Exam 2 Flashcards
1
Q
What is a lipoprotein?
A
A general term for molecules that are protein and fat
2
Q
What defines the different type of lipoproteins?
A
They are categorized by density
3
Q
Which lipoprotein do you want more of?
HLD vs. LDL
A
HDL
4
Q
What is dyslipidemia?
A
Elevated levels of TC, LDL or triglycerides
5
Q
How is dyslipidemia measured?
A
It is measured with a fasting lipids profile
6
Q
What are the goal levels for lipoproteins?
A
LDL<100mg/dl
TC<200mg/dl
HDL>60mg/dl
7
Q
A severe lipoprotein elevation may cause?
A
xanthomas or acute aterial blockages
8
Q
What is atherosclerosis?
A
The development of fibrous, fatty lesions in the intima of large and medium-sized arteries (aorta, coronary arteries, cerebral arteries, peripheral arteries)
9
Q
What is the most common type of coronary heart disease?
A
Atherosclerosis
10
Q
What are some of the risk factors for atherosclerosis?
A
Family history
Hyperlipidemia
Increasing age
Male Gender
Cigarette Smoking
Obesity/diabetes
Emerging role of inflammation
11
Q
What are 3 of the biggest contributors to Athlerosclerosis?
A
HTN
LDL
Smoking
12
Q
What type of calcification occurs in athersclerosis?
A
Distrophic calcification
13
Q
What do the manifestions of atherosclerosis depend on?
A
the vessel affected and extent of the narrowing
14
Q
What are the manifestations of atherosclerosis?
A
If occuring in the coronary arteries, exertion can cause chest pain and discomfort
15
Q
When atherosclerosis occurs in the preripheral arteries it is called?
A
Peripheral Arterial Disease
16
Q
What is the main symptom of Peripheral Arterial Disease?
A
Intermittent claudication
17
Q
What is claudication?
A
A dull aching pain often in the calf muscle that occurs due to anerobic metabolism that is most predictable with activity
18
Q
What are some of the long term manifestations of PAD that are not claudication?
A
Changes in skin->cool, pale
Hair and toenails are abnormal
19
Q
How is PAD diagnosed?
A
Ultrasound
Signs of chronic hypoxia in the limb
Weak/absense of pedal pulses
Cool skin
Pallor
Hairloss
(Uncle Sam Can Play Hockey)
20
Q
What is an option for treatment for people with PAD?
A
A stent
21
Q
What is an aneursym?
A
Atrophy or weakness of the medial layer of vessel wall caused by dilation of the artery
22
Q
Where are aneursyms commonly found?
A
While they can be located anywhere, they are commonly found in the abdominal aorta or cerebral arteries
23
Q
What causes an aneursym?
A
Degeneration may be caused by atherosclerosis, connective tissue disorders, increased blood pressure around a stenotic area
24
Q
What is law of LaPlace?
A
An increasing radius at the weakened spot increases tension inside the wall fo the artery
25
What is a 'Triple A'?
Abdominal Aortic Aneursym
26
What demographic is most likely to get a Triple A?
Usually men over 50 with a history of smoking
27
While normally a Triple A is asymptomatic, what is the one tell tale sign?
If you see a pulsating mass midline
28
What is a Aortic dissection?
A unique more dangerous aneursym that is common in the ascending aorta that causes a rupture or hemorrage into the vessel wall.
29
What occurs if someone experiences an aortic dissection?
An abrupt and intense pain
BP quickly falls
Most likely fatal
30
Why does an aortic dissection tear the vessel tissue?
The pressure that builds up in the dead end channel from the blood will tear the tissue
31
What are the units of blood pressure?
mmHg
32
What is the formula for blood pressure?
BP=Cardiac output x peripheral vascular resistance
33
What is the formula for mean arterial pressure?
MAP=(Systolic BP + 2Distolic BP)/3
34
What are the short term regulators of BP?
Neural Mechanisms
Humoural Mechanisms
35
What are the short term neural mechanisms that regulate BP?
Baroreceptors
Chemoreceptors
36
What are the short term humoral mechanisms that regulate BP?
RAA System
Vasopressin/ADH
37
What is the pericardium?
The sac around the heart that is filed with fluid
38
What are the 3 main pericardium problems?
Pericarditis
Pericardial effusion
Special Situation: Cardiac Tamponade
39
What is Pericarditis?
Inflammation of the pericardium that may restrict the hearts movement due to:
-Serous exudate filling pericardial cavity
-Fibrous scar tissue making the pericardium stick to the heart
40
What is pericardial effusion?
