Diseases Quiz 3 Flashcards

1
Q

Circulatory Shock

A

Generalized

Severe reduction in blood supply to the body tissues –> metabolic needs are not met.

Arterial pressure usually low (even w/ compensatory mechanisms)

Severe shock –> inadequate brain blood flow leads to loss of consciousness w/ sudden onset. (syncope)

Sx: pallor, cold clammy skin, rapid HR, muscle weakness, venous constriction

Additional Compensatory Processes:

  • Rapid, shallow breathing –> promotes VR via action of respiratory pump
  • Increased renin release –> increased TPR via formation of angiotensin II
  • Increased circulating levels of ADH –> increases TPR
  • Increased circulating levels of epinephrine
  • Reduced capillary hydrostatic pressure resulting from intense arteriolar constriction –> reabsorption
  • Increased glycogenolysis in the liver (induced by epi and norepinephrine)

Progressive Shock: general CV situation progressively degenerates

Irreversible Shock: no intervention can halt the ultimate collapse of the CV system –> death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cardiogenic shock

A

Cardiac pumping compromised –> decreased CO

Ex: severe arrhythmias, abrupt mitral malfunction, MI, coronary occlusions

Patient’s skin cold and clammy (intense vasoconstriction). Oxygen content high on swan-ganz (blood is rushing past tissues)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hypovolemic shock

A

Depletion of body fluids –> decreased BV –> reduced cardiac filling –> reduced SV

Ex: hemorrhage (>20% of BV), fluid loss from severe burns, chronic diarrhea, prolonged vomiting

Patient’s skin cold and clammy (intense vasoconstriction). Oxygen content high on swan-ganz (blood is rushing past tissues)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Anaphylactic shock

A

Severe allergic reaction –> relase of histamine, prostaglandins, leukotrienes, bradykinin –> increased arteriolar vasodilation –> increased microvascular perm –> loss of venous tone –> decreased TPR and CO

Patient’s skin will be warm and pink (intense vasodilation). Oxygen content low on swan-ganz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Septic Shock

A

Severe vasodilation due to release of substances from infectious agenst

i.e. LPS –> NO synthase increased –> vasodilation

Patient’s skin will be warm and pink (intense vasodilation). Oxygen content low on swan-ganz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Neurogenic shock

A

Loss of vascular tone due to inhibition of normal tonic activity of sympathetic vasoconstictor nerves

Ex: deep anesthesia, reflex response to deep pain associated w/ trauma, vasovagal syncope.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute Coronary Syndrome

A

Unstable angina vs. MI

Caused by rupture of unstable plaque w/ partial or complete lumen occlusion by aggregated platelets/thrombosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MI

A

Complete thrombotic occlusion of an atherosclerotic coronary artery or hypotensive event superimposed on a partially occuled CA

> 30 min of complete ischemia = myocardial death

transmural infarciton: more likely STEMI

Extent of infarction depends on collateral circulation.

ACUTE sequelae:
Severe /unrelenting angina, acute congestive heart failure (CHF) with dyspnea (pulmonary edema/oxygen desaturation) cardiogenic shock, dysrhythmias, sudden death

Subacute sequale (several days - 2 weeks):
Mural thrombosis/risk of embolism, left ventricular rupture = free wall, septal, or papillary muscle:  fatal hemopericardium,  acute VSD, or acutely flail/regurgitant mitral valve;  peri-infarct pericarditis. 

Chronic sequelae:
Left ventricular aneurysm; if infarct large enough or multiple infarcts = chronic CHF: LV ejection fraction usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cor pulmonale

A

Pure right sided hypertensive heart disease.

due to chronically increased pulmonary artery pressure from: -COPD

  • interstitial fibrosing diseases. -Chronic hypoxia causing vasoconstriction (i.e. sleep apnea)
  • Pulmonary vascular disease (primary pulmonary HTN or chronic recurrent thromboemboli)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Calcified Aortic Stenosis

A

Leading cause of valve replacement surgery along w/ mitral valve prolapse.

