Exam 1 Flashcards
(397 cards)
1
Q
what is the leading cause of death i the US and the world
A
CV disease
2
Q
what are causes of cardiovascular disease
A
genetic
neurohumoral
inflammatory mechanisms
3
Q
what are the underlying cellular processes of cardiovascular diseases
A
endothelial injury
remodeling
stunning
reperfusion injury
autoimmune disease
4
Q
what is a varicose vein
A
a vein in which blood has pooled
distended, tortous, palpable veins
5
Q
what is the usual vein for varicose vein
A
spahenous
6
Q
what causes varicose veins
A
-Trauma or gradual venous distention, rendering valves incompetent (standing on hard floor for long periods of time)
-altered connective tissue proteins
-increased proteolytic enzyme activity
-decreased transforming growth factor B in vein walls
7
Q
what is normal arterial pressure
A
120/80 mmHg
8
Q
what is normal venous pressure
A
0-8
9
Q
what is normal pressure going into RA
A
5
10
Q
veins have a _______ muscle layer
A
thin
have great distendability
11
Q
arteries have a _________ muscle layer
A
thick
12
Q
anytime you have inflammation what are three sings
A
heat
redness
swelling
13
Q
what does inflammation trigger
A
inflammatory mediators, cytokines then neutrophils, macrophages then elastase protease
these dissolve damaged tissue and replace it with fibrin
14
Q
what can inflammatory mediators lead to
A
further damage (dissolving of damaged tissue to replace it with fibrin)
15
Q
what does fibrin from damaged tissue lead to? what property is lost in this process
A
scar tissue (fibrin)
elasticity/stretch (no collagen)
16
Q
what can chronic venous insufficiency lead to
A
venous stasis ulcers
17
Q
what is chronic venous insufficiency
A
inadequate venous return over a long period of time as a result of varicose veins, valvular incompetence
18
Q
how does the heart compensate for venous insufficiency
A
increased HR
19
Q
what causes varicose veins in saphenous to be painful
A
runs with the saphenous nerve
20
Q
what is treatment for varicose veins and chronic venous insufficiency
A
-leg elevation, compression stockings, physical exercise
-endovenous ablation (radiofrequency and laser)
-ultrasound-guided foam sclerotherapy
-surgical ligation and vein stripping
21
Q
what can DVT lead to
A
thromboemboli then PE
22
Q
what is a blood clot that is attached
A
thrombus
23
Q
what is a blood clot loose in venous system
A
emoboli
24
Q
what is Virchows triad
A
For DVT
1. Venous stasis
2. Hypercoagulability
3. Venous endothelial damage
25
how many miles of vessels are in body
64,000 miles
26
what does the venous system rely on for return from legs
muscular contraction
27
how do you prevent DVTS
1 mobilization after sx, illness, bed rest, injury
2 prophylactic LMWH, antithrombin agents, warfarin, pneumatic devices
28
how do you prevent DVT from causing PE
IVC filter
29
what are tests for DVT
d dimer
CT
MRI
30
where do saddle thrombus form
pulmonary artery biforcation
31
what is treatment for DVT/PE
LMWH, unfractionated heparin, antithrombin agents, sub q heparin
thrombolytic therapy
ASA
32
what are risk factors for DVT
smoking
overweight
truck driver
33
T/F Heparin dissolves clots?
false
prevents more clots,
prevents current clot from growing
34
what is a D-dimer
fibrin degradation product elevated when clot is present
35
what does ASA prevent
platelet function
36
what are values for HTN
>140 sys or >90 diastolic
37
what is pre htn
120-139/80-89
38
what is isolated systolic HTN
elevated SBP with normal DBP
39
what is primary/essential HTN
unknown cause
95% of all HTN cases
40
what does HTN increase with age
decreased flexibility of arteries/hardening of plaque formation
41
what is secondary HTN
HTN due to underlying primary disease or drugs
42
what is the most significant factor in causing target organ damage
systolic HTN
43
systolic HTN puts at an increased risk for
stroke (more pressure change between diastolic and systolic)
44
a higher diastolic pressure puts more pressure on the
heart
45
Why is BP important?
