Chapter 9 Flashcards
how do myocardial cells function
one large cell
how many chambers are in the heart
4
what are the heart chambers
right/left atria and ventricles
role of atria
receiving chambers
role of ventricles
pumping chambers
how many systems are in the heart
2
pulmonary system
right side
deoxygenated blood to lungs
systemic system
left side
oxygenated blood to rest of body
electrocardiogram
electrical activity
true or false: the heart generates it’s own electricity
true
p wave
atrial depolarization
qrs complex
ventricle depolarization (contraction)
t wave
ventricle repolarization
what do all heart disorders affect
cardiac output and/or effort
examples of heart disorders/affects
pump failure
obstructed flow
regurgitant flow
shunted flow
abnormal conduction
congenital heart disease
cyanotic or acyanotic
atrial/ventricular septal defects
tetralogy of fallot
cyanotic CHD
right to left
less common
poorly oxygenated blood flows to oxygenated
BLUE
acyanotic CHD
left to right
more common
adds to right side workload, more blood
types of atrial/ventricular septal defects
shunt
manifestations of ASD/VSD
murmur
easily fatigued
RIGHT sided heart failure
tetralogy of fallot defects
VSD
pulmonary stenosis
right ventricle hypertrophy
misplaced aorta
manifestations of tetralogy of fallot
cyanosis
digital clubbing
slow growth
heart failure
variable life expectancy
treatment for tetralogy of fallot
surgery shortly after birth
ductus arteriosus
allows blood to bypass lungs using pulmonary artery to descending aorta
normally closes at birth
patent ductus arteriosus
shunt stays open after birth
cyanosis
blood shunted from aorta to pulmonary artery
is heart failure a disease
no, syndrome
what is the meaning of heart failure
describes several types of cardiac dysfunction that results in inadequate perfusion of tissues with blood-borne nutrients
is heart failure age associated
yes
is heart failure prevalence increasing or decreasing? why?
increasing, people are living longer
what are 2 ways the heart compensates to inadequate perfusion
increase SNS and cardiac muscle hypertrophy
systolic heart failure
impaired contraction caused by incomplete emptying
what happens to EF in systolic heart failure
decreases
less than 40%
normal ejection fraction
55%
what causes systolic heart failure
coronary artery disease
ischemia
cardiomyopathy
previous heart attack
diastolic heart failure
impaired filling
relaxation phase
what happens to EF in diastolic heart failure
remains same
what causes diastolic heart failure
ventricular stiffness caused by hypertension
results in smaller chamber size
compensated heart failure
failing ventricles dilate, increases chamber size to maintain cardiac output
don’t know you’re in heart failure
uncompensated heart failure
increased stretching results in weaker contractions
uncompensated forward failure
low cardiac output
uncompensated backward failure
upstream venous conjestion
is left or right sided heart failure more common
left
what causes left sided failure
cardiac muscle damage (MI)
valve defects
hypertension
cardiomyopathy
what causes right sided failure
LUNGS
pulmonary hypertension
pulmonary valve defect
forward heart failure
inadequate cardiac output
decreased perfusion (kidneys)
organs downstream don’t get as much oxygen
backward heart failure
increased pressure due to blood backing up
pulmonary edema
hepatomegaly
symptoms of left sided failure
dyspnea
increased heart rate
pulmonary edema
LVent dilation
FATAL due to hypoxia, acidosis, arrhythmias
symptoms of right sided failure
dilated neck veins
swelling
ascites
edema in liver and spleen
NO DYSPNEA
how do you diagnose heart failure
ECHO
ways to treat heart failure
diet, drugs
dietary treatment for heart failure
weight loss
low salt diet
stop smoking
drug treatment for heart failure
diuretics
ACE inhibitors
aldosterone receptor blockers
digoxin
prognosis for heart failure
poor unless underlying cause is treatable
what is the role of coronary arteries relative to the heart
supply blood to heart through right and left arteries
coronary artery atherosclerosis
atherosclerosis blocks coronary arteries leading to ischemia
what is ischemia
low oxygen due to low flow
what can ischemia cause
angina
myocardial infarction
arrhythmias
conduction deficits
heart failure
sudden death
acute ischemia
may result in angina pectoris
comes on quickly
unremitting
angina pectoris
chest pain due to ischemia
types of angina pectoris
stable and unstable angina
silent myocardial ischemia
stable angina
most common and predictable
pain when heart’s oxygen demand increases
unstable angina
no pattern, comes quickly
caused by aggregation of platelets on plaque
MEDICAL EMERGENCY
silent myocardial ischemia
myocardial ischemia without pain
myocardial infarction
necrosis of heart muscle due to ischemia
what causes MI
sudden disruption of plaque, leads to thrombus
thrombus occludes vessel
what is the rank of MI in deaths in US
leading cause of death
1.5million cases/yr
⅓ die
percent of MI that occurs without warning
20%
percent of MI patients arriving alive
80-90%
cause of death in MI patients in die before hospital
cardiac arrhythmia
are there complications of MI?
