Disorders of Cardiac Function, Heart Failure, Circ. Shock Flashcards
1
Q
The pericardium is a
A
Double layered serous membrane surrounding the heart
2
Q
In between the two layers of the pericardium is the
A
Pericardial sac
3
Q
The pericardial sac contains
A
Serous fluid (about 50 mL)
4
Q
Pericarditis is
A
An inflammatory process of the pericardium
5
Q
Acute pericarditis is
A
Pericardial inflammation of less than 2 weeks
6
Q
The most common cause of acute pericarditis is
A
Viral infections
7
Q
Acute pericarditis is often associated with
It allows what?
A
Increased capillary permeability
> > Allows plasma proteins to leave capillaries and enter the pericardial space
8
Q
Acute pericarditis leads to fibrin exudate that
A
Heals or progresses to scar tissue and forms adhesions between the layers of serous pericardium
9
Q
What is the triad of acute pericarditis?
A
The three symptoms
Chest pain
Pericardial friction rub
ECG changes
10
Q
How do most patients describe the pain of acute pericarditis?
A
Abrupt in onset
Sharp (may radiate to the neck, back, abdomen, or side)
Acute = Abrupt
11
Q
An effusion is the
A
Accumulation of fluid in the pericardial cavity
12
Q
A sudden accumulation of ___ mL may raise intracardiac pressure to levels that
A
200 mL
Seriously limit the venous return to the heart
13
Q
Cardiac tamponade results in
A
Increased intracardiac pressure
Reduced diastolic filling
Reductions in stroke volume (SV) and cardiac output (CO)
14
Q
Manifestations of an effusion
A
May be asymptomatic unless abrupt
|»_space; Then there are signs of decreased cardiac output
15
Q
Cardiac tamponade is very serious since
A
The heart can’t fill or eject properly
16
Q
Cardiac tamponade is very serious since
A
The heart can’t fill or eject properly
17
Q
Cardiac tamponade is tachycardia or bradycardia?
A
Tachycardia
The heart is surrounded by fluid so it has limited space to pump; it tries to make up for limited space by pumping faster
18
Q
How do each of the following respond in cardiac tamponade?
- Cardiac contractility
- Central venous pressure
- Jugular vein: distended
- Systolic BP: falls/decreases
- Pulse pressure
- Heart sounds
Plus, signs of …
A
- Increased
- Elevated
- Distended
- Falls/decreases
- Narrows
- Muffled
Circulatory shock
19
Q
In constrictive pericarditis what develops and where?
A
Fibrous, calcified scar tissue develops in the pericardial sac
20
Q
In constrictive pericarditis, the scar tissue ___ and interferes with ____
A
Contracts and interferes with diastolic filling
21
Q
Causes of constrictive pericarditis are
A
Radiation
Cardiac surgery
Infection
22
Q
A prominent early finding of constrictive pericarditis is
Other manifestations are
A
Ascites (fluid collects in abdomen)
Pedal edema
Dyspnea on exertion
Fatigue
23
Q
The coronary arteries supply what to where?
A
Oxygenated blood to the myocardium (heart muscle)
24
Q
CAD stands for
A
Coronary artery disease
25
CAD is caused by
Impaired coronary blood flow
In most cases, caused by atherosclerosis
26
CAD can cause
> Myocardial ischemia (obstructed blood flow to heart
muscle) and angina (severe pain in chest)
> MI/heart attack
> Cardiac arrhythmias
> Conduction defects
> Heart failure
> Sudden death
27
Atherosclerosis causes ____ that can ____
Plaque that can obstruct blood flow
Can eventually lead to thrombus formation
28
Two types of plaque are
Stable (fixed)
Unstable (vulnerable)
29
What does stable plaque do?
Implicated in what?
Obstructs blood flow
Stable angina
30
Unstable plaque can ___ and cause ___
Implicated in what?