Serous exudate filling pericardial cavity-aka an accumulation of fluid in the pericardial cavity
41
What is Constrictive pericarditis?
Fibrous scar tissue making the pericardium stick to the heart
42
What are the two different categories of pericarditis?
Acute-often viral or after trauma
Chronic-exudate may remain for months or years
43
What is generally seen in the capillaries during acute pericarditis?
Increased capillary permeability allows exhudate into pericardial cavity
44
What are the symptoms of acute pericarditis?
Sharp chest pain, EKG changes, a friction like sound (like sandpaper) when auscitating the heart sounds
45
What is generally the cause of chronic pericarditis?
Often due to autoimmune disorders and it generally less severe although it still requires monitoring
46
What are the causes that can result in a pericardial effusion?
Usually the result of a d/t infection or inflammation
47
What are the negative effects on the heart from a pericardial effusion?
It can compress the heart, which increases intracardiac pressures and reduces venous return to the heart.
48
How is a pericardial effusion treated?
With a pericardiocentesis->Literally place a needle in between the viseral and paretal layer and drain the fluid
49
What occurs to the left ventricle during a paricardial effusion?
Because the heart cannot expand, the left ventricle can't accept enough blood.
This leads to decreased cardiac output, which results in a drop in blood pressure which can lead to shock.
50
What occurs to the right ventricle during a pericardial effusion?
The right ventricle can't accept enough blood leading to increased systemic venous pressure and jugualar vein distension
51
What is a cardiac tamponade?
Significantly more severe than a pericardial effusion->
it is a severe compression of the heart due to a large acute pericardial effusion. This is normally caused by bleeding into the pericardial sac
52
What are the symptoms of a cardiac tamponade?
Jugular vein distension
Drop in systolic BP
Circulatory shock (can lead to)
Weak pulse pressure
Muffled heart sounds
Whatever Jackie Doesn't Care Maybe
53
Balance between ______________ ______________ supply and demand must be maintained.
myocardial oxygen
54
What is myocardial oxygen demand influenced by?
Heart Rate
Contractility
Muscle Mass
Ventricular wall tension
55
Ventricular wall tension is influenced by?
Afterload
56
What is myocardial oxygen supply influenced by?
coronary blood flow
O2 carrying capacity
Vascular resistance
57
What is the difference between an ischemia and an infarction?
Ischemia: effect of reduced perfusion
Infarction: Effect of absent/acute lack of perfusion
58
The left main coronary arteries subdivide into?
The circumflex coronary artery (Above)
The left anterior descending coronary artery
59
What is the leading cause of death in the US?
Coronary Artery Disease
60
What is coronary artery disease?
Heart disease due to impaired coronary blood flow usually due to atherosclerosis
61
What are the 3 established risk factors for coronary artery disease and what are the 3 risk factors that are starting to be recognized as major risk factors?
Hypertension, hyperlipidemia, smoking
Diabetes, Chronic Kidney disease and obesity
62
Coronary artery disease subdivides into acute and chronic syndromes/diseases. What are the two categories of acute coronary syndromes?
Unstable Angina, Non-STEMI
ST-segment elevation MI (STEMI)
63
What are the diagnosis factors for Coronary artery disease?
Severity of chest pain
Timing of chest Pain
Cardiac Enzymes blood markers
EKG Changes in the ST segment
Direct imaging of coronary arteries
(Sally Takes Cold Evening Drives)
64
What is troponin?
An enzyme only found in cardiac myocytes
65
If troponin is in circulating blood, what does that mean?
It means cardiac myocytes have died in some sort of infarction, **seen in both STEMI and nonSTEMI
66
What causes the pain during a myocardial ischema?
The O2 shortage forces the myocardium to use anaerobic metabolism and this is what causes the pain
67
What physiological compensation normally occurs right before chest pain?
There is a mild increase in HR and BP due to SNS compensation
68
What are the Sequelae and complications of a myocardial ischema?
Angina
Conduction abnormalities/dysrhymias
Myocardial infarction
Unlikely:
Heart failure
Sudden death
69
What is a predictable first warning sign of coronary artery disease?
A stable angina
70
What is predictable with stable angina and what does this indicate?
A stable angina is predictable onset with activity (can be with significatn emotional distress as well) and subsides with rest indicating that the myocardium is experiencing ischemia
71
For a stable Angina, an ECG may show?
ST-segment depression
72
What are the other types of Myocardial Ischemia?
Variant or Vasospastic
Silent ishemia
73
What is occuring during a Vasospastic ischemia?
The coronary arteries are physically tightening unpredictably often at night
74
People who have ischemia but are experiencing no pain are likely to have what kind of ischemia?
