Lecture 5: Cardiac Pathology & Pharmacology Flashcards
KNOW: Cardiac muscle dysfunction typically develops on one side or the other
Etiology: hyper tension, coronary artery disease, myocardial infarction, dusrhthmias, valvular heart disease… all lead to heart failure
Risk factors: Emotional stress, physical ianctivity, obersity, DM, nutritional deficiency, fever, infection, anemia, thyroid disorders, pregnancy, pulmonary disease, medications, drug toxicity, renal disease
The subjective complaint of difficulty with respiration, also known as shortness of breath
Dyspnea
Dyspnea that occurs in a flat supine position, Relief occurs w/ more upright sitting or standing (lift head of bed up)
Orthopenea
Blueish skin color changes due to poor circulation or oxygen saturation
Cyanosis
Difference betwee systolic and diastolic. Represents the maximal and minimal circulatory pressures during the cardiac cycle
Pulse pressure
Represents the percentage of end diastolic volume ejeced during systole and is normally about 60%. Tells you how the heart is doing. Typically taken before surgery to see if heart will holds up
Ejection fraction
Dyspnea
tachypnea
rapid breathing
paroxysmal nocturnal
sleep apnea, stopped breathing at night
this is for cardiac muscle dysfunction.
I think just know symptoms
Which side of the heart is the side with high pressure?
Left side
KNOW: the symptoms of right sided heart failure are all because the blood backs up
S/S of right sided heart failure? (8)
1) Dependent Edema (areas influenced by gravity - think extremities swelling)
2) Jugular vein distention (blood is backed up into it) - seen in the neck
3) Abdominal pain and distension (blood backs up into gut)
4) Weight gain (due to the blood backing up)\
5) Anorexia, nausea (due to organs being backed up)
5) Right upper quadrent pain or ascites or jaundice (backed up into these organs)
6) Cardiac cirrhosis - hardening of heart tissue (maybe scabbing because blood isnt pumping through)
7) Cyanosis
8) Psychological disturbacnes - due to the vital organs not being able to clear
R sided heart failure: Right ventricle cannot adequately pump blood to the lung and results in peripheral edema and venous congestion of the organs
- decreased CO because the right side of the heart didnt do its job in pushing it into LV
- decreases renal blood flow = sense BP pressure change and increases BP, however now the heart is pumping against even more pressure
- increased venous pressure resulting in edema in the legs (because the vena cava gets backed up, increasing the pressure pushing the other blood back down which will make it harder to clear that old blood from the legs = edema)
S/S of left sided heart failure
* pushed blood to rest of body and is a high pressure system
1) Exertional –> progressive dyspnea: backs up to the lungs if the LV isnt pumping out at the rate it needs to = difficulty breathing
2) Paroxysmal nocturnal dyspean (shortness of breath at night) / orthopnea (difficulty breathing while lying down) - while sleeping and lying down flat gravity doesnt help drain and lungs back up
3) Productive spasmatic cough - we have backup into the lungs –> body thinks it has fluid in lungs so it creates cough to try and expell it
4) pulmonary edema –> because our capiliaris in the lungs are going to be increased in pressure (doesnt help get nutrients in and out)
5) Cerebral hypoxia –> brain isnt getting enough O2 because LV isnt working
6) Muscular weakness –> because muscles arent gettting enough blood = decreased O2
7) Renal changes –> kidneys are going to realize theres something going on w/ heart because of RAAS system
Left sided heart failure: Failure of LV prevents the heart from pumping enough blood through the arterial system to meet the body’s metabolic needs and causes either pulmonary edema or disturbances in the respiratory contorl mechanism
- pulmonary vein backs up
- Shortness of breath –> may be short of breath because theres not enough O2 exchange and it takes more effort to take O2 into body because heart isnt working heart enough
- Decreased CO = triggers kidneys to increase BP (decrease renal BF stimulates this)
- High pressure in pulmonary capilaries leads to pulmonary congestion or edema (because blood isnt being pumped out of the heart at a high enough rate)
I think congestive heart failure is either the right or left side of the heart not being strong enough to pump blood out, leading to back ups or fluid retention.
Dyspnea
Shortness of breath
Congestive heart failure = end result of chronic heart issues like hypertension
* So drugs that are used to treat it are similar to those that treat hypertension
These drugs will selectively increase cardiac contractile performance and produce a positive inotrophic effect - these drugs increase the contraction
Positive ionotrophic effect = harder contraction
Main drug for CHF
* Two other durgs that end in
* 2 other drugs used to treat this
Digoxin
End in one
Dopamine/Dobutamine
* Sit as agonists in beta 1 heart receptors to make it beat harder (just like sympathetic activation)
NOTE: these drugs are used to decrease the workload on the heart
Digoxin (digitalis):
* Treats what
* MOA
* What does it do to CO?
* Does it increase ot decrease ability to EX?
CHF
Increases the heart’s mechanical pumping ability by bringing about an increase in intracellular calcium concentration = more actin and myosin interaction
Increases cardiac output at rest and during EX (increases ability to EX because more CO)
Patients on anticoagulant therapy should be educated about:
1) The need for frequent high-intensity EX
2) Avoiding resistance training completely
3) Using caution with activities that carry a risk of bleeding or injury
4) Only participating in low impact activities
3
Fowler’s position
HOB 45 degrees
Used for CSF to drain the lungs (helps w/ dyspnea)
KNOW: You can have right H failure or left or both
What are the 3 kinds of cardiomyopathies?