Rupture and cause platelet adhesion and thrombus formation
Unstable angina and MI
31
Plaque disruption can occur ___ but is often triggered by ___
Spontaneously
Hemodynamic factors (increased BP, HR, cardiac contractility, and coronary blood flow)
32
Plaque disruption occurs most frequently during the first hour upon awakening, suggesting that
Physiologic factors* may promote atherosclerotic plaque disruption and platelet deposition
*such as surges in coronary artery tone and blood pressure
33
List the four steps of thrombosis and vessel occlusion
1. Plaque disruption - involves lipid core, smooth muscle cells, macrophages, collagen
2. Tissue factor released
3. Coagulation pathway initiated
4. Thrombin is generated and fibrin deposited
34
ACS stands for
Acute Coronary Syndrome
35
ACS includes
UA (unstable angina)
Non-ST-segment elevation MI (NSTEMI)
ST-segment elevation MI (STEMI)
36
What are the two key factors that help distinguish between UA, NSTEMI, and STEMI?
ECG changes
| Biomarkers
37
ECG changes that occur with ACS involve
T-wave inversion
ST-segment elevation
Development of an abnormal Q wave
38
ECG changes vary depending on
Duration
Extent
Location
39
ST segment elevation indicates
Myocardial ischemic injury (STEMI)
40
If there is no ST segment elevation, but they have other signs of an MI, that’s considered
NSTEMI
41
Serum biomarkers for ACS include
Cardiac-specific troponin I (TnI) and troponin T (TnT)
| Creatinine kinase MB (CK-MB)
42
What happens when myocardial cells become necrotic?
> Intracellular components are released into surrounding tissue, then picked up into circulation
> These biomarkers are noted in a blood draw/lab work
43
Troponin rises within ___
May remain elevated for ___
3 hours
7-10 days
44
CK-MB rises within ___
Returns to normal in ___
4-8 hours
2-3 days
45
Between UA, NSTEMI, and STEMI, which two are very similar?
UA and NSTEMI
46
List the five phases of UA/NSTEMI
1. Unstable plaque ruptures or erodes with nonocclusive thrombosis
2. Obstruction due to spasm, constriction, dysfunction, or adrenergic stimuli
3. Severe narrowing of the coronary lumen
4. Inflammation
5. Physiologic state causing ischemia
47
Pain in UA/NSTEMI is
Has at least one of three factors
Persistent and severe
1. Occurs at rest, lasting more than 20 minutes
2. Severe and described as flank pain and of new onset (i.e., within 1 month)
3. More severe, prolonged, or frequent than previously experienced
48
Is ST-segment elevated in either UA or NSTEMI?
No, it is depressed
49
What is the difference between UA and NSTEMI?
UA: negative for serum biomarkers
NSTEMI: Positive for serum biomarkers
50
The principal biochemical consequence of STEMI is
Conversion of aerobic metabolism to anaerobic metabolism
51
STEMI results in
Inadequate energy for normal myocardial function
52
In regards to STEMI: what occurs at each of the following intervals?
60 seconds
Within minutes
20-40 minutes
Contractile function is lost in 60 sec.
Ischemic area non-functioning within minutes
Irreversible damage/necrosis in 20-40 min.
53
STEMI chest pain is described as
It is located where?
Constricting or suffocating
Substernal, radiating to the left arm, neck, or jaw
54
Is STEMI pain relieved by rest or nitroglycerin?
No
55
Other than pain, what are some manifestations of STEMI?
```
Gastrointestinal (GI) complaints
Sensation of epigastric distress
Nausea and vomiting
Fatigue/weakness (esp. arms and legs)
Anxiety, restlessness, and feelings of impending doom
Productive cough (frothy, pink sputum)
Skin - pale, cool, and moist
```
56
Females experiencing STEMI have
Atypical ischemic-type chest discomfort
57
The elderly experiencing STEMI complain of ___ more frequently than chest pain
SOB
58
In Myocardial ischemia, the blood flow through coronary arteries do not meet what?
The metabolic demands of the heart
59
Myocardial ischemia is most commonly a result of
What else may be involved?
Atherosclerosis
Vasospam
60
Chronic stable angina is associated with
A fixed coronary obstruction
61
In stable angina, does blood meet the demands of the body?
No, it does not
62
What are some precipitating factors of stable angina?
Increased demands of the heart
| > such as physical exertion, exposure to cold, and emotional stress
63
What are the characteristics of stable angina pain?
Steady constricting, squeezing, or suffocating
| > increases in intensity only at the onset and end of the attack
64
Where is stable angina pain located?