Silent
75
What are the 3 Acute coronary syndromes?
Unstable angina
Non-ST segment elevation MI
ST segment elevation MI
76
What type of angina is considered the precursor or harbinger of a myocardial infarction?
Unstable Angina
77
An unstable angina occurs when?
A significant portion of a coronary artery is blocked and pain may happen without any exertion
78
What is different in regards to pain from an unstable angina and a stable angina?
Anginal pain is more severe, lasts longer and is less predictable
79
What acute coronary syndrome does NOT have elevated cardiac enzymes?
Unstable Angina
80
What do we see on a EKG if a patient has an unstable angina?
No ST elevation, ST segment may be depressed or the T wave is inverted
81
What is a myocardial infarction?
A sudden blockage of one or more coronary arteries that stops blood flow to a section of the myocardium and the myocardium begins to die
82
Where is the most common place to have a myocardial infarction?
The tissues of the left ventricle
83
What are the manifestations of a MI?
Patient will be sweating, nausous, experiencing chest pain that doesn't go away and will be very anxious.
Ischemia chest pain does not go away with rest
Diaphoresis
Nausea/Vomiting
Anxiety
*Women often have different symptoms
84
What are the manifestions that are more likely to be seen in women who are experiencing an MI?
Fatigue
Insomnia
Back pain
Shortness of breath
Pain on right side of jaw
85
At the tissue level, what are the effects of an MI?
reduced myocardial contractility
(not participating in systole)
86
What are the overall effects of an MI?
Abnormal ventricular wall motion
Reduced contractility and compliance
Reduced stroke vol->Reduced EF->decreased CO
dysrythmias
If you have an MI, the cells that die wont be able to act normally, resulting in reduce function
87
What is the difference between a myocardial infarction and cardiac arrest?
*******
A myocardial infarction is blocked blood flow causing tissue death while a cardiac arrest is a severe dysrythmia
88
An MI in the __________ ___________ coronary artery usually results in death.
Left main
89
The diagnosing blood marker of an MI is?
Cardiac enzymes (troponin) in circulating blood
90
A NSTEMI has?
Symptoms of an MI but NO elevation of EKG, but has cardiac enzymes in the blood
91
A STEMI has?
Raising of the ST segment
Cardiac enzymes in the blood
92
Which is more severe?
A STEMI or a NSTEMI
A STEMI
93
What are 3 severe complications of an MI?
Papillary muscle rupture
Cardiac Rupture
Cardiogenic shock
94
What valve is normally effected by papillary muscle rupture?
The mitral valve
95
What is a cardiac rupture?
The necrotic area of the ventricle wall ruptures after a MI leading to massive bleeding into the pericardium (leading to a cardiac tamponde)
96
What is considered cardiac shock?
When an MI affects >40% of the left ventricle and causes a severe drop in systemic and cardiac circulation
Most likely not survivable
97
What is the milder complication of an MI?
Heart failure
98
What is preload?
Volume that fills the heart at the moment of diastole from the pulmonary vein and vena cava
99
True/False
Coronary artery disease is more likely to result in chronic ischemia (causing a stable angina) than acute coronary syndrome.
True
100
A Cardiac tamponade will directly impact which function of the heart?
Afterload or Preload?
Preload
101
What is Valvular heart disease?
Damage or changes to any of the four heart valves that creates abnormal blood flow and increases cardiac work
102
Normal valves allow ________________ and ___________________ blood flow.
unidirectional and unimpeded
103
VHD:
What is regurgitation?
valve doesn't close properly and allows backflow creating volume work
104
VHD:
What is stenosis?
the valve opening is restricted, preventing forwards flow, creating pressure worke
105
What is a murmur?
An audible turbulent blood flow across a heart valve
106
What are two of the most common causes of Valve disease?
infective endocarditis or rheumatic fever
107
What are some of the other causes of of valve disease besides infective endocarditis and rheumatic fever?
Connective tissue defects
Rupture of papillary muscles
Damages from an MI
Congenital malformations
Calcifications
108
What are the valves most commonly affected by valve disease?
Mitral and Aortic
(think entrance and exit of left ventricle)
109
What are some of the variables when it comes to manifestations of valve disease?
Valve involved
Severity of Damage
Rapidity of onset
Compensatory mechanisms
110
A valve that develops _______________ is much more _____________ than one that develops ____________.
A valve that develops acutely is much more serious than one that develops chronically.
111
What is infective endocarditis?
A rare but life threatening infection of the endocardium that is often caused by the bacteria staphylococci, streptococci or enterococci
(just remember it ends in -cocci)
112
How does one contract infective endocarditis?