pressure of oxygen delivery
46
what does HTN increase the risk of
MI
kidney disease
stroke
47
how does HTN lead to kidney disease
damages glomerulus
48
how does HTN lead to stroke
HTN causes generalized dilation of vessels in vein in head, ruptures and causes hemmg stroke
49
why does HTN lead to MI
heart has to pump faster/harder to overcome pressure
heart receives blood in diastole
inadequate time to oxygenate heart
50
when does heart receive blood flow
diastole
51
what are risk factors for HTN
family hx
age
female >70, male <55
black
sodium intake
DM
alcohol use
obesity
smoking
low K, Mg, Ca
52
what are the two causes of HTN
increased CO or SVR (or both)
53
what causes HTN from increased CO
increased HR or stroke volume
54
what causes HTN from increased SVR
any factor that increases blood viscosity or causes vasoconstriction
55
how is HTN treated lifestyle
-reducing risk factors
-sodium restriction 2.4g/day
-increased K intake
-decreased saturated fat
-weight control
-DASH diet
-stop smoking
-exercise program
56
what are pharm treats for lifestyle
thiazide diuretics,
beta blockers
ACEI
ARBs
CCBs
57
why thiazide diuretic in HTN
k sparing, longer lasting
58
why do we use ACEI first for HTN
stopping a normal physiologic process, doesnt impact heart at all, decreases fluid retention and prevents vessel constriction
59
what do pharmacologic therapies reduce risk of
end-organ damage
prevent MI stroke
60
what are thiazide diuretics and beta blockers associated with
lipid disorders
glucose intolerance
61
what are ACEI and ARBs effective for
HF, CKD, after MI, recurrent stroke
62
what is an aneurysm
local dilation of vessel wall
63
what is a true aneurysm
all three layers of the arterial wall
fusiform aneurysm
circumferential aneurisms
64
what are the three layers of the artery
intima
media
adventitia
65
what is a false aneurism
tear in intima and media that pouches in adventitia
saccular aneurism
66
most cerebral aneurisms are
saccular (false)
67
what is present in 50% of people with aneurisms
arteriosclerosis and HTN
68
where do aneurisms usually occur
increased pressure or branching
69
how do aneurisms in heart present
dysrhythmias, HF, embolism of clots to the brain
70
how do aortic aneurisms present
asymptomatic till it ruptures, then it is painful
71
what are clinical signs of thoracic aneurism
dysphagia, dyspnea
72
what are signs of abdomen aneurism
flow to an extremity is impaired, causing ischemia
73
where does an Abdomen Aneurism occur
where the iliacs branch off
74
most of the time saccular refers to an aneurism that ___________ involve all three layers
does not
75
a false aneurism is really a
hematoma (clot formation)
76
what is a dissecting aneurism
form of false
rips through intima and media, blood collets in adventitia
77
what is the most serious/fatal of all aneurism
dissecting, saccular
78
what are treatments for aneurism
maintain low blood volume
low BP
smoking cessation
B blockers
Surgery
79
which aneurism is a surgical emergency
aortic dissecting aneurism
80
why are aneurisms formed in aorta
high BP in aorta hits the curved wall of aorta with high pressure causing damage of lining
81
what causes arterial thrombus formation
athersosclerosis roughening the intima activates the clotting cascade
high BP causes high flows that damage intima lining (
trauma like car crash
82
what areas do arterial thrombi from htn occur
anywhere with a branch, carotid artery,
83
what is arteriosclerosis
hardening of the arteries, media looses elasticity, not as expanded
84
what is atheroscleosis
disruption of intima with plaque formation, a form of arteriosclerosis
85
what is treatment for arterial thrombus
heparin, warfarin, thrombin inhibitors, thrombolytic agents
balloon tipped catheter used to remove or compress an arterial thrombi
86
what do arterial thombi damage
heart
kidney
brain
87
what is an embolism
bolus of matter circulates in the bloodstream then lodges and obstructs blood flow
88
what are examples of emboli
thrombus from DVT
air
amniotic fluid
aggregate of fat
bacteria
cancer cell
foreign substance
89
what causes arterial emboli from heart
MI, valve disease, endocardidits, dysrhythmias, HF
90
what can an embolism cause
occlusion of coronary artery
occlusion of cerebral artery (stroke)
ischemia or infarction or necrosis distal to obstruction
91
does heparain dissolve clots
no, it prevents new clots from forming or clot from getting larger
92
when can you use a thrombolytic agent
within 4 hours, must have a good history
93
how does an extremity appear distal to a arterial occlusion
waxy whiteness of skin do to lack or erythrocytes
numbness and pain from neuronal ischemia
94
any time you get an arterial occlusion you get what
avascular necrosis
95
what is raynaud disease
episodic vasospasms (ischemia) in the arteries and arterioles of the fingers
96
how does reynauds manifest
changes in skin color and sensation caused by ischemia
97
what is reynaud phenomenon
same thing but secondary to other systemic diseases or conditions
98
how do you treat Reynaud's phenomenon
arm exercises
medications
99
why are decubitus ulcers difficult to heal
need blood flow and epithelization, doesnt occur in dead tissue
100
what does debridement do for ulcer
cuts away dead tissue so that there is live tissue that can grow
101
what causes raynauds disease
primary vasospastic disorder of unkown origin
102
how do you treat raynauds disease
avoidance of emotional stress and cold and cessation of smoking
