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PAS- PATHOPHYSIOLOGY > Chapter 33 > Flashcards

Chapter 33 Flashcards

Alterations of Cardiovascular Function

1
Q

coronary artery disease

  • any vascular disorder that narrows or occludes the coronary arteries
  • results in an imbalance between coronary supply of blood and myocardial demand for oxygen and nutrients
  • -reversible myocardial ischemia or irreversible infarction may result
  • most common cause: atherosclerosis
  • nonmodifiable risk factors:
  • -_____; _____
  • -_____ gender or _____

modifiable risk factors:

  • _____
  • _____
  • -_____, increase in myocardial demand
  • _____
  • -_____ and increase in _____, decrease in _____ (_____)
  • _____ and _____
  • -risk of developing coronary artery disease is increased up to _____ by which factor
  • –_____ damage, _____ of the _____
  • _____ and/or _____
  • -_____, _____, and _____: _____
  • _____
A 
advanced age
family history
male
women after menopause
dyslipidemia
hypertension
endothelial
cigarette smoking
vasoconstriction 
LDL
high density lipoprotein HDL
diabetes mellitus
insulin resistance 
threefold
endothelial 
thickening 
vessel wall
obesity
sedentary lifestyle 
obesity
dyslipidemia
hypertension
metabolic syndrome 
atherogenic diet
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2
Q

modifiable risk factors
why are they risk factors for CAD?
diabetes mellitus
-is associated with CAD because of the resulting alteration of _____; it increases _____ levels and is involved in _____. _____ is the only factor responsible for a _____ increased risk of atherosclerotic cardiovascular disease

cigarette smoking
-_____ stimulates the release of _____ (e.g. the neurotransmitters: _____, _____) which increases the _____ and causes _____. as a result, _____ increases as do both _____ and _____

A 
hepatic lipoprotein synthesis 
triglyceride levels 
low density lipoprotein oxidation
hypertension
twofold to threefold
nicotine
catecholamines 
epinephrine 
norepinephrine   
heart rate
peripheral vascular constriction 
blood pressure
cardiac workload 
oxygen demand
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3
Q

why are they risk factors for CAD
high levels of HDL
-high levels of HDLs may be more _____ for the for the development of _____ then low levels of _____

low levels of HDL
-low levels of HDL cholesterol are also a strong indicator of _____

A

protective
atherosclerosis
LDLs
coronary risk

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4
Q

coronary artery disease
nontraditional risk factors
-markers of _____ and _____
–_____ is a laboratory test and an indirect measure of _____

  • _____
  • _____
  • _____
  • -adiponectin and leptin
  • _____
  • -microorganisms and periodontal disease
  • air pollution
  • coronary artery _____, _____ thickness
A 
inflammation
thrombosis
C-reactive protein 
atherosclerosis
troponin I
hyperhomocysteinemia
adipokines
infection
calcification
carotid wall
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5
Q

CAD
myocardial ischemia
-develops if the supply of _____ cannot meet the demand of the _____ for _____ and _____
-_____: causes predictable _____
-prinzmetal angina (variant): causes _____
-silent ischemia: causes _____
-angina pectoris: causes _____ discomfort
–_____ is triggered by _____

A 
coronary blood 
myocardium 
oxygen
nutrients 
stable angina 
chest pain
unpredictable chest pain
no detectable symptoms 
transient substernal chest
angina pectoris 
myocardial ischemia
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6
Q 
CAD
acute coronary syndromes (ACS)
-sudden coronary obstruction because of thrombosis formation over a ruptured atherosclerotic plaque 
-examples:
--\_\_\_\_\_
--\_\_\_\_\_
A

unstable angina

MI

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7
Q

ACS acute coronary syndromes

fixed stenosis of the coronary arteries

A

stable angina

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8
Q

ACS

transient clotting of the coronary arteries

A

unstable angina

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9
Q

ACS

persistence of thrombus with grater plaque disruption than in unstable angina

A

NSTEMI (MI)

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10
Q

ACS

complete thrombosis of the coronary arteries

A

STEMI (MI)

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11
Q

Myocardial infarction

  • individuals at highest risk for complications
  • -_____ (_____) on the ECG requires _____
A

ST segment elevations (STEMI)

immediate intervention

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12
Q

myocardial infarction
subendocardial MI
-if the thrombus breaks up after complete distal tissue necrosis occurred, the infarction will involve only the myocardium directly beneath the endocardium
-causes marked _____ and _____. _____!!

