patho exam 3 Flashcards
1
Q
Describe normal blood flow through the heart
A
SVC/IVC → RA → tricuspid valve → RV → pulmonary valve → pulmonary artery → lungs → pulmonary veins → LA → mitral (or bicuspid) valve → LV → aortic valve → aorta → all around the body → back to the SVC/IVC
2
Q
What system is high pressure?
A
Systemic
3
Q
What system is low pressure?
A
Pulmonary
4
Q
What are the main purposes of the CV system?
A
- Transport
- O2, nutrients, hormones
- Remove CO2/wastes
5
Q
Describe the different layers of the heart
A
- Epicardium → outermost layer
- Pericardium → protective sac around the heart
- Myocardium → middle layer, responsible for pumping action
- Endocardium → innermost layer, provides a smooth lining
6
Q
What causes the sound of S1?
A
Closing of the AV valves (tricuspid and mitral)
7
Q
What part of the heart is contracting during S1?
A
Atrial contraction followed by ventricular contraction
8
Q
What causes the sound of S2?
A
Closing of the semilunar valves (pulmonary and aortic)
9
Q
What part of the heart is contracting during S2?
A
Ventricular contraction
10
Q
What are the main coronary arteries and what parts of the heart do they supply?
A
- RCA (right coronary artery) → RA, RV, septum
- LCA (left coronary artery) → left anterior descending (LAD), LV, septum
- Circumflex → posterior LV & LA
11
Q
What is collateral circulation?
A
Chronic blockages; arteries make capillaries to avoid and go around the plaques
12
Q
What is the SA node?
A
Normal pacemaker of the heart (60-100 bpm)
13
Q
What is the formula for cardiac output (CO)?
A
CO = SV x HR
14
Q
What are the determinants of stroke volume?
A
- Preload
- Afterload
- Contractility
15
Q
What is the difference between veins and arteries?
A
Arteries take blood AWAY from the heart; the aorta holds the most blood
16
Q
Where does oxygenated and nutrient delivery occur?
A
Capillaries
17
Q
How does the SNS control blood pressure?
A
Increases HR and contractility
18
Q
How does the PNS control blood pressure?
A
Decreases HR
19
Q
What is turbulence in blood flow?
A
More pressure required to maintain blood flow through the vessel
20
Q
What are the factors affecting blood flow?
A
- Pressure
- Resistance
- Viscosity
- Vessel diameter & length
21
Q
What is dyslipidemia?
A
Abnormal lipid levels
22
Q
What is hyperlipidemia?
A
Elevated lipid in the blood → high cholesterol
23
Q
What is the structure of lipoproteins?
A
- Hydrophilic outer layer (proteins & phospholipids)
- Hydrophobic inner layer (triglycerides & cholesterol)
24
Q
What are the two pathways to create cholesterol?
A
- Exogenous pathway: lipid absorbed from the GI tract
- Endogenous pathway: liver
25
What is the difference between LDL and HDL?
* LDL (bad cholesterol) → excess can injure blood vessels
* HDL (good cholesterol) → transports excess cholesterol to the liver
26
What are risk factors for high cholesterol?
* Diet
* Obesity/sedentary lifestyle
* Genetics
* Diabetes mellitus
27
Define metabolic syndrome.
Associated with increased cardiovascular disease; 3 or more of the following: elevated fasting glucose, elevated blood pressure, elevated waist circumference, dyslipidemia
28
What is atherosclerosis?
Abnormal thickening and hardening of the endothelium
29
What are the non-modifiable risk factors for atherosclerosis?
* Age
* Gender
* Family history/genetics
30
What are the modifiable risk factors for atherosclerosis?
* Cigarette smoking
* Hypertension
* Diabetes mellitus
* Obesity
* Physical inactivity
* Hyperlipidemia
31
What causes endothelial injury in atherosclerosis?
* Smoking
* High LDL levels
* Hypertension
32
What are the symptoms of Raynaud’s disease?
