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Pathophysiology 2 > Exam 1 - Cardio > Flashcards

Exam 1 - Cardio Flashcards

1
Q

What two things make up the Endocardium?

A

Lining of chambers and valves

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2
Q

What are the two types of valve dysfunction?

A

Stenosis (blood not getting through), Insufficiency (blood regurgitation back)

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3
Q

Which side of the heart are valve disorders more common?

A

Left side of heart

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4
Q

If a valve is dysfunctional do other organs try to compensate?

A

Yes. The heart and kidneys (among others) try to compensate for valve dysfunction.

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5
Q

Which two valves are effected by stenotic conditions/pathologies?

A

Aortic Valve (left semilunar valve), Mitral Valve (left AV valve)

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6
Q

What are three major causes of Valve Stenosis?

A

Congenital (abnormally bicuspid instead of tricuspid), Degeneration (common in older populations), Inflammatory (2º rheumatic heart disease)

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7
Q

What two diseases can result in inflammation of heart valves causing Stenotic Valves?

A

Rheumatic fever=post-infectious systemic inflammatory disease/response due to streptococci bacteria, effects joints, skin, CNS, and heart
Rheumatic heart disease=the inflammation associated with rheumatic fever can scar/deform the valves

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8
Q

Rheumatic heart diseases can result in what sort of heart valves?

A

Stenotic heart valves

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9
Q

Stenotic Valves cause what sort of sound on auscultation?

A

Murmur

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10
Q

Which phase does a sound from a stenotic valve occur?

A

Systolic phase

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11
Q

Where does one auscultate the aortic valve?

A

Right parasternal 2nd intercostal space

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12
Q

What happens to CO and SV volumes from Stenotic Valves?

A

Reduced CO and SV from LV into Aorta

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13
Q

How does the heart compensate for decreased flow from Stenotic Aortic Valve?

A

Increased LV contractility in attempt to increase SV and maintain CO

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14
Q

What is “Exertional Insufficiency” in Stenotic Aortic Valve disease?

A

When SV and CO are insufficient during exertion but “sufficient” at rest

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15
Q

In a Stenotic Aortic Valve what volume changes are present in the LV?

A

Increased volume in end of systole

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16
Q

At end of Systole what is the difference in volume in LV from normal in Stenotic Aortic Valve?

A

Increased volume in LV

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17
Q

What happens to Systolic BP in Stenotic Aortic Valve?

A

Decreased Systolic BP

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18
Q

How does the body compensate for decreased Systolic BP in Stenotic Aortic Valve disease?

A

Body will increase systemic vascular resistance to try to compensate for decrease in CO

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19
Q

What happens to LV systolic pressure in Stenotic Aortic Valve disease?

A

Increased systolic pressure in LV due to incomplete emptying of ventricle

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20
Q

In Stenotic Aortic Valve what causes increased systolic pressure in LV?

A

Incomplete emptying of LV

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21
Q

What happens to Peak Systolic and End Systolic pressures in Stenotic Aortic Valve?

A

Increased, due to incomplete emptying

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22
Q

In Stenotic Aortic Valve what happens to the peak systolic pressure gradient between LV and Aorta?

A

Increased

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23
Q

What are the four types and pressures of Peak Systolic pressure gradient between LV and Aorta in Stenotic Aortic Valve?

A

Mild=less than 20mmHg
Moderate=20-39
Severe=40-59
Very severe=more than 60

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24
Q

Increased LA pressure, increased pulmonary pressure, and pulmonary HTN can lead to what?

A

Pulmonary Edema on left side of heart from Stenotic Aortic Valve

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25
Q

Thickening of the LV from working harder in Aortic Valve Stenosis is called

A

Hypertrophy

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26
Q

Hypertrophy of LV in Stenotic Aortic Valve causes wall of LV to be ____ and ____

A

Thicker and non-complaint

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27
Q

LV Hypertrophy causing thicker, non-complaint LV wall will increase ____ pressure

A

Preload

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28
Q

LV Hypertrophy resulting in thick and non-compliant wall can result in coronary circulation _____

A

Insufficiency/Ischemia

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29
Q

LV Hypertrophy resulting in thick and non-compliant wall can result in ____ to heart electrical flow

A

Ventricular Dysrhythmias

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30
Q

If mitral valve is healthy what will it help do in left sided congestive pattern?

A

Help protect against

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31
Q

What is the most common etiology of Mitral/left AV valve Stenosis?

