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Pathophysiology > Exam 2 - Alterations Of Cardiac Function > Flashcards

Exam 2 - Alterations Of Cardiac Function Flashcards

1
Q

Two types of valves in the heart and where is each kind located?

A 
AV Valves (inside the heart)
Semilunar valves (open to outside of heart)
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2
Q

What are the two AV valves?

A

Tricuspid

Mitral

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3
Q

What are the two semilunar valves?

A

Aortic

Pulmonary

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4
Q

Why are the AV valves important?

A

They prevent backflow

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5
Q

Why are the semilunar valves important?

A

Anything that’s pushed out of them affects the rest of the body

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6
Q

List the path the blood takes through the heart

A 
Superior vena cava
Right atrium
Tricuspid valve
Right ventricle
Pulmonary valve
Lungs
Left atrium
Mitral valve
Left ventricle
Aorta
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7
Q

Amount of blood ejected from the heart each minute

A

Cardiac output

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8
Q

Where does blood ejected from the heart go?

A 
To aorta (from left ventricle)
To pulmonary trunk (from right ventricle)
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9
Q

2 factors that regulate cardiac output

A

Stroke volume

Heart rate

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10
Q

What is stroke volume?

A

Volume of blood pumped by the ventricle each heart beat

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11
Q

What is heart rate?

A

Number of heart beats per minute

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12
Q

3 factors that regulate stroke volume

A

Preload
Contractility
Afterload

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13
Q

Why are the 3 factors that regulate stroke volume so important for nurses?

A

We administer drugs that affect all 3 factors

We also measure them

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14
Q

What is preload?

A

STRETCH of the heart before it contracts

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15
Q

What is preload based on?

A

Volume

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16
Q

How is preload measured?

A

Pressure generated in the left ventricle at the end of diastole

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17
Q

What is contractility?

A

STRENGTH of contraction at any given preload

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18
Q

How is contractility measured?

A

Degree of myocardial fiber shortening

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19
Q

What is afterload?

A

PRESSURE that must be exceeded before ejection of blood from the ventricles can begin

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20
Q

What is afterload measured by?

A

Resistance to ejection of blood from the left ventricle

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21
Q

If diastolic BP # is extremely low or extremely high, there is an issue with what?

A

Preload

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22
Q

What does preload affect?

A

Contractility

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23
Q

What does contractility affect?

A

Afterload

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24
Q

What is systole?

A

Contraction that propels blood out of the ventricles and into circulation

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25
Q

What is diastole?

A

Ventricular relaxation; blood fills the ventricles

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26
Q

What is blood pressure?

A

Pressure that is exerted on the walls of the arteries

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27
Q

What does blood pressure measure?

A

The pressure of blood in the arteries when ventricles contract (systole) and when ventricles relax (diastole)

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28
Q

What is ejection fraction?

A

Amount of blood ejected from ventricle with each heart beat

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29
Q

What is a normal ejection fraction?

A

60-70%

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30
Q

Why can ejection fraction never be higher than 70%?

A

Because the rest of the blood volume is out in the tissues

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31
Q

What should you ask a patient who you suspect has a low ejection fraction?

A

“How far can you walk without getting short of breath?”

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32
Q

Why does a low ejection fraction cause shortness of breath?

A

Not enough blood going out to tissues

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33
Q

What does a low ejection fraction indicate?

A

Pt at rist for ventricular failure

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34
Q

What is ventricular failure?

A

Ventricles fail to squeeze out all of the blood they have

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35
Q

What would a heart likely look like in someone who has a suffering ejection fracture?

A

Dead heart muscle (due to myocardial infarction)

Bigger ventricle because of more workload over time

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36
Q

Two types of resistance

A

Peripheral vascular resistance

Systemic vascular resistance

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37
Q

What is peripheral vascular resistance?

A

Resistance to blood flow determined by:
Vascular muscle tone
Diameter of blood vessels (vascular tone)

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38
Q

What is systemic vascular resistance?

A

Resistance the left ventricle must overcome to pump blood through the systemic circulation

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39
Q

What happens to SVR when someone has hypotension?

A

The peripheral blood vessels constrict, so the SVR increases

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40
Q

What is hypertension?

A

Consistent elevation of systemic arterial blood pressure

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41
Q

What causes hypertension?

A

Increased volume of cardiac output
Increased total peripheral resistance
(Or both)

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42
Q

Who is more at risk of hypertension?

A

Men
African americans

(Prevalence increases with age as well)

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43
Q

Why are African Americans more at risk for hypertension than caucasions?

A
  • Genetic predisposition
  • Compliance
  • Background
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44
Q

What is secondary hypertension?

A

Hypertension caused by systemic disease

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45
Q

What systemic disease usually causes secondary hypertension?

A

Kidney disease

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46
Q

Causes of secondary hypertension?

A
  • Renal disease
  • Adrenal disorders
  • Vascular disease
  • Drugs
  • Any condition that raises peripheral vascular resistance or cardiac output
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47
Q

Why is kidney disease so likely to cause secondary hypertension?