The person requires an already-damaged endocardium and an entry point for bacteria to enter into the circulatory system
113
What does infective endocarditis do to the heart?
bacteria and resulting inflammation create vegetations on heart valves that can look like nodules or cauliflower. Patient may have systemic infection symptoms and well as heart murmer
114
How is infective endocarditis diagnosed?
Blood cultures and an echocardiogram
115
What is acute rheumatic fever?
A systemic inflammatory disease that may occur after group A beta hemolytic streptococcal pharyngitis (strep throat)
116
What is the theory on why this strep causes rheumatic fever?
the theory is that the infection causes a type II or III autoimmune response
117
What is Rheumatic Heart disease?
The cardiac manifestation of RF and may involve all three layers of the heart where autoantibodies react with host tissue causing damage to the valves that results in stenosis or regurgitation
118
What is mitral valve stenosis?
Resistance to blood flow from LA->LV that causes the LA to work harder and becomes dilated and thickend due to hypertrophy
The pressure from the LA backs into pulmonary circulation and causes pulmonary pressures to rise
119
What are the symptoms of mitral valve stenosis?
Enlarged LA
pulmonary congestion/edema
Reduced cardiac output
Increasing exertional dyspnea]
Tachycardia
Atrial dysrhythmia
120
While Mitral valve stenosis starts out as a pressure problem, how does it turn into a volume problem?
The blood will eventually back up into the lungs
121
What is mitral regurgitation?
during systole, some blood flows backward into the LA instead of moving forward through aortic valve because RHD has caused mitral prolapse
122
During mitral regurgitation, the LA dilates to accomodate backflow, but what happens if this fails?
The pressure in the pulmonary circuit rise and left sided heart failure occurs
123
Acute mitral valve regurgitation is usually?
Fatal
124
What is one of the classic reasons for heart failure?
Aortic stenosis
125
What is aortic stenosis?
a narrowed aortic valve obstructs blood flow into the aorta from LV during systole
126
What will occur to the left ventricle if experiencing aortic stenosis?
hypertrophy
127
When do symptoms of Aortic Stenosis occur?
at ~50% narrowing
128
What are the symptoms of Aortic Stenosis?
Angina
Syncope
LV failure
Loud Systolic murmur
129
What is the survival rate upon the onset of symptoms of Aortic Stenosis?
5 year survival rate
130
Heart failure is defined as?
The chronic complex syndrome that involves imparments of ventricular filling or ejection of blood from ventricles
131
What is an ejection fraction?
a measurement of the amount of blood that is pumped out of the heart with each contraction, as a fraction of the total amount of blood in the left ventricle. It is expressed as a percentage, and a normal EF is typically around 55-70%.
132
Patients with heart failure have a greatly reduced?
cardiac reserve
133
HFrEF is what part of the ejection fraction?
The systolic
134
HFpEF is what part of the ejection fraction?
diastolic
135
_________________ or_________________ tells us if the heart is failing to pump out enough blood or failing to accept enough blood from the body/lungs.
HFrEF or HFpEF
(systolic or diastolic)
136
A reduced ejection fraction tells us?
That the issue is systolic and is an issue with contractility
Also called a "pumping problem"
137
A preserved ejection fraction tells us?
The issue is diastolic and is an expansion issue because the LV is not able to relax and fill with blood.
Also called a "filling problem"
138
What are the common causes of Systolic HF?
Ischemic heart disease
Dilated cardiomyopathy
Extreme stress
Viral infections
139
What are the common causes of Diastolic heart failure?
Long term hypertension resulting in hypertrophy of LV
Aortic Stenosis
Aging
140
The pressure in the aorta must be __________ than the pressure in the left ventricle or blood will stop flowing.
less
141
What are the diagnosing criteria of heart failure?
signs and symptoms related to reduced cardiac output
lab results
ejection fraction measured by echocardiogram
142
What is a normal ejection fraction?
Normal is 60-70%
Or as Dr. Cuter said "2/3"
143
In the classification of Heart failure, if you see 'refractory' what does this tell you?
The heart disease has progressed to be untreatable
144
What are the compensatory mechanisms of heart failure?
Frank-starling mechanism
SNS activity
RAA mechanism
Natriuretic peptides: ANP, BNP
Endothelin
Myocardial hypertrophy/remodeling
145
What are the good parts of the Frank-Starling mechanism?
The increased sodium and water retention by the kidneys due to low perfusion increases blood volume.
This increase in blood volume increases the end-diastolic volume (pre-load) leads to increased contractility and stroke volume.
