exam 2 Flashcards
what is the difference between systole and diastole
systole is when ventricles contract
diastole is when ventricles relax and fill
what is preload
end-diastolic pressure
“volume”
“stretch”
what is afterload
work/force required to move blood into the aorta
“pressure”
“squeeze”
what increases preload
hypervolemia
regurgitation of cardiac valves
heart failure
what increases afterload
hypertension
vasoconstriction
true or false: increasing afterload decreases cardiac workload
false
what is atrial fibrillation
rapid, irregular beating
why does atrial fibrillation cause low blood pressure
the heart does not have enough time to fill; causing BP to drop
what is hypertension
sustained elevation of blood pressure
what is the primary risk factor of cardiovascular disease
hypertension
what is the leading cause of morbidity/mortality worldwide
hypertension
what race is most likely for hypertension
african americans
true or false: men are more likely to have a cardiovascular disease
true
what is atherosclerosis
the build up of fats, cholesterol, and other substances in and on the artery wall
what effect does smoking have on the cardiovascular system
increases: HR, CO, BP, and coronary flow
what is thrombosis
blood clots block veins or arteries
true or false: PAD and CAD are both caused by fatty deposits in the wall of the arteries (atherosclerosis)
true
where is CAD located
in the heart
where is PAD located
usually in the legs
what are the major risk factors of PAD and CAD
family history
age
smoking
high cholesterol
diabetes
obesity
what is the most common heart disease
CAD
what is the single leading cause of death in America today
CAD
true or false: PAD is a common circulatory problem
true
what increases the risk of PAD by 400%
smoking
what is likely to increase the risk of CAD
PAD
what can cause a decrease in coronary blood flow
vasospasm
fixed stenosis
thrombosis
what can cause angina (chest pain)
decreased coronary blood flow
increased oxygen consumption
what can cause increased oxygen consumption
increased: heart rate, contractility, afterload, preload
what stages of coronary artery disease have elevated troponins
NSTEMI
STEMI
what labs will you look for to evaluate heart damage
troponin
creatine phosphokinase
myoglobin
myocardial infarction -> pericardial inflammation -> ??
pericarditis
myocardial infarction -> electrical instability -> ??
arrhythmias
myocardial infarction -> tissue necrosis -> ventricular wall rupture -> ??
cardiac tamponade
myocardial infarction -> tissue necrosis -> papillary muscle infarction -> mitral regurgitation -> ??
congestive heart failure
myocardial infarction -> impaired contractility -> ??
congestive heart failure
myocardial infarction -> impaired contractility -> hypotension, decreased coronary perfusion, increased ischemia -> ??
cardiogenic shock
myocardial infarction -> impaired contractility -> ventricular thrombus -> ??
stroke (embolism)
what is pericarditis
inflammation of the pericardium
what is cardiac tamponade
rapid accumulation of exudate compresses the heart
what is pericardial effusion
serous exudate filling the pericardial cavity
what is constrictive pericarditis
fibrous scar tissue making the pericardium stick to the heart
what is stenosis
cardiac valve doesn’t open properly
what is regurgitation
valve doesn’t close properly
what valves are most commonly affected by stenosis
aortic and mitral
what do PTs with stenosis present with
fatigue
shortness of breath
arrhythmias
what are the signs and symptoms of mitral valve stenosis
pulmonary congestion
orthopnea
nocturnal paroxysmal dyspnea
palpitations
fatigue
what are the signs and symptoms of aortic valve stenosis
angina
syncope
easily tired
dyspena
peripheral cyanosis
what are the signs and symptoms of mitral valve regurgitation
don’t develop symptoms for years
pulmonary congestion
dyspnea on exertion
orthopnea
what are the signs and symptoms of aortic valve regurgitation
dyspnea on exertion
orthopnea
drop in diastolic pressure
widening arterial pulse pressure
what are the valves experiencing during systolic murmurs
pulmonic and aortic stenosis
mitral and tricuspid regurgitation
what are the valves experiencing during diastolic murmurs
aortic and pulmonic regurgitation
mitral and tricuspid stenosis
what causes heart failure
decreased cardiac output and tissue perfusion
increased fluid retention
what examples of fluid retention can contribute to heart failure
peripheral edema
shortness of breath
exercise intolerance
what does cardiac remodeling do
dilating ventricles and increasing wall thickness
what does inotropic do
contractility or force of heart
what does chronotropic do
heart rate
what is a consequence of dilation
it becomes inadequate and CO decreases
what is a consequence of hypertrophy
less volume space
poor circulation
impaired filling
higher oxygen needs
risk for ventricular dysrhythmias
true or false: ventricular heart failure (systolic) has a high ejection fraction and (diastolic) has a low ejection fraction
