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Semester 4 > Systemic pathology 400 (CV path 2) > Flashcards

Systemic pathology 400 (CV path 2) Flashcards

1
Q

valvular disease

A

Any heart valve can become stenotic (narrowed) or incompetent/insufficient (doesn’t close properly)

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2
Q

what changes take place long before SSx appear when valves stenose?

A

Causes hemodynamic changes long before symptoms

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3
Q

do valvular insufficiencies occur simultaneously in multiple valves?

A

Most often valvular stenosis or insufficiency occurs in isolation in individual valves,

but multiple valvular disorders may coexist

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4
Q

mitral valve and valvular disease

A

Mitral regurgitation

Mitral stenosis

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5
Q

insufficiency vs stenosis

A

insufficiency means that your valve doesn’t fully close

stenosis means that your valve is narrowed and doesn’t open fully

opposite but related (?)

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6
Q

mitral regurgitation

A

incompetency (insufficiency) of the mitral valve (bicuspid) causing backflow (reflux) from the left ventricle into the left atrium

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7
Q

Mitral stenosis

A

narrowing of the mitral valve impeding blood flow from the left atrium to the left ventricle

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8
Q

valvular disease and AORTIC VALVE

A

Aortic regurgitation

Aortic stenosis

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9
Q

Aortic regurgitation

A

incompetency of the aortic valve causing backflow from the aorta into the left ventricle

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10
Q

Aortic stenosis

A

narrowing of the aortic valve obstructing blood flow from the left ventricle to the ascending aorta

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11
Q

valvular disease etiology / risk factors

A

rheumatic heart disease

endocarditis

congenital valvular disease

autoimmune disorders

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12
Q

valvular disease – pathogenesis

A

Abnormalities in valves causes back flow of blood

Back flow of blood overburdens chambers

Overburdening causes hypertrophy of chamber

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13
Q

also related to pathogenesis of valvular disease

A

HTN (hypertension)

decreased systemic bloodflow (as a result)

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14
Q

valvular disease clinic manifestations, SSx

A

Angina

Dyspnea

Heart failure

Arrhythmia

Palpitations

Heart murmur

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15
Q

valvular disase Dx, Tx, Px

A

Echocardiogram, auscultation

Tx:
Valve replacement, medication

Px:
Variable

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16
Q

ischemic heart disease

A

Major disorders of the heart due to insufficient blood supply

AKA coronary heart disease (CHD) or coronary artery disease (CAD)

—-> MI, angina, cardiac arrest

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17
Q

ischemic heart disease epidemiology

A

CAD/IHD is the leading cause of death globally

CAD is the most common cause/type of cardiovascular disease

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18
Q

ischemic heart disease pathogenesis

A

Ischemic heart disease that develops as a result of slowly progressive narrowing of the coronary arteries results in hypoperfusion of myocardium and slowly evolving pump failure (congestive heart failure)

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19
Q

ischemic heart disease pathogenesis 2

A

Ischemic heart disease can develop due to sudden occlusion of a major coronary artery resulting in an infarct

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20
Q

ischemic heart disease risk factors

A

Age
Gender
Family history
Ethnicity
Infection
Smoking
High cholesterol
HTN
Alcohol

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21
Q

ischemic heart disease risk factors 2

A

Diet
Obesity
Physical inactivity
Diabetes
Hormonal status
Medication
Excessive alcohol consumption
Stress

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22
Q

ischemic heart disease clinical manifestations

A

Variable – depending on rapidity and extent of blockage and which arteries are blocked

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23
Q

can ischemic heart disease be asymptomatic

A

yes

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24
Q

ischemic heart disease other clinical manifestations and SSx

A

Asymptomatic
Pain
Angina pectoris
Breathlessness (dyspnea)
Palpitations
Congestive heart failure
MI
Death

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25
Q

ischemic heart disease Dx, Tx

A

Echocardiogram
Stress test

Tx:
Meds
Surgery
Prevention***

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26
Q

angina pectoris

A

Type of CAD/IHD

Crushing chest pain, typically precipitated by exercise or strain and relieved by nitroglycerin (stable angina)

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27
Q

angina etymology

A

“strangling”

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28
Q

angina pectoris caused by

A

Caused by any condition that alters:

Blood supply to myocardium

Blood requirements of myocardium
(—>circulatory disorders, blood loss)

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29
Q

angina pectoris – pathogenesis

A

Narrowed or obstructed blood vessels limit blood supply to tissues

When the cardiac workload exceeds oxygen supply to myocardial tissue, ischemia occurs causing temporary chest pain

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30
Q

Chronic stable angina (type)

A

Classic exertional angina

Preceded by exercise or stress and relieved by rest or nitroglycerin

Predictable and consistent

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31
Q

Prinzmetal’s angina (vasospastic or variant angina) (type)

A

Symptoms similar to typical angina

Caused by coronary artery spasm

Usually occurs early morning; unrelated to exertion

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32
Q

Decubitus angina (resting angina) (type)

A

Atypical

Occurs at rest, worse when laying down (decubitus)

Reduced when sitting or standing

More prevalent in women

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33
Q

decubitus etymology

A

from Latin decumbere ‘lie down’, on the pattern of words such as accubitus ‘reclining at table’.

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34
Q

Unstable angina (progressive or crescendo angina)

A

Residual ischemia triggers angina

Unpredictable

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35
Q

Angina Pectoris, Dx, Tx

A

Dx:
History
Clinical manifestation
Angiogram

Tx:
Medications to treat symptoms or underlying conditions

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36
Q

MYOCARDIAL INFARCTION

A

Development of ischemia with resultant necrosis of myocardial tissue

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37
Q

MI is due to

A

Due to occlusion of a coronary artery

Anterior descending branch of left coronary artery (50%)
(LAD – LEFT ANTEIROR DESCENDING)

Right coronary artery (30-40%)

Left circumflex artery (15-20%)

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38
Q

Myocardial Infarction – risk factors

A

same as for CAD

Age
Gender
Family history
Ethnicity
Infection
Smoking
High cholesterol
HTN
Alcohol

Diet
Obesity
Physical inactivity
Diabetes
Hormonal status
Medication
Excessive alcohol consumption
Stress

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39
Q

MI – death occurs in what percentage of cases?

A

Death occurs in 25% of cases due to arrhythmia (ventricular fibrillation), heart block, pump failure, asystole (cardiac arrest)

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40
Q

can MI be asymptomatic?

A

Symptoms are variable but can be asymptomatic (rarely)

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41
Q

MI SSx

A

Can also include crushing pericardial pain, syncope, pallor, SOB, cold sweating, fatigue, referred pain (left arm), heartburn, nausea

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42
Q

syncope recall

A

temporary loss of consciousness caused by a fall in blood pressure.

Syncope, commonly known as fainting or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery.

It is caused by a decrease in blood flow to the brain, typically from low blood pressure

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43
Q

MI Dx

A

Diagnosis includes clinical history, clinical manifestation, ECG,

blood tests (troponin or CK/CPK)

44
Q

note ck test, cpk test, troponin test

A

Healthcare providers sometimes use a creatine kinase (CK) test to help diagnose a heart attack, though not very often

CK testing used to be a common test for heart attacks, but healthcare providers now use another test, called troponin, which is better at detecting heart damage.

The creatine phosphokinase (CPK) isoenzymes test measures the different forms of CPK in the blood. CPK is an enzyme found mainly in the heart, brain, and skeletal muscle.

45
Q

MI Tx

A

Treatment – medications, surgery

Resuscitation must be immediate or death will occur

46
Q

MI can lead to

A

Can lead to
cardiac arrest,

cardiogenic shock,

multisystem organ failure (brain, kidneys),

myocardial rupture (cardiac aneurysm),

mural thrombi

47
Q

MI prevention

A

Prevention includes minimizing risk factors

48
Q

Congestive Heart Failure

A

A condition in which the heart is unable to pump sufficient blood to supply the body’s needs

Failure can occur on left or right, but predominantly affects the left

Can be chronic or acute

49
Q

CHF, epidemiology

A

Common complication of ischemic heart disease and hypertension

500,000 new cases per year in US

Most common cause of hospitalization in the elderly

Increasingly common

50
Q

MOST COMMON CAUSE OF HOSPITALIZATION
IN ELDERLY

A

CONGESTIVE HEART FAILURE

51
Q

CHF pathogenesis

A

“Failing” heart keeps working, but is less effective

Inability to pump blood out of heart decreases blood returning to the heart

52
Q

where is edema common in CHF

A

Edema, especially in LE (dependent edema)

53
Q

dependent edema define

A

Dependent edema is specific to parts of the body that that are influenced by gravity, such as your legs, feet, or arms.

