Pathology II - Cardiac + LYMPHEDEMA Flashcards
What is another term for heart failure?
Congestive heart failure
what is a condition where the heart cannot maintain a normal cardiac output to meet the body’s demands for blood and oxygen?
Heart failure
heart failure typically begins with what part of the heart?
left ventricle
what heart sounds may be heard with heart failure?
S3 gallop “ventricular gallop”
What drug is used to increase the strength of contraction in heart failure?
digitalis
What are 4 common compensations seen in heart failure due to impaired cardiac output?
INcreased
blood volume
cardiac filling pressure
heart rate
cardiac muscle mass
what is one common sign of heart failure?
tachycardia
What is left vs. right sided heart failure associated with congestion where?
Left: signs of pulmonary venous congestion
Right: signs of systemic venous congestion
Diagnoses such as left ventricular infarct, aortic or mitral vale disease, and hypertension create pulmonary congestion that my result in left-sided heart failure but over time can lead to?
fluid accumulation spreading to ankle, congestive hepatomegaly, ascites, and pleural effusion
AKA RIGHT SIDED HEART FAILURE
What is an abnormal swishing or whooshing sound that may be due to turbulent flow through a damaged or narrowed heart valve?
Heart Murmur
What heart sound is an early sign of HTN?
S4
BP classifications
Noraml <120/80
Elevated 120-129 <80
Stage I 130-139 80-89
Stage II >140 >90
What is a nuclear medicine procedure that tests the function of the lymphatic system?
Lymphoscintigram
what is the most common cause for secdonary lymphedema in the U.S.?
breast cancer surgery and treatment
What are the 3 types of insufficiencies of the lymphatic system?
- Dynamic
- Mechanical
- Combined
what type of lymphatic insufficiency occurs when there is excess lymph circulating that exceeds the transport capacity of the system?
What kind of edema does it result in?
Dynamic Insufficiency
Pitting edema
What type of lymphatic insufficiency occurs when the transport capacity of the system is reduced due to damage to the lymph system?
What type of edema does it result in?
Mechanical insufficiency
non-pitting edema (PROTEIN-RICH LYMPHEMDEMA)
What type of edema results from PROTEIN-RICH lymphedema?
NON-PITTING (its hard, fibrotic)
What type of lymphatic insufficiency occurs when there is both an increased in lymph fluid as well as a decrease in transport capacity?
Combined Insufficiency
What technique involves injection of a contrast medium into a lymph vessel to allow for visualization of the entire lymph system through radiography?
Direct lymphography
what technique invovles injection of a contrast medium just under the skin to allow for visualization of smaller superficial lymph vessels?
Indirect Lymphography
What technique involves injection of radioactive material to allow for visualizaiton of the lymphatic system through nuclear medical imaging to determine how effectivley lymph is being transported?
Lymphoscintigraphy
How many circumferencial measurements are recommended for upper and lower extremities to deduce fluid has been removed and not redistrubuted in lymphedema?
7
what are the 3 classifications for circumferential measurements of lymphedema?
Mild: <3 cm difference between affected and unaffected
Moderate: 3-5 cm difference between affected and unaffected
Severe: >5 cm difference between affected and unaffected limbs
What are the stages of lymphedema, names, and descriptions?
0: Latent (preclinical) Stage. NO visible edema, transport capacity has been affected
1: Reversible Lymphedema Stage. Pitting present, increases with activity or heat but diminishes with ELEVATION AND REST
2: Spontaneously Irreversible Lymphedema. edema is NON-PITTING (protein rich) and does not change with elevation or rest. Fibrotic changes. Stemmer sign positive
3. Lymphostatic Elephantiasis Stage. Characterized by extensive non-pitting (protein rich) edema, significant fibrotic changes, papillomas, deep skinfolds, and hyperkeratosis. Infections common
what is the standard of care for patients with lymphedema?
Complete Decongestive Therapy
What 4 things comprise complete decongestive therapy?
- manual lymphatic drainage
- Compression therapy
- Exercise
- Skin Care
Manual lymphatic drainage should first be directed in what areas?