Aging related atherosclerosis of aortic valve cusps w/ secondary nodular calcification producing severe ( age 65): association with CAD

Sx: angina, dyspnea, fatigue, syncope, hypertrophied LV, eventual CHF.

Rx: Aortic valve replacement +/- coronary re-vascularization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cardiomyopathy

A

Intrinsic myocardial disease NOT associated w/ ischemic, valvular, hypertensive, or structural congenital heart disease.

Clinically divided into dilated, hypertrophic, or restrictive.

Causes include: genetic, myocarditis (i.e. viral), drug effects (alcohol, chemo), hemochromatosisi, and amyloidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tamponade

A

Increased pericardial sac fluid critically compresses the heart

Many causes:

  • effusion: from infx or non-infectious disease (CHF, neoplastic infiltrate, uremia)
  • hemopaericardium: (ruptured MI, retrograde rupture of aortic dissection, or penetrating chest trauma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Constrictive pericarditis:

A

Progressive pericardial space fibrosis which critically compresses the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Rhabdomyoma

A

Tumor found in children, usually w/ tuberous sclerosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Myxoma

A

Most common adult cardiac tumor. Usually left atrium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Anemic Chest Pain

A

Severe anemia (Below 10 or 11) can cause angina due to ischemia especially when coupled with existing CAD.

17
Q

Left Hypertensive Heart Disease

A

Systemic/arterial hypertension (chronic/long-standing) can cause:

  • left ventricular hypertrophy (LVH) = increased LV wall thickness.
  • in addition, hypertension is a risk factor for atherosclerotic CAD
  • congestive left heart failure may result from:either systolic (low EF) or diastolic (preserved EF) failure: associated left atrial enlargement can cause atrial fibrillation
  • sudden death may occur with LVH
  • control of hypertension can reverse LVH
18
Q

Right Hypertensive Heart Disease

A

RV failure: peripheral edema, elevated jugular venous pressure, congestive hepatomegaly, ascites

  • commonly secondary to chronic left heart failure
  • often due to chronic hypoxemic pulmonary disease (esp. COPD, chronic interstitial lung disease) or pulmonary hypertension = cor pulmonale

Note: Chronic hypoxemia states – induce pulmonary vasoconstriction/hypertension

19
Q

Bicuspid aortic valve

A

1% of the population

Premature/accelerated AS due to flow abnormalities (often 6th decade symptoms): can be associated with aortopathy (aortic root dilatation/dissection): may cause severe AR in young adults

20
Q

Mitral Valve Prolapse (MVP)

A

Most common cause of isolated sever mitral regurg in US requiring surgery.

Myxomatous degeneration/ballooning of mitral valve leaflets w/ elongation/thinning of chordae tendinae (+/- rupture of flail leaflets)

=systolic click murmur syndrome: 3% of U.S adults (usually incidental finding)

21
Q

Artificial Heart valve complications

A

Thromboembolism (usually mechanical valves) - need lifelong anticoagulation

Infective endocarditis

Structural deterioration (esp. bioprosthetic valves) calcification and tearing

Intravascular hemolysis

22
Q

Acute Aortic Regurgitation

A

typically due to:

  • acute bacterial endocarditis
  • acutely dilated aortic root secondary to aortic dissection
  • traumatic rupture
23
Q

Acute Mitral Regurgitation

A

Typically due to:

  • papillary muscle/chordae rupture following AMI or chordae rupture in MVP patients = flail MV
  • acute bacterial endocarditis
  • blunt chest trauma
24
Q

Dilated Cardiomyopathy

A

Dilation and impaired contractility of one or both ventricles

Typically associated w/:
-impaired systolic function, arrhythmias, SUDDEN DEATH

Causes: Genetic (20-50%), myocarditis, alcohol abuse, chemo, hemochromatosis, peripartum

Clinical: most commonly affects ages 20-50 w/ progressive symptoms.50% mortality within 2 years. Risk of mural thrombi w/ potential systemic embolism

Rx: LVAD, cardiac transplant.

