP and CO drop
- decreased BP can cause cardiogenic shock
- left ventricle can’t fill all the way
- right ventricle cant accept enough blood
In pericardial effusion, what does the right ventricle not accepting enough blood do the body?
you get an increase in venous pressure and it creates jugular distension
on inhaling, the right ventricle overfills with blood, this is called:
Pulsus Paradoxis
Pulsus Paradozis
- R ventricle fills too much with blood
- L Ventricle gets squished and cant take in as much
- decreased CO and decreased BP
- may need Pericardiocentresis- needle into heart to suck out fluid
Cardiomyopathies: definition
disease of heart muscle that makes it harder to pump blood to the rest of your body.
Hypertophic cardiomyopathy
- defects in contractile proteins that makes cells too weak
- heart has to compensate, so intraventricular septum hypertrophies
- the septum becomes so large it cuts off Aortic Valve
- decreased Bp and ^ chance of fibrilation.
