Medical Conditions/Patho of Flashcards
What is angina? How does it present?
- angina is chest discomfort due to myocardial ischemia (heart is not getting enough oxygen) - increase in demand, decrease in supply
- pain occurs due to build up of CO2 and lactic acid
- often it displays as a squeezing/heavy sensation, it may radiate, deep breathing may increase the pain
- often resolved by decreasing the demand or increasing oxygen levels
- can lead to infarct if not corrected
Stable angina
- typical and predictable
- often due to increase in workload to the heart
- will come with heavy/squeezing sensation but is typically not long lasting (uncommon to last beyond 30 minutes)
Patho of Angina
- due to coronary artery obstruction leading to a difference between the oxygen supply and demand
- the demand for oxygen goes up, but the heart can not keep up leading to pain (therefore, need to provide heart with more oxygen or get it to rest)
- commonly due to CAD (build up of plaque)
Unstable angina
- could be sign of pre-infarct
- often symptoms come at rest, can not be relieved with meds/oxygen, and are more severe than typical angina (often lasts more than 20mins)
- from blood flow to the heart being slowed by narrowed vessels or small clots that formed in coronary arteries
Variant angina
“transient” or “prinzmetal”
- due to spasm of coronary artery often while sleeping
- often not long lasting but can lead to MI/lethal arrhythmias
- common in type A personalities, people who smoke, females
Takotusbo Cardiomyopathy
- sudden onset of chest pain which mimics an MI
- due to emotional stress and release of stress hormones
- also known as broken heart syndrome
Brugada syndrome
- sudden death during sleep from lethal arrythmias
- from sodium gene mutation causing ventricles to beat irregularly, leading to blood circulation being improper
Myocardial Infarction
- prolonged ischemia
- presents with angina like pain (pressure, squeezing), pain may radiate, may have N/V,
- rest/meds will not help
- some people (especially women) may present as unwell or N/V only - no chest pain
Patho of Myocardial Ischemia
- tissues become damaged due to lack of oxygen, often due to plaque build up
- injured tissue will have a fibrin mesh/clot form - the tissue is injured from lack of oxygen/blood flow
- injured tissue cells will die if ischemia is not reversed (infarct is when they die)
- MI occurs when ischemia has lasted long enough to cause cell death due to cut off blood supply - pain is due to CO2 and lactic acid build up
What are acute MI’s caused by?
usually from a thrombus formation, or can be from hypovolemia (global ischemia)
What is one way in hospital that MI’s are detected?
troponin release
- troponin is a regulatory protein found in the heart/skeletal muscle that is released when injury has occurred to the myocardium
- higher levels lead to a greater chance the patient has had an MI
What needs to happen if patient is having an MI?
blocked vessels need to be reopened, often through use of stents, fibrinolytic, angioplasty
How do fibrinolytics work?
they work by activating plasminogen which forms plasmin
- plasmin breaks down fibrin (which is found in clots)
What is an angioplasty? A stent?
A - unblocking a vessel through the use of a balloon which will push the plaque outwards against the artery wall
S - an insertion of a tube (metal or plastic) into artery to open and keep the artery open
What is the aftermath of the heart in the case of an MI?
- the necrotic tissue is replaced by scar tissue over the few weeks after an MI
- the scar tissue is a poor conductor, can nor contract and decreases the hearts effectiveness - potential for arrhythmias
The two forms of treatment for chest pain are nitro and ASA. How does nitro work?
- nitric acid is used for relaxation of smooth muscle. nitro will be converted to this in the blood
- it will help to relax smooth muscle and vasodilate which will help lessen chest pain
- decreases your preload (pressure at the beginning of systole)
How does ASA work in terms of chest pain?
“COX blocker” or Thromboxane A2 inhibitor
- inhibits cyclooxygenase which is needed to make thromboxane A2 (which promotes platelet aggregation and vasoconstriction)
- reduces platelet aggregation which will stop a clot from progressing
What is an aneurysm?
- an aneurysm is when part of an artery wall weakens causing it to balloon out/widen abnormally
- can be caused from high blood pressure on arterial walls, atherosclerotic disease, infectious disease (syphilis), genetic disorders, trauma
Two classifications of aneurysms?
- saccular (sac-like)
- fusiform (tube-like)
Abdominal aneurysm - what is it?
- often not known until leaking/rupture occurs (when symptoms start)
- usually begin as small tear in intima allowing blood to leak in aorta and the tear will eventually continue outwards causing bleeding to continue into other areas of the body
Signs of an abdominal aneurysm:
- mass seen in stomach region (may be pulsing)
- pain goes from abdomen to back (excruciating)
- might become hypotensive, syncopal
- could be bradycardic (vagus nerve stimulation due to being around the aorta)
- might have rigidity to abdomen
- femoral pulse may be absent
Thoracic aneurysm - signs?
- can cause severe pain beginning in the back spreading to abdomen
- may have difficulty swallowing, cough, wheezing, unequal pressures in the arms
Dissecting aneurysm - what is it?