103
what causes atherosclerosis
thickening and hardening caused by the accumulation of lipid-laden macrophages in the arterial wall
-plaque development
104
what is a trigger for reynauds
stress
105
what is the leading cause of coronary artery and cerebrovascular disease
atherosclerosis
106
T/F atherosclerosis only occurs in one area
F, process occurs throughout the body
107
what are steps of atherosclerosis
1-endothelium injury
2-inflammation of endothelium
3-cytokines released
4-cellular proliferation
5-macrophage migration (gobble up ldl)
6-LDL oxidation (foam cells)
7-fatty streak (formed by LDL)
8=fibrous plaque
9-complicated plaque
108
where does atherosclerosis most commonly occur
branches
carotid
coronary vessels
abd aorta splits
aortic arc
109
why kind of blood flow does a branch create
turbulent
110
what are the layers of the artery
intima, media, adventitia
111
where do fatty streaks develop in atherosclerosis
between intima and media (pushes it away)
112
what is fatty streak made from
LDLs
113
what makes an unstable plaque
fatty core (foam cells) and thin fibrous outer shell
can rupture easier
114
what makes a stable plaque
thick fibrous shell around plaque
less likely to break off
115
what happens when part of plaque ruptures
thrombosis (blood clot) begins at the site of the plaque rupture
116
what happen when blood clot on plaque enlarges
occlusion, blocks artery and all tissues supplied by that artery begin to die
heart attack, stroke etc
117
where does atherosclerosis occur (what layer)
media, this is where muscle and elasticity is from
118
what happens when artery is made smaller by plaque formation
increased pressure, increased turbulent flow, increased damage, so increased plaque formation
decreased flow to organs distal to narrowing
119
how does atherosclerosis manifest
depends on organ affected, will inadequately perfuse tissue the artery supplies
120
what is treatment on atherosclerosis
focuses on reducing risk factors
removing initial causes of vessel damage
prevent lesion progression
121
what are lifestyle changes for atherosclerosis
exercising
smoking cessation
controlling HTN
controlling DM
reducing LDL cholesterol by diet and medications
122
what is coronary artery disease
Any vascular disorder that narrows or occludes the coronary arteries
123
what does a CAD lead to
imbalance between coronary supply of blood and myocardial demand for oxygen and nutrients
124
what is the most common cause of CAD
atherosclerosis
125
what are non-modifiable risk factors for CAD
advanced age, family history
male gender, women after menopause
126
carotid artery occlusoin causes
stroke
127
coronary artery occlusion causes
MI
128
what is prolonged ischemia causes irreversible damage to the heart muscle
MI
129
50% of all aneurisms have
arteriosclerosis and aneurism
130
arthersclerosis is a form of
arteriosclerosis
131
what is myocardial stunning
temporary loss of contractile function that persists for hours to days after perfusion has been restored
132
What is hibernating myocardium?
Tissue that is persistently ischemic undergoes metabolic adaptation to prolong myocyte survival
(adapts to less O2)
133
What is remodeling?
process that occurs in the myocardium after an MI
134
we have __________% more mitochondria in heart than in any othermuscle
20%
135
a heart muscle cell can live for _________ without fresh O2
20 min
136
when do electrical signals send with myocardial ischemia
6-8 seconds after blockage
137
what are ECG changes with MI
ST depression
T wave inversion
ST elevation
138
what are the two major types of MI
subendocardial and transmural
139
what is a subendocardial MI
under the surface, heart can still pump because deeper muscle layers can still function
140
what is a transmural MI
MI through all layers of heart, worse kind
141
what ECG signs of MI require immediate intervention
STEMI
142
smaller infarction are ______ associated with STEMI
Not
143
T/F in NSTEMI myocardium not at risk
false
144
what are clinical manifestations of MI
sudden severse chest pain
ECG changes
troponin I: (most specific)
Creatinine phosphokinase-MB (PCK-MB), LDH (lactic acid)
hyperglycemia
145
why do you have hyperglycemia with MI
1-myocardial tissue damages causes catecholamine release (epi, norepi)
2-epi causes liver to turn glycogen to glucose (glyconeogenesis)
3- epi causes pancrease to stop producing insulin
146
what are MI treatment
hospitilization
O2 and ASA
morphine
bed rest
thrombolytics
antithrombotics
vasodilators
PCI
Sx
147
how long does troponin I elevated with MI
2-4 hrs
148
what is acute pericarditis
acute inflammation of the pericardium (bacterial, viral, covid vaccine)
149
what are s/s pericarditis
fever
myalgias
malaise
sudden onset severe chest pain
150
why is troponin released in MI
damage to muscle cells cause troponin release into blood stream
151
what is treatment for pericarditis
rest
salicylates (ASA)
NSAIDS
nonsteroidals and chochicine
152
what is pericardial effusion
cardiac tamponade
153
what is treatment for pericardial effusion/tamponade
pericardiocentesis
154
T/F there is a natural amount of fluid around heart
T 20-50 ccs
155
if you have pericardial effusion you usually have what kind of HF
bilateral HF
156
what is purpose of fluid around heart
lubricant
157
what is constrictive/restrictive pericarditis
Fibrous scarring with occasional calcification of the pericardium causes the visceral and parietal pericardial layers to adhere.