146
What are the bad parts of the Frank-Starling mechanism?
Increased cardiac muscle stretch->Wall tension->Increased O2 demand->EDV and ESV increase->Increased myocardial consumption
Because the increased cardiac muscle stretching leads to wall tension.
This wall tension increases O2 demand.
The end Diastolic and systolic volume increase because the myocardium can't handle increased volume.
This leads to pulmonary congestion and increased myocardial oxygen.
147
Decreased cardiac output leads to __________________ perfusion.
renal
148
What are the good parts of the RAA Mechanism?
Kidneys release renin in response
Vasoconstriction leads to increase in BP
149
Aldosterone release results in Na+ _______________ by kidney.
Reabsorption
150
The increase in blood pressure and reabsorption of Na+ increases preload and theroretically ________________ and __________________.
stroke volume
cardiac output
151
What are the bad parts of the RAA system?
The progressively weakening myocardium cannot contract or dilate well enough to handle increasing volume.
This increase in systemic venous return increases afterload (the workload on the heart)
152
What are the Natriuretic Peptids?
ANP
BNP
153
When are the natriuretic peptides released?
In response to atrial stress, pressure or volume overload
154
What do the natriuretic peptides promote?
Vasodilation and inhibits sodium reabsorption and leads to natriuresis (excretion of sodium in the urine)
155
In what patients do you see elevated levels of natriuretic peptides?
Patients with chronic HF
156
What are Endothelins?
Endothelins have a role in the development of pulmonary hypertension because their release leads to vasoconstriction and results in cardiac myocyte hypertrophy and fibrosis.
The have an overall negative effect on symptoms and progression of heart failure
157
HEART FAILURE:
JVD is a classic manifestation of what type of heart failure?
Right sided heart failure
158
What occurs in Diastolic left sided heart failure?
The LV does not accept enough blood from lungs causing the body to lack blood and the lungs fill with fluid.
159
What occurs in Systolic left sided heart failure?
The left ventricle does not pump enough blood to the body, causing blood to back up behind the LV.
160
What occurs in Diastolic right sided heart failure?
The Right ventricle doesn't accept enough blood from the body causing the blood to back up behind the RV.
This causes the body to fill with blood creating systemic edema and the lungs do not oxygenate enough blood.
161
What occurs in Systolic right sided heart failure?
The right ventricle does not pump enough blood to the lungs and the blood backs up behind the RV.
This causes the body to fill with blood creating systemic edema and the lungs do not oxygenate enough blood.
162
What is the difference in left vs. right sided heart failure?
Left sided causes diminished output via the aorta and a backup of blood volume/pressure into the pulmonary circulation
Right sided often occurs following left sided, but the diminished output via pulmonary arteries that causes systemic congestion and edema
163
What occurs during Pulmonary edema?
Capillary fluid
Stiffened Lungs
Harder to exhale (decreased compliance)
Less gas change in alveoli
Crackles on auscultation
Frothy pink sputum
164
What are the three categories of pleural disorders?
Pleuritis/Pleuritic chest pain
Pleural Effusions
Pneumothoraxes
165
What is Pleuritis?
Localized inflammation that has a sudden onset that can be due to trauma or infection that is usually on one side.
166
What is the pain of pleuritis like?
Acute pain upon inspiration in a very specific place because the pressure is highest at inspiration
167
What are the 3 types of Pneumothoraxes?
Spontaneous
Traumatic
Tension
168
Pleural Effusions are different from edema in what way?
Plueral Effusions are more like a 'pocket' unlike edema which is kind of like an area
169
What is a pleural effusion?
A collection of fluid in the pleural cavity that decreases lung expansion during inspiration
170
What are the different types of exhudate from plueral effusions?
Transudate
Exudate
Empyema
Hemothorax
171
What is Transudate (hydrothorax) exudate?
Exudate that is mostly plasma that normally comes from fluid volume overload
172
What is Exudate?
Fluid filled with cellular debride
173
What is Empyema?
Fluid created from an infection in the plural lining that contains WBC, Plasma, Debride and glucose.
In severe cases infection can cross over into plural cavity
174
What is hemothorax?
Blood in plural linging
175
What is the V/Q mismatch for Pleural effesions?
Ventilation effected so V/Q ratio goes down
176
What are the manifestations of Pleural Effusions?
Decreased lung expansion will affect gas exchange
Dull Percussion and reduced breath sounds over fluid
Dyspnea when infusion is large
Compensatory tachypnea possible
177
A patient is admitted with bilateral pleural effusions. What other symptoms would the nurse expect?
