CV pathology Flashcards
what are the 3 main aspects of a chest x ray?
- heart size and shape
- surface anatomy
- lungs and pulm vasculature
what is the surface anatomy of the heart
sup and inf vena cava RA RV LV aorta pulm trunk
what is the cardiac origin of chest pain?
- angina
- MI
- pericarditis
- aortic aneurysm
- aortic stenosis
- cor pulmonale
- mitral valve prolapse
what is the non-cardiac origin of chest pain pulmonary?
- pleurisy
- pneumothorax
- pulmonary emoblism
- pneumona
what is the non-cardiac origin of chest pain GI?
- gastroesophagel reflux disease (GERD)
- peptic ulcer disease (PUD)
- pancreatitits
what is the non-cardiac origin of chest pain musculoskeletal?
- fibromyalgia
- costochondritis
- rib fracture
- cervical/horacic radiculopathy
- TOS
- shoulder disorders
what is the non-cardiac origin of chest pain neuro?
- anxiety
- panic
what is the non-cardiac origin of chest pain other?
- metastases
- herpes
what is angina pectoris?
discomfort in the chest associated with myocardial ischemia but WITHOUT necrosis
what is MI?
local arrest or sudden insufficnecy of arterial blood supply thta produces an area of necrosis in the heart
what happens when the oxygen demand is greater than the oxygen supply?
heart attack
what happens with CAD?
there is a flow limit and the coronary artreries do not dilate well
what is atheroscelerosis?
plaque that develops is underneath the intima so inside vessel is fibro, fatty, muscular plaque
-endothelial lining can burst and then the blood is exposed to the plaque=instantatnoues coagulation
what is acute coronary syndrome (ACS)?
due to a sudden decrease in coronary arteries blood flow leading to cardiac dysfunction and possibly necrosis
what are the complications of MI?
- impaired contractility
- tissue necrosis
- electrical instability
- pericardial inflammation
what are the pain patterns of myocardial ischemia?
- squeezing, burning, pressure, choking
- diffuse, nonfocal
- typically 1-3 minutes
- angina equivalents: SOB/DOE, nausea/vomit, weakness/lethargic
what are aggravating factors for myocardial ischemia?
-demand>supply
physical exertion, emotional stress, early AM(bc increase in sympathetic activity and circadian rhythym)
-no impact: body position/ROM -palpation -deep breathing/coughing -eat/drinking
what are relieving factors for myocardial ischemia?
-decreased demand
rest, medications:NTG
- increased supply
medications: anticoagulations, thrombolytics, aspiring
-surgery: PCI or CABG
what is chronic stable angina?
- established level of onset
- consistent angina threshold: workload that will elicit symptoms
- usual pain pattern
- as CV demand goes up, hit repetitive threshold
what is unstable angina pectoris?
- change in a pre-exisitng angina pattern
- decrease angina threshold/loss of cardiac reserve/ decresae exercise reserve
should call doctor bc impending MI
it increases morbidity and mortality
should not return to PT until stable
what is angiography/ventriculography?
-invasive procedure
-catheter is passed into artery and advanced to heart
usually fem artery
-radio opaque contrast medium injected
information gathered:
-patency of coronary arteries; location and severity of lesions
-intracardiac volumes and intracardiac pressures
direct measurement of CO/SV/EF
what is the treatment of myocardial ischemia?
- risk factor reduction
- cardiac rehab
- pharamcologic therapy
- surgery: angiopalsty and bypass surgery
what are the typical sternal precautions
- 6-8 weeks
- weight restriction of 5-10 lbs
- UE ROM: shoulder elevation< 90 degrees and horz abduction
- driving 6-8 weeks post op
consider pain management, pulmonary hygeine, bracing with cough
what are some common concerns post CV surgery?
- pulmonary complications: atelectasis(alveolar collapse), weak/poor cough, decreased inspiration, increased risk of pneumonia
- infections (incisions, lines/tubes)
- dysrhytmias- A fib, PVCs
- Cardiopulm bypass: post-perfusion syndrome when transietn decline in attention, memroy, fine motor function and speed of rsponses
- HTN
- hyperglycemia
- post op MI
- abnormal lab values
- pain
- depression- motrality rates sky rocket
what is the cause of essential/primary HTN?
-unknown etiology
-risk factors: genetic predisposition, environmental factors (obesity, stress, sodium intake)
account for 90% of all HTN cases
what is the cause of secondary HTN
renal disease
endocrine disease
10% of all HTN cases
HTN= primarily an abnormality of TPR
what are the complications of prolonged, uncontrolled HTN?
-changes in vessel wall lead to vascular damage/trauma, arterioscelerosis and atheroscleroisis
-complications arise due to target organis impacted: CV system: CAD/MI, aneursysms renal: renal insufficinecy and failure NS: stroke, vascular dementia eyes: aneyrysms and blindness
what is HF
inability of the heart to supply adequate blood flow and oxygen delivery to peripheral tissues and organs
- fluid backs up
- someone who has had an MI will likely end up with HF eventually
what happens with a lower afterload?
function gets better= better SV and output
what is the systolic HF classification?
pump failure
-heart failure with reduced ejection fraction
EF <40%
what is the diastolic HF classifcation?
filling failure
-heart failure with preserved ejection fraction
EF> 50%
what is echocardiography?
- use of reflected US to assess cardiac function
- info gathered: size and thickness, valve function, vnetricular wall motion, SV and CO, EF, R and L pressures
- noninvasive
- air, bone and adipose decrease image quality
- to improve image quality: transesophageal echocardiogprahy or doppler
what is transesophageal echocardiography TEE?
transducer inserted directly into esophagus
requires sedation and invasive
improves image quality
what is a normal EF?
55-70%
why is EF important?
important in regards to lifespan
what is the relationship between EF and Vo2?
EF can NOT predict how pt performs
what other organ systems/problems exist wtih HF?
-abnormal vent reserve and regulation
-obesity
-anemia
-impaied autonomic reg
-systolic dysfunction
-decrease skeletal muscle mass
-decrease oxidative caapcty
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