CVD Conditions (Other) Flashcards
What are cardiac arrythmias?
Any variation from a normal heart rhythm
What are the 2 different types of cardiac arrythmias?
- disorders of impulse formation (abnormal rate of impulse generation by pacemakers in the heart) - includes atrial and ventricular fibrillation, and sinus and ventricular tachycardia
- disorders of impulse conduction (abnormal conduction of impulses through conduction system) - includes first and second degree heart block
What is atrial fibrillation?
Irregular heart contractions caused by electrical signals originating from the AV node instead of the SA node
Implications:
- loss of atrial kick
- build up of stagnant blood in LA (can cause thrombus to develop)
- inadequate CO causing hypoxia, hypotension and angina
What are the SSX of atrial fibrillation?
Symptoms:
- palpitations
- dyspnoea
- fatigue
- dizziness
Signs:
- irregularly irregular pulse
Complications:
- thrombus formation in LA
- decreased CO causing hypoxia, hypotension
- heart failure
What medications are used to treat atrial fibrillation?
- Calcium channel blockers
- controls HR by blocking entry of calcium into myocardium - Beta blockers
- controls HR by blocking B1 receptors in heart - Amiodarone
- controls rhythm - Anticoagulants
What is pericarditis?
Inflammation of the pericardium
What are the SSX of pericarditis?
Symptoms:
- sudden onset severe chest pain
- pain referring to back & shoulder via phrenic nerve
- pain aggravated by lying down & respiraton
- dysphagia
- restlessness / anxiety
- fatigue
Signs:
- friction rub at apex
- tachycardia
What are the causes of pericarditis?
90% viral or idiopathic
What is pericardial effusion?
Buildup of fluid in pericardial cavity (between parietal and visceral layers of pericardium)
- often caused by inflammation
- can be a complication of pericarditis
What is endocarditis?
Inflammation of the endocardium
Infective:
- most common
- formation of “vegetations” composed of infective micro-organisms, inflammatory cells and fibrin
- cause valvular and cardiac damage
Non-infective
- less common
- no vegetation formation
What is the aetiology of endocarditis?
Bacterial - staph, strep
Rhematic fever or rheumatic heart disease
Infection from dental / surgical procedure or IV
What are the SSX of endocarditis?
- variable & not always present
- chest pain
- fever
- fatigue
- aches and pains
- sore throat
What are the 2 major types of valvular disorders?
Stenosis - stiffening of valve increases resistance to normal blood flow
Regurgitation / incompetence - valve does not close properly, allowing backflow of blood
What are the 4 different valvular disorders, and their implications?
Aortic Stenosis:
- stenosis of aortic valve
- causes hypertophy, dilation and failure of LV
Mitral Stenosis:
- stenosis of mitral valve
- fluid overload of LA
- causes LA hypertrophy, dilation and failure
Atrial Regurgitation:
- aortic valve incompetence
- backflow of blood from aorta to LV
- fluid overload of LV
- LV hypertrophy, dilation and failure
Mitral Regurgitation:
- mitral valve incompetence
- backflow of blood from LV to LA
- LA hypertrophy, dilation, and failure
Outcomes for all 4:
- left sided heart failure
What is heart failure, and the 2 different types?
Heart failure = inability of heart muscle to maintain adequate cardiac output
Left sided - failure of LV, usually primary
Right sided - failure of RV, usually secondary
What are the two types of left sided heart failure?
Systolic:
- LV hypertrophies in response to increased workload
- LV eventually dilates and fails
Diastolic:
- LV is stenotic and can’t expand enough to accomodate adequate blood volume
- contractions are normal but adequate CO still not reached
Which type of heart failure usually develops first?
Left sided
right sided develops as a secondary outcome of left sided failure
What is the process of systolic heart failure (left or right)?
- Increased afterload for ventricle
- ventricle hypertrophies
- hypertrophy eventually causes dysfunction and decreased contractile strength in ventricle (because of the makeup of cardiac muscle)
- as contractile strength decreases, amount of blood remaining in ventricle at the end of contraction (ESV) increases
- ventricle dilates to accommodate increased ESV
- ventricle eventually fails
How does left sided heart failure cause right sided heart failure to develop?
- As left ventricle fails and cannot adequately pump blood, backflow of blood builds up in the pulmonary circuit and causes pulmonary hypertension
- Pulmonary hypertension increases the afterload for the right ventricle
- Right ventricle hypertrophies, then dilates and fails (same steps as left sided heart failure)
What are the symptoms of heart failure?
Classic triad:
- profound fatigue
- palpitations
- dyspnoea
Other:
- angina
- pulmonary oedema
- peripheral oedema
- tachycardia
- cyanosis
What are the causes of heart failure?
Left sided:
- valvular disorders
- arrythmias
- CHD (ischaemia of myocardium causing myocyte failure)
- PE / atherosclerosis / HTN (increased afterload)
Right sided:
- usually a result of left sided
- pulmonary disease occluding pulmonary blood flow (ie: pneumonia, COPD, tuberculosis)
What is the process of developing cardiogenic pulmonary oedema?
- left sided heart failure causes backflow of blood in pulmonary system
- hydrostatic pressure exceeds osmotic pressure in pulmonary system, forcing fluid into the interstitium and alveoli
- buildup of fluid in alveoli hinders gas exchange at the respiratory membrane
- hypoxia occurs
- hypoxia triggers vasoconstriction (to increase blood pressure and therefore O2 distribution), increasing BP and further congesting CPO
What are SSX of cardiogenic pulmonary oedema?
Symptoms:
- dyspnoea
- pardoxysmal noctural dyspnoea
- orthopnoea
- cough with pink frothy sputum
Signs:
- bilateral basal crackles
- dullness at lung bases with percussion (fluid buildup)
Describe an aortic dissection
Definition:
- tear in tunica intima of aorta
- Type A (aortic root / ascending aorta)
- Type B (descending aorta)
Risk factors:
- HTN (most common)
- atherosclerosis
- aortic aneurysm
- aortic valve disease
- blunt trauma
- cocaine and amphetamines
SSX:
- abrupt onset chest / upper back pain radiating to neck / back
- pain is severe, sharp, ripping, tearing, knife like
- dyspnoea
- sudden difficulty speaking
- different BP and pulse in arms bilaterally
Implications:
- rapid hypotension
- loss of consciousness and death
Mortality:
- 75% dead in first 24 hours
Describe cardiomegaly
Definition:
- enlarged heart
Aetiology:
- valvular pathology
- chronic heart failure (hypertrophy or dilation of ventricles)
- HTN (hypertrophy of LV)
- CHD
SSX:
- displaced apical beat (palpation / auscultation)
- fatigue / dizziness
- angina
- tachycardia
- thready pulse
- decreased urination at day and increased urination at night
- oedema
- palpitations