A

Kidneys are key component in blood pressure and fluid volume in general

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48
Q

Causes of hypotension

A
  • Anatomic variation
  • Altered body chemistry
  • Antihypertensive and antidepressant therapy
  • Prolonged immobility due to illness
  • Starvation
  • Physical exhaustion
  • Fluid volume depletion
  • Venous pooling
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49
Q

Why can antihypertensive and antidepressant drugs cause hypotension?

A

BP too low if have too much of drug. If stopped immediately, would have rebound high BP. So need to wean off of these medications

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50
Q

Signs and symptoms of low blood volume:

A
  • Decreased blood pressure
  • Increased heart rate (body trying to get volume back up)
  • Pallor
  • Turger > 3 sec. (= dry skin)
51
Q

Why does venous pooling cause hypotension?

A

A lot of blood out in vascular space that can’t get back

52
Q

How is hypotension treated?

A

Add fluids

Hydrate pt with isotonic solution

53
Q

What is an aneursym?

A
  • Weakness in large vessel that causes bulging
54
Q

What does an aneursym change?

A

Cardiac output and other measures

55
Q

Which vessle is most susceptible to an aneursym and why?

A

Aorta because it’s under constant stress

56
Q

Where do most aneursyms occur in the body?

A

3/4 are in abdomen (where the aorta is)

57
Q

Most common cause of aneursyms?

A

Atherosclerosis

58
Q

2nd most common cause of aneursyms?

A

Syphilis and other infections

59
Q

Types of aneurysms?

A

True (AKA fusiform AKA circumferential)

False (AKA saccular)

60
Q

What is a true aneurysm?

A

Involves all three layers of vessel (and usually goes all the way around)

61
Q

What is a false aneurysm?

A

Extravascular hematoma

Communicates with intravascular space

62
Q

Symptoms of an aneurysm

A

Both types are asymptomatic until they rupture

Can see prominent mass pulsating in abdomen

63
Q

Symptoms of a ruptured aneurysm

A

Extreme pain
Dysphagia (can’t swallow)
Dyspnea (can’t get oxygen b/c losing RBCs)
Pressure builds up in abdomen

64
Q

What happens when a person has an aortic aneurism rupture?

A
  • Blood squirts out of aorta into abdomen with each heart pump
    (Aorta holds 20% of blood, so this is a lot of blood going into abdomen)
65
Q

What is an aortic dissection?

A

A hole develpos in aorta

Basically the same thing as a rupture

66
Q

What is a thrombus?

A

A clot that remains attached to vessel wall

67
Q

What is a thromboembolism?

A

A detached thrombus

68
Q

What happens when someone has a thromboembolism?

A

Clot gets caught in heart (heart attack) or brain (stroke)

69
Q

How does a thromboembolism develop?

A

When someone has a condition that promotes coagulation or the clotting cascade
Ex: chronic inflammation

70
Q

What is thrombophelbitis?

A

Inflammation of vein (with or without an associated clot)

71
Q

What can cause thrombophlebitis to develop?

A

Some drugs we give through IVs

72
Q

What is an embolus?

A

Bolus circulating in the bloodstream

73
Q

What can the bolus of an embolus be made of?

A 
Air bubble
Amniotic fluid
Fat
Bacteria
Cancer cells
Foreign substance
74
Q

What happens to the bolus of an embolus?

A

Travels in the bloodstream until it reaches a vessel it cannot fit

75
Q

Clinical manifestations of an embolism

A

Ischemia or infarction distal to obstruction

Life threatening

76
Q

What is arteriosclerosis?

A

Chronic disease of arterial system

77
Q

Characteristics of arteriosclerosis

A

Abnormal thickening and hardening of vessel walls

78
Q

Patho of arteriosclerosis

A

Smooth muscle cells and collagen fibers migrate into part of vessel causing stiffness and thickness

79
Q

What does arteriosclerosis do to the arteries?

A

Decreases the arteries ability to change lumen size
AKA:
- Decreases contractility
- Increases resistance

80
Q

What is atherosclerosis?

A

A form of arteriosclerosis

Where intraarterial fat and fibrin collect (like a clot)

81
Q

What are the forms of atherosclerosis dependent upon?

A

Anatomic vessel location
Age and genetic predisposition; physiologic status
Risk factors (habits)

82
Q

Risk factors for atherosclerosis

A 
Smoking
Hypertension
Diabetes
Hyperdyslipidemia
Autoimmune phenomenon (chronic inflammation issues)
Long term infection
83
Q

What is atherosclerosis the leading contributor to?

A

Coronary artery disease

Stroke

84
Q

What is coronary artery disease?

A

Any vascular disease that narrows or occludes the coronary arteries

85
Q

Most common cause of coronary artery disease

A

Atherosclerosis

86
Q

Why are we so worried about clots getting into the coronary arteries?

A
  • They feed the muscle tissue of the heart (located on outside of heart)
  • They’re small so easier for clots to get stuck
87
Q

What are the nonmodifiable risk factors of coronary artery disease?