A

Rheumatic heart disease. Degenerative not as common.

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32
Q

Which gender develops Mitral/Left AV Valve Stenosis more often?

A

Female

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33
Q

When is the murmur heard with Mitral/Left AV Valve Stenosis?

A

Diastole

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34
Q

What causes the diastolic murmur in Mitral/Left AV Valve Stenosis?

A

Narrowed AV valve during LV filling

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35
Q

Where is the Mitral/Left AV Valve auscultated?

A

Left 5th intercostal space, along midclavicular line

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36
Q

What part of the diastolic phase is Mitral/Left AV Valve Stenosis auscultated?

A

Mid-to-late diastolic phase

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37
Q

What is the primary change in atrial output in Mitral/Left AV Valve Stenosis?

A

Less atrial output

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38
Q

How does the LA try to compensate for Mitral/Left AV Valve Stenosis?

A

Increased atrial contractility to try to increase output

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39
Q

If Mitral/Left AV Valve Stenosis progresses to a severe state how is the SV and CO into the aorta affected?

A

Reduced SV and CO output

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40
Q

How might the LV compensate for severe Mitral/Left AV Valve Stenosis to maintain CO?

A

Increasing SV output

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41
Q

What happens to the end diastolic volume in Mitral/Left AV Valve Stenosis in the LV?

A

Decreased diastolic volume in LV

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42
Q

What happens to the left atrial filling volume in Mitral/Left AV Valve Stenosis?

A

Increased filling volume

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43
Q

What happens to the LA pressure in Mitral/Left AV Valve Stenosis?

A

Increased LA pressure

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44
Q

Increased LA pressure in Mitral/Left AV Valve Stenosis can lead to what type of edema?

A

Pulmonary edema

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45
Q

Increased LA pressure in Mitral/Left AV Valve Stenosis causes what pressure change pulmonary vessels?

A

Increased pulmonary pressures, leading to pulmonary hypertension and pulmonary edema

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46
Q

Pulmonary Hypertension from Mitral/Left AV Valve Stenosis can lead to what type of edema?

A

Pulmonary Edema

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47
Q

What can Mitral/Left AV Valve Stenosis progress to on the right side of the heart?

A

Right side congestive changes

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48
Q

What does severely progressed Mitral/Left AV Valve Stenosis do to SV and CO?

A

Reduce SV and CO, causing decreased systemic BP

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49
Q

Reduced SV and CO from Mitral/Left AV Valve Stenosis will do what to systemic BP?

A

Decrease systemic BP

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50
Q

What is the attempted compensation for severely progressed Mitral/Left AV Valve Stenosis resulting in decreased systemic BP?

A

Body increasing systemic vascular resistance to “offset” drop in CO

51
Q

What structural changes can occur in the LA in Mitral/Left AV Valve Stenosis?

A

LA wall dilation/hypertrophy

52
Q

What can happen to the electrical rhythm of the LA in Mitral/Left AV Valve Stenosis?

A

Atrial Dysrhythmias

53
Q

Dyspnea in Mitral/Left AV Valve Stenosis is due to what?

A

Pulmonary HTN/congestion (Pulmonary Edema)

54
Q

What effect can Mitral/Left AV Valve Stenosis have on position and breathing?

A

Orthopnea (difficult to breathe laying down, easier when sitting up). (Also nocturnal dyspnea.)

55
Q

What is a Regurgitation/Insufficient condition mean?

A

Blood is flowing back from the chamber it came from through a valve that is not completely closing.

56
Q

What are the two valves that a Regurgitation/Insufficient condition can exist in?

A

Aortic Semilunar Valve, Mitral/Left AV Valve

57
Q

What are two possible broad causes of Aortic Valve Insufficiency/Incompetence?

A

Congenital, secondary to disease

58
Q

What three types of diseases can cause Aortic Valve Insufficiency/Incompetence?

A

Rheumatic heart disease, CAD, bacterial endocarditis

59
Q

When is a murmur heard in Aortic Valve Insufficiency/Incompetence?

A

Diastolic phase

60
Q

Where do you auscultate for Aortic Valve Insufficiency/Incompetence?

A

2nd intercostal space, right parasternal side

61
Q

What is the primary change in the aorta of SV and CO with Aortic Valve Insufficiency/Incompetence?

A

Decreased SV and CO.

62
Q

What happens to some of the blood volume in aorta in Aortic Valve Insufficiency/Incompetence?

