CP LEC 2: CMD Flashcards
What is the most common cause of pulmonary congestion and edema
Heart failure
Coronary artery disease is the second most common cause of _____
Cardiac muscle disease
Scar formation at ischemic areas of the ventricle can cause
Poor compliance, decrease filling and decreased contractility
What is the main issue with arrhythmias?
Drop in cardiac output
What is more life threatening? Supraventricular tachycardia or ventricular tachycardia
Ventricular tachycardia is life threatening.
The principle treatment of renal insufficiency (due to fluid overload) is to…
Reduce reabsorption of fluid at kidneys, maintain electrolyte balance
During severe renal insufficiency, you will see Azotemia which is….
High blood content of nitrogen compounds such as
Urea
Creatinine
bc kidney cant filter them out
During severe renal insufficiency, what happens in regard to BUN and Sympathetic nervous system activity
Increased BUN (blood urea nitrogen)
Increased sympathetic nervous system activity to increase BP
What are the three types of cardiomyopathies
Dilated
Hypertrophic
Restrictive
What is a primary cause of cardiomyopathy
Idiopathic mechanisms
What is a secondary cause of cardiomyopathy
Prolonged HTN
Metabolic Disorder
heart valve problems
Arrhythmia
What is HFrEF and what is the cause
Dilated Cardiomyopathy: Heart Failure with reduced Ejection Fraction (<40%)
*systolic issues
Due to metabolic problems, toxicity from alcohol abuse, infections, genetic predisposition
When you have dilated cardiomyopathy how is the left ventricular end-diastolic volume effected
Increased
Note: impaired frank starling mechanism, reduced contractility
Hypertrophic cardiomyopathies
Mainly a diastolic issue. From an enlarged heart. Heart failure with preserved ejection fraction. Muscle cells are disorganized, inefficient pump
During hypertrophic cardiomyopathies, you have increased pressure in the….
Left atrium, pulmonary artery, and pulmonary capillaries
(Increased left end diastolic volume)
What kind of cardiomyopathies are common in young athletes
Hypertrophic cardiomyopathies
The disorganized, malalignment of cardiac cells in hypertrophic cardiomyopathy is a risk for
fatal arrhythmias
What is restrictive cardiomyopathies?
myocardial fibrosis
similar to hypertrophic which often develops
diastolic dysfxn
Causes of restrictive cardiomyoptahies
Cardiac amyloidosis (proteins that thicken heart walls)
diseases of the heart lining (endocardoum) such as endomyocardial fibrosis
scarring after radiation or chemo
sarcoidosis
scleroderma (hardening of CT)
tumors
When you have a heart valve abnormality how can it effect the Cardiac muscles
It produces Cardiac muscle disease due to impaired relaxation
heart muscles have to work harder to pump the blood through
valvular insufficiency vs stenosis
Insufficiency - valve doesn’t close all the way and allows blood to back flow
stenosis - valve is narrowed or blocked, decreasing BF through the valve
Mitral valve incompetency dilates the _____
Left atria
Tricuspid valve incompetency dilates the _____
Right atria
Aortic valve incompetency dilates the ______
Left ventrical
Pulmonic valve incompetency dilates the _______
Right ventricle
What levels are mean pulmonary arterial hypertension
MPAP > 25mmHg at rest, 30 with exercise
Pulmonary HTN and a PE both increase the work placed on the ___ ventricle
right
If pulse pressure is below 40-60 what is likely?
Heart failure
For every unit of blood transfused, what is the recommended rest period
30 minutes of rest b4 activity
Heart failure primarily effects what kind of skeletal muscle fibers
Type 1
If a patient has elevated troponin or elevated creatinine kinase are they safe to get up from bed? what does this indicate?
No
these enzymes are relased into the bloodstream with heart muscle cells die (MI)
What does an ST segment elevation indicate?