25
Hypertrophic Cardiomyopathy
Increased LV wall thickness or mass NOT caused by pathological loading disorders. Prevalence at least 1 in 500 Most often IV septum is asymmetrically thickened Impaired diastolic relaxation/filling. Limits CO and Increases LVEDP. Sx: exertional dyspnea, myocardial ischemia, a fib, eventual ventricular failure w/ dilation. Ventricular arrhythmias and sudden death. SUDDEN DEATH IN YOUNG (black) ATHLETES --> think Hank Gathers Rx: Beta blockers, and occasionally partial septal ablation.
26
Primary / Essential Hypertension
Hypertension of unknown origin. 90% of HTN is this. Treat sx, not the cause. Rx: Restrict salt intake Lowers BP because of reduced requirement for water retention to osmotically balance the salt load Diuretic therapy: Inhibit renal tubular salt (and fluid) reabsorption Beta Blockers: Inhibit sympathetic influences on heart and renal renin release ACE Inhibitors & Angiotensin II Receptor Blockers: Block the effects of the renin-angiotensin system
27
Prominent Cricopharyngeus Muscle
May be asymptomatic or can interfere w/ normal swallowing. "lump in the throat."
28
Esophageal stricture
Secondary to GERD. Acid reflux inflames the esophageal lining causing scarring and subsequent constriction.
29
Achalasia
Senosis of Esophageal hiatus (LES). Causes dlation of esophagus, swallowing difficulty, weight loss, chest pain, heartburn
30
Aortic aneurysm
Usually occur in the ascending or descending aorta. Sx: hoarsness (pressure on left recurrent laryngeal nerve), dysphagia (pressure on esophagus), and dyspnea (pressure on trachea, root of lung, and/or phrenic nerve)
31
Restrictive Cardiomyopathy
Much less common than dilated or hypertrophic CM. Impaired ventricular filling. Non-dilated/usually non-hypertophic ventricles Causes: idiopathic/familial, amyloidosis, diabetic CM, sarcoid, chemo (anthracyclines)
32
Pheochromocytoma
NorEpi secreting tumor. Can cause stress-induced CM. Dx w/ increased Vanillymandelic aced (VMA) urine levels.
33
Syncope
Transient loss of consciousness secondary to cerebral hypoperfusion chacterized by rapid onset, short duration, and complete spontaneous recovery. Classified as: Neurally (reflex) mediated, cardiogenic, autonomic dysfunction, and other.
34
Neurally mediated (reflex) syncope
Vasovagal - pain, fear, emotional stress, prolonged standing --> overwhelming psns response. Situational - urination, defecation, coughing, sneezing, swallowing, exercise, weight lifting, otherst Carotid sinus syncope - shaving, massage, etc. Clues on hx: defecation, urination, or prolonged coughing, pain, fear, heat exposure
35
Cardiogenic
Arrhythmias, structural disease Clues on hx: syncope during prone position, during exercise, palpitations, startling (long QT)
36
Autonomic dysfunction
Primary autonomic failure (lewy body disease, Parkinson's disease.) Secondary autonomic failuire - diabetic neuropathy - amyloid neuropathy - spinal cord injury Medications - antihypertensives, diuretics, tricyclic antidepressants, phenothiazines, others Alcohol, exercise, post-prandial Orthostatic hypotesnion -diarrhea, hemorrhage, vomitting, adrenocortical insufficiency Clues in history: standing quickly, prolonged standing, postprandial, heat exposure, following cessation of exercise
37
Stable Vtach
3 or more consecutive beats of ventricular origin (wide QRS) at a rate 100-200 Asymptomatic Rx: Amiodarone --> plan for elective synchronized cardioversion. Long term: Implantable cardioverter defibrillator, amiodarone, beta blockers 6 months w/o arrhythmia before driving.
38
Unstable Vtach
3 or more consecutive beats of ventricular origin (wide QRS) at a rate 100-200 Unstable - if sx (chest pain, dyspnea), hypotension (SBP 50 joules initially Long term: Implantable cardioverter defibrillator, amiodarone, beta blockers 6 months w/o arrhythmia before driving.