Reduced breath sounds
Dyspnea
178
What is a pneumothorax?
A buildup of air inside the pleural cavity that restricts lung expansion
179
A spontaneous pneumothorax is?
Unexpected
No obvious cause
180
What may a spontaneous pneumothorax occur from?
Blebs (Air blister on the surface of the lung that can burst)
neoplasms (Malignant tumors can be related to formation of pocket)
181
What is a traumatic pneumothorax?
A pneumothorax created due to a chest wall injury (injury may penetrate the chest wall)
182
An example of an injury that could cause a traumatic pneumothorax is?
A gunshot/car accident/hit with bat
183
What are the two subcategories of a traumatic pneumothorax?
Open traumatic pneumothorax
Tension traumatic pneumothorax
184
An open pneumothorax means?
the injury penetrates the plural lining creating a channel
This creates a loss of seal, but still has bidirectional movement of air
185
A tension pneumothorax is?
A tension pnemothorax is an EMERGENCY
Air has entered the pleural cavity with each inhalation, but cannot exit.
186
What are the side effects of a tension pneumothorax?
The air entering the effected lung stays compressed, but eventually the air will continue to build up and both sides will become compressed and displaced.
187
What is the treatment for a tension pneumothorax?
A chest tube
188
What are the manifestations of a tension pneumothorax?
Displaced trachea
Hypoxemia
typnea
Tachacardia
Difficulty breathing
189
What happens to the V/Q ratio during a tension pneumothorax?
The ratio will go down
190
To which direction will the trachea deviate towards in a tension pneumothorax?
Towards the unaffected side
191
How is a tension pneumothorax diagnosed?
(What machine)
Diagnosed by Chest Xray or chest CT
192
What is Atelectasis?
A sequela of several respiratory disorders that is the collapse of sections of alveoli due to underinflation of the lung.
193
What are the two causes of Atelectasis?
Compression
Obstruction
194
How does compression cause Atelectasis?
The extrinsic pressure pushes air out of alveoli and causes them to collapse
195
What are 3 respiratory disorders that could cause Atelectasis?
Pleural Effusion
Pneumothorax
Severe Abdominal Distension
196
How does obstruction cause Atelectasis?
The airway to the alveoli is blocked
197
What are 3 things that could cause obstruction Atelectasis?
Mucous Plug
Increased secretions
Narrowed Airways
198
What kind of Atelectasis is preventable after surgery and how?
Obstruction Atelectasis
Prevented by use of a spirometer to help keep those airways clear
199
What are the manifestation of Atelectasis?
Tachypnea (abnormal rapid breathing)
Tachycardia (rapid heart rate)
Dyspnea (difficult/labored breathing)
Hypoxemia
Possibly Cyanosis
200
If Atelectasis is large enough, what is it referred to as?
A collapsed lung
201
Airway _______________ makes expiration difficult.
Obstruction
202
What are the common obstructive disorders?
Asthma
Emphysema and chronic bronchitis (COPD)
203
The two common signs of an airway obstruction are?
Dyspnea
Wheezing
204
What is a respiratory disorder that is common in children but can develop as an adult, and can "flare up" or be exacerbated?
asthma
205
What is Asthma?
An inflammatory response in the airways causing hyperresponsiveness and narrowed airways
206
What are the two ways Asthma is characterized and why?
Extrinstic-Type 1 hypersensitivity reaction to an external antigen
Intrinsic-A non-immune reaction to various other airway irritants
207
What is the common type of immune cell seen in asthma?
Mast cells are very active and release inflammatory mediators into airway
208
What are the effects of asthma?
(Like what is actually happening in the lungs)
swelling of mucousal lining
Swelling around bronchioles
Secretion of mucosa/exudate
Smooth muscle contration
209
What are the phases of Extrinsic asthma?
Early phase: Asthma lasts minutes to hours
Late Phase: Acute problems resolve several hours to days. The risk of a flare up is high here
210
If asthma is left untreated it can cause long term airway damage known as?
Airway remodeling
211
Airway remodeling is seen as?
Airways loose flexibility, get stiffer, stenotic, and more and more progressive damage occurs
212
What are the manifestations of asthma?
Dyspnea
Persistant cough
Tachypnea, tachycardia
Wheezing
Diminished breath sounds
Chest tightness
Prolonged expiratory phase
213
Why do people suffering from asthma experience a prolonged expiratory phase?
Because of the swelling in the airways, the patient is having to use their muscles to force air out
214
How is asthma diagnosed?
Pulmonary function tests
215
What type of asthma would exercise induced asthma be considered?