A myocardial infarction, or maybe the electrodes are not on the patient well
Arrthmyas cause a _____ in cardiac output
reduction
True or false: If the heart rate is too slow OR too fast, cardiac output drops
True
Too fast does not allow for proper filling
True or false: arrythmias can only take place in SA node
False, they can happen to any part of the conduction system
What is supraventricular tachycardia
Arrythmia where the atria is contracting too fast
What electrolytes are important in an arrythmia
Sodium
Potassium
Magnesium
Chloride
increased Mg levels may lead to
while decreased Mg levels may lead to
arrythmias, complete heart block, cardiac arrest
arrythmias, tachycardia, seizure
What can dehydration cause in regards to electrolytes
Increased sodium
Increased risk of an arrythmia
True or false: High OR low potassium is a problem that can cause arrythmias
True
If the heart cannot pump enough blood to kidneys what happens?
GFR rate drops, reduction in renin
What is renin?
Enzyme produced in kidneys that converts angiotensin to angiotensin 1 - > angiotensin 2 -> signals adrenal cortex to release aldosterone -> causes kidney to reabsorb sodium and water
How can renal insufficiency cause cardiac issues?
(aldosterone released) too much fluid retained = blood volume increases, increased MAP
during heart failure, kidneys aren’t receiving proper BF due ot reduced BP, so they release renin = angiostatin II = vasoconstriction (more taxing on heart)
What is the main issue with diuretic medication, and when might this be used?
produces release of sodium and potassium which leads to electrolyte imbalances
used for renal failure if pt is retaining fluid and salt
If someone is taking diuretics, what should you pay attention to prior to getting the patient up?
Electrolyte balance
What is cardiomyopathy?
Disease of heart muscle
Cardiomyopathy can cause difficulty for the heart to contract OR it can cause difficulty ______
for the heart to relax
Drug use can cause ______ cardiomyopathy
secondary
Frank-Starling Law states that
the stroke volume of the left ventricle will increase as the left ventricular volume increases due to the myocyte stretch causing a more forceful systolic contraction
With a PE which obstructs the pulmonary artery, there is a ___ in SpO2 and ___ in RR
decrease in SpO2 (decrease in oxygen getting to the bodys blood)
increase in RR to compensate, trying to get more oxygen
If VO2 falls below a critical level then serum lactate levels will _____
Increase
As one exercises, bloodflow is not only increased to the muscles, but also to the ____ to promote cooling
skin
What is V/Q ratio? What is the ratio in the upper and lower part of the lung?
Ventilation/Perfusion
1:1 is ideal
The ratio is higher in the upper lung and lower in the lower lung. Lower lung has more perfusion and upper lung has more ventilation.
The average V/Q ratio for the whole lung is 0.8
What VQ ratio is considered deadspace
An infinite V/Q ratio with all ventilation and no perfusion
example of deadspace: Trachea ( upper airway) all ventilation but no perfusion
Often times you can correct a low V/Q ratio with supplementary _____
Oxygen
The upper lung typically has ____ V/Q ratio than the lower part of the lung
Higher
Is any shunting or deadspace expected to take place at the level of the alveoli
NO, the V/Q ratio should always be close to 1 at the alveoli (unless there’s an abnormal blockage of the airway or perfusion)
Note: for V:Q ratio
Shunting: Ratio is 0
Deadspace = Ratio is infinite
The __________ part of the lung shunts blood to other parts
the ____ part is a physiological deadspace
Lower part
Upper Part (apices)
_____ arteries have more elastic property to accomadate high blood pressure
____ arteries have more smooth muscle to allow for vasodilation and vasoconstriction
Larger
Smaller
What happens to the vessels in the lungs when the oxygenation in the blood decreases
Reflexive vasoconstriction
What is BNP enzyme?
Enzyme that is produced by atria or ventricles when they are stretched
More stretch= more BNP
Enzyme is monitored in patients with heart failure
What do high BNP levels mean
More serious heart failure
What does a swan-ganz catheter measure
Right sided/pulmonary artery pressure
What is congestive heart failure?
a pathological decrease in cardiac output due to left ventricle failure leading to pulmonary congestion
fluid backs up into pulmonary veins, then pulmonary capillaries, and the increased pressure in the capillaries causes fluid to leak out into the alveolar sacs
what pressure level in the pulmonary capillaries suggests left sided heart failure?