158
what are s/s restrictive pericarditis
exercise intolerance
dyspnea on exertion
fatigue
anorexia
159
what is treatment of pericarditis
dietary sodium restriction
digitalic glycosides
diuretics
160
what are sx treatments of MI
1-CABG (vein from leg (saphenous) sutures into block and then aorta. multiple blocks or posterior)
2-LIMA (left internal mammary artery suture branches and then put it into block. these work best on LAD)
3-PCI- stents
161
what do you do if medical treatments for restrictive pericarditis are not successful
surgical excision of scaring
162
What is cardiomyopathy?
neurohumoral response to ischemic heart disease or HTN on the heart muscle cause remodeling
163
T/F many cases of cardiomyopathy are iopathic
true
164
what is dilated/congestive cardiomyopathy
Impaired systolic function, leads to increased intracardiac volume, ventricular dilation, and systolic heart failure
165
how does ventricle wall appear in dilated/congestive cardiomyopathy
thin
166
what are causes of dilated/congested heart failure
CONDUCTIVE ISSUES (over filling)
MI
DM
alcohol
niacin deficiency
vit D deficiency
selenium deficiecy
hyperthyroidism
167
what are s/s congestive heart failure
dyspnea, fatigue
bradycardias
168
what rhythm is common with dilated cardiomyopathy
a fib
169
what are treatments for congestive HF
salt restriction
vasodilators
diuretics
inotropes
anticoagulants
pacemakers
170
what are two kinds of hypertrophic/asymmetric cardiomyopathy
hypertrophic obstructive cardiomyopathy
hypertensive or valvular hypertrophic cardiomyopathy
171
what CO do we need
5L/min
172
anything that causes the heart to work harder would lead to
hypertrophic cardiomyopathy
173
what is hypertrophic obstructive cardiomyopathy
common inherited (genetic) heart defect of a thick septal wall
174
what causes young athletes to die during aport/event
hypertrophic obstructive cardiomyopathy
175
what are s/s hypertrophic obstructive cardiomyopathy
angina
syncope
palpitations
176
what is treatment of hypertrophic obstructive cardiomyopathy
-beta blockers/verapamil to slow HR
-surgical resection of hypertrophied myocardium
-septal ablation (cut off the excess muscle)
-prophylactic placement of ICDs
177
what is hypertensive or valvular hypertrophic cardiomyopathy
hypertrophy of myocytes: attempting to compensate for increased work load
178
what are s/s hypertensive or valvular hypertrophic cardiomyopathy
asymptomatic OR
angina, syncope, dyspnea, palpitations
179
what causes increased workload of valvular dysfucntions
increased afterload leads to decreased CO, so heart increases HR , this leads to hypertrophy
180
what are s/s restricive cardiomyopathy
R sided HF occurs with systemic venous congestion
181
restrictive cardiomyopathy is a ________ in contractility
decrease
182
what are the two kinds of restrictive cardiomyopathy
amyloidosis
sarcoidosis
183
What is restrictive cardiomyopathy?
myocardium becomes rigid and noncompliant, impeding ventricular filling and raising filling pressures during diastole
184
what is treatment for restrictive cardiomyopathy
correct underlying cause
185
what are disorders of endocardium
dysfunction of the heart valves
186
what determines CO
HR
contractility
preload
afterload
187
what does valvular dysfunction lead to
chamber dilation and/or myocardial hypertrophy
188
what is treatment for valvular dysfunction
Careful fluid management. Valvular repair or valve replacement with a prosthetic valve, followed by long-term anticoagulation therapy and life-long antibiotic prophylaxis before invasive procedures.
189
what valves have stenosis
aortic and mitral
190
what valves have regurge (leak)
aortic, mitral, tricuspid
191
what is subaortic stenosis
hypertrophic obstructive cardiomyopathy
192
What is aortic stenosis?
narrowing of the aortic valve so decreased blood flow from LV into aorta
193
what are causes aortic stenosis
bicuspid valve
dystrophic calcification
194
what are S/S aortic stenosis
angina, syncope (decreased O2 to brain), HF
195
what is treatment of aortic stenosis
valve replacement/repair, long term anticoag therapy
transcatheter aortic valve implantation
196
what is mitral stenosis
narrowing of the mitral valve, so decreased flow from LA to LV
197
what is the most common cause of mitral stenosis
acute rheumatic fever
198
What are the s/s of mitral stenosis?
opening snap
199
what are treatments of mitral stenosis
surgical repair, valve replacement
200
normal EF is greater than
55%
201
T/F every mitral stenosis requires valve replacement
F, has to be very severe, gravity alone allows enough volume to pass through
202
What is aortic regurgitation?
inability of the aortic valve leaflets to close properly during diastole
203
What are the s/s of aortic regurgitation?
widened pulse pressure from increased stroke volume and diastolic back flow
204
what is treatment for aortic regurgitation
valve replacement but can be delayed with with use of vasodilators and inotropic agents
205
what is most common cause of mitral regurgitation
mitral valve prolapse and rheumatic heart disease
206
What is mitral regurgitation?