Edema may be a side effect of medications for conditions such as high blood pressure or diabetes.

54
Q

why is edema common in lower extremity in CHF

A

esp because of gravity

55
Q

CHF pathogenesis (continued)

A

Inability to pump blood out of heart increases blood in the chambers and lungs

SOB, especially in recumbent position

56
Q

CHF — what is the result involving kidney response?

A

Decreased peripheral blood flow causes kidney to release renin

—> End result = increased blood volume

—> Heart can’t keep up = more edema and HTN

57
Q

what does renin do?

A

The renin-angiotensin-aldosterone system is a series of reactions designed to help regulate blood pressure.

When blood pressure falls (for systolic, to 100 mm Hg or lower), the kidneys release the enzyme renin into the bloodstream.

58
Q

CHF — What then happen to left ventricle?

A

Left ventricle pumps harder to try to get more blood to tissues, leading to left ventricular hypertrophy

59
Q

resulting in (which adverse effect involving the coronary arteries?)

A

Coronary arteries cannot meet demand of overworked heart

60
Q

which can result in?

A

Can lead to ischemia, angina, and/or MI

61
Q

how can this entire cycle be classified?

A

Positive feed back loop

62
Q

why positive feedback loop?

A

the more it becomes challenging to send blood to periphery (hypoperfusion)

the more renin-angiotensin-aldosterone pathway attempts to regulate BP (INCREASE BLOOD VOLUME)

The more blood volume increases, the more edema and HTN

= The more heart can’t keep up (has to work harder)

= the more left ventricle hypertrophy

= the more difficult it is to circulate blood

and so on

63
Q

CHF Tx

A

Diet, exercise, and lifestyle modifications

Medications

64
Q

CHF Px

A

Poor

65
Q

Cor Pulmonale

A

Cor pulmonale is right ventricular hypertrophy

secondary to a lung disorder.

Right ventricular heart failure follows.

66
Q

Cor Pulmonale Etiology (Chronic)

A

Chronic cor pulmonale is usually caused by COPD.

(Chronic Obstructive pulmonary disorder)

67
Q

Cor Pulmonale Etiology (Acute)

A

Acute is caused by pulmonary embolism

68
Q

COPD

A

“Chronic obstructive pulmonary disease (COPD) is a common lung disease causing restricted airflow and breathing problems. It is sometimes called emphysema or chronic bronchitis.”

“Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by shortness of breath, cough and sputum production”

69
Q

Cor Pulmonale Pathogenesis

A

Pulmonary disorders lead to hypertension in pulmonary artery

—> Blood backs up in RV

RV dilates and hypertrophies

RV fails

70
Q

Cor Pulmonale clinical manifestations

A

Dyspnea

Exertional fatigue

Heart murmurs

Lower Extremity edema

71
Q

can Cor Pulmonale be asymptomatic?

A

yes

72
Q

Why lower extremity edema in Cor Pulmonale

A

since Right side is congested blood becomes held back in veins

esp as a result of gravity, lower extremity is most often affected

73
Q

Cor Pulmonale Dx

A

History
Examination
ECHO

74
Q

Cor Pulmonale, Tx

A

Medications

75
Q

Pulmonary Embolism

A

The occlusion of one or more pulmonary arteries by thrombi that originate elsewhere,

typically in the large veins (DVT) of the lower extremities or pelvis, break free of the vessel, and circulate to the lungs.