Intrinstic because inspiration in these pts is not normal but expiration is worse
216
Are the two categories of Chronic Obstructive Pulmonary Disease?
Emphysema
Chronic Bronchitis
217
A respiratory disease that has a long preclinical period until progressive airflow limitations that smoking is the primary cause of is?
COPD
218
What respiratory disease is the leading cause of disability and death?
COPD
219
Since both Emphysema and Chronic bronchitis are both considered COPD, do patients just have one or the other?
Majority of patients have bronchitis and emphysema, and a selects few have just one
220
What are the Types of Emphysema?
Primary (1-3%)
Secondary (97-99%)
221
What is primary emphysema?
Genetic breakdown of a maintenance enzyme that leads to breakdown of elastin
222
What is the maintenance enzyme that keeps up elastin in the lungs?
Alpha 1 Antitripsin
Breakdown of this enzyme can cause primary hypertension
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What is secondary emphysema?
Breakdown of elastin due to direct effects of cigarette smoking or air pollution
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What is elastin?
Connective tissue that allows to the lung to return to its normal size after stretching
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90% of secondary emphysema cases are what age?
Age 45 and older
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What are some direct effects of emphysema?
Expiration is directly impacted
Hyperinflated Lungs
Increase in total lung compacity
Chest enlarges
Alveoli enlarge
Blebs and Bulla may form on lung surface
(Every Hippopotamus Is Crunching Apples & Bananas)
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What is a tell tale sign that a patient has ephysema and not Chronic Bronchitis?
Little cough or sputum*
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What is a common stance that emphysema patients tend to take?
They lean forward in a tripod position with pursed lips
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What is chronic bronchitis?
The other end of the COPD Spectrum were irratants such as smoking, air pollution cause increased mucus production and the size and number of mucous glands
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How does mucus effect the lungs in chronic bronchitis?
The thick copious mucous impairs the cilia
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A key feature of Chronic Bronchitis compared to Emphysema is?
A productive cough lasting at least 3 consecutive months/years for at least 2 consecutive years
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What occurs to the lungs over time from chronic bronchitis?
The bronchial walls become thickened from edema and inflammation and fibrosis occurs. Eventually increased mucus and narrowed bronchioles result in obstruction of large and small airways
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What are the manifestations of Chronic bronchitis?
Wheezing and SOB
Chronis productive cough
Frequent pulmonary infections
Polycythemia
Cyanosis
Decreased exercise tolerance
The wheezing blue man coughs alot due to his frequent infections that don't let him exercise
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Compare and contrast Emphysema and Chronic Bronchitis.
Emphysema:
-increase respirations to maintain oxygen levels
-Dyspnea
-Accessory muscles are used to aid breathing
Chronic Bronchitis:
-Cannot increase respirations enough to maintain oxygen levels
-More cyanosis and polycythemia are seen
-Cor pulmonale, fluid volume overload
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Both Emphysema and Chronic bronchitis tend to retain more CO2, and therefore they tend to stay in a state of?
Respiratory Acidosis
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What is something in concern to oxygen therapy and COPD?
You can't give them too much supplemental oxygen or their respiratory rate will drop
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A DVT from the leg can NOT?
Cause a stroke in the brain
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What is a pulmonary embolus?
A blockage that develops in the pulmonary circulation
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What kind of material can cause a Pulmonary embolus?
Blood
Fat
Amniotic fluid
Air
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What are the signs and symptoms of a pulmonary embolus?
Restlessness (Feeling of something is wrong/impending doom)
Dyspnea
Tachycardia
Tachypnea
Pleuritic pain
A restless man who's heart is beating really fast feels doomed complaining of pain in his lungs and fast or difficult breathing.
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What is the V/Q mismatch for a Pulmonary Embolus?
Ratio goes up because decrease in perfusion=decrease in Q
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A _______________ _______________ will not impact breath sounds.
pulmonary embolus
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What are the primary and secondary causes of pulmonary hypertension?
Primary:Genetic, idiopathic
Secondary: Due to other lung disease, left ventricle disfunction, chronic PEs
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What is Cor Pulmonale?
Failure of the RIGHT ventricle due to primary lung disease or pulmonary hypertension
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What are the signs and symptoms of pulmonary hypertension?
Systemic edema
SOB
Hypoxemia
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What is Acute Respiratory failure?
A failure of the lungs to efficently perform gas exchange and generally the final complication of other lung diseases.
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What is the V/Q mismatch on Acute Respiratory Failure?
Depends on the case, it can go either way
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In Acute respiratory failure, where does the impaired gas exchange occur?
At the aveoli
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What PaO2 stat would indicate acute respiratory failure?