> 15-20mmHg
Stage A-D of heart failure
A - high risk but no structural disorder
B - structural disorder, no symptoms
C - past or current symptoms
D - end stage disease
Class I-IV Heart failure
class I, no limitation
II: slight limitation, comfortable at rest
III: marked limitation, comfortable at rest
IV: inability to do PA without discomfort, symptoms at rest
A full blockage of a coronary artery will cause an ST segment ________ and a myocardial infarction, whereas a partial blockage of a coronary artery will appear as an ST segment ________
Partial blockage: depression
Complete blockage: elevation
Identify
ST segment depression
Identify
ST segment elevation
stable angina
chest discomfort or anginal equivalent that is provoked with exertion and alleviated at rest
Atrial flutter
Myocardia in the atria let off signals that make the atria contract rapidly (but with a regular rythm
Ventricular fibrillation
the lower heart chambers contract in a very rapid and uncoordinated manner. As a result, the heart doesn’t pump blood to the rest of the body.
atrial fibrillation
Afib stands for atrial fibrillation (AF), which is a type of arrhythmia, or abnormal heartbeat. Afib is caused by extremely fast and irregular beats from the upper chambers of the heart
Note: different than atrial flutter because it’s irregular
The liver releases _______ in response to low blood pressure or adverse changes in sodium
The kidneys produce _______ which helps make the ___________
Angiotensin
Renin
Angiotensin 1
The lungs release ACE (angiotensin converting enzyme) which turns angiotensin 1 into….
Angiotensin 2
Note: angiotensin 2 causes vasoconstriction by decreasing nitric oxide synthesis ( a vaso dialator)
Angiotensin 2 causes the release of aldosterone which promotes..
Sodium and water retention
Note: combined with the vasoconstriction effect of angiotensin 2, this raises blood pressure
When the kidney senses raised blood pressure, it reduces the reduction of Renin to stop more angiotensin 2 from being released
What is cardiac tamponade?
enough fluid accumulates in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock
anxiety, chest pain, fainting
what would either high or low WBC levels indicate?
high WBC can indicate infection which can cause pericardial effusion
low WBC can be sign of sever infection or immune system dysfxn
What does a doppler measure?
blood flow?
what are some common types of arrythmias?
sick sinus node syndrome / heart block (SA isnt sending signal to AV, AV has to take over)
prolonged supraventricular tachycardia (taxing for the heart)
rapid atrial fib/flutter
**ventricular tachycardia fibrillation - life threatening
what is a d-dimer test
suggests clot formation and breakdown (sign of a DVT)
Digitals and Lanoxin are medications used to
increase contractility during HF
myocardial contractility is negativelt affected by
loss of myocardial cells
acidosis (low pH)
hypercapnia (inc CO2)
anoxia (low O2)
beta blockers
hypoxia vs hypoxemia
hypoxia - low oxygen in the tissues
hypoxemia - low oxygen in the blood
B1 receptors
B2 receptors
B1 - iotropic and chronotropic
B2 - bronchodilation
a1
a2 receptors
a1 - vasoconstriction of GI, kidney, brain
a2 - vasodilation
how is they sympathetic NS impacted during HF?
it becomes overstimulated (trying to compensate) and leads to down regulation of the B1 receptors, which overall leads to decreased myocardial contractility and HR
what is hepatic venous congestion?
during HF, fluid backs up all the way to the veins for the liver and can cause hepatomegaly (swelling)
bc HF, there is a decrease is BF and oxygen going to the liver, causing cardiac cirrhosis of the liver (scarring, more dysfxn of liver)
how does the kidney respond to HF?
when it detects low O2 levels, it stimulates erythropoietin to make more RBC to increase oxygen carrying capcity of the blood, but this just causes polycythemia, increasing bloods thickness and taxing the heart even more
at what PaO2 does desaturation occur?
60mmHg!
Why are those with CHF at risk for thrombocytopenia, and what does this mean in terms of treatment?
liver and kidney damage mean decreased thrombin secretion and higher risk for bleeding (less clot formation)
be careful not to cause bleeding!
How are skeletal muscles affected during CHF?
changes cause overall weakness and deconditioning
How are glucose levels affected during CHF?
decreased BF to pancreas results in decreased insulin release
HF = sympathetic NS = glucogenolysis (release into blood)
normally heart will use fatty acids as source of fuel but now has to use glucose which is less efficient