A

Backflows into LV

63
Q

How does the LV compensate in Aortic Valve Insufficiency/Incompetence?

A

Increased LV contraction to try to compensate for “back flow loss”

64
Q

When the LV increased contractibility in Aortic Valve Insufficiency/Incompetence what is the net result of the SV and backflow to LV?

A

Increased SV into aorta but some SV returning to LV

65
Q

What is the diastolic volume result in LV due to Aortic Valve Insufficiency/Incompetence?

A

Increased end diastolic volume in LV

66
Q

What are the pressure changes in systolic, diastolic, and pulse pressure seen in Aortic Valve Insufficiency/Incompetence?

A

Systolic up, Diastolic down, increased pulse pressure “widens”

67
Q

What is the cause of increased Systolic BP in Aortic Valve Insufficiency/Incompetence?

A

Increased SV

68
Q

What is the cause of decreased Diastolic BP in Aortic Valve Insufficiency/Incompetence?

A

Back flow of blood into LV

69
Q

What happens with the end diastolic pressure of the LV in Aortic Valve Insufficiency/Incompetence?

A

Increased LV end diastolic pressure

70
Q

What can Aortic Valve Insufficiency/Incompetence progress to?

A

Left sided congestion pattern

71
Q

What sort of edema is seen in Aortic Valve Insufficiency/Incompetence?

A

Pulmonary Edema, from pulmonary HTN

72
Q

What are the LV structural changes in Aortic Valve Insufficiency/Incompetence?

A

Dilation/hypertrophy of LV

73
Q

What causes LV dilation (not hypertrophy) in Aortic Valve Insufficiency/Incompetence?

A

To compensation/main SV and CO volumes the LV dilates

74
Q

What can LV dilation cause damage to in Aortic Valve Insufficiency/Incompetence?

A

Further valve damage making the problem even worse

75
Q

What causes LV hypertrophy (not dilation) in Aortic Valve Insufficiency/Incompetence?

A

Increased workload and larger SV/CO

76
Q

What electrical problems can be seen with Aortic Valve Insufficiency/Incompetence?

A

Ventricular dysrhythmias

77
Q

What sort of pulse changes/feeling are found in Aortic Valve Insufficiency/Incompetence?

A

Bounding Peripheral Pulses, due to increased pulse pressure

78
Q

In what condition is Bounding Peripheral Pulses found in?

A

Aortic Valve Insufficiency/Incompetence

79
Q

What are the etiologies of Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Rheumatic heart disease, endocarditis, Mitral Valve prolapse progressing into regurgitation, CAD, congestive cardiomyopathy, systemic CT disorders

80
Q

Mitral Valve Prolapse progressing into mitral valve regurgitation is caused by…

A

Mitral (Left AV Valve) Insufficiency/Incompetence

81
Q

What phase is a murmur heard in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Through Systolic phase

82
Q

Where do you auscultate for Mitral (Left AV Valve) Insufficiency/Incompetence?

A

5th intercostal space along midclavicular line

83
Q

What is primary change of SV and CO into aorta in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Decreased SV and decreased CO

84
Q

What causes decreased SV and CO into aorta in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Due to backflow of blood from LV into LA during ventricular contraction

85
Q

What is the heart’s compensation for decreased SV and decreased CO into aorta in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Increased LV contractility in attempt to increased SV and CO

86
Q

What happens to end diastolic volume of LA in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Increased end diastolic volume in LA

87
Q

How does an increased end diastolic volume in the LA cause the LA to compensate in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Increased LA “kick” to increase blood flow to LV, which increases LV end diastolic volume

88
Q

What is the change in systemic BP seen in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Decreased systemic blood pressure

89
Q

How does the body compensate for decreased systemic BP in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Increased systemic vascular resistance to off set decreased CO

90
Q

What is the change in left atrial filling pressure found in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Increased LA filling pressure

91
Q

What is the change in end diastolic pressure of LV in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Increased end diastolic pressure in LV

92
Q

What can Mitral (Left AV Valve) Insufficiency/Incompetence progress to?

A

Progress to left side congestive pattern

93
Q

What is Left Atrium hypertrophy/dilation due to in Mitral (Left AV Valve) Insufficiency/Incompetence?

A

Due to increased end diastolic volumes in LA

94
Q

What is the vicious cycle that can happen in Mitral (Left AV Valve) Insufficiency/Incompetence ?

A

Dilation of LA can enlarge valve opening even more

95
Q

What is the most common valve disorder in the US?