Reflux of blood from left ventricle into left atrium during systole
207
what is treatment for mitral regurgitation
Surgical repair or valve replacement
208
what does rheumatic fever lead to
inflammation of the joints, skin, nervous system, and heart
209
What is rheumatic fever?
1. it is an inflammatory disease that may develop after an infection with beta-hemolytic streptococcus bacteria
a febrile illness
210
if left untreated what does rheumatic fever lead to
rheumatic heart disease
211
What causes rheumatic fever?
abnormal immune response to the M proteins - treats it as an allergic response antibodies against betahemolyitc strep also attack the body
212
what are the fibrinoid necrotic deposits from rheumatic fever
aschoff bodies- form on heart
213
what sound is associated with mitral valve prolapse
click
214
What are s/s of rheumatic fever?
carditis: murmur
polyarthritis: large joints maily affected
Chorea: sudde, aimless, irregular, involuntary movements
erythemia: truncal rash
215
what is a murmur
leaky valve
216
where is calcium deposited in body
kidney, lungs, aortic valve
217
what is treatment for rheumatic fever
10 days of antibiotics, NSAIDs, abx for up to 5 years
218
dilated cardiomyopathy is a __________ issue
conduction
219
if afterload increase then CO ______________
decreases (inverse relationship)
220
in dilated cardiomyopathy afterload is ___________
high
221
what medications do we use to treat dilated cardiomyopathy
inotropes (digosxin)
222
dilated cardiomyopathy is more common in the ______ side
RV
223
what are the two types of hypertrophic cardiomyopathy
HTN/Valvular
224
what causes HTN/valvular hypertrophic cardiomyopathy
increased workload of heart causes remodeling (thickening) of LV
225
what two conditions lead to aortic stenosis
calcium deposits
bicuspid aortic valve
226
how does the heart respond to aortic stenosis
increase contractility
increase HR
227
aortic stenosis results in a _________ CO
decreased
228
the thickening of the LV in hypertrophic cardiomyopathy results in a ___________ in SV
decrease
229
what kind of cardiomyopathy is caused by an enlarged IVS
obstructive cardiomyopathy
230
what is another word for obstructive cardiomyopathy
sub aortic stenosis
231
what two reasons does aortic stenosis occur
bicuspid aortic valv
calcification
232
where does most stenosis occur
aoritc and mitral (high prressure)
233
what is infective endocarditis
inflammation of the endocardium from infectious agents
-bloodborne microorganism adhere to heart
234
where do microorganisms from infective endocarditis gather in heart
on valve leaflets- form vegetations
235
what are clincial manifestations of infective endocarditis
fever
murmur
petechial lesions of the skin, conjuctiva, and oral mucosa
Osler nodes-on fingers and toes
Janeway lesions-on palms and soles
236
what is treatment for infective endocarditis
high dose antibiotics for 4-6 weeks
surgery to repair affected valve
237
what is HF
heart can no longer provide blood to oxygenate body
inadequate perfusion of tissues
238
what are risk factors for HF
ischemic heart disease
htn
239
what are signs of RHF
peripheral edema
JVD
hepatosplenomegaly
240
what is RHF
inability of heart to provide adequate blood flow to pulmonary circulation
241
what are signs of LHF
pulmonary edema
dyspnea
orthopnea
cough with frothy sputum
242
what is LHF
inability of heart to generate adequate cardiac output to perfuse vital tissues
243
what are dysrythmias
disturbances of heart rhythm
244
what causes dysrhthmias
can be caused by an abnormal rate of impulse generation or an abnormal impulse conduction
245
in utero what is the openeing between the atria
foramen ovale
246
in utero what joins the pulmonary artery to the aorta
ductus arteriosus
247
in utero what connects the inferior vena cava to the umbilical vein
ductus venosus
248
where does the fetus receive oxygen carrying blood
placenta/umbilical vein
249
where does the blood entering the fetus first go
liver
portal/hepatic circulation
250
when does the heart form in utero
3-7 weeks
251
T/F baby and fetus share blood/circulation
F it is separate
252
when does heart get some contractility
4 weeks
253
upon entering the fetus how much of the heart is diverted to liver
40% (60% to heart )
254
what diverts the blood flow from the liver to the inferior vena cava in fetus
ductus venousus
255
where does blood shunted from liver through ductus venosus go next
IVC
256
what is blood path through fetal heart
enter RA from IVC
shunter through foramen ovale and into LA
to LV
aorta
257
where does less saturated blood from fetus head/neck arms go in fetus
from superior vena cava into RA
258
what does the foramen ovale bypass in fetus
RV/lungs
259