transmural MI

  • if the thrombus in a coronary artery permanently lodges in the vessel and the infarction extends through the myocardium from the endocardium to the epicardium
  • causes marked _____ on the EKG. _____!!
A 
ST segment depression
T wave inversion 
non-STEMI
elevation of ST segments 
STEMI
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13
Q 
myocardial infarction
clinical manifestations
-\_\_\_\_\_ of \_\_\_\_\_ means \_\_\_\_\_!!
-\_\_\_\_\_: most specific 
--elevate in \_\_\_\_\_
  • _____ (_____)
  • _____
A 
elevations
cardiac biomarkers 
MI
troponin I
2-4 hours
creatine phosphokinase- MB (CPK-MB)
LDH
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14
Q

when is the scar tissue that is formed after a MI most vulnerable to injury?

  • during the recovery period (_____), individuals feel more capable of increasing activities and thus may stress the _____
  • after _____, the _____ is completely replaced by _____, which is strong but unable to _____ and _____ like healthy _____
A 
10 to 14 days after infarction
newly formed scar tissue
6 weeks
necrotic area
scar tissue
contract
relax
myocardial tissue
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15
Q

heart failure
systolic heart failure
-inability of the heart to generate adequate cardiac output to perfuse tissues
-_____ (_____ and _____)

A

natriuretic peptides
BNP
ANP

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16
Q

brain natriuretic peptide (BNP) and heart failure

  • _____ is produced and released in response to _____ and _____ overload of the _____
  • BNP causes _____ and _____, _____ and _____ of the _____ system
A 
BNP
pressure
volume
cardiac chambers
arterial 
venous dilation
natriuresis 
suppression
renin-angiotensin-aldosterone
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17
Q

brain natriuretic peptide (BNP) and heart failure

  • diagnosis of _____
  • prognosis of _____
  • monitoring _____ of _____
  • treatment of _____
A 
heart failure
heart failure
treatment
heart failure
heart failure
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18
Q

systolic heart failure

  • heart failure with reduced _____ (_____) is defined as _____ of less than _____ and an inability of the heart to generate an adequate _____ to perfuse vital tissue
  • MI is the most common cause of _____
A 
ejection fraction (EF)
EF
40%
cardiac output 
decreased contractility
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19
Q 
heart failure
systolic heart failure 
clinical manifestations:
-\_\_\_\_\_, \_\_\_\_\_, \_\_\_\_\_ of \_\_\_\_\_
-\_\_\_\_\_
-decreased \_\_\_\_\_ and \_\_\_\_\_

below are the descriptions of the clinical manifestations

  • _____ (SOB when lying down the patient sleeps on _____ or even sitting up)
  • _____
  • _____ (_____), _____ on _____
  • _____
  • _____
A 
orthopnea
more than one pillow
paroxymal nocturnal dyspnea 
pulmonary congestions (rales) Kerley B lines on CXR
edema
bilateral pleural effusions
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20
Q

heart failure

  • diastolic heart failure
  • -heart failure with preserved _____
  • -decreased compliance of the _____ and abnormal _____ (_____)
A

ejection fraction
left ventricle
diastolic relaxation (lusitropy)

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21
Q

heart failure
right heart failure
-can result from _____ and elevated _____

clinical manifestations
-_____, _____, _____ (underlying pulmonary disease), _____

A 
diffuse pulmonary disease
pulmonary vascular resistance 
jugular venous distention 
peripheral edema
hepatosplenomegaly 
ascites
22
Q

left heart failure
_____ edema
clinical manifestations:
-_____, _____, _____ of _____

pathophysiologic process
-inability of the heart to generate adequate _____ to _____

A 
pulmonary
dyspnea
orthopnea
cough
frothy sputum
cardiac output
perfuse vital tissues
23
Q 
right heart failure
\_\_\_\_\_ edema
clinical manifestations:
-\_\_\_\_\_ and \_\_\_\_\_
-inability of the heart to provide adequate blood flow into the \_\_\_\_\_ at a normal central \_\_\_\_\_
A 
peripheral 
jugular venous distension
hepatosplenomegaly
pulmonary circulation
venous pressure
24
Q

disorders of the myocardium
valvular regurgitation
-fail to _____ completely, permitting the _____ of _____ to continue

