Patho Exam 3 Flashcards
What is Aortic regurgitation?
Where the aortic valve leaks blood back into LV
-due to an inability of aortic valve leaflets to close properly during diastole
How does aortic regurgitation affect preload and afterload?
- Preload increases due to volume overload from leakage
- Afterload increases bc there is more to pump out of LV from overload of blood
What is Mitral regurgitation?
Where the blood in the LV flows back into the LA during systole (contraction)
What are Primary causes of valvular regurgitation?
- congenital
- valve degenerative (in elderly)
What are Secondary causes of valvular regurgitation?
- chronic hypertension
- rheumatic heart disease
- bacterial endocarditis
- syphilis
- connective tissue disorders
How does mitral regurgitation affect preload and afterload?
- Preload increases bc blood from LV flows back into LA
- Afterload decreases bc there is less blood volume for LV to push out in systole ( due back flow during systole)
What is Tricuspid regurgitation?
Where blood leaks back into RA
How does tricuspid regurgitation affect preload and afterload?
-Preload and afterload both increase due to volume overload
What is infective endocarditis?
inflammation of the endocardium
What are some causes of endocarditis?
Bacteria Viruses Fungi Rickettsiae (small bacteria transmitted by mites, ticks, lice, causes febrile illness) Parasites
What are the three critical elements in the Pathogenesis of endocarditis?
3 Critical Elements:
- Damaged endocardium
- from heart disease, trama etc.
- endothelial damage causes inflammation - Adherence of blood-borne microorganisms to the damaged endocardial surface
- bacteria may enter blood stream during dental procedures, cardiac surgery, catheters, IV drug use etc. - Formation of infective endocardial vegetations
- bacteria and thrombi form lesions via clotting cascade
What are the clinical manifestations of infective endocarditis?
Classic findings:
- Fever
- New or changed cardiac murmur
Characteristic physical findings:
- Osler nodes:
- painful erythematous nodules on the pads of the fingers and toes - Petechial lesions of the skin, conjunctiva, and oral mucosa
- small red, brown , or purple spots on body - Janeway lesions
- nonpainful hemorrhagic lesions on the palms and soles
Other: weight loss, back pain, night sweats, and heart failure
What is heart failure?
A general term that characterized by any cardiac disorder that results in inadequate CO for adequate tissue perfusion
What is the most common diagnosis upon admission for those 65yrs +?
Heart failure
What are the most common risk factors of heart failure?
age obesity diabetes renal failure valvular heart disease excessive alcohol use
What is Left heart failure or congestive heart failure?
How is it categorized?
This is heart failure characterized by:
-inadequate CO to perfuse vital tissues
Can be categorized by:
- A reduced ejection fraction <40% (systolic)
- A preserved ejection fraction (diastolic)
What is systolic heart failure?
L side heart failure categorized by a reduced EF of < 40%
-due to fact that LV cannot pump with enough force to push blood into circulation (reduce CO)
What is ventricular remodeling?
This is a change in the shape of fnx of the ventricles of the heart
Causes: MI, myocarditis, cardiomyopathy
- can cause reduced afterload abilities bc of reduced contraction during systole
- increases preload due to difficulty expelling blood into circulation
What is diastolic heart failure?
L side heart failure is defined as pulmonary congestion despite normal stroke volume
Causes: myocardial hypertrophy, ischemia, diabetes, valvular and pericardial disease
What are the manifestations of L heart failure?
- pulmonary vascular congestion and inadequate perfusion
- dyspnea (labored breathing), orthopnea (SOB), cough of frothy sputum, fatigue, decreased urine output, and edema
- pulmonary edema (cyanosis, inspiratory crackles, pleural effusions), hypotension or hypertension, an S3 gallop, and evidence of underlying CAD or hypertension
What is shock?
shock is where the cardiovascular system fails to perfuse the tissues adequately so that it impairs cellular metabolism
What is multiple organ dysfunction syndrome?
This is where two or more organ systems fail after severe illness or injury
What are the manifestations of shock?
- hypotension
- tachycardia
- increases respirations
Cellular:
- impaired oxygen use
- impaired glucose use
What is cariogenic shock?
Condition where the body cannot meet the bodies needs.
Characterized by:decreased cardiac output & tissue hypoxia
-in presence of adequate intravascular volume
What is hypovolemic shock?
Loss of blood from hemorrhage
How does the body try to compensate for hypovolemic shock?
The body tries to retain fluid and produce more blood to make up for the hemorragic blood loss.
- ADH
- RASS
- Spleen makes RBC
- Increased HR to increase perfusion (dry sponge)
- Catecholamines (epi, norepi, aldosterone)
What is Neurogenic shock? “vasogenic”
This is massive widespread vasodilation from:
- parasyapathetic overstimulation
- sympathetic understimulation
what triggers neurogenic shock?
Depressive drugs
Anesthetic agents
Severe emotional stress or pain
What are the manifestations of hypovolemic shock?
- lactic acidosis
- impaired cellular metabolism, nutrient delivery, anaerobic metabolism
- increased SVR
- thirst
- oliguria
- decreased preload
- rapid HR
- thready pulse
- skin turgor
What is Anaphylactic shock?
a result from a severe and widespread hypersensitivity reaction to an allergen
- IgE, (immunoglobulin antibody)
- vasoactive inflammatory cytokines
What are the basic physiologic alterations of anaphylactic and neurogenic shock?
- vasodilation
- hypovolemia
- decreased tissue perfusion
- impaired cellular metabolism
What is Septic shock?
Shock that stems from infection that progresses to a bacterium the n to systemic inflammatory response syndrome (SIRS)
- sepsis
- severe sepsis
- septic shock
- multiple organ dysfunction
What are the main causes of multiple organ dysfunction?
Sepsis or septic shock
-any disease that activates a massive systemic inflammatory response