* Skin pale to cyanotic
* Cold sensation
* Numbness/tingling
* Redness and throbbing during hyperemia
33
Define true aneurysm.
Bound by complete vessel wall
34
What is a dissecting aneurysm?
Layers have torn, bleeding between layers
35
What is orthostatic hypotension?
Fall in systolic BP >20 mmHg when moving to a standing position
36
What are the causes of orthostatic hypotension?
* Idiopathic
* Hypovolemia
* Drug-induced
* Bedrest/immobility
37
What is the role of the skeletal muscle pump?
Helps return blood in the veins back to the heart
38
What are varicose veins?
Dilated, tortuous veins of lower extremities due to prolonged increased pressure
39
What is the definition of hypertension urgency?
SBP > 180 OR DBP > 120 with no signs of organ failure
40
What defines a hypertensive emergency?
High BP with signs of organ damage/dysfunction
41
What are the short-term mechanisms that control blood pressure?
* RAA system
* Aldosterone
* Angiotensin II
* ADH
* Baroreceptors
42
What are the long-term mechanisms that control blood pressure?
Renal mechanisms regulate BP by regulating fluid volume
43
What is the pathophysiology of primary hypertension?
* Vasoconstriction/increased pressure
* Remodeling of arterioles/arteries
* Hypertrophy of arterial smooth muscle
44
What is the pathophysiology of varicose veins?
Dilated, tortuous veins of lower extremities due to prolonged ↑ P → incompetence of valve → venous enlargement → further valve incompetence → ↑ hydrostatic P → edema
## Footnote
Varicose veins result from increased pressure in the veins, leading to their abnormal dilation.
45
What are the signs and symptoms of varicose veins?
Palpable, tortuous veins, aching, edema
## Footnote
These symptoms are often worsened by prolonged standing or sitting.
46
What is chronic venous insufficiency?
Veins in the legs fail to effectively return blood to the heart, leading to blood pooling (venous stasis) in the lower extremities
## Footnote
This condition can result in serious complications if left untreated.
47
What are the causes of chronic venous insufficiency?
Varicose veins, DVT, decreased muscle pump activity
## Footnote
DVT stands for deep vein thrombosis.
48
What are the signs and symptoms of chronic venous insufficiency?
Stasis dermatitis, venous ulcers
## Footnote
Stasis dermatitis presents as thin, shiny bluish, brown skin.
49
What are the risk factors for venous thrombosis?
Venous stasis, endothelial injury, hypercoagulability
## Footnote
These factors contribute to the formation of blood clots in the veins.
50
What are the signs and symptoms of venous thrombosis?
Leg pain or tenderness, swelling, redness or warmth, enlarged veins, low-grade fever, general discomfort
## Footnote
Symptoms can vary based on the location and extent of the thrombosis.
51
What are the complications of venous thrombosis?
Pulmonary embolism, post-thrombotic syndrome, chronic venous insufficiency, recurrent venous thrombosis
## Footnote
Pulmonary embolism can be life-threatening and requires immediate medical attention.
52
What is compartment syndrome?
When pressure within a muscle compartment increases to a point where it exceeds the perfusion pressure, leading to reduced blood flow and oxygen supply to the muscles and nerves within the compartment
## Footnote
This condition can lead to serious complications if not treated promptly.
53
What are the signs and symptoms of compartment syndrome?
Pain, swelling, paresthesia, pallor, pulselessness, paralysis, tightness
## Footnote
Early recognition is crucial to prevent permanent damage.
54
What is the pathophysiology of pressure injuries?
When sustained pressure on the skin and underlying tissues leads to localized damage
## Footnote
These injuries are often preventable with proper care and positioning.
55
What are the consequences of pressure injuries?
Infection, chronic pain, delayed healing, functional impairment
## Footnote
Pressure injuries are a significant concern in immobile patients.
56
What are the four factors contributing to pressure injuries?
* Shear
* Pressure
* Friction
* Moisture
## Footnote
Each factor can exacerbate skin breakdown and injury.
