Disorders of cardiac function Flashcards
Pericarditis & and causes
inflammation of the pericardium (the membrane enclosing the heart)
Acute =
Pericarditis manifestations
Decreased CO Pericardial friction rub Chest pain Precordial Abrupt onset, sharp, radiates Scapula pain increases with deep breath, cough relief when sitting forward
ECG changes
Pericardial Effusion
Accumulation of fluid in the pericardial cavity/space Causes - Inflammation of pericardium - Infection elsewhere - Neoplasms - Cardiac surgery - Trauma Symptoms dependent on rapidiy & amount of fluid build-up
Cardiac Tamponade & causes
Compression d/t fluid/blood
A build-up of blood or other fluid in the pericardial sac puts pressure on the heart, which may prevent it from pumping effectively.
Causes: Trauma Myocardial rupture post MI Cardiac surgery Aortic dissection
Tamponade: Manifestations
Dependent on amount and rapidity
Limits stroke volume and CO = low SBP
CNS: change in mentation
Resp: dyspnea, tachypnea
CVS: chest pain, tachycardia
- Elevated central venous pressure & jugular venous pressure (distention)
- Circulatory shock
Tamponade: Diagnosis/Treatment
Muffled heart sounds- d/t to extra layer of fluid Pulsus paradoxus > 10 mmHg fall with respiration ECG - Decreased voltage Echocardiogram CT, MRI Treatment: immediate pericariocentesis
What assists coronary artery flow?
- Endothelial cells lining arteries
-Diastolic pressure in aorta
Time in diastole
What impairs coronary artery flow?
Atherosclerosis most common
Non-Modifiable Risks for CAD
Sex/Gender Post-menopausal women Age Ethnicity Genetics
Modifiable Risks for CAD
- Hypertension
- Hyperlipidemia
- Tobacco use
- Diabetes
- Obesity
- Sedentary lifestyle/physical inactivity
- Ability to cope with stress
Stable Angina
- Pain/pressure d/t transient ischemia
- Precordial/substernal
- Possible radiation
- Possible epigastric discomfort
- Often d/t a fixed coronary narrowing
- Occurs with exercise/exertion/cold/emotions
- Relieved with rest & nitroglycerine
Artery in the heart is partially blocked, so not getting enough O2.
Variant/Prinzmetal Angina
d/t spasms of coronary artery
Cause is unclear
Often @ night
Variable symptoms
Treatment is dependent on findings of investigative diagnostics
Silent MI
Silent MI’s (or atypical symptoms) are more likely in the elderly
? Less myocardium involved
? neuropathy
- hypotension, low body temp, vague complaints of discomfort, mild diaphoresis, stroke-like symptoms, dizziness, sensorium changes
Treatment is dependent on findings of investigative diagnostics
Acute Coronary Syndrome
Risk is classified based on ECG changes
Unstable Angina/Non ST-segment elevation Myocardial Infarction (non-STEMI)
ST-segment elevation MI (STEMI) - ischemia to heart muscle
All caused by an imbalance in myocardial oxygen supply and demand
Potential Causes of ACS: Primary & Secondary Causes
> Unstable plaque, rupturing to form a clot
- Thin fibrous cap with fatty core is most unstable
Coronary vasospasm
Atherosclerotic narrowing (progressive)
Inflammation/infection
Secondary causes
- anemia
- fever (basal metabolic rate is high)
- hypoxemia
Unstable Angina/Non-ST MI
Typical Pattern of Manifestations > With pre-diagnosis of “Stable Angina” - But more severe or more often than usual > Occurs at rest (or minimal exertion) > Lasts > 20 minutes
If biomarkers are elevated = non-STEMI
High risk of STEMI
ST Elevation MI
Ischemic death of myocardial tissue
> Typical Pattern of Manifestations
Crushing/constricting pain; usually abrupt
- Substernal with radiation to left arm, jaw, neck
- Epigastric distress/nausea
- Palpitations
- Cool, clammy skin
- SOB
- Anxiety
Unrelieved by rest/nitro
ST Elevation MI Con’t…
Cardiac muscle wall ischemia & necrosis
- Subendocardial
- Transmural = Q wave
- “Stunned” myocardium
Cell death in 15-20 minutes
Early perfusion & revascularization can prevent necrosis.