Commonly located in the precordial or substernal area of the chest
> May radiate to the left shoulder, jaw, arm, or other areas of the chest
65
Chronic stable angina is provoked by ___ and relieved by ___
Provoked by exertion or emotional stress
| Relieved within minutes by rest or nitroglycerin
66
What are the three categories of stable angina?
These three denote what?
1. Occurs at rest
2. New onset
3. Increasing in intensity or duration
A risk for MI
67
Infective endocarditis (IE) is a
Life-threatening infection of inner heart surface, heart valves and endocardium affected
**an infection of the inner lining of the heart muscle**
68
IE occurs with valvular issues such as
Prolapse
Prosthetic heart valves
Implantable devices
69
The leading cause of IE is
Other causes are
Staphylococcal infections
Streptococci and enterococci
70
The major factor leading IE is
Seeding of the blood with microbes
71
The portal of entry for IE may be an _____, or a _____
An obvious infection
| A dental or surgical procedure
72
______ _______ and ______can incite the formation of a thrombus along the endothelial lining
The thrombus is susceptible to
Endothelial injury, bacteremia, and altered hemodynamics
Bacterial seeding
73
In IE, what forms on heart valves?
Vegetative lesions
74
The vegetative lesions formed in IE are a collection of
As the lesions grow, they cause
Infectious organisms
Cellular debris
Fibrin strands
Valve destruction
75
IE presents with
Fever and signs of systemic infection
Change in heart murmur
Evidence of embolic distribution of vegetative lesions
76
In IE, small petechial hemorrhages frequently result when emboli lodge in the
Small vessels of the skin, nail beds, and mucous membranes
77
Rheumatic heart disease (RHD) can develop into
Chronic valvular disorders that cause permanent dysfunction
78
RHD is a complication of ___ and a possible ____
Streptococcal throat infection
| Immunologic response
79
RHD is an immune mediated response to
Group A (beta-hemolytic) streptococcal (GAS) throat infection
80
Most patients with rheumatic fever (RF) have a history of
Sore throat, headache, fever, abdominal pain, nausea, vomiting, swollen glands
> Like strep throat
81
The most common and the first manifestation of RF is
Polyarthritis
82
Polyarthritis affects
One joint and moves to another
83
Acute rheumatic carditis can affect
The endocardium, myocardium, or pericardium
84
Subcutaneous nodules occur in the
Wrist, elbow, ankle, and knee joints,
85
Erythema marginatum are
Lesions on trunk, upper arm, thigh
86
Sydenham chorea presents with
Irritability, behavior problems, involuntary activities
87
RHD/RF are associated with what conditions?
```
Polyarthritis
Acute rheumatic carditis
Subcutaneous nodules
Erythema marginatum
Sydenham chorea
```
88
Function of the heart valve is to narrowing of the valve orifice and failure of the valve leaflets to open normally
Promote unidirectional blood flow through the heart
89
Dysfunction of the heart valves results from
```
Congenital defects
Trauma
Ischemic damage
Degenerative changes
Inflammation
```
90
The most commonly affected valves are
The mitral and aortic valves
91
Two types of mechanical disruptions occur with valvular heart disease
Stenosis
| Regurgitation
92
Stenosis is the
How does this effect the chamber emptying through the narrowed valve?
Narrowing of the valve orifice and failure of the valve leaflets to open normally
It increases the volume and the work of the chamber emptying through the narrowed valve
93
Regurgitation occurs when
This causes
The valve does not close properly, permitting backward flow of blood
The blood to flow back into the emptying chamber
94
Manifestations common to most mitral and aortic valvular disorders (if progressed) are
Murmur
Manifestations associated with left ventricular failure and pulmonary congestion
> Dyspnea
> Orthopnea (Discomfort when breathing while lying down flat)
> Paroxysmal nocturnal dyspnea (a sensation of shortness of breath after 1-2 hrs of sleep)
> Fatigue
95
Heart failure is a complex syndrome resulting from ___ that results in manifestations of
Any function or structural disorder of the heart
Decreased cardiac output and/or pulmonary or systemic congestion.