yes, most develop clinical complications
what areas are affected by MI
left ventricle
anterior
what type of necrosis is MI
coagulative
symptoms of acute MI
angina…severe, crushing, constrictive, or heartburn
SNS responses…GI distress, nausea, vomiting
tachycardia, vasoconstriction
anxiety, restlessness, feeling of impending doom
hypotension…shock, weakness in extremities
men vs. women MI symptoms
men have more hallmark symptoms
women MI symptoms
unusual fatigue
sleep disturbances
indigestion
anxiety
do all MI patients have symptoms
no
diagnosis of MI
ECG abnormalities
elevation of blood enzymes
ECG abnormalities of MI
ischemia in ventricles
T wave of ST segment
elevated blood enzymes of MI
due to tissue necrosis
creatine kinase
cardiac CK
cardiac troponin
what are the enzyme levels in more severe heart attacks?
stronger/larger enzyme levels
does angina have elevated enzymes
no
what is the most common cause of CAD
thrombus blocking blood flow
goals of CAD treatment
reverse thrombosis
control pain
limit infarct size
reduce cardiac workload w/beta blockers
treat complications
lifestyle treatments for CAD
lose weight
low salt
stop smoking
increased physical activity
drug treatments for CAD
nitroglycerin (vasodilator)
antiplatelet/anticoagulant (warfarin, aspirin)
beta blockers (inhibits SNS)
antiarrhythmias (maintains stability)
surgery treatments for CAD
destroy clot via (angioplasty)
cardiac bypass (INVASIVE, rerouting blood flow)
stent (brace lumen so vessel remains open)
long term complications of MI
heart failure
cardiogenic shock
pericarditis
thromboemboli
cardiomyopathy
heart rupture
ventricular aneurysms
late complications of MI
heart failure
early complications of MI
arrhythmias
hypertensive heart disease
due to hypertension ONLY
LEFT SIDE
manifestations of HTN heart disease
LVent hypertrophy
enlarge heart…chamber size decreases resulting in diastolic failure…heart may be so thick and result in angina
left heart failure
pulmonary edema
treatment for HTN heart disease
reduce blood pressure
is HTN heart disease reversible
yes
what is the role of valves
control direction of flow
must fully open/close
types of valves in heart
AV values
semilunar valves
stenosis
failure to open completely
regurgitation
failure to close tightly
blood regurgitates to previous chamber
valvular stenosis
aortic/mitral stenosis
valvular insufficiency
aortic regurgitation (LVent)
mitral regurgitation (LAtria)
tricuspid regurgitation (RVent)
degeneration
most common cause of valve disease
types of degeneration
aortic stenosis
calcification of mitral valve
mitral prolapse (regurgitation)
why is left valvular degeneration more common
age, greater workload, higher pressure
what causes valve disease
rheumatic fever
valvular dysfunction
irregular blood flow
stenosis
regurgitation
manifestations of valvular dysfunction
ASYMPTOMATIC
murmur
easily fatigued
shortness of breath
aortic stenosis
most common valve defect w/age
what causes aortic stenosis
age-associated wear and tear
calcification
manifestations of aortic stenosis
increase LVent pressure during ejection…increased resistance to flow/reduced stroke volume
LVent hypertrophy…impaired filling
back up blood into LAtria….increases LAtrial pressure
what is aortic stenosis a risk factor for
heart failure
arrhythmia
atrial fibrillation
is aortic stenosis a systolic or diastolic murmur
systolic
causes of mitral stenosis
rheumatic fever
manifestations of mitral stenosis
difficulty emptying blood into LVent during diastolic…reduces EDV and Q
blood backs up into LAtria…hypertrophy, pulmonary congestion and hypertension
is mitral stenosis a systolic or diastolic murmur
diastolic
regurgitation of mitral valve
backflow of blood into LAtria
manifestations of regurgitation of mitral valve