what two places does blood go out of fetal RV
small portion to lungs
most bypasses blood through ductus arterious into descending aorta
260
T/F the mother and fetus have the same blood
F, fetus has one blood
261
T/F the lungs of the Fetus are functional
false
262
what shunt bypasses the liver
ductus venosus
263
blood from descending aorta in fetus goes where
returns to placenta through two umbilical arteries
264
blood coming from the umbilical vein bypasses the
RV and lungs (goes from RA to LA to LV)
265
what two special structures does fetal blood from umbilicus gothough
ductus venousus- bypasses liver to IVC
foramen ovale- bypasses RV and lungs
266
what special structure does fetal blood from head/arms go through
from SVC to RA, to RV, some to lungs, most through DUCTUS ARTERIOSUS to descending aorta
267
what are the three special fetal blood systems
ductus venous-bypasses liver
ductus ovale-bypasses RV
ductus arteriosus- bypasses lungs
268
what happen with first breath in fetus
lungs descend, PA opens, pressure change closes: foramen ovale
269
what does the ductus venosus become
round ligament (ligamentum venosus)
270
what does the foramen ovale become
fossa ovale
271
What does the ductus arteriosus become?
ligamentum arteriosum
272
what is a portal hepatic shunt
unclosed ductus venosus bypasses liver
273
what is it called when ductus arteriosus doesn't heal
patent ductus arteriosus
274
what is the leading cause of death in first year of life
congenital heart disease (besides premature)
275
what are congenital defects classified by
based on blood flow
-increasing pulmonary blood flow
-decreasing pulmonary blood flow
-obstructive lesions
-mixing lesions
276
what are clinical signs of congenital defects
poor feedin/sucking
failure to thrive
dyspnea, tachypnea, diaphoresis, grunting, nasal flaring, wheezing, coughing
skin changes like pallor or motling
hepatomegaly
pulmonary overcirculation
277
what is a common condition with congenital birth defects
hypoxemia
278
what is eisenmenger syndrom
pulmonary vascular resistance increases, exceeds or equals systemic vascular resistance, causes a reversal/shunting of blood
279
what is a VSD
Ventricular septal defect-> hole in between ventricles
280
a left to right shunt is okay because
still pumping out oxygentated blood
281
a right to left shift is bad because
pumping our deoxygenated blood
282
eisenmengers syndrome begins as a
1 L to R shunt- forms pulmonary HTN
2 pressure builds on R side, increasing PVR
3 R to L shunt develops
4 aorta pushes out deoxygenated blood
283
T/F eseinmengers is a chronic condition
true
284
what defects cause hypoxemia and cyanosis
tetralogy of fallot
R to left shunts
285
what is patent ductus arteriousus
failure of the ductus arteriosus to close
286
when does the ductus arteriousus usually close
15 hours-2 weeks after birth
287
what does the ductus arteriousus connect
PA to aorta
288
what are the clinical manifestations of PDA
continuous machinery-type murmur (washer machine)
289
what is treatment for PDA
surgical closure by ligation by incision, catheter or video-assisted thoracoscopy
290
PDA is a defect of _____________ pulmonary blood flow
increasing
291
what is an ASD
-atrial septal defect
-hole in the septum b/t the right and left atria that results in increased pulmonary blood flow (left to right shunt)
292
what are the clinical manifestations of murmur
often asymptomatic, diagnosed by murmur
293
what are the three major types of ASD defects
ostium primum
ostium secundum
sinus venosus
294
what is the treatment for ASD
Surgical closure before school age
synthetic patch
295
ASD is a defect of ___________ pulmonary bloodflow
increasing
296
what is VSD
Ventricular septal defect-> hole in between ventricles
shunting from the high-pressure left side to the low pressure right side
297
what are the types of VSDs
perimembranous
muscular
supracristal
AV canal or inlet
298
VSDs is a defect of ___________ pulmonary blood flow
increasing
299
what is an atrioventricular canal defect
abnormalities in the atrial and ventrical septa and AV valves
300
what are the types of AVC defects
complete, partial, and transitional
301
what are clinical manifestations of AVC
murmur, HF
302
what is treatment for AVC defect
complete repair between 3 and 6 months of life
303
AVC is a defect of _____________ pulmonary blood flow
increasing
304
ASD
305
PDA
306
VSD
307
AVC
308
what are the 4 aspects of tetralogy of Fallot
VSD
Overriding aorta straddles the VSD
Pulmonary valve stenosis
Right Ventricle hypertrophy
309
what are s/s tetralogy of fallot
Cyanosis and clubbing
feeding difficulty
squatting
310
what is the cause of clubbing
lack of O2 to nailbed
311
what generally occurs with crying an exertion with tetralogy of fallot