A

Genetics
Family history
Gender

88
Q

What does modifiable risk factor mean?

A

Risk factor that can be changed to some degree

89
Q

Modifiable risk factors of coronary artery disease

A 
Hyperlipidemia
Hypertension
Cigarette smoking
Diabetes
Obesity
Sedentary life-style
Estrogen deficiency
Heavy alcohol consumption
Personality
90
Q

What is myocardial ischema in a large area?

A

Impared blood flow to myocardiam

Develops within 10 seconds of deprivation

91
Q

Patho of myocardial ischemia?

A

Insufficient coronary blood flow to meet the needs of the heart

92
Q

Reasons for reduced blood supply to the heart that causes myocardial ischemia

A 
Decreased blood volume
Tachycardia
Low hemoglobin
Shock
Increased demand:
   - Hypertension, stress, hyperthyroidism, anemia
93
Q

Most common cause of myocardial ischemia?

A

Atherosclerosis

94
Q

Three types of local myocardial ischemia:

A

Stabile angina
Prinzmetal angina
Silent ischemia

95
Q

What is prinzmetal angina related to?

A

Spasms in coronary artery

96
Q

What is silent ischema?

A

Silent chest pain (pts don’t realize or relate it to chest pain)

97
Q

Acute inflammation of pericardium?

A

Acute pericarditis

98
Q

Top cause for acute pericarditis?

A

Infection

99
Q

Clinical manifestations of acute pericarditis?

A 
Sudden onset of severe chest pain
Pain worsens with breathin and laying down
Dysphagia
Restlessness (can’t get comfortable)
Anxiety
Weakness
Malaise (feeling blah)
Low-grade fever
Tachycardia
100
Q

Accumulation of fluid in the pericardial cavity

A

Pericardial effusion

101
Q

What fluid can be caught in pericardial cavity with pericardial effusion?

A

Serous

Exudate

102
Q

Complication that can happen due to pericardial effusion

A

Tamponade (cardiac compression)

Because the fluid causes more pressure on the heart

103
Q

Clinical manifestations of pericardial effusion

A

Muffled or distant heart sounds (bc listening through fluid)
Dyspnea on exertion
Dull chest pain

104
Q

How to treat pericardial effusion

A

Drain

Make pericardial window

105
Q

What is cardiomyopathy?

A

Diverse group of diseases affecting myocardium

106
Q

What do all of the diseases affecting the myocardium (cardiomyopathy) cause?

A
  • Remodeling of myocardium secondary to long-term hypertension and ischemic heart disease (because of excess fluid over time)
107
Q

What can cardiomyopathy be caused by?

A

Infection
Exposure to toxins
Nutritional deficiencies

108
Q

Types of cardiomyopathy

A
  • Dilated
  • Hypertrophic (excessive blood flow b/c they’re being overused)
  • Restrictive
109
Q

What would the ejection fraction look like for the different types of cardiomyopathy?

A

Dilated and hypertrophic would have the same EF

Restrictive would have a lower EF

110
Q

Treatment for cardiomyopathy?

A

Treat symptoms and try to lower volume

111
Q

Types of valvular dysfunction

A

Stenosis

Regurgitation

112
Q

What is stenosis?

A

Valvular dysfunction:

  • constricted and narrowed valve
  • so blood does not flow forward
  • workload in front of diseased valve is increased
113
Q

What is regurgitation?

A

Valvular dysfunction:

  • failure of valve to shut completely
  • allows blood flow to continue when valve should be closed
114
Q

Difference between stenosis and regurgitation valvular dysfunctions?

A 
Stenosis = narrowed
Regurgitation = incompetent
115
Q

What are the results of regurgitation?

A

Increased volume the heart must pump

Increased workload of atrium and ventricle

116
Q

Causes of aortic valve stenosis?

A

Inflammatory damage from rheumatic heart disease
Congenital malformation
Degeneration of aortic wall resulting from calcification

117
Q

Clinical manifestations of aortic valve stenosis

A

Decreased stroke volume
Reduced systolic blood pressure
Narrowed pulse pressure (BP #s get closer together)
Bradycardia

Hypertrophy develops to compensate

118
Q

Cause of mitral stenosis

A

Acute rheumatic fever

Bacterial endocarditis

119
Q

Patho of mitral stenosis

A

Narrowing of orifice occurs as inflammatory leasions heal resulting in long term scarring

120
Q

Clinical manifestations of mitral valve stenosis

A
  • Chamber dilation and hypertrophy

- Decreased cardiac output during exertion

121
Q

What happens if mitral valve stenosis is left untreated?

A

Hypertension
Edema
Right ventricular failure

122
Q

What causes aortic valve regurgitation?

A 
Acute or chronic lesions of rheumatic fever
Bacterial endocarditis
Syphilis
Connective tissue disorders
Atherosclerosis
Hypertension
123
Q

Causes of mitral valve regurgitation

A 
Mitral valve prolapse
Rheumatic heart disease
Infective endocarditis
CAD
Connective tissue disorders
Congestive cardiomyopathy

Pathophysiology (14 decks)

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