What PaCO2?
Under 50-60mmHg
Over 50mmHg
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Acute respiratory failure patients may be hypoxemic or hypercapnic. Why?
If the ARFs patients are just experiencing a gas exchange failure they will just be hypoexemic only.
If they are experiencing a ventilatory failure they can be hypoxemic/hypercapnic/
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In just a gas exhange issue in acute respiratory failure, what do we generally see in the blood?
The oxygen is not able to cross into the blood, but the CO2 can cross-giving high levels of CO2 in the blood.
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What is the order of symptoms of hypoxia related acute respiratory failure?
Neurological changes are prominent then cardiovascular follows
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What are the signs and symptoms of hypercapnia acute respiratory failure?
Cerebral Dilation
Increased Blood Flow
Increased intracranial pressure
Progressive sedation
Reduced LOC
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What is Acute respiratory distress syndrome (ARDS)?
ARDs is a specific type of respiratory failure resulting from many types of lung injuries and illnesses
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What is the MOA of ARDs?
Easy Explaination: Inflammatory rxn increases the capillary membrane of aveoli and causes lungs and aveoli to fill with fluid.
Slide Explanation:The massive inflammatory response increases the permeability of the alveolar capillary membrane resulting in fluid moving into the interstital and alveolar spaces
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What is the onset of ARDs?
Rapid onset of respiratory distress and failure (12-18 Hours) after a caustive event
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What is the end result of ARDs?
End result of ARDs is diffuse, noncardiogenic pulmonary edema and atelectasis
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What does noncardiogenic mean?
Not born from the heart
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What is the mortality rate for ARDs?
50-60%
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What are some specific things to remember about ARDs?
The Causes:
-ARDs is a specific type of respiratory failure resulting from many types of lung injuries and illnesses
Inflammation is not from the heart.
Similar concepts with pneumonia
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What is the volume per min for Ventilation (V)?
about 4L/min
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What is the volume per min for Perfusion (Q)?
about 5L/min
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What is the average fraction for V/Q?
0.8-0.9
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A low V/Q Ratio (<.8) indicates?
Inadequate ventilation in well perfused lungs
Sometimes "shunting"
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What are the causes of a low V/Q Ratio?
Atelectasis
Asthma (due to Bronchioconsriction)
Pulmonary Edema
Pneumonia
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A High V/Q Ratio (>.8) indicates?
Adequate ventilation but poor lung perfusion
"Aveolar dead space"
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What are the causes of a high V/Q Ratio?
Pulmonary Embolism
Shock
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Blood flow with no air would have which mismatch?
low V/Q
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Air but no blood flow would be which V/Q Mismatch?
High V/Q ratio
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An oxyglobin dissociation curve tells us?
How oxygenated our patient actually is
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96% SaO2 would indicate what PaO2 level?
around 80%
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A decreased affinity of hemoglobin for O2 means?
The O2 dissociates from RBCs more quickly and so there is more O2 available for cells.
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A decreased affinity of hemoglobin for O2 means what in regards to the oxyhemoglobin curve?
Visible shift as a right shift of the curve
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What causes a decreased affinity of hemoglobin for oxygen?
Acidosis
High PCO2 levels
Increased Temp
High 2,3-DPG
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An increased affinity of hemoglobin for O2 means?
O2 seperates from RBCs slower, therefore there is less O2 available for cells
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An increased affinity of hemoglobin for O2 does what in regards to the oxyhemoglobin dissociation curve?
Visible shift to the left of the curve
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What causes An increased affinity of hemoglobin for O2?
Alkalosis
Low CO2 levels
Decreased Temp
Low levels 2,3-DPG
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What are the steps to using the oxyhemoglobin dissociation curve?
1)What is factors are causing an increase or decrease for Hb for O2
2)How does this increase or decrease shift the curve
3)Use the curve to find PO2
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What are some of the manifestations of pulmonary disease?
Chest pain
Abnormal Sputum
Hemoptysis
Hypoventilation
Hyperventilation
Cyanosis
Clubbing
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What is hypercapnia?
High levels of CO2
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What is the property of all muscle tissue that is part of the Frank-Starling Mechanism?
The property of muscle fibers where they loosen a little bit before contraction, and this allows a stronger contraction.
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What is preload?
Preload refers to the volume of blood present in the ventricles of the heart at the end of diastole, which is the relaxation phase of the cardiac cycle.
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What is afterload
afterload refers to the pressure against which the left ventricle must pump blood during systole, which is the contraction phase of the cardiac cycle. The afterload is determined by the pressure in the aorta and the peripheral resistance in the arteries.