Myocardial Ischemia/Necrosis result in…
Decreased contractile force
- Decreased CO
- Decreased coronary artery perfusion
- Decreased pulmonary vasculature pressure
Interruption of conduction
- dysrhythmias
Diagnosis of myocardial ischemia also based on Serum Biomarkers
> Troponin (involved in muscle contraction)
Rises within 2-3 hrs; remains elevated for 7-10 days
> Myoglobin (functions as oxygen storage)
Rises within 1 hr, peaks at 4 hrs
Also from skeletal muscle damage
> Creatine Kinase MB (CK-MB) (levels can indicate muscular dystrophy)
Peaks at 4-6 hrs; gone in 2-3 days
Specific to cardiac muscle
Acute MI Treatment
Oxygen Pain relief Reperfusion - Fibrionolytics - Percutaneous transluminal coronary angioplasty (PTCA) - Stents
Coronary Artery Bypass Grafting (CABG)- taking a vein from another part of the body and using it in the heart
Complication of an Acute MI
- Arrhythmias – most common cause of sudden death
- Reinfarction
- Heart failure
- Pericarditis
- Embolic CVA or Pulmonary embolus
- Valve deformities
- Septal rupture
- LV wall aneurysms/rupture
- Cardiogenic shock
- Dressler syndrome
Cardiomyopathies
Cardio = heart Myo = muscle Pathy = disorder/syndrome/bad
“Idiopathic cardiomyopathy” Muscle disorders Mechanical (eg: heart failure) Electrical (eg: arrhythmias) Primary Secondary
Hypertrophic Cardiomyopathy (HCM)
Leading cause of sudden cardiac death in young adults
Unexplained genetic ventricular septal thickening Poor diastolic finding LV outflow obstruction Left ventricular hypertrophy (LVH) Disruption of normal conduction pathways
Hypertrophic Cardiomyopathy (HCM) Manifestations
> Variable > Decreased stroke volume d/t impaired diastolic filling - Dyspnea - Chest pain - Syncope post exertion
> Atrial fibrillation
Lethal ventricular arrhythmias
Endocarditis & and Risk factors
Any infection of inner lining of heart
- Usually staphylococcus aureus
- Vegetative (growth)
- Involvement of mitral & aortic valves most common
- Acute: relatively healthy individual
- Sub-acute/chronic: h/o valve abnormalities
Risk Factors Infection elsewhere Dental surgery/surgery, IV drug use/contaminants Immunodeficiency/immunosuppression Valve prolapse (sudden or congenital)
Endocarditis manifestations & complications
> Manifestations
S&S of systemic infection
Heart sound changes
Symptoms related to embolism
> Complications
Emboli (lung, renal, brain, etc.)
Valve dysfunction
arrhythmias
Rheumatic Heart Disease
> Caused by rheumatic fever
- Which occurs after streptococcal pharyngitis
- Sore throat, h/a, fever, n&v, joint pain
- One or all layers (pancarditis)
- valves
- Aschoff bodies
Immunological response but pathogenesis unclear
Acute, chronic, or recurrent
Rheumatic Heart Disease diagnosis and treatment
> Acute phase = pancarditis
- Pericardial friction rub, murmur
- Mitral/aortic valve involvement
- Arrhythmias
> Diagnosis
- Evidence of GAS infection
- Elevated WBC, ESR, CRP
- Echocardiogram, Ultrasound
> Treatment
Antibiotics, prevention of complications
Valvular Disorders causes
Congenital Trauma Ischemic damage Degenerative changes Inflammation
Valvular Disorders treatment
Preventative APA (antiplatelet aggregator) Symptoms Percutaneous valvuloplasty Surgery
Valvular Disorders Diagnosis
Auscultation
Doppler Echo
ultrasound
When Will You Hear Murmurs?