57
What are the risk factors for congenital heart disease (CHD)?
Genetic/chromosomal abnormalities, environmental factors, maternal illness, maternal medications, idiopathic causes
## Footnote
Trisomy 21 (Down syndrome) has a high association with CHD.
58
What are the four main types of congenital heart disease?
* Increased pulmonary blood flow
* Decreased pulmonary blood flow
* Decreased cardiac output
* Mixed
## Footnote
Each type presents with distinct clinical features and management needs.
59
What is a Patent Ductus Arteriosus (PDA)?
An open connection between the pulmonary artery and aorta, common in premature babies, leading to left to right shunt
## Footnote
Increased pulmonary pressure and workload on the right and left ventricles result from this condition.
60
What are the signs and symptoms of Atrial Septal Defect (ASD)?
May be asymptomatic, but can lead to right ventricular overload and increased pulmonary blood flow
## Footnote
Early detection is important to prevent complications.
61
What is Ventricular Septal Defect (VSD)?
The most common congenital heart defect, characterized by a left to right shunt and possible asymptomatic presentation
## Footnote
Increased pulmonary pressure and workload on the right ventricle can occur.
62
What is Tetralogy of Fallot?
A congenital condition characterized by four defects: VSD, overriding aorta, pulmonic stenosis, RV hypertrophy
## Footnote
This condition causes mixed oxygenated and deoxygenated blood, leading to cyanosis.
63
What are the signs and symptoms of Coarctation of the Aorta?
High BP in upper extremities, low BP in lower extremities, decreased pulses/BP in legs, cool lower extremities
## Footnote
This condition can lead to significant complications if not treated.
64
What is the pathophysiology of Kawasaki Disease?
Vasculitis affecting small to large vessels, especially the coronary arteries, with a risk of aneurysms and myocardial infarction
## Footnote
It is the most common cause of acquired heart disease in children.
65
What are the signs and symptoms of Kawasaki Disease?
Abrupt fever, rash, redness of hands and feet, conjunctivitis, lymph node enlargement, strawberry tongue
## Footnote
Early recognition and treatment are vital to prevent serious complications.
66
What occurs during the P wave of an ECG?
Atrial depolarization
## Footnote
This reflects the electrical impulse starting in the SA node.
67
What does the QRS complex represent in an ECG?
Ventricular depolarization
## Footnote
This is crucial for the contraction of the ventricles.
68
What happens during the T wave of an ECG?
Ventricular repolarization
## Footnote
This prepares the ventricles for the next heartbeat.
69
What defines normal sinus rhythm?
Rate of 60-100 bpm, regular rhythm, P waves present before each QRS complex, normal PR interval, normal QRS duration
## Footnote
This indicates a healthy heart function.
70
What is the difference between atrial fibrillation and ventricular dysrhythmias?
Atrial fibrillation involves rapid irregular electrical activity in the atria, while ventricular dysrhythmias originate in the ventricles and can compromise blood flow
## Footnote
Both conditions can lead to serious complications.
71
What causes unstable angina?
Occurs when an unstable plaque ruptures, leading to clot formation and significant blockage
## Footnote
This can result in acute coronary syndrome.
72
What is the ejection fraction?
The percentage of blood pumped out of a filled ventricle with each contraction (normal: 50-65%)
## Footnote
It is a key measure of heart function.
73
What characterizes dilated cardiomyopathy?
Dilation of all chambers of the heart with systolic dysfunction
## Footnote
It can lead to complications such as mitral valve regurgitation.
74
What is the difference between stenosis and regurgitation in valvular heart disease?
Stenosis: impaired opening; Regurgitation: impaired closing
## Footnote
Both conditions can lead to significant heart dysfunction.
75
What is rheumatic fever?
An inflammatory disease post-Group A strep infection, causing heart valve damage and other systemic symptoms
## Footnote
It is a type 2 hypersensitivity reaction.
76
What is infective endocarditis?