A

shut
backflow
blood

25
Q

disorders of the endocardium
aortic stenosis
-orifice of the aortic semilunar valve narrows, causing diminished blood flow from the left ventricle into the aorta
-causes: _____ and _____

clinical manifestations:
-_____ and _____

A

left ventricular hypertrophy
dilation
angina
syncope

26
Q

disorders of the endocardium

  • mitral stenosis
  • -impairment of blood flow from the left atrium to the ;eft ventricle
  • -causes _____ and _____
  • -most common cause: _____
A

left atrial hypertrophy
dilation
acute rheumatic fever

27
Q

disorders of the endocranium

  • mitral regurgitations
  • -_____ and _____ and _____
  • -permits back flow of blood from the left ventricle into the left atrium
A

left atrial
left ventricular dilation
hypertrophy

28
Q

disorders of the endocardium

  • tricuspid regurgitation
  • -leads to volume overload in the right atrium and ventricle, increased systemic venous blood pressure, and right heart failure
  • _____ and _____ and _____
A

right atrial
right ventricular dilation
hypertrophy

29
Q

mitral valve prolapse syndrome

  • anterior and posterior cusps of the mitral valve billow upward (prolapse) into the atrium during systole
  • it is also a _____ and is thought to have an _____ inheritance pattern, as well as being associated with _____
A

female valvular disorder
autosomal dominant
connectie tissue disease

30
Q

mitral valve prolapse syndrome

  • mitral valve prolapse tends to be the most prevalent in _____. studies suggest an _____ and _____ inheritance pattern.
  • because mitral valve prolapse is often associated with other inherited connective tissue disorders (e.g. _____, _____, _____), it is thought to result from a _____ or _____ disruption of _____ during the _____ or _____ week of _____
A 
young women
autosomal dominant
X-linked
marfans syndrome
ehlers-danlos syndrome 
osteogenesis imperfecta 
genetic 
environmental 
valvular development 
fifth
sixth
gestation
31
Q

disorders of the myocardium
cardiomyopathies
-are a diverse group of diseases that affect the _____
–effects _____ responses to _____ or _____ on the heart muscle cause _____
–many cases of cardiomyopathy are _____

A 
myocardium
neurohumoral
ischemic heart disease
hypertension
remodeling
idiopathic
32
Q

disorders of the myocardium
cardiomyopathies
-dilated (congestive) cardiomyopathy
–impaired _____, leading to increases in _____. causes _____ dilation and grossly impaired _____ function, leading to _____

A 
systolic function
intracardiac volume
ventricular 
systolic
dilated heart failure
33
Q

disorders of the myocardium
cardiomyopathies
-hypertrophic obstructive cardiomyopathy
–common _____ heart defect of a _____ of the _____, which may cause _____ to the _____ outflow tract

A 
inherited
thickening
septal wall
outflow obstruction 
left ventricle
34
Q

disorders of the myocardium
cardiomyopathies restrictive cardiomyopathy
-myocardium becomes rigid and noncompliant, impeding ventricular filling and raising filling pressures during diastole
-restrictive cardiomyopathy may occur _____ or as a cardiac manifestation of systemic diseases, such as _____, _____, _____, _____, _____, or a number of inherited _____

A 
idiopathically 
scleroderma
amyloidosis
sarcoidosis
lymphoma
hemochromatosis 
storage diseases
35
Q

disorders of the heart wall
disorders of the pericardium
-acute pericarditis clinical manifestations
–describe several days of _____, _____, and _____, followed by the sudden onset of _____ that worsens with _____ and with _____
-although the pain may radiate to the _____, it is generally felt in the _____ and may be initially confused with the pain of an acute MI
-individuals with acute pericarditis also may report _____, _____, _____, _____, and _____

A 
fever
myalgias
malaise
severe chest pain
respiratory movement 
lying down
back
anterior chest
dysphagia
restlessness
irritability
anxiety
weakness
36
Q

acute rheumatic fever and rheumatic heart disease
rheumatic fever
-is a diffuse inflammatory disease caused by a delayed immune response to infection by the _____

A

group A beta-hemolytic streptococci

37
Q

acute rheumatic fever and rheumatic heart disease
rheumatic fever
-abnormal immune response to the M proteins that cross react with normal tissues
-clinical manifestations:
–carditis: _____- can cause _____
–_____: _____- causes a transitory truncal rash that is _____ and _____ with _____ that may fade in the center, making them appear as a _____

A 
murmur
acquired aortic regurgitation
erythema marginatum 
truncal rash
nonpruritic 
pink
erythematous macules
ringworm
38
Q

infective endocarditis (IE)

