Chapter 24 Disorders of Cardiac Function Flashcards
What are examples of disorders of the pericardium?
inflammation of the pericardium, autoimmune disorders, accumulation of fluid in the pericardial cavity, calcified scar tissue developing between the visceral and parietal layers of the serous pericardium, damage due to radiation therapy
What is the pericardium?
the double layered serous membrane that isolates the heart form other thoracic structures
What are acute disorders of the pericardium?
inflammation, presence of friction rub
what is the diagnosis for acute disorders of the pericardium?
clinical manifestations of the friction rub where every time the heart beats there is a friction rub that causes inflammation, ECG, chest radiography, echocardiography
What are chronic disorders of the pericardium?
autoimmune disorders, viral infections, pathogens
What is pericardial effusion?
accumulation of fluid in the pericardial cavity
What can pericardial effusion lead to?
cardiac tamponade – where the heart is compressed due to build up of fluid meaning the heart will not be able to expand as much and cannot pump out as much blood
How would you treat pericardial effusion?
NSAIDs to reduce inflammation, corticosteroids, or a pericardiocentesis to get rid of fluid
What is constrictive pericarditis?
when scar tissue develops between the visceral and parietal layers of the serous pericardium – causing them to stick together when they usually slide past one another, cardiac output becomes fixed
What causes constrictive pericarditis?
chronic inflammation from radiation treatment, surgery or infection
What are the clinical manifestations for constrictive pericarditis?
ascites, pedal edema, distension of jugular veins, dyspnea, fatigue, kussmaul signs
What is the treatment for pericarditis?
surgery to try and take the 2 layers of the membrane apart
What is acute coronary syndrome?
acute ischemic heart diseases ranging from unstable angina to myocardial infarction
What causes ACS?
unstable plaque that ruptures forming a thrombus brought on by increased sympathetic activity and increased blood flow due to stress or increased activity (think around Xmas time)
How does ACS affect an ECG?
it affects the repolarization phase the T wave and ST segment
How do you detect ACS?
serum markers like troponin, myoglobin, creatine kinase MB which are all heart proteins
Pathological changes in ACS depend on what?
area, location, and extent of occlusion
What are some possible pathological changes that ACS can cause?
heart converts to anaerobic metabolism, cell death and irreversible damage within 40 minutes of ventricular remodeling, transmural infarcts, affected area ceases to contract, hypertrophy of dead heart muscle that is not able to regenerate
Which areas of the heart can ACS affect?
endocardium, myocardium, epicardium
What are the clinical manifestations for ACS?
abrupt pain, severe crushing pain of chest, radiating pain to the left arm, neck or jaw, nausea and vomiting, SOB, silent MIs (heart attacks that occur when you are not doing taxing activities or you don’t notice it), fatal arrhythmia
How do you medically manage a myocardial infarction?
defibrillation
Oxygen
aspirin - to reduce chance of another clot
nitrates - vasodilation
morphine - pain management
beta blockers - slow the heart rate and reduce blood pressure
reperfusion - thrombolytics within a half hour is the goal
intervention (whether a stent, angioplasty, coronary artery bypass grafting…) within 90 minutes is the goal
What is a CABG?
coronary artery bypass graft – taking a blood vessel from somewhere else in the body and using it to replace another vessel
What is chronic ischemic heart disease?
recurrent, transient myocardial ischemia, plaque reduces blood flow
What are primary cardiomyopathies?
heart muscle diseases of an unknown cause
What are the examples of primary cardiomyopathies?
dilated, hypertrophic, restrictive, myocarditis
What is dilated primary cardiomyopathy?
enlarged hypo-contracting heart – the chamber gets bigger and then you have less strength in the contractions of the heart
What is hypertrophic primary cardiomyopathy?
it is a genetic heart muscle disease where the left ventricle is enlarged
What is restrictive primary cardiomyopathy?
rigidity of the elastic tissue of the ventricular walls which decreases stroke volume = heart does not expand very well
What is myocarditis?
inflammation of the heart muscle and conduction system usually due to a viral infection
What are secondary cardiomyopathies?
heart muscle diseases that cause cardiac abnormalities due to another disorder
What conditions/disorders cause secondary cardiomyopathies
diabetes, cancer treatment, autoimmune disorders (Strep), alcoholic cardiomyopathy
How do you treat cardiomyopathies?
medication - beta blockers to slow the heart rate
implanted pacemakers to control regularity of the heart
defibrillators
ventricular assist devices
ablation – getting rid of the part that isnt working well
heart transplant
What are the goals for treatment of cardiomyopathies
symptom relief
What is valvular heart disease?
narrowing of valve openings so that it does not open properly = stenosis
OR
Distortion of the valve so it does not close properly and causes regurgitation – permits backward flow
How are valvular heart diseases diagnosed?
heart murmurs, echocardiography
What are the valvular disorders of the mitral valve?
mitral valve stenosis, regurgitation, prolapse
What is mitral valve stenosis?
narrowing of the opening of the mitral valve
What is mitral valve regurgitation?
mitral valve does not close properly and allows for the backflow of blood across the valve
What it mitral valve prolapse?
displacement of the mitral valve leaflet into the left atrium during systole
What are the aortic valve disorders?
aortic valve stenosis, regurgitation
What is aortic valve stenosis?
narrowing of the valve between the heart and the aorta
What is aortic valve regurgitation?
valve between the heart and aorta does not close fully allowing blood to leak back into the heart