Start in uninvolved areas to prepare them for new lymph flow then direct treatment to more involved areas
What type of resting pressure do short stretch bandages have?
LOW resting pressure
During phase II treatment for lymphedema what time of the day are compression garments vs. compression bandages worn?
Compression garments during day
compression bandages at night
Why is the immune system impaired in lymphedema allowing for more bacterial and fungal growth?
due to the protein rich fluid of lymphedema
what is a disease caused by parasitic infection that is most often seen in tropical climates?
Filariasis
what is thickening of the outermost layer of the skin, typically seen in stage 3 lymphedema?
Hyperkeratosis
What is infection and inflammation of a lymph node?
Lymphadenitis
What is enlargement of a lymph node which commonly occurs secondary to cancer, infections, and allergic reaction?
Lymphadenomegaly
What is any disease that affects size, number or consistency of lymph nodes?
Lymphadenopahty
what is infection and inflammation of the lymphatic pathways?
Lymphangitis
What is an inherited type of primary lymphedema that typically presents in infancy?
What is the most common symptom?
milroy’s disease
bilateral LE edema is the most COMMON symptom
what is fluid accumulation that is harder and no compressible to pressure, seen in later stages of lymphdema?
NON-PITTING EDEMA
What is a benign wart like skin growth typically observed with stage 3 lymphedma?
Papilloma
What is fluid accumulation that can be compressed and seen in early stages of lymphedema?
Pitting edema
What is an organ located in the upper left quadrant of the abdomen that is responsible for filtration of red blood cells as well as production of antiboides to help fight infection?
Spleen
What is Stemmer’s sign? whats positive? Whats it for?
For LYMPHEDEMA diagnosis
+ if the skin at the dorsal base of the second toe/finger cant be easily lifted away from bone indicating thickening of skin due to fibrotic changes
What cells does the thymus produce and their function?
T Cells and T Lymphocytes to help combat infection
- What kind of MI involves full-thickness of the myocardium?
- What kind of MI involves subendocardial are (inner third of myocardium)?
- Transmural MI
2. Nontransmural MI
What is the most common location of infarct and what area of the heart does it affect?
Anterior Descending Branch of left coronary artery
affects the LEFT VENTRICLE
What do the following indicate on an ECG…
- Inverted T wave
- elevated ST segment
- depressed ST segment
- myocardial ischemia
- acute infarction
- pending subendocardial or transmural infarction
What refers to inflammation and weakness of the myocardium and can lead to symptoms of heart failure?
myocarditis
In pericardiitis there is inflammation of the pericardium of the heart. What happens to the fluid between the two layers of the pericardium?
the fluid increases (pericardial effusion)
Percarditis is usually a complication of what?
Viral infections
What complication can occur with pericarditis where fluid in the pericardium creates pressure on the heart preventing the heart from properly filling with blood?
Cardiac tamponade
What might a sharp chest pain indicate for someone with pericarditis?
result of friction between the two pleural membranous layers
What is the common symptom of pericarditis?
Sharp chest pain that can radiate into the neck or shoulders
What is another term for Peripheral Vascular Disease (PVD)?
arteriosclerosis obliterans
What is the primary cause of Peripheral Vascular Disease?
atherosclerosis
What is the most common symptom for the early stages of PVD?
intermittent claudication
What are 3 skin related symptoms of peripheral vascular disease?
- changes in skin color
- decrease in skin temperature
- absence of hair on the extremity
- What is the goal in minutes for continuous exercise with peripheral vascular disease?
- how long after starting an exercise program should resistive exercise begin?
- walking 30 continuous minutes
2. 4-6 weeks
For patients with pain at rest and at night with peripheral vascular disease what should they do?
elevate head of bed 4-6 inches
What can result from untreated or poorly treated strep throat from group A streptococcus bacteria that can damage the hear valves and cause heart failure?
Rheumatic Fever
What are two possible manifestations of valvular heart disease?
Regurgitation due to insufficiency or incompetence of valves
OR
Stenosis due to thickening, stiffening, or fusing together