- aneurysm will start as tearing allowing blood to start to move through the layers of the wall due to increased pressure
- as more blood moves, it will eventually rupture the outer wall leading to mass hemorrhage into the thoracic/pleural cavities
- hypertension is a common factor contributing to an aneurysm dissecting
Signs of a dissecting aneurysm:
- excruciating pain described often as a ripping sensation (can be in back/abdomen/epigastric region/extremities)
- they will be sweaty/pale
- may have pulse deficits, BP may become unattainable
- person may be syncopal
- may have signs of blood pooling
- may be altered mental status (blood not getting to brain)
Pericardial tamponade - what is it? what can cause it?
Tamponade is when the pericardium (sac surrounding the heart) fills with blood leading to inadequate filling of the heart and less cardiac output
- can be caused by a AAA if it dissects to the heart, trauma, pericarditis
Signs of pericardial tamponade:
- chest pain
- Becks triad: JVD, muffled heart sounds, hypotension
- tachycardia
- resp distress
- dizzy/faint
What is thrombophlebitis? What is DVT?
- inflammation of vein wall
- blood clot forming (often in legs)
Patho of DVT
- blood clot will form blocking flow of blood in a vein
- often occurs in legs, the issue is if it breaks off forming an embolus that can travel to the lungs
What factors impact chance of a DVT?
- smoking
- birth control
- trauma
- recent surgery
- pregnancy
What is congestive heart failure? What causes it?
- condition when the heart can not pump blood to meet the needs of the tissues
- can be caused by too much volume, too much pressure, loss of myocardial tissue (can not pump properly), impaired contractility (pump does not work)
Left sided heart failure
- left ventricle can not pump properly causing blood to back up into pulmonary circulation
- can be due to hypertension, valve heart disease
What are the forward effects of left sided heart failure?
- less ventricle emptying = less cardiac output
- less perfusion of tissues
- RAS system will activate, so more sodium/water reabsorbed = increase in BP
What are the backwards effects of left sided heart failure?
- JVD
- pulmonary edema
- crackles
- wheezing
- pink tinged sputum
- SOB
- agitation/anxiety (due to hypoxia)
- elevated heart rate
Right sided heart failure
- often due to left sided heart failure causing too much pressure in pulmonary circulation
- due to increase in workload on right side, pump will fail
- can be due to hypertension, COPD, PE, right sided infarct
Right sided heart failure symptoms
- peripheral edema in legs
- ascites in abdomen (fluid)
- venous congestion (will cause distention in organs like liver/spleen that are distendable)
- increased blood volume systemically
How is CHF treated?
- ACE inhibitors
- angiotensin receptors blockers
- beta blockers
- diuretics
What is flash pulmonary edema?
- rapid accumulation of fluid in the lungs
What is insulin’s role in the body?
- when blood glucose rises, pancreas releases insulin
- insulin will transport glucose into cells to be used for energy or it will take up the glucose and have it stored as glycogen in the liver for later use (will decrease blood sugar levels)
What is glucagon’s role in the body?
- when glucose levels fall, it will increase levels through glycogenolysis or gluconeogensis
- glyco (breakdown of glycogen to glucose in liver to be released for use by cells
- gluco (turning to fat metabolism to get energy)
When blood sugar levels fall, what are common signs?
- combative/aggressive/altered
- slurred speech/ won’t make sense
- “drunk like”
- sweaty
- dilation of pupils
- tachycardia
What is type 1 diabetes?
- beta cells in pancreas produce no insulin
- need insulin injections and often strict diet/exercise regimen
- diagnosed young
What is type 2 diabetes?
Non-insulin dependent
- beta cells produce insulin but not enough to meet bodies needs/cells become desensitized to it
- diagnosed later in life
- impacted often by lifestyle
What is HHNK?
- commonly seen in type 2 diabetics (often elderly)
- high blood sugar levels often caused by not following proper treatment plans, illness/infection, certain meds like diuretics
- body will try to pee out excess glucose leading to chance of severe dehydration if not treated
Signs of HHNK
- polyuria/polydipsia (excessive peeing/thirst)
- dry mouth
- warm, dry skin
What is DKA?
Diabetic Ketoacidosis
- type 1 diabetes: not enough insulin, can not take up glucose to use for energy
- body turns to burning fats for energy leading to production of ketones
Signs of DKA:
- polydipsia, polyuria
- high blood sugar
- acetone breath, kussmauls resps
- hypotensive
- high heart rate
What are some things used to diagnose someone with diabetes?
- polyuria, polydipsia
- wounds that do not heal
- weight loss
- numbness in feet
- high fatigue
- dizzy, blurred vision
What are the role of beta, alpha and somatostatin cells?
beta - produce insulin
alpha - secrete glucagon
somato - decrease levels of insulin/glucose in blood
Why do seizures occur? Some common causes?