LAtria pressure increases, hypertrophy
atrial fibrillation
increase LVent EDV…increase preload and Q
net amount of blood ejected is reduced because it’s going back to where it came from
what can regurgitation of mitral valve lead to
right side heart failure
is regurgitation of mitral valve a systolic or diastolic murmur
systolic
regurgitation of aortic valve
backflow of blood into LVent
manifestations of regurgitation of aortic valve
volume overload…LV pressure increases
increase LV EDV
hypertrophy of LVent…heart failure
is regurgitation of aortic valve a systolic or diastolic murmur
diastolic
acute rheumatic fever
autoimmune disorder
streptococcal infection
cardiomyopathy
pathology of heart muscle
what causes cardiomyopathy
inflammation
acquired (diet…alcohol, radiation)
genetic
symptoms of cardiomyopathy
asymptomatic
types of cardiomyopathy
dilated, hypertrophic, restrictive
dilated cardiomyopathy
ventricles weaken because of too much stretching, enlarge
MOST COMMON
reduced systolic function….no strong contraction
cause of dilated cardiomyopathy
idiopathic
what does dilated cardiomyopathy lead to
heart failure, valve disease, irregular heart rate
hypertrophic cardiomyopathy
ventricles and septum enlarge and thicken
affects mitral valve (diastolic) function if chamber gets too thick
cellular changes in myocardium
who is the most at risk for hypertrophic cardiomyopathy deaths
young athletes
what causes hypertrophic cardiomyopathy
genetic (mutation in myosin)
acquired (hypertension)
idiopathic
how to screen for hypertrophic cardiomyopathy
familial history
ECHO
blood genetic tests
restrictive cardiomyopathy
heart is rigid and restricted from increased stretching
ventricles don’t thicken
DIASTOLIC
what does restrictive cardiomyopathy lead to
heart failure
valve problems
causes of restrictive cardiomyopathy
idiopathic
amyloidosis
chemotherapy
symptoms of cardiomyopathy
NONSPECIFIC
asymptomatic
murmur
dyspnea
angina
syncope
arrhythmia
complications of cardiomyopathy
heart failure
blood clots
valve defects
cardiac arrest
sudden death
pericardial disease
inflammation of pericardium
what causes pericardial disease
MI due to inflammation factors
is pericardial disease primary or secondary
secondary to other conditions like virus, bacteria, infection
complications of pericardial disease
leads to chronic scarring and restrictive pericarditis
restrictive pericarditis
interference with heart ability to pump
primary tumors of the heart
rare
myxoma
90% benign
90% occur in left atria
what is most common with tumors of the heart
metastasis
normal sinus rhythm
cardiac conduction system important for coordination of pumping
arrhythmias
disturbance of heart rhythm (irregular heartbeat)
classification of arrhythmias
abnormal impulse formation
abnormal conduction
tachycardia
bradycardia
automaticity arrhythmia
SA node is natural pacemaker
enhanced or suppressed automaticity
factors enhancing automaticity
increase SNS, CO2, H+, stretch
decrease PNS, O2
hypokalemia
atria arrhythmia
atrial fibrillation (disorganized)
atrial flutter (beats faster than ventricle)
stroke
ventricular arrhythmias
premature ventricular contractions (PVC)
ventricular tachycardia
ventricular fibrillation (no ejection of blood)
re-entry
mechanism for arrhythmia
2 distinct pathways come together to form loop
examples of re-entry
afib
atrial flutter
ventricular tachycardia
complications of ventricular arrhythmias
sudden cardiac death
complications of atrial arrhythmias
atrial thrombi
increase risk for stroke
treatment for arrhythmias
anti-arrhythmic drugs
defibrillation
ablation
pacemaker
sudden cardiac death
natural death from cardiac causes within one hour of acute symptoms
what causes sudden cardiac death
arrhythmia
MI
aortic aneurysm
electrocution
drugs like cocaine