false: systolic had low and diastolic has normal
what does ventricular heart failure (diastolic) lead to
decreased stroke volume and CO
venous engorgement in pulmonary and systemic vascular systems
what can be a diagnosis for ventricular heart failure (diastolic)
pulmonary congestion
pulmonary hypertension
ventricular hypertrophy
normal EF
systolic dysfunction has what heart sound
S3
diastolic dysfunction has what heart sound
S4
where does left sided heart failure send venous return
lungs
where does right sided heart failure send venous return
body organs except lungs
true or false: left heart failure is the most common cause of right heart failure
true
what does acute decompensated heart failure manifest as
pulmonary edema
what are the signs and symptoms of pulmonary edema
anxious
pale, possibly cyanotic
skin is clammy and cold
severe dyspnea
wheezing, coughing
blood-tinged sputum
crackles, wheezes, rhonchi
HR rapid, BP variable
what are natriuretic peptides
natural substances released by the heart
what does ANP do and where is it secreted from
lower blood pressure
atrium
what does BNP do and where is it secreted from
regulates circulation (dilate blood vessels, causes kidneys to excrete more salt and water)
ventricles
true or false: high BNP levels equals better cardiac health than lower levels
false
what is the natural pacemaker of the heart
SA node
what is arrhythmias
abnormal conduction and/or formation of cardiac impulses
what are the common causes of arrhythmias
abnormal structure (hypertrophy and dilation)
inadequate oxygen
fluid/electrolyte/pH disturbances (potassium)
injury
excessive demand
where is atrial depolarization
p interval
where is ventricular depolarization found
QRS interval
where is ventricular repolarization found
t interval
what common arrhythmias leads to cardiac arrest
ventricular tachycardia and fibrillation
which valve is affected with damage if the papillary muscle is in the left ventricle
mitral
PT reports shortness of breath, tachycardia, productive cough, and orthopnea. these symptoms are consistent with
left ventricular failure
what clinical manifestations are associated with right-sided heart failure
distended neck veins
putting edema in the feet and ankles
abdominal ascites
what conditions would likely lead to diastolic heart failure
cardiac hypertrophy from long-standing hypertension
cardiac tamponade
restrictive cardiomyopathy
what is the functional unit of the kidney
nephron
what is the function of the kidneys
filter blood of toxins/waste and reabsorb needed molecules
what can high levels of uric acid in the urine cause
kidney stones
gout
what could high amounts of urea in the urine indicate
urea is a byproduct of protein formed in the liver
high levels could indicate tissue breakdown or diet high in protein (bodybuilders)
what is the function of the nephron
reabsorption of water, electrolytes, and other substances from bloodstream
what endocrine functions does the kidney perform
1) creates erythropoietin which regulates the differentiation of red blood cells
2) increases calcium absorption and regulates calcium deposition in bone
what diuretics affect potassium levels
loop and thiazide diuretics
what are the characteristics of normal urine
1) clear, amber-colored fluid
2) 95% water and 5% dissolves solids
3) contains metabolic wastes, no plasma proteins, blood cells, or glucose molecules
how much urine does the kidney normally produce
1.5L of urine
what is specific gravity of urine
provides a valuable index of the hydration status and functional ability of the kidneys
what is a health/normal range for the specific gravity of urine
1.030-1.040
what would a specific gravity of urine of 1.000 indicate
a very hydrated person
what is renal clearance
the volume of plasma that is completely cleared each minute of any substance that finds it’s way into urine
what are the determining factors of renal clearance
1) the ability of the substance to be filtered in the glomeruli
2) the capacity of the renal tubules to reabsorb or secrete the substance
what primary hormone is produced by the kidney
erythropoietin
what tests are used to test for renal function
1) urinalysis
2) GFR
3) serum creatinine
4) ultrasonography
what is the difference between agenesis and hypogensis
1) agenesis: kidneys don’t develop
2) hypogenesis: kidney underdeveloped
what is potter syndrome and what are some characteristics
newborns with renal agenesis
- eyes widely separated with epicanthic folds, ears low set, nose broad and flat, eyc
what are some causes of potter syndrome
cystic renal dysplasia
obstructive uropathy
autosomal recessive polycystic disease
unilateral agenesis
what is cystic disease of the kidney
fluid-filled sacs or segments of a dilated nephron
what are kidney stones and what are the most common type
crystalline structures that form from components of urine
calcium (oxalate and phosphate)
what is the second leading bacterial infection seen by healthcare providers
UTI
