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Pathophysiology > Class #2 > Flashcards

Class #2 Flashcards

1
Q

What is pericarditis?

A

Inflammation of the pericardium around the heart, usually as a result of a virus or a bacteria, or blunt trauma. Inflammation increases capillary permeability, which causes the influx or more inflammatory chemicals to the area.

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2
Q

How would pericarditis present in my patient?

A
  • decreased cardiac output
  • pericardial friction rub–super painful!
  • ECG changes
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3
Q

Explain the pain associated with pericarditis

A
  • precordial, doesn’t radiate
  • abrupt onset
  • sharp pain
  • scapula pain
  • increased pain with deep breath and cough
  • relief when leaning forward
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4
Q

What is Dressler Syndrome?

A

chest pain post heart-attack after hospital treatment

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5
Q

What is a pericardial effusion?

A

accumulation of fluid in the pericardial space, caused by inflammation of the pericardium, infection, neoplasms, cardiac surgery, and trauma

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6
Q

What is the worst case scenario of fluid building up in the pericardial sac?

A

Cardiac Tamponade. This occurs when enough blood or other fluid has built up in the pericardial sac that it compresses the heart, which may prevent it from pumping effectively.

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7
Q

What can cause Cardiac Tamponade?

A
  • Blunt trauma (MVA)
  • Myocardial rupture post MI
  • Cardiac surgery
  • Aortic dissection
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8
Q

If I suspect that my patient is experiencing cardiac tamponade, how might they present to me?

A

It depends on the amound and the rapidity, but ultimately the compression limits stroke volume and cardiac output, which leads to low systolic blood pressure. You would see:

  • chest pain and tachycardia, muffled heart sounds
  • dyspnea and tachypnea
  • change in mentation.
  • elevated jugular venous pressure
  • circulatory shock
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9
Q

How is Cardiac Tamponade diagnosed?

A
  • Pulsus paradoxus
  • ECG (would indicate decreased conductivity)
  • Echocardiogram
  • CT, MRI
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10
Q

How is cardiac Tamponade treated?

A

immediate pericardiocentasis

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11
Q

What is pulsus paradoxus?

A

a drop in systemic arterial pressure of greater than 10 mmHg on inspiration

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12
Q

LOOK UP CORONARY ARTERY CHART IN NOTES

A

LOOK AT IT NOW!

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13
Q

What 3 things assist coronary artery flow?

A
  1. Endothelial cells lining the arteries
  2. Diastolic pressure in the aorta
  3. Time in Diastole
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14
Q

What can you teach your patients if they want to reduce their risk for CAD?

A

Teach them the modifiable risks for the disease:

  • HTN
  • Hyperlipidemia
  • Tobacco use
  • Diabetes
  • Obesity
  • sedentary lifestyle
  • ability to cope with stress
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15
Q

What are the non-modifiable risks for CAD?

A
  • post-menopausal women are more at risk
  • age
  • ethnicity
  • genetics/family history
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16
Q

Your patient comes into the emergency room complaining of chest pain, afraid that he might be having a heart attack. It turns out that he is experiencing stable angina. How can you explain this condition to him? What are the common manifestations?

A
  • benign chest pain d/t lack of oxygen, often with exercise, exertion, cold temperatures, or high emotions
  • Often a FIXED coronary narrowing
  • normally substernal pain, occasionally radiates
  • may experience epigastric discomfort
17
Q

If your patient experiences stable angina again in the future, how can he relieve the pain?

A

Rest and nitroglycerine (if prescribed by dr)

18
Q

What is the difference between stable angina and variant angina?

A

stable angina occurs with fixed coronary narrowing, but variant angina occurs d/t spasms of the coronary artery

19
Q

Why are silent MI’s more likely in the elderly?

A
  • Less myocardium involved, which decreases intensity of pain
  • neuropathy, which leads to decreased sensitivity
  • hypotension, which leads to vauge discomfort, mild diaphoresis, occasional stroke-like symptoms
20
Q

What are the potential causes of Acute Coronary Syndrome?