hypervyanotic spell or tet spell
312
tetralogy of fallot
313
tetralogy of fallot is a defect of ___________ pulmonary blood flow
decreasing
314
what is tricuspid atresia
Complete closure of the tricuspid valve
no communication between RA and RV
315
what defects are found in tricuspid atresia
septal defect
hypoplastic or absent RV
enlarged mitral valve and LV
pulmonic stenosis
316
what are clinical manifestations of tricuspid atresia
central cyanosis and growth failure
exertional dyspnea
tachypnea
hypoxemia
317
what is treatment of tricuspid atreasia
prostaglandin admin
blalock-taussig shunt
rashkind procedure: ballon atrial septostomy
band
closure of septal defects
318
tricuspid atresia is a disease of ____________ pulmonary blood flow
decreasing
319
tricuspid atresia
320
what is coarctation of the aorta
narrowing of the aorta
321
what are clinical signs of coarctation of the aorta
CHF : hypotension, acidosis, shock
hypertension in upper extremities
decreases pulses in lower extremities
cool mottled skin
leg cramps during exercise
322
what is treatment for coarctation of the aorta
prostaglandin admin
mechanical ventilation
inotropic support
surgery
323
coarctation of the aorta
324
tricuspid atresia is a __________ defect
obstructive
325
coarctation of the aorta is an _________ defect
obstructive
326
What is aortic stenosis?
narrowing of the aortic valve
327
what causes aortic stenosis
malformation or fusion of the cusps
328
aortic stenosis ___________ the workload of the LV
increases
329
what are s/s aortic stenosis
often asymptomatic
signs of exercise intolerance in preadolescence
syncope
epigastric pain
exertional chest pain
330
what is treatment of aortic stenosis
balloon aortic valvuloplasty
aortic valvotomy
331
aortic stenosis
332
aortic stenosis is an _____________ defect
obstructive
333
what is pulmonary stenosis
narrowing of the pulmonary valve
334
what is a severs form of pulmonary stenosis
pulmonary atresia
335
what are s/s pulmonary stenosis
often asymptomatic
exertional dyspnea
murmur
fatigue
336
what is treatment for pulmonary stenosis
mild: not treated
severe: balloon angioplasty, pulmonary valvotomy
337
pulmonary stenosis is an __________ defect
obstructive
338
pulmonary stenosis
339
what is hypoplastic left heart syndrome
left side of the heart is underdeveloped
obstruction to blood flow from the left ventricle outflow tract
340
what is underdeveloped in hypoplastic left heart syndrome
left ventricle
aorta
aortic arch
341
what two conditions are observed in hypoplastic left heart syndrome
mitral atresia
stenosis
342
what happens when ductus closes in hypoplastic left heart syndrome
hypoxemia
acidosis
shock
343
what is treatment of hypoplastic left heart syndrome
prostaglandins
correction of acidosis
inotropic support for adequate cardiac output
ventilatory manipulation
surgery/transplant
344
what are the three surgical treatments for hypoplastic left heart syndrome
norwood
glenn
fontan
345
hypoplastic left heart syndrome
346
hypoplastic left heart syndrome is an ____________ defect
obstructive
347
what is transposition of the great arteries
When aorta arises from the right ventricle and the main pulmonary artery from the left ventricle
348
in transposition of the great arteries unoxygenated blood is circulated through the __________ circulation and oxygenated blood is circulated through the __________ circulation
systemic
pulmonary
349
what are s/s transposition of the great arteries
worsening cyanosis in first day of birth
350
what is treatment fo transposition of the great arteries
surgery to switch the arteries
351
transposition of the great arteries is an example of a ____________ defect
mixed
352
transposition of the great arteries
353
what is total anomalous pulmonary venous connection (TAPVC)
pulmonary veins connect to the right side of the heart, directly or indirectly, through one or more systemic veins that drain in to the ra
354
what are s/s what is total anomalous pulmonary venous connection (TAPVC)
cyanosis
355
what is treatment for what is total anomalous pulmonary venous connection (TAPVC)
repair obstructive lesions at times of diagnosis
unobstructive lesions are generally repaired during infancy
surgery: anastomosis of the common pulmonary vein to the left atrium, closure of the atrial septal defect
356
what is total anomalous pulmonary venous connection (TAPVC)
357
what is total anomalous pulmonary venous connection (TAPVC) is an example of a _____________ defect
mixed
358
what is truncus arteriousus
failure of the embryonic artery to divide into the pulmonary artery and aorta, trunk straddles an always present VSD
359
what is a type 1 truncus arteriousus