A

Mitral Valve Prolapse Syndrome

96
Q

What happens to the mitral valves during systole in Mitral Valve Prolapse Syndrome?

A

Enlarged valves prolapse back into LA during systole

97
Q

What causes enlargement of the mitral valves in Mitral Valve Prolapse Syndrome?

A

Degeneration of the leaflets or accumulation of abnormal connective tissue

98
Q

What happens to the valve leaflets in Mitral Valve Prolapse Syndrome?

A

Billow back into LA

99
Q

What happens to the Chordae Tendinae as cusps billow into LA in Mitral Valve Prolapse Syndrome?

A

Become stretched/elongated

100
Q

What beings when mitral cusps cannot fully close in Mitral Valve Prolapse Syndrome?

A

Mitral Valve regurgitation develops

101
Q

Is Mitral Valve Prolapse Syndrome always sympatomatic?

A

No. Large continuum of symptoms

102
Q

What two things might a routine exam reveal about heart sounds?

A

Mid-systolic click or systolic murmur

103
Q

What is the prognosis for Mitral Valve Prolapse Syndrome in most cases?

A

Good outcome and good prognosis

104
Q

What are some severe outcomes in Mitral Valve Prolapse Syndrome?

A

Rupture of chordae tendinae, emboli formation, ventricular failure, infective endocarditis, stroke, death

105
Q

What are the two broad causes of Tricuspid (right AV valve) insufficiency/incompetence?

A

Congenital (enlarged RV), Secondary result of Pulmonary HTN pathologies

106
Q

What phase is a murmur heard in Tricuspid (right AV valve) insufficiency/incompetence?

A

Systolic

107
Q

Where do you auscultate to hear the systolic murmur in Tricuspid (right AV valve) insufficiency/incompetence?

A

Left 5th intercostal space, along para-sternal line

108
Q

When/how long is the murmur heard in Tricuspid (right AV valve) insufficiency/incompetence?

A

Throughout the systolic phase

109
Q

What are the primary changes in cardiac output in Tricuspid (right AV valve) insufficiency/incompetence?

A

Decreased SV and decreased CO into Pulmonary Trunk

110
Q

What causes the decreased SV and decreased CO into the Pulmonary Trunk in Tricuspid (right AV valve) insufficiency/incompetence?

A

Due to backflow of blood into into RA during ventricular contraction

111
Q

What is the attempted compensation of the heart in Tricuspid (right AV valve) insufficiency/incompetence?

A

Increased RV contractility to try to increased SV and CO

112
Q

What happens to the end diastolic volume of the RA in Tricuspid (right AV valve) insufficiency/incompetence?

A

Increased end diastolic volume in RA

113
Q

What does the increased diastolic volume in the RA cause the atrial kick to do in Tricuspid (right AV valve) insufficiency/incompetence?

A

Increased atrial kick in attempt to force more blood into RV

114
Q

What happens to end diastolic pressure of RA in Tricuspid (right AV valve) insufficiency/incompetence?

A

Increased end diastolic pressure of RA

115
Q

What can Tricuspid (right AV valve) insufficiency/incompetence progress into?

A

Right sided congestive pattern

116
Q

Tricuspid (right AV valve) insufficiency/incompetence can cause a right sided congestive pattern. What happens to the CVP, RA pressure, and venous pressure?

A

All increase

117
Q

What happens to RA structure in Tricuspid (right AV valve) insufficiency/incompetence?

A

RA dilation/hypertrophy

118
Q

What happens to venous pressure in Tricuspid (right AV valve) insufficiency/incompetence?

A

Increases. Results in jugular vein distention and lower extremity/generalized edema.

119
Q

Distended jugular veins and lower/generalized edema is found in which condition?

A

Tricuspid (right AV valve) insufficiency/incompetence

120
Q

Which condition causes increased venous pressure?

A

Tricuspid (right AV valve) insufficiency/incompetence

121
Q

Widened pulse pressure (“bounding pulse”) most consistent with which valve disorder?

A

Aortic Regurgitation

122
Q

Narrowed pulse pressure (“Weaker pulse”) most consistent with which three valve disorders?

A

Sortic Stenosis, Mitral Valve Stenosis, and Mitral Valve Regurgitation

123
Q

Increased CVP and venous distention is most consistent with which valve disorder?

A

Tricuspid/Right AV Valve Regurgitation

Pathophysiology 2 (15 decks)

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