Diseases Flashcards
Angina Pectoris
Chest pain associated with ischemia
- Increased oxygen demands but coronary vessels cannot deliver adequate amount of blood that is required (usually from atherosclerosis)
- Progressive disease
- Unstable occurs at rest and does not respond well to treatment
- Stable occurs during activity or emotional stress and responds well to treatment
Myocardial Infarction
Myocardial tissue death/necrosis from prolonged decrease in oxygen blood supply
- Most infarcts occur in left ventricle
Transmural infarct
Full thickness of myocardium death
Subendocardial infarct
Only deep levels of myocardium experience tissue death
Most common complication of MI
Dysrhythmias
Heart failure
Mechanical failure that results in cardiac output not being able to meet tissue oxygen demands
- Most common complication is shortness of breath and pulmonary edema (rales/crackles on auscultation)
Left ventricular heart failure
Left ventricle cannot eject all the blood delivered from the right ventricle via the lungs; causes back pressuring into pulmonary circulation
Increased pressure to pulmonary veins/capillaries —> plasma forced into alveoli —> pulmonary edema and hypoxia
Starlings law allows for a short period of compensation
Right ventricular heart failure
Right ventricle fails causing pressure in the systemic venous circulation and pedal (pitting) edema
Causes of MI
Atherosclerosis Thrombus/embolism Vasospastic angina or unstable angina Microemboli (cocaine) Acute volume overload Hypotension Hypoxia Trauma
Where to MI’s usually occur?
Left coronary artery occlusion- anterior, lateral, or septal infarct
Right coronary artery occlusion - inferior, posterior, or right ventricle
Causes of right ventricle heart failure
Most common is left sided ventricle failure Systemic hypertension Pulmonary hypertension (COPD) MI Cor pulmonale Pulmonary embolism
Cor pulmonale
Isolated right sided heart failure from pulmonary pathology, with no left sided heart involvement
Congestive heart failure
Heart’s reduced stroke volume causes an overload of fluid to the body (edema)
- Edema can occur in pulmonary, peripheral sacral, or ascetic areas
Signs and symptoms of CHF
Acute - pulmonary edema, pulmonary hypertension, or MI
Chronic - heart enlargement (hypertrophy), left or right sided heart failure
Paroxysmal nocturnal dyspnea - sudden difficultly breathing that occurs after laying down
Cardiac tamponade
Fluid (blood, pus, air, serum) that accumulates between the visceral and parietal pericardium, in excess of the normal 25mL
Fluid increases intrapericardial pressure impairing diastolic filling, decreasing stroke volume that the ventricles can expel blood
Signs and symptoms of cardiac tamponade
Chest pain (dull, sharp, severe) Shortness of breath JVD Pulsus paradoxus (systolic BP drop of 10 mmHg or more on inspiration) Muffled or faint heart sounds
Hypertensive emergencies
Life threatening evaluation of blood pressure and and a rapid increase in diastolic mmHg; rapid decrease needed to stop end organ failure
Class = >120-130 mmHg
AHS = >186/>110
Accompanied by restlessness, confusion, blurred vision, N/V
Hypertensive encephalopathy
Brain dysfunction due to significantly high blood pressure
Severe headache, N/V, visual disturbances (blindness), paralysis, seizures, stupor, coma
Could cause left ventricular failure, pulmonary edema, or stroke
What BP is considered chronic hypertension?