- electrical activity in the brain becomes abnormal causing erratic firing of neurons
- symptom of an underlying issue
- common causes include: tumors, trauma, hypoglycemia, overdose/toxicology, infection, fever, epilepsy, eclampsia, stroke, brain defects/bleeds
Tonic clonic seizures
Grand mal
- sudden tonic muscle bilateral contractions, followed by clonic phase (relaxation phase)
- often have no warning, and a postictal phase will follow
- incontinence is common, oral injury is common
Petit Mal seizure
Absence
- non-convulsive, lasting 1-10 seconds
- may have automatism, repetitive activities
- often can return to normal active immediately following
Atonic seizure
Drop attack
- sudden loss of muscle tone
- cause of falls, head will droop, jaw will go slack
Simple partial seizures
Focal
- involves one hemisphere of the brain
- have an aura prior to
- may have tremors in impacted area of brain, tingling sensation, may go flush/be tachy/hypotensive but no LOC
Complex partial seizure
Temporal lobe seizures
- may have automatism, hallucinations, deja vu
- patient will have postictal phase - will not remember event
- often misdiagnosed as psych problem
Pseudoseizures
- seizure like activity due to psych disturbance
- movements tend to be bilateral, symmetrical
- can sometimes be interrupted with sharp command
- incontinence/injury rare
Febrile seizures
- seizure due to fever often in children between 9 months-5 years
- often occur within first 24 hours of illness
- often stops on it’s own within a few minutes
- child may tighten on both sides of body, cry/moan, eye rolling, vomit, pass urine, sometimes stop breathing/turn blue, not responsive to parents voice
What is epilepsy?
CNS disorder where brain activity becomes abnormal
- can be developed at birth, from trauma, infection, tumors
What is status epilepticus?
- a seizure lasting longer than 5 mins, or having more than one seizure in short period of time without regaining consciousness
- medical emergency that can lead to brain damage due to hypoxia
- may have convulsions or may look like they are day-dreaming/acting irrational
What is a CVA?
Cerebrovascular Accident (Stroke)
- interruption of blood flow to the brain leading to cerebral infract/neuro deficits due to lack of oxygen/blood flow
What causes a stroke?
- thrombus
- embolus
- hemorrhage in the brain
Ischemic Stroke
- due to blocking of an artery that supplies blood to the brain (tumour, atherosclerosis)
- slow developing but most common
- might have history of stroke, angina, vessel disease
Hemorrhagic stroke
- bleeding into brain tissue from burst vessel leading to ischemia, rising ICP
- often occurs at points of exertion/stress
- rapid deterioration
Intracerebral Hemorrhage (stroke)
- bleeding into brain often due to hypertension
- cerebral vessels will develop aneurysms
Subarachnoid hemorrhage (stroke)
- caused by rupture of aneurysm
- presents as a severe headache with nuchal rigidity and photophobia
What is the main treatment for strokes?
tPA - tissue plasminogen activator
- dissolves blood clots, but needs to be within the 6 hour window
- will turn plasminogen to plasmin (which breaks down clots)
What is a TIA?
Transient Ischemic Attack
- mini stroke
- symptoms typically resolve within an hour, but it is often a precursor to a CVA
- often from atherosclerosis
What are common findings in strokes?
- facial droop
- arm/leg drift
- unilateral weakness
- slurred speech/mute
- have gaze to one side
- high BP
What are some things that can mimic strokes?
- postictal patients
- infection
- tumor
- toxicology
- trauma (bleed)
What is meningitis?
Inflammation of the meninges around the brain/spinal cord
- can be viral or bacterial
Symptoms of meningitis
- severe headache
- nuchal rigidity
- fever
- altered mental status
- photophobia
- rash (petechia)
- seizures
- N/V
- recent infection
Kerning’s sign
when hip is flexed to 90 degrees, can not straighten leg
Brudzinski’s sign
severe neck stiffness, pts knees/hips flex when neck is flexed
What are the two bacteria that can cause meningitis?
- streptococcus pneumonaie (pnuemococcus)
- neisseria meningitdis (meningoccous)
What is anaphylaxis?
severe, life-threatening allergic reaction
What are the steps in an allergic reaction?
- initial contact with allergen will be made
- antibodies (IgE) will be made and will bind to mast cells and wait for another exposure
- re-exposure happens, the antigen will bind with the antibody causing degranulation of mast cell to release mediators (histamine)
What is the function of histamine in an allergic reaction?
purpose is to increase capillary permeability to white blood cells and proteins to allow them to engage with pathogens in tissues
Effects of histamine
- vasodilation (patient becomes hypotensive)
- contraction of smooth muscle (bronchoconstriction, GI troubles - N/V)
- increase in capillary permeability (can lead to hypotension, fluid shifting, less CO)
- swelling of the face, throat, eyes, mouth
Leukotrines
- mediator of allergic reaction
- bronchoconstrictor
- causes wheezing
- coronary vasoconstriction
- cap permeability
Eosinophils
- attracted to the allergic reaction
- deactivates leukotrienes to turn off reaction