76
Q

pulmonary embolsim is cause of

A

acute cor pulmonale

77
Q

pulmonary embolism etiology and risk factors (DVT)

A

DVT – iliofemoral (50%), deep calf veins (5%), subclavian vein (20%)

78
Q

pulmonary embolism etiology and risk factors

A

Immobility
Surgery
Pregnancy

79
Q

pulmonary embolism more risk factors / etiology

A

LE fractures
Malignancy

80
Q

more risk factors PE

A

Blood stasis
Endothelial injury
Hypercoagulable states

81
Q

other risk facotrs PE

A

Previous PE

82
Q

more

A

CHF
CHD (CAD)
COPD

Obesity
Smoking

Catheterization
Oral contraceptives
HRT

Neurological disability

83
Q

can pulmonary embolism be asymptomatic

A

yes

84
Q

other clnical manifestations of pulmonary embolism

A

Cardiac arrest
Dyspnea
Chest pain
Apprehension
Cough
Tachypnea

Rales
Tachycardia
Fever
Hemoptysis
Edema
Murmur
Cyanosis

85
Q

rales

A

“to rattle”

an abnormal crackling or rattling sound heard upon auscultation of the chest, caused by disease or congestion of the lungs.

86
Q

Pulmonary embolism, Dx, Tx, Px

A

Dx:
History and S&S
Rule out other pathologies
Imaging as a last resort

Tx:
Medications

Variable
—> Mortality ranges from 0.5% if treated early to 25% if untreated

87
Q

Dysrhythmia

A

Aka – arrhythmia

Disturbance of heart rate or rhythm

Caused by an abnormal rate of electrical impulse generation, abnormal conduction of electrical signal, tissue death

88
Q

can arrhythmia be caused by tissue death

A

yes

89
Q

arrhythmia classification

A

via speed

via location

90
Q

Classified according to
origin (atria or ventricles)
and speed (slow or fast)

A

..

91
Q

Tachycardia – HR > 100
Bradycardia – HR < 60

A

..

92
Q

what does clinical significance of arrhythmia depend on?

A

Clinical significance
depends on effects
on cardiac output and BP

93
Q

Atrial fibrillation (arrhythmia)

A

Fibrillation - rapid, uncoordinated heart beats

The most common chronic arrhythmia

Rapid, involuntary irregular muscle contraction of atrial myocardium

94
Q

potential result of atrial fibrillation

A

Blood remains in atria after contraction

—> Ventricles don’t fill properly

Heart races but blood flow diminishes

95
Q

important note about last semester notes

A

( NOTE THAT IN LAST SEMESTER’S NOTES, ATRIAL FIBRILLATION NOT CONSIDERED A SERIOUS EMERGENCY, B/C VENTRICLES STILL FILLED PASSIVELY DESPITE DYNSFUNCTIONING ATRIAL CONTRACTION)

96
Q

atrial fibrillation SSx

A

S&S: asymptomatic, SOB (dyspnea), palpitations, fatigue, death (rare)

97
Q

can atrial fibrillation be asymptomatic

A

yes

98
Q

what does atrial fibrillation usually occur secondary to

A

Usually occurs secondary to heart disease

99
Q

ventricular fibrillation

A

Electrical phenomena that results in involuntary, uncoordinated muscular contractions of the ventricular muscle

Frequent cause of cardiac arrest

Treatment includes depolarizing the muscle

100
Q

note

A

ventricular fibrillation considered a much more serious medical emergency b/c absence of ventricle’s pumping capability leads to quick hypoperfusion of vital organs

whereas the ventricles can still fill passively in the absence of the pumping capability of the atria

101
Q

Heart block (AV block)

A

Interruption in passage of impulses through the heart’s electrical system

May occur because SA (node??) misfires or because impulses are not transmitted properly

102
Q

1st vs 2nd vs 3rd degree heart block

A

With first-degree heart block, you might not need treatment.

With second-degree heart block, you may need a pacemaker if symptoms are present or if Mobitz II heart block is seen.

With third-degree heart block, you will most likely need a pacemaker.

“Key Points. There are 3 degrees of AV block: first, second, and third. First- and second-degree blocks are partial and third-degree block is complete. First-degree AV block is rarely symptomatic and no treatment is required.”

103
Q

heart block causes

A

Can be caused by heart disease or increased heart meds

Can cause fatigue, dizziness, fainting

Treatment includes meds or pacemaker

104
Q

paroxysmal tachycardia

A

An abnormally rapid heart rate that begins and ends suddenly

105
Q

Ectopic Beats

A

An electrical activation of the heart that originates outside the SA node.

106
Q
A

Semester 4 (22 decks)

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