96
List some disorders that can cause heart failure
CAD (Coronary Artery Disease)
Hypertension
DCM (Dilated Cardiomyopathy)
Valvular heart disease
97
Systole is ventricular
Ejection (normal is 70 ml ~ 2.5 ounces)
98
Diastole is ventricular
Filling (normal is 110 ml ~ 4 ounces)
99
Stroke volume is the
This is the difference between
Amount of blood ejected with each heartbeat
End-diastolic and end-systolic volumes
100
Ejection fraction (EF) is the fraction of
Remember the formula
The volume ejected at the end of diastole
Stroke volume/end-diastolic volume = EF
101
Cardiac output is the
It is the product of (formula)
Amount of blood pumped each minute
| ```
Stroke volume (SV) and heart rate (HR
CO = SV x HR)
```
102
Pre-load is the
End-diastolic pressure when the ventricle has been filled
103
Afterload is the
Work post contraction required to move blood into the aorta
104
With heart failure, the CO
Does not meet the body’s demands
105
Heart failure is categorized as _________ and _________
Systolic vs. Diastolic
| Right vs. Left ventricular dysfunction
106
What is a normal EF?
55% - 70%
107
Systolic dysfunction is when
Preload is increased/decreased
Blood accumulates in the
The ventricle cannot eject an adequate cardiac output
(EF < 40%)
Increased
Pulmonary veins
108
Increased preload can lead to
Accumulation of blood in the atria and the venous system (which empties into the atria), causing pulmonary or peripheral edema
109
In diastolic dysfunction, EF is ____ but left ventricle doesn’t ______ which reduces _______
Blood accumulates in
Preserved
Fill adequately during diastole
Cardiac output
The pulmonary venous system
110
Causes of diastolic dysfunction are
Increased age, female gender, hypertension
111
Right ventricular dysfunction results in
Because of this, there is a congestion of blood in
The inability to move blood from systemic venous circulation to the pulmonary circulation
The systemic venous system
112
The major effect of right ventricular dysfunction is
Peripheral edema
113
If you had a patient with right ventricular dysfunction, what would you expect to see?
```
Peripheral edema
Dependent edema and ascites
GI tract congestion
Anorexia/Weight loss
GI distress
Liver congestion
Impaired liver function.
```
114
Left ventricular dysfunction impairs the
This ______ cardiac output
Movement of blood from pulmonary circulation to arterial circulation
Decreases
115
In left ventricular dysfunction, blood accumulates in
The left ventricle, left atrium, and pulmonary circulation
116
If you had a patient with left ventricular dysfunction, what would you expect to see?
```
Activity intolerance and signs of decreased tissue perfusion
Cyanosis and signs of hypoxia
Cough with frothy sputum
Orthopnea
Paroxysmal nocturnal dyspnea.
```
117
Manifestations of heart failure depend on
Extent and type of dysfunction
118
What is a frequent cause of sudden cardiac decompensation?
A dietary excess of sodium
119
Respiratory manifestations are due to congestion of
Pulmonary circulation
120
Exertional dyspnea is
Perceived shortness of breath when related to increased activity
121
Orthopnea is
Shortness of breath when supine
122
Paroxysmal nocturnal dyspnea is the
Sudden attack of dyspnea during sleep
123
Cheyne Stokes respiration is a
Characterized by
Pattern of periodic breathing
Gradual increase in depth (and occasionally rate) of breathing to a maximum, followed by a decrease resulting in apnea
124
Acute pulmonary edema is where the
Capillary fluid moves into alveoli
***life threatening!***
125
A patient with acute pulmonary edema would present with
Fatigue, Weakness, and Mental Confusion are due to
Pulse is rapid
Skin is moist and cool
Lips and nail beds are cyanotic
Decreased CO
126
Nocturia is
A nightly increase in urine output that occurs relatively early in the course of heart failure.
127
Oliguria is
Decrease in urine output as a late sign related to severely reduced CO and resultant renal failure
128
What causes cardiac cachexia and malnutrition?
Fatigue & depression interfering with food intake
Congestion of the liver and GI structures impairing digestion and absorption
Producing feelings of fullness
Circulating toxins and mediators released from poorly perfused tissues that impair appetite and contribute to tissue wasting.