Damage to endothelium or valve due to bloodborne organisms leading to vegetation formation
## Footnote
It is often associated with certain risk factors such as heart disease and IV drug use.
77
What is heart failure?
Inability of the heart to maintain sufficient cardiac output
## Footnote
It can arise from various risk factors including ischemic heart disease and hypertension.
78
What is heart failure?
Inability of the heart to maintain sufficient CO
## Footnote
CO stands for cardiac output.
79
What are the risk factors for heart failure?
* Increasing age
* Ischemic HD (CAD)
* HTN
* Cardiomyopathy
* Valvular heart disease
* Others: dysrhythmias, DM, obesity, congenital HD, pulmonary disease
80
What is the formula for cardiac output (CO)?
SV x HR = CO
## Footnote
SV stands for stroke volume, HR stands for heart rate.
81
Define ejection fraction.
The percentage of blood pumped out of a filled ventricle with each contraction (normal: 50-65%)
82
How does the heart compensate when it begins to fail?
* Increased sympathetic nervous system activity
* Increased blood pressure
* Increased contractility/SV
* Increased afterload
* Causes tachycardia
* Increased workload for the heart
* Increased myocardial oxygen demand
* Decreased renal blood flow
83
What is the role of the RAAS in heart failure?
* Angiotensin II increases BP
* Aldosterone → increased blood volume and pressure
* Vasoconstriction → increased afterload
* Contributes to myocardial remodeling
* Leads to volume overload
84
What are ANP and BNP?
* Atrial natriuretic peptide (ANP): released from distended atria
* B-type natriuretic peptide (BNP): released from ventricles
* Both promote diuresis/natriuresis
85
What are the signs and symptoms of heart failure?
* Volume overload: SOB, orthopnea, PND, chronic cough
* JVD, edema, liver congestion
* Pulmonary edema: SOB, cough, chest pain
* Poor perfusion: hypotension, cool extremities, altered mental status
86
Differentiate between right and left-sided heart failure.
* Right-sided: JVD, congestion of peripheral tissues, dependent edema, GI tract congestion
* Left-sided: Decreased CO, pulmonary congestion, cyanosis, pulmonary edema
87
What is systolic dysfunction?
The heart’s ability to pump and contract blood out of ventricles is impaired, leading to reduced ejection fraction (HFrEF)
88
What is diastolic dysfunction?
The heart’s inability to relax properly and fill with blood during diastole, leading to preserved ejection fraction (HFrEF)
89
How is heart failure diagnosed?
* H & P
* Echocardiogram to assess heart function
* ECG, CXR
* CBC, metabolic panel, liver and renal function tests
* BNP levels
90
What are the management strategies for chronic heart failure?
* Antihypertensives: ACE inhibitors, ARBs, Beta-blockers
* Diuretics to decrease congestion
* Inotropes (e.g., digoxin) to increase contractility
* Oxygen in acute exacerbations
91
What is shock?
Inadequate tissue perfusion leading to cellular hypoxia, dysfunction, and organ failure
92
What are the causes of hypovolemic shock?
* Decreased vascular volume
* External losses: bleeding, GI losses, diuretics
* Internal fluid shifts due to increased capillary permeability
93
What are the signs and symptoms of hypovolemic shock?
* Hypotension
* Increased HR, thready pulse
* Cool, pale, clammy skin
* Decreased urine output
* Altered LOC
94
What is cardiogenic shock?
Caused by left ventricular failure, acute MI, cardiomyopathy, valve disease, or sustained arrhythmia
95
What are the signs and symptoms of cardiogenic shock?
* Cool, pale, clammy skin
* Cyanosis
* Decreased urine output
* Increased HR
* Altered mental status
96
What is multiple organ dysfunction syndrome (MODS)?
Consequence of shock & poor perfusion, leading to dysfunction of two or more organs
97
What is the relationship between organ failure and mortality risk in MODS?
* 20% mortality if one organ fails
* 40% if two organs fail, etc.