- If a valve is stenotic, you will hear a murmur of blood shooting through the narrow opening when the valve is open
- If a valve is regurgitant, you will hear a murmur of blood leaking back through when the valve should be closed
Mitral Valve Stenosis
Fibrous, stiff tissue, often causing chordae tendineae to shorten Incomplete opening obstructs blood flow Causes RF Congenital
Mitral Valve Stenosis manifestations & complications
Manifestations
-Chest pain, weakness, fatigue, palpitations
Complications
- Arrhythmias (atrial fibrillation, atrial tachycardias)
- Mural thrombi
Mitral Valve Regurgitation (MVR) & causes
> Incomplete closing
- Some blood returns to LA during systole
> Causes
- RDH
- Chordae tendineae or papillary muscle rupture
- LVH dilates orifice
- Mitral valve prolapse
Mitral Valve Regurgitation manifestations and complications
Manifestations
- Slow process = compensation
- Pulmonary congestion
- Pansystolic murmur
- LA Atrial and LV hypertrophy
Complications
- Atrial fib
- thrombus
Mitral Valve Prolapse manifestations and complications
> Leaflets enlarge, become “floppy”
Associated with:
Marfan’s sydrome & Osteogensis imperfecta
Manifestations “snap” Asymptomatic Chest pain, dyspnea, etc. Complications MVR, a. fib thrombus
Aortic Valve Stenosis causes and manifestations
Narrowing causing resistance to ejection Slow progression = compensation Causes: Congenital or acquired Male, active inflammation
Manifestations
Loud systolic ejection murmur or split S2
Chest pain, dyspnea, syncope, heart failure (LV hypertrophy)
Aortic Valve Regurgitation & causes
Scarring of leaflet and/or enlarged orifice
Blood flow back into LV during diastole
Causes
RHD, ideopathic aortic dilation, congenital, endocarditis, Marfan’s, HPTN, trauma
Chronic Aortic Regurgitation
- Slow progression = compensation
- LV enlarges but works harder
Manifestations
- Blowing sound over valve
- Widening pulse pressure
- Korotkoff sounds persist to zero!
- Tachycardia, water-hammer pulse
- “pounding” of heart when lying down
- Eventually orthopnea, dyspnea, paroxysmal nocturnal dyspnea
Acute Aortic Regurgitation causes & manifestations
> Causes
Acute endocarditis
Trauma
Aortic dissection
> Manifestations Too quick for compensation! Extreme rise in LVEDP = pulmonary edema - Decreased coronary artery perfusion Dysrhythmias = lethal
Patent Ductus Arteriosus
Persistent delay > 3 months
Normally closes @ 24-72hrs
Delay if premature
Manifestations
Dependent on size
High pressure from aorta = pulmonary hypertension
Atrial Septal Defects
Non-closure of foramen ovale
Often asymptomatic until teenage
Manifestations
Increased pulmonary pressures
Atrial dilatation = dysrhythmias
Ventricular Septal Defects cause and manifestations
Most common congenital heart defect (25-30% of all)
Cause:
Incomplete separation of ventricles during development invitro
1/3 close spontaneously
Manifestations dependent on size
Asymptomatic heart failure
Tachypnea, tachycardia, pulmonary congestion, failure to thrive
Pulmonary Stenosis
Obstruction of blood flow from RV Causes Pulmonary valve lesions Pulmonary artery lesions Combination
10% of all congenital cardiac disease
Often associated with other patho
Tetralogy of Fallot
Most common cyanotic congenital heart defect (5-7% of all)
Pulmonic narrowing RV hypertrophy Ventricular septal defect Dextroposition of aorta Over-rides RV, attaches to septal defect
Tetralogy of Falot manifestations and treatment
Manifestations
Cyanosis with increased oxygen demands
Crying, feeding, defecation
Loss of consciousness possible
Treatment
Knee-chest position
Surgery
Transposition of the Great Arteries
RV empties into aorta LV empties into pulmonary arteries Risk Factors Mothers with diabetes Boys > girls Manifestations Cyanosis Survival if patent ductus arteriosus or septal defect
Coarctation of the Aorta
Associated with other congenital lesions
Manifestations BP lower in legs than in arms Asymptomatic Hypertension later in life LVH