129
Cyanosis is the
Bluish discoloration of skin and mucous membranes
130
Cyanosis is caused by
Excess desaturated hemoglobin in the blood
131
Arrhythmias and Sudden Cardiac Death are due to
Interruption of normal electrophysiology of heart caused by altered structure and hypoxemia
132
Circulatory shock is an acute failure of the circulatory system to
Provide adequate oxygen to body tissues
133
Most immediate compensatory mechanisms are
What is the lifespan of these mechanisms?
Sympathetic nervous system
Renin release
They are not effective over the long term and become detrimental
134
In sympathetic nervous system mechanism, what happens?
Blood vessels vasoconstrict
Heart rate increases
Myocardial muscle contracts
Bronchioles relax
135
Renin release results in an increase in ___ which contributes to
Angiotensin II, augmenting vasoconstriction
Aldosterone-mediated increase in sodium and water retention by the kidneys
136
What are the different types of shock?
Cardiogenic
Hypovolemic
Distributive
Obstructive
137
In cardiogenic shock, the heart fails to
Pump blood sufficiently to meet the body’s demands
138
The most common cause of cardiogenic shock is
Myocardial Infarction
139
Clinical manifestations of cardiogenic shock are
```
Hypoperfusion w/ hypotension
Lips, nailbeds & skin cyanotic
Arterial and Systolic BP decrease
Decreased urine output
Neurologic changes (alterations in cognition or consciousness)
```
140
In cardiogenic shock, decreased CO and SV leads to
Eventually ___ is impaired
Compensatory mechanisms like HF
Coronary artery perfusion
141
In hypovolemic shock there is an acute loss of
This is caused by the
And what kicks in?
15-20% of circulating blood volume
Loss of whole blood, internal hemorrhage, third-space losses
Compensatory mechanisms
142
In hypovolemic shock, manifestations are due to
Compensatory mechanism
143
The early signs of hypovolemic shock are
Other manifestations are
Thirst
Increased HR
Decreased urine output
Change in mentation
Cool and Clammy skin, decreased arterial BP, metabolic acidosis, coagulopathy, hypothermia, circulatory failure
144
Distributive shock is also called
```
Vasodilatory shock
Normovolemic shock (blood volume remains normal)
```
145
Distributive shock is characterized by
Loss of blood vessel tone
Enlargement of the vascular compartment
Displacement of the vascular volume away from the heart and central circulation
146
What are the three types of distributive shock?
Neurogenic
Anaphylactic
Septic
147
Neurogenic shock is caused by
Decreased sympathetic control of blood vessel tone
148
Examples of neurogenic shock
```
Spinal shock (occurs in people w/ spinal cord injury)
Fainting as a result of emotional causes
General anesthetic agents (can cause a neurogenic shock–like reaction)
```
149
Anaphylactic shock represents the
Most severe systemic allergic reaction
150
Examples of anaphylaxis are reactions to
Medication (penicillin)
Foods
Venoms
Latex
151
Sepsis is
Septic shock is
Suspected or proven infection, plus a systemic inflammatory response syndrome
Severe sepsis with hypotension
152
Septic shock results in the release of
Pro-inflammatory and anti-inflammatory mediators
153
Some manifestations of neurogenic shock are
Lower HR, in contrast to other types
| Dry and warm skin
154
Some manifestations of anaphylactic shock are
```
Abdominal cramps
Apprehension
Warm or burning sensation of the skin
Itching, hives
Coughing, choking, wheezing
Chest tightness
Difficulty breathing
```
155
Some manifestations of septic shock are
```
Hypotension
Warm flushed skin
Decrease in systemic vascular resistance (in contrast of other types)
Hypovolemia
Reduced cerebral blood flow
```
156
Obstructive shock results from
Mechanical obstruction of blood flow in central circulation
157
Some causes of obstructive shock are
Which is the most common?
```
Dissecting aortic aneurysm
Cardiac tamponade
Pneumothorax
Atrial myxoma
Evisceration of abdominal contents in to the thoracic cavity due to ruptured hemidiaphragm
Pulmonary embolism ***MOST COMMON***
```
158
In obstructive shock, there is elevated _____ because of impaired _______
Right heart pressure
| Impaired right ventricular function.
159
If a patient came in with obstructive shock, you'd expect to see
Signs of right ventricular heart failure
>> Such as elevated central venous pressure and jugular venous distention