most common (60%) the main pulmonary artery arises from the truncus
360
what is a type 2 truncus arteriousus
20%, pulmonary arteries arise from the posterior aspect of the truncus
361
what is a type 3 truncus arteriousus
10% pulmonary arteries arise from the lateral aspect
362
what is a type 4 truncus arteriousus
pseudotruncus: severe form of tetralogy of Fallot with the bronchial arteries arising from the descending aorta to supply the lungs
363
what are s/s truncus arteriousus
cyanosis that worsens with activity
364
what is treatment of truncus arteriousus
modified Rastelli procedure involving VSD patch closure to divert the blood flow from the left ventricle outflow tract into the truncus
correct pulmonary arteries
365
truncus arteriousus is an example of a __________ defect
mixed
366
truncus arteriousus
367
what causes systemic htn in children
renal disease, coarctation of the aorta
368
what are risk factors for childhood htn
race
socioeconomic
lack of health insurance
sedentary lifestyle
369
what is associated with childhood obesity
parental obesity
370
what does childhood obesity place child at risk for
asthma
sleep apnea
htn
type 2 diabetes
dyslipidemia
cardiovascular disease
371
congenital heart defects come from
failure in embryonic failure
372
Define anemia
Decrease in number of circulating RBCs or decrease in quality or quantity of hemoglobin
373
Etiology of anemia
Altered RBC production
Blood loss
Increased RBC destruction
Combo of all three
374
Classification of anemias in size
“Cytic”
Macrocytic microcytic normocytic
375
Class of anemia by hemoglobin content
“Chromic”
Normochromic and hypochromic
376
What is macrocytic normochromic anemia
B12 or folate deficiency
377
What is microcytic hypochromic anemia
Iron deficiency
Thalassemia
378
Normochromic normocytic anemia
Hemorrhage
Hemolytic
Aplastic
379
How does anemia present
Hypoxia
Fatigue
Weakness
Angina
Dyspnea
380
How can tissue hypoxia present
Ischemia
Weakness
Fatigue
Pallor
Increase RR
Dizziness/fainting
381
What are compensatory mechanisms for tissue hypoxia
Increased HR
Increase SV
Dilate capillaries
Increase renin aldosterone
Increase erythropoietin
Increase BPG cells
382
Pathological mechanisms of anemia of chronic disease
Decreased erythrocyte life span
Suppressed production of erythropoietin (kidney damage)
Ineffective bone marrow response to erythropoietin
Altered iron metabolism
383
What causes chronic disease anemia
Chronic disease or inflammation
Infections
Cancer
Autoimmune diseases
384
What is pancytopenia
Reduction of absence of all three types of blood cells
WBC RBC PLT
385
Pathophysiology of aplastic anemia
Hypocellular bone marrow that has been replaced with fat
386
What is aplastic anemia caused by
Pancytopenia results
Autoimmune disorders due to chemicals drugs physical agents unpredictable exposures, inherited or idiosyncratic cause
387
How does aplastic anemia manifest
Hypoxemia
Pallor
Weakness
Fever
Dyspnea
Signs of hemorrhaging if platelets affected
388
what is atherosclerosis
intimal lesions atheromas or fibrofatty plaques which protrude into and obstruct vascular lemns and weaken the underlying media
contributes 50% mortality in the western world
389
where does atherosclerosis happen
higher pressure vessels/larger vessels often have it
bifurcations
chronic inflammatory problem
390
what are the three principal components
cells (macrophages/foam cells, smooth muscle cells, lymphocytes)
macrophages that are engulfed LDL
extracellular matrix (ECM/collagen)
lipid (LDL, oxidized LDL)
391
factors that promote atherogenisis
endothelial injury that alters the normal hemostasis of the endothelium
--increased adhesion and permeability
--more procogulant
--formation of vasoactive cytokines and growth factors
continuing inflammatory response
cyclic accumulation of cells and lipids
392
potential consequences of atherosclerosis
narrowing of vessels=ischemia
sudden vessel obstruction caused by plaque hemorrhage or rupture
thrombosis leading to embolism
aneurysmal dilation due to weakening of vessel wall (outside of the plaque)
393
define hypertension
BP > 140/90
normal is <130/85
394
pathogenesis of HTN
increased CO and or SVR
increases afterload
kidneys, RAAS, and SNS all contribute
395
consequences of HTN
vessel injury
prolonged vasoconstriction-target organ disease
retinal changes
renal disease
cardiac disease (CAD, CHF)
neuro disease (stroke, dementia, encephalopathy)
396
what are factors that lead to increased Na retention
-genetics
-increased SNS
-increased RAAS
-endothelial dysfunction
-dysfunction of natriuretic hormones
-renal glomerular and tubular --inflammation
-obesity
-insulin resistance
-increased dietary intake
-decreased dietary K, Mg, and Ca
397