  • inflammation of the endocardium from infectious agents
  • IE is a general term used to describe _____ and _____ of the _____- especially the _____
  • -most common: _____, especially _____, _____, and _____
A 
infection
inflammation
endocardium
cardiac valves
bacteria
streptococci 
staphylococci 
enterococci
39
Q

risk factors for infective endocarditis

  • acquired _____
  • _____ abuse
  • long-term _____ (e.g. for _____ monitoring, _____, or _____)
  • recent _____
A 
valvular heart disease
intravenous drug
indwelling catheterization
pressure
hyperalimentation
hemodialysis 
cardiac surgery
40
Q

cardiac complications of acquired immunodeficiency syndrome (AIDS)
-most common: _____ and _____

A

pericardial effusion

left heart failure

41
Q

diseases of the veins

  • varicose veins
  • -vein in which blood has pooled
  • -usually the saphenous vein
  • -distended, tortuous, and palpable vein
  • -cause: _____ or _____, damage to the _____ in veins
A

trauma
gradual venous distention
valves

42
Q

diseases of the veins

  • deep venous thrombosis (DVT)
  • -DVT is a usual source of a _____
A

pulmonary emboli

43
Q

disease of the veins

  • superior vena cava (SVC) syndrome
  • -_____ of the _____ that leads to _____ in the _____ and _____
A 
progressive occlusion
SVC
venous distention
upper extremities
head
44
Q

hypertension

  • affects of the entire cardiovascular system
  • -_____: most significant factor in causing _____
  • increases the risk for _____, _____, and _____
  • caused by increases in _____ or _____, or both
A 
systolic hypertension
target organ damage
myocardial infarction
kidney disease
stroke
cardiac output
total peripheral resistance
45
Q

pathophysiology of hypertension in the kidney

-pathologic change occurs to the kidney’s _____ as a result of _____ cause to have _____ in the _____

A

glomeruli
hypertension
ischemia
kidney tubules

46
Q

hypertension
treatment
-parmacologic therapies
1. _____, angiotensin-receptor blockers (ARBs), or aldosterone antagonists
2. individuals with heart failure, have _____, are _____, or have had _____
3. _____
4. combination of _____ and other _____

A 
angiotensin-converting enzyme (ACE) inhibitors 
chronic kidney disease
post myocardial infarction
recurrent stroke
calcium channel blockers
thiazide diuretics 
antihypertensives
47
Q

orthostatic (postural) hypotension

-_____ versus _____

A

acute

chronic orthostatic hypotension

48
Q

orthostatic hypotension

  • may be _____ or _____
  • acute orthostatic hypotension (temporary type) may result from (1) altered _____, (2) _____ (e.g. _____, _____), (3) prolonged _____ caused by _____, (4) _____, (5) _____, (6) any condition that produces _____ (e.g. _____, _____ or _____ depletion), and (7) _____ (e.g. _____, extensive _____ of the _____)
  • _____ are susceptible to this type of orthostatic hypotension, in which _____ are slowed as part of the aging process
A 
acute
chronic
temporary
body chemistry
drug action
antihypertensives 
antidepressants
immobility
illness
starvation
physical exhaustion
volume depletion
massive diuresis 
potassium 
sodium
venous pooling
pregnancy
varicosities
lower extremities
older adults
postural reflexes
49
Q

aneurysm

  • local dilation or out pouching of a vessel wall or cardiac chamber
  • _____ is a common cause of aneurysms because _____ erodes _____

clinical manifestations:

  • thoracic:
  • -_____ (difficultly in _____) and _____ (_____) are caused by the _____
A 
atherosclerosis 
plaque formation
vessel wall
dysphagia 
swallowing
dyspnea
breathlessness
pressure
50
Q

thoracic aneurysm
-_____ resulting from a thoracic aneurysm is due to _____ of thoracic aneurysm on _____ cause symptoms of _____ (difficulty _____) and _____ (_____)

A 
dyspnea
pressure
surrounding organs 
dysphagia 
swallowing
dyspnea 
breathlessness
51
Q

peripheral vascular disease

  • thromboangitis obliterans (_____ disease)
  • -occurs mainly in young men who smoke
  • _____ disorder of the _____ small- and medium-size arteries in the _____ and sometimes in the _____
A 
buerger
inflammatory 
peripheral arteries 
feet
hands
52
Q

peripheral vascular disease

  • raynaud phenomenon and Raynaud disease
  • -_____ (ischemia) in the arteries and arterioles of the _____; less commonly in the _____
  • -clinical manifestations: changes in _____ and _____ caused by _____
A 
episodic vasospasm
fingers
toes
skin color
sensation
ischemia

PAS- PATHOPHYSIOLOGY (17 decks)

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