* Which of these 3 is most likely to lead to CHF
* Which one of these 3 happens in younger atheletes, typically aferican american
What are the 3 things that cause them?
1) Dilated
2) Hypertrophic
3) Restrictive
Dilated most likely to lead to CHF (its stretched out and cannot pump efficiently)
Restrictive happens in young african american adults
These are an issue because the heart cannot fully releax or fully pump
Causes:
1) Genetic
2) Acquired (think stronger medications)
3) Mixed
What is a dilated cardiomopathy?
* What causes it (risk factors)
* What is it likely to cause?
It is a increased left ventricular end diastolic pressure that dilates the LV (but can be both ventricles) - so incressed fluid in LV
* Alcohol abuse
* Systemic HTN
* Infection
* Smoking
* preggo (increase fluid retention = increase load on heart)
* Chemotherapy can also cause this (Anthracycline drug)
Likely to cause CHF
NOTE: This muscle is over stretched - and we know muscles that are stretched too far cannot contract as well = force of contraction will be less
What kidn of cardiomyopathy is this?
Hypertrphic Cardiomyopathy
* these muscle is much bigger
* too big cant contract well
Why does hypertrophic cardiomyopathy cause a diasolic dysfunction primarily?
Because the ventricles can’t fill as much because they have hypertrophied so much (they’re fine pumping the blood out, but can’t fill with blood enough)
What does hypertrophic cardiomyopathy do to LVEDP and why
* Does this increase or decrease ventricular filling time?
* What does it do to ejection fraction?
Increases it because the heart pushes harder to get all the blood in
causes hypercontractility of LV which leads to that hypertrophy
decreases ventircular filling because its a smaller space
Ejection fraction is basically uncahnged because you’re still filling all that you exerted –> but you’re still just not filling up much
Leads to sudden cardiac death (black male atheletes working out –> because thats when you’re exerting the most force)
Restricted Cardiomyopathy:
* MOA
* What happens to diastolic volume?
* What often causes
Both LV and RV, decreased compliance (decreased volume, increased pressure becuase more blood is trying to fit in a smaller area)
Diastolic dysfunction –> does not fill properly
Has both primary or secondary causes:
* infection getting to heart can cause some issues where it impaires the endocardium or myocardium
Caused by myocardial fibrosis (scaring), hypertrophy, infiltration, or a defect in myocadial relaxation
* Heart attack can cause that scaring
Walls are essentially thicker (w/ hypertrophic the walls are bigger)
chemical induced cardiomypathy
Broke heart syndrome cardiomyopathy
* extreme emotions / stress
What are the two problems that happen w/ heart valves
Insufficiency/regurgititation = dont close
* blood is backed up
Stenosis = narrowing that causes a resitrction in BF
Need to open when filling and close when contracting (to keep from regurgitation)
* Valves provide that unilateral flow
Where is the mitral valve located?
Between L atria and L ventrical
think mitraLLLLLL
Which valves can have prolapse?
Mitral or tricuspid
What are the 3 pathologies that the mitral valve can have and explain them?
1) Mitral stenosis: hardening of that mitral valve, primarily affects women - asymptomatic
2) Mitral regurgitation: ischemic heart disease, associated with aging, asymptomatic until irreversible left ventricle dysfunction
3) Mitroal valve prolapse: detected during pregnancy, slight variation in mitral valve shape (floppy valve syndrome), asymptomatic
all are asymptaomtatic
What are the two pathologies that go along w/ aortic valve dysfunction? explain them
1) Aortic stenosis: assocaited w/ aging, caused by progressing valvular calcification, Asynptomatic, CO maintained until severe
* PT is contraindicated if severe enough because it drops CO very low, and we demand more CO ouput and vital organs arent gonna get vital blood supply
2) Aortic regurgitation: (insufficiency) leakage of blood during systole. Mainly asymptomatic, but exertional dyspnea, fatigue, excessive perspiration may happen later on
Tricuspid stenosis: which chambers are involved
Right ventricale and Right right aortia
What two things cause tricuspid stenosis / regurgitation
1) congenital
2) Rheumatic in origin (inflammatoin)
Note these are less common
undergo surgery and exercise testing after surgical repair is indicated
What causes pulmonic valve stenosis/regurgitation?
Congenital
What is the least likely heart valve to be affected?
Pulmonic Valve
Pulmonary hypertension:
Blood vessels in the lung increase in congestion. Meaning the R side of the heart has to work harder to push blood into the lungs. So the right ventrical is going to have a pressure overload.
Thats going to cause stress through the R ventrical walls.
Because of altered bioenergetics (ischemia, mitochondrial remodeling) / Neurohormonal and immunologic activation we have myocardial remodeling (hypertrophy; matrix remodeling increase in RV contractility)
This will often lead to diltation and heart failure and arrhymias
Rehab implications for pulmonary hypertension:
* Prescription exercise has to be individualized like with any person
BOLO: Pulmonary edema, fatigue, exertional dyspnea, weakness, pallor
* Medical emergency (if having them together, not in isolatoin): confusion, dizziness, heart palpitations, unstead gait
Valve surgeries