A

-Unstable plaque rupturing to form a clot
-coronary vasospasm
-atherosclerotic narrowing
-Inflammation/Infection
SECONDARY CAUSES
-anemia, fever, hypoxemia, surgery

21
Q

What is unstable angina?

A

[NSTEMI]

  • with pre-diagnosis of “stable angina”
  • occurs at rest, which is different from stable angina, which occurs with exertion
22
Q

I might suspect my patient may be having an ST Elevation MI if he is exhibiting what specific symptoms?

A
  • crushing/constricting pain or pressure
  • substernal with radiation to the L arm and jaw
  • epigastric distress/nausea
  • palpitations
  • cool, clammy skin
  • Shortness of breath
  • Anxiety
23
Q

How long does it take for cell death to occur in an MI?

A

15-20 mins– Early perfusion and revascularization can prevent necrosis! ACT QUICK!

24
Q

Myocardial ischemia and necrosis result in…

A
  1. Decreased contractile force
    - decreased CO
    - decreased coronary artery perfusion
    - increased pulmonary vasculature pressure
  2. Interruption of conduction
    - dysrhythmias
25
Q

LOOK AT THE CHART ABOUT THE DIFFERENCE BETWEEN MI IN MEN AND WOMEN

A

LOOK AT IT NOW

26
Q

True or false?

Men experience more more complications related to heart attacks and heart surgery than women do

A

FALSE
Men have larger vessels than women do, and therefore there is more “grace space”. Women experience complications more often because their vessels are typically smaller and narrower

27
Q

What are the 3 most common diagnostic tests to determine whether or not a patient has had an MI?

A
  1. Troponin
    - enzyme released specific to heart muscle. 2-3 hrs after damage has occurred to the heart muscle, remains for 7-10 days
  2. Myoglobin
    - protein released from skeletal muscle damage that rises within 1 hr of the event and peaks at 4 hrs
  3. Creatine Kinase MB
    - Specific to cardiac muscle, rises in 4-6 hrs gone in 2-3 days
28
Q

LOOK AT CHART COMPARING ANGINAS

A

SERIOUSLY, STUDY IT NOW!

29
Q

If lab results indicate a significant rise in troponin in your patient, you can suspect they have experienced a heart attack. What is the appropriate acute treatment for an MI?

A

-apply oxygen to increase perfusion
-pain relief
-reperfusion-fibrionolytics
-Percutaneous transluminal coronary
angioplasty (Blow job)
-Coronary artery bypass graft (CABG) in an attempt to bypass the clogged up area of the blood vessel

30
Q

What is the most common cause of death in a patient who has experienced an MI?

A

Fatal arrythmias

31
Q

What is the leading cause of sudden cardiac death in young adults? Explain the physiology of this condition

A

Hypertrophic Cardiomyopathy (HCM)
Unexplained genetic ventricular septal thickening.
-poor diastolic filling
-Left ventricle outflow obstruction
-left ventricular hypertrophy
-disruption of normal conduction pathways

32
Q

What are the manifestations of Hypertrophic Cardiomyopathy?

A

HCM causes decreased stroke volume d/t impaired diastolic filling. This causes:

  • dyspnea
  • chest pain
  • syncope past exertion
  • atrial fibrillation
  • lethal ventricular arrhythmias
33
Q

What is endocarditis?

A

any infection of the INNER lining of the heart, mostly affects the mitral & aortic valves

34
Q

What puts an individual at risk for endocarditis?

A
  • infection elsewhere
  • dental surgery
  • IV drugs
  • immunodeficiency
  • valve prolapse
35
Q

You have just arrived on the medical unit for the start of your shift. One of your patients is a new-admit diagnosed with endocarditis. What symptoms might you expect to see? What potential complications do you want to be aware of?

A

-Signs and symptoms of systemic infection
-changes in heart sounds
-symptoms related to embolism
COMPLICATIONS:
-emboli (lung, renal, brain)
-valve dysfunction
-arrhythmias

Pathophysiology (10 decks)

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