what is the most common bacteria that causes UTI’s
e. coli
what conditions lead to kidney stone formation
acidic pH
supersaturated urine
urine stasis
what is glomerulonephritis and what are common characteristics
inflammation of the glomerular structure
- hematuria
- diminished GFR
- azotemia
- oliguria
- hypertension
what is the second leading cause of renal failure
glomerulonephritis
true or false: static urine flow will predispose your patient to development of a UTI
true
what is renal failure
a condition in which the kidneys fail to remove metabolic end products from the blood and regulate the fluid
what are the types of renal failure
acute and chronic
what GFR is indicative of chronic renal failure
GFR < 15mL/min/1.73m2
what are the clinical manifestations of chronic renal failure
accumulation of nitrogenous waste
anemia and coagulation disorders
hypertension
gastrointestinal disorders
immunologic disorders
what are the cardiovascular disorders of renal failure
hypertension
heart disease
pericarditis
what are the hematologic disorders of renal failure
anemia
coagulopathies
what is a pulmonary embolism
a blockage in one or more of the pulmonary arteries in your lungs
what is virchow’s triad and what makes it up
the perfect environment for a pulmonary embolism
- hypercoagulability
- vascular damage
- circulatory stasis
what are the signs and symptoms of pulmonary embolism
SOB
chest pain
dyspnea
tachypnea
tachycardia
shock
what is pulmonary hypertension
pressure in the blood vessels leading from the heart to the lungs is too high
signs and symptoms of pulmonary hypertension
SOB
fainting
dizziness
chest pressure
tachycardia
what is cor pulmonale and what causes it
right-sided heart failure caused by a primary lung disorder
describe the pathogensis of cor pulmonale
1) lung disorder damages the lungs
2) low oxygen or hypoxia leads to pulmonary vasoconstriction which limits blood flow to alveoli
3) vascular remodeling (thickening of arteries)
4) increased pulmonary arterial pressure (>20mmHg)
5) increased right ventricular afterload
what is the most common cause of cor pulmonale
COPD
what are the clinical manifestations of cor pulmonale
SOB
chest pain
severe fatigue
exercise intolerance
warm/moist skin
peripheral edema
what is an anatomical dead space
refers to the volume of ventilated air that does not participate in gas exchange
- nose, pharynx, trachea, bronchi)
what is ventilation
the flow of air into and out of the alveoli
what is perfusion (Q)
the flow of blood to alveolar capillaries
what is dead space
portion of each tidal volume that does not take part in gas exchange
what is a shunt
pathological condition in which alveoli are perfused but not ventilated (blood get shunted away from the area without ventilation to find an area with ventilation)
what is an acute respiratory disorder
a failure of the respiratory system to add oxygen to the blood and remove CO2 and represents a life threatening occurrence
what are three types of acute respiratory disorders
acute respiratory distress syndrome (ARDS)
acute respiratory failure (ARF)
covid-19
what is acute respiratory distress syndrome (ARDS)
respiratory failure in critically ill patients
acute onset of cardiogenic pulmonary edema and hypoxemia caused by alveolar inflammation or infection requiring mechanical ventilation
what are common causes of acute respiratory distress syndrome
near drowning
heroin
infections (most common)
trauma (burns, chest trauma)
shock
what is respiratory failure
failure of gas exchange due to heart or lung failure
what is the difference between ARDS and ARF
ARDS = life threatening condition caused by injury to the capillary wall either from illness or injury (alveolar walls become leaky)
ARF = broader term that refers to failure of lungs from any causes
what is covid-19 and what causes it
an infectious disease caused by the SARS virus (severe acute respiratory syndrome)
what is the pathogensis of covid-19
vital entry
macrophage activation
pro inflammatory cascade
acute lung injury
respiratory failure
what are the stages of covid-19
1) asymptomatic stage (initial 1-2 days of infection)
2) upper airway and conducting airway response
3) hypoxia, progression to ARDS
what are treatments for covid-19
1) antiviral treatments - target specific parts of the virus to stop it from multiplying in the body
2) monoclonal antibodies - help immune system recognize and respond more effectively to virus
what is the main function of the respiratory system
remove appropriate amounts of CO2 from blood and add appropriate amounts of oxygen leaving the pulmonary circulatory system
what is hypoxemia
decreased arterial oxygen supply (PaO2 of 92% or lower)
what is hypoxia
decreased oxygen content in the tissues
what is hypercapnia
increased CO2 in the blood
what are the signs and symptoms of hypoxia
restlessness
headache
confusion
tachycardia
anxiety
dyspnea
severe cyanosis
low HR (severe)
what are the signs and symptoms of hypoxemia
headache
dyspnea
tachycardia
wheezing
coughing
confusion
cyanosis (severe)
what is strider
construction in the airways leading to a whistling noise
how does the purse lip breathing technique help
helps control rate and volume
prolonged expiration of air
keeps airway open during exhalation and excretion of CO2
what is cyanosis
abnormal blue discoloration of the skin and mucus is membranes caused by an increased concentration of deoxygenated hemoglobin in capillary bed
SpO2 less than 85%
what is pleural effusion
excess fluid between the layers of the pleura outside the lungs
what are the causes of pleural effusion
heart problems
cancer
pneumonia
pulmonary embolism
what is pneumonia
disorder of inflammation of the bronchioles and alveoli
dead cell and debris then build up creating pus and filling parts of the small airways
what causes pneumonia
infectious agents
what is pulmonary edema and what causes it
lungs filled with fluid
lung congestion
causes: fluid overload, heart failure
what is atelectasis and what causes it
an avoidable state where the alveoli don’t fill properly/incomplete lung expansion
causes: immobility, mucus plug, external pressure
pnuemothorax
condition where air has entered normally closed pleural space (and expanded this space) driving pleural pressure up toward atmospheric pressure
what are obstructive airways disorders characterized by
progressive declining lung function
airflow obstruction
abnormal chronic
inflammatory response
airway remodeling
what is airway remodeling
cells that shouldn’t be there show up
what is chronic/refractory asthma characterized by
chronic airway inflammation
airway hyper-responsiveness
airway obstruction
massive immune response
airway remodeling
genetics
what is the inflammatory cascade
cause construction of epithelium
immune response is totally out of control
what does refractory/chronic asthma cause
there is a “pro-inflammatory” Th2 response
activation of eosinophils and phagocytes which exacerbates allergies causing type-1 hypersensitivity reactions
what are the clinical manifestations of asthma
SOB
chest tightness
wheezing
troubling sleeping
what is the third leading cause of death worldwide
COPD
two major categories of COPD
emphysema and chronic bronchitis
what is emphysema
gradual damage of lung tissue (destruction of alveoli)
what is chronic bronchitis
long term inflammation of the bronchi and the hyper production of mucus
chronic infection in COPD leads to?
overproduction of mucus
chronic airway inflammation
reduced gas exchange
remodeling
emphysema clinical manifestations
barrel chest
high CO2 retention
purse lip breathing
dyspnea
anxious
thin appearance
poor diffusion
fewer metabolic issues then chronic bronchitis
chronic bronchitis clinical manifestations
recurrent cough
hypoxia
high incidence in smokers
leads to right sided heart failure
what is the normal anterior/posterior diameter
1:2
effects of COPD
increased risk of cardiovascular disease
depression and anxiety
osteoporosis
overproduction of EPO from hypoxia
what is bronchiectasis
permanent and abnormal dilation of the bronchi, bronchioles (uncommon type of COPD)
what is cystic fibrosis and how do you treat it
genetic disease causing the mutilation of the cystic fibrosis transmembrane conductance regulator (treatment is lung transplant)
what is obstructive sleep apnea
the brain sends a signal to the muscles and the muscles make an effort to take a breath bit muscles are unsuccessful because the airway is obstructed
most common sleep related disorder
obstructive sleep apnea
what are interstitial lung disorders
umbrella term for problems with the lungs themselves can be related to the expansion rate of the lungs or total volume the lungs can hold
what is idiopathic pulmonary fibrosis
most common form of ILD
starts with chronic cough and dyspnea
dilation of bronchi
alveolar remodeling
no cure (lung transplant)
what are extrinsic restrictive lung diseases
problems outside of the lungs place pressure on the lungs or paralysis of muscles that help with breathing
what do pulmonary function tests measure
lung volume
capacity
rates of flow
gas exchange
diagnostic and determination for the best treatments
what is forced expiratory volume 1 (FEV1)
volume of air forcefully exhaled in 1 second
one of the most important factors
what is forced vital capacity (FVC)
volume of air forcibly exhaled after deepest breath possible
FEV1/FVC ratio
volume of air that once can forcefully exhale
what is total lung capacity
volume of gas in the lung at the end of a full inspiration
~6 liters in a healthy adult
what is residual volume (RV)
the volume of air remaining in the lungs after maximal exhalation
what is the diffusing capacity for carbon monoxide (DLCO)
measures the ability of gas to transfer from the alveoli across the alveolar epithelium and the capillary endothelium to the red blood cells
- helps determine the underlying disorder and tell the severity
what is functional residual capacity (FRC)
the volume of air in the lungs after a normal, passive exhalation