Over 160/90
Cardiogenic shock
Most severe form of pump failure; left ventricle is compromised to the point that the heart cannot meet the body’s demand and can no longer compensate
- Usually occurs after an MI involving 40% of the left ventricle, or widespread ischemia
- Remains after dysrhythmias and hypovolemia have been corrected
- Body tries to compensate by increasing contractile force, improving preload or decreasing peripheral resistance
Signs and symptoms of cardiogenic shock
Patient appears shocky in early strages
- cold extremities
- weak/absent pulses
- low BP
Causes of cardiogenic shock
Tension pneumothorax/cardiac tamponade MI Pulmonary embolism Valve malfunction Recreational drug use Trauma Underlying disease (neurological, renal, GI, sepsis, metabolic)
Aneurysm
Ballooning of an arterial wall, resulting from a defect or weakness in the wall; most occur from atherosclerosis and involve the aorta where pressure is the highest
Fusiform -symmetrical bulge around the circumference of the aorta (most common)
Saccular - asymmetrical bulge on one side
Thoracic aortic aneurysm
Can be located in the upper aspect of the aorta above the diaphragm; involves the ascending aorta, aortic arch, or descending aorta
Can by asymptomatic or:
- hoarse voice
- trouble swallowing
- stridor
- neck swelling
- tearing sharp pain between shoulder blades
- chest pain
Abdominal aortic aneurysm (AAA)
Can be located in aorta, below renal arteries, and/or above the bifurcation of the common iliac arteries
Signs/symptoms:
- abdominal pain (pulsating masses)
- sudden lower back, flank, or should blade pain
- ripping sensation
- urge to defecate
- difference in BP between left and right arms (30mmH)
Dissecting aneurysm
A tear or degenerative changes in smooth muscle and elastic tissue where blood gets between the layers of the aortic wall
Causes a sudden, sharp or stabbing chest or back pain
Careful movement of patient as they are at high risk of rupture; need to be moved without compressing the abdomen
Pericarditis
Inflammation or irritation of the pericardium sac around the heart
Can occur as a result of an infection, MI, neoplasm (tumour), high dose radiation to the chest, uraemia, trauma
Chest pain as a result of layers of pericardium rubbing together; patient feels relief when they lean forward, and worsens when laying down
Signs and symptoms of pericarditis
Pain that radiates to trapezius ridge or scapula
Sharp sudden pain that starts over the sternum, radiating to the neck, shoulders, back, and arms
Pain increases with deep inspiration
Deep vein thrombosis (DVT)
Blood clot in vein, commonly in the large veins of the thigh and calf
Often caused by immobilization for long periods of time (e.g., flying), post-surgery inactivity, pregnancy, trauma
Signs and symptoms of deep veins thrombosis
Gradually increasing pain and calf tenderness
Leg swelling from occluded venous drainage
Warm, red skin
Homan’s sign - hyperextension of the foot at the ankle towards the nose causes pain in the calf and/or posterior knee
Risk of pulmonary embolism, stroke, or MI if clot travels
Prinzmetal’s angina
Coronary artery vasospasm; a temporary increase in coronary vascular tone causing a reduction in luminal diameter
- More common in women
- Occurs at rest with most patients not experiencing exertional symptoms
Acute coronary syndrome (ACS)
Sudden reduction of coronary blood flow
Arteriosclerosis
Chronic disease of the arterial system causing abnormal thickening and hardening of the vessel walls, losing it’s elasticity
Change of metabolism of lipids and cholesterol within tunica intima
Atherosclerosis
Form of arteriosclerosis caused by soft deposits of intra-arterial fat and fibrin (plaque) which narrow arterial lumen
Leading cause of coronary/cerebrovascular disease
Usually occurs at points of high pressure, high flow, and high points of turbulence
Peripheral arterial disease
Reduced blood flow to the lower limbs due to atherosclerosis of the femoral and peripheral arteries
Raynaud’s disease
Small peripheral artery spasms
Reduced circulation to fingers, toes, skin precipitated by cold environments/stress
Marfan syndrom
Inherited disease of connective tissue causing cardiovascular, skeletal, and ocular anomalies
Progressive dilation or mitral valve prolapse
Ischemia
Immediately during arterial occlusion, subendocardial ischemia occurs
ST segment depression, and inverted t-waves
Infarction
Myocardial cells die and there is a release of cardiac markers (within 20-30 minutes)
- Troponin
Pathological q-waves (<1mm or 25% of R-wave)
Injury
Prolonged ischemia (>20-40 minutes) that causes injury to follow the endocardial surface
ST segment elevation
Stable angina
“Choking of the chest” - supply of oxygen to the myocardium cannot meet the demand and cardiac muscle becomes Ischemic
Principle symptom of Coronary artery disease (CAD)
What is primary hypertension?
Chronic hypertension
Causes the heart to work harder, leading to hypertrophy of cardiac muscle, and left ventricular failure
Progresses at same rate as atherosclerosis
1 in 5 Canadians have HTN, and half don’t know (asymptomatic)
What BP defines hypertension?
140/90
Headache is the most common symptom
What is secondary hypertension?
Caused by structural or hormonal issues (e.g., pregnancy, tumours)
- Exogenous causes: oral contraceptives (increased renin-angiotensin system), sympathomimetic drugs, cocaine, ETOH
- Renal causes: damaged nephrons, renal artery stenosis
