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Pathophysiology > Unit 2 - Cardiovascular System Part 3 > Flashcards

Unit 2 - Cardiovascular System Part 3 Flashcards

1
Q

heart failure

A

occurs when the heart is unable to pump enough blood to meet the body’s metabolic demands. Indicative of a weakened and dilated heart

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2
Q

the end result of many different cardiovascular diseases, including:

A 
Coronary artery disease (CAD) – “progressive atherosclerosis”
Post myocardial infarction
Intrinsic muscle disease
Increased pressure/volume load
Hypertension
Valvular disease
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3
Q

common cause: decrease in myocardial capacity

A

Post myocardial infarction
Heart muscle is damaged, which in turn has a negative impact on pumping function. Necrotic muscle tissue is replaced by scar tissue and no longer contributes to ejection of blood.
b. Intrinsic muscle disease - myocarditis, cardiomyopathy
Coxsackie virus, bacteria, genetic, alcohol or drug induced, Idiopathic

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4
Q

common cause: increased pressure/volume load

A 
a. Hypertensive cardiovascular disease
Increased resistance to blood flow. 
Causes:
Diffuse or localized vessel narrowing
Fluid retention
Requires an increased Driving