Common Cardiac Disorders

Question 1

What are the two types of disorders?

Answer 1

Mechanical: Reduced pumping effectiveness and efficiency of heart

Electrical: Conduction system impairment

Question 2

What are the two main factors that cause ischemia?

Answer 2

When Metabolic demand does not equal oxygen demand

Question 3

Cascade of heart failure

Answer 3

Untreated, chronic high BP ->
Coronary artery disease ->
Ischemic event ->
Myocardial infarction ->
Heart failure

Question 4

What is the number one cause of mortality and morbidity in the US?

Answer 4

Coronary Artery Disease (CAD)

Question 5

What is primary hypertension?

Answer 5

Accounts for 95% of cases in HTN
No universally established cause

Combination of:
Excess salt, Abnormal arteries, Increased blood volume, Genetic disorders, Stress

Question 6

What is Secondary HTN?

Answer 6

Less than 5% of HTN

Caused by:
- Health conditions
- Certain medications
- Recreational drugs
- Pregnancy
- Hormonal therapy

Question 7

AMA Guidelines for HTN

Answer 7

Question 8

HTN to CHF Chain of Events

Answer 8

HTN ->
Left Ventricle Hypertrophy/ LV remodeling/ Acute MI ->
LV Dilatation/ Dysfunction ->
CHF ->
Signs & symptoms/ Arrhythmias/ Sudden Death

Question 9

HTN: Medical Therapy

Answer 9

Diuretics, Beta Blockers, Calcium Channel Blockers, ACE Inhibitors

Question 10

HTN Lifestyle Changes

Answer 10

Diet/weight changes
Exercise
Reducing/stopping smoking
Reduce salt intake
Stress reduction

Question 11

Coronary Artery Disease (Acute Coronary Syndrome)

Answer 11

Plaque build up that ruptures and creates thrombus formation

End product of atherosclerosis

Oxygen loss effects both myocardium and electrical conduction very acutely and very quickly

Question 12

CAD Clinical Presentation

Answer 12

Chest pain (angina pectoris)
Neck/arm pain or discomfort
Palpitation
Dyspnea
Syncope
Fatigue
Nausea (anginal equivalent)
Men and woman report differently

Question 13

CAD Risk Factors (Modifiable)

Answer 13

Lipid metabolism related factors
Hypertension
Clotting factors
Smoking
Behavior

Question 14

CAD Medications

Answer 14

Vasodilators
Beta blockers
Calcium channel blockers
Anti-vasospasmodics (Reduce coronary artery spasm)

Question 15

CAD Invasive treatments

Answer 15

Percutaneous transluminal coronary artery angioplasty (PTCA)
Coronary artery stents (CAS)
Coronary artery bypass graft (CABG)

Question 16

What is Angina Pectoris?

Answer 16

“Pain in chest”

An ischemic disorder with lactic acidosis characterized by gradual onset over time
First symptoms—substernal pain with episodes of exertion—radiates to left arm, jaw
Symptoms usually occur after more than 50% occlusion of a vessel

Question 17

Symptoms of Angina?

Answer 17

Pain and discomfort are the main symptoms of angina. Angina is often described as pressure, squeezing, burning, or tightness in the chest

Pain from angina also can occur in the arms, shoulders, neck, jaw, throat, or back. It may feel like indigestion

Symptoms such as nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, or weakness also may occur

Women are more likely to feel discomfort in their back, shoulders, and abdomen and report fatigue and nausea (“anginal equivalent”)

Question 18

Stable Angina

Answer 18

Usually during physical exertion
Episodes of pain will be similar for each patient
Lasts a short time (<5 min)
Relieved by rest or medicine

Question 19

Unstable Angina

Answer 19

Often occurs at rest, while sleeping at night, or with little physical exertion
More severe and lasts longer
Usually not relieved with rest or medicine
May get continually worse
May mean that a heart attack is imminent

Question 20

Variant Angina

Answer 20

Prinzmetal angina
Due to coronary vasospasm in the absence of CAD
Tends to be severe
Is relieved by medicine

Question 21

Myocardial Infarction

Answer 21

Sudden occlusion of coronary artery — heart attack
Approximately 1.5 million in U.S. per year
Approximately one in three fatal
80–90% from atherosclerosis with associated risk factors
Time = Muscle!
Can lead to heart failure

Question 22

Myocardial Infarction Signs and Symptoms

Answer 22

Severe, crushing retrosternal pain without relief with usual medications and lasting > 30 min
Pain may radiate—left arm, jaw, even back
Pallor, cyanosis
Nausea and vomiting Differential Dx
Diaphoresis
Weak pulse
Apprehensive, sense of doom
Fever—due to inflammation with necrosis

Question 23

MI Treatment

Answer 23

Medications
- Thrombolytics
- Pain relievers
- Vasodilators
- Anti-clotting agents

Percutaneous Transluminal Coronary Angioplasty

Coronary Artery Bypass Graft

Question 24

Heart Failure

Answer 24

Inability of the heart to pump or receive
blood
Syndrome: Central and peripheral mechanisms compensate for decreased cardiac function

Question 25

What are the two Heart Failure classifications?

Answer 25

Systolic dysfunction HFrEF (Ejection fraction less than 40% — Heart can’t pump, Walls are stretched and thin)

Diastolic dysfunction HFpEF (Made by exclusion in the presence of a preserved ejection fraction— Heart can’t fill, Walls are still and thick)

Question 26

New York Heart Association Heart Failure Classification

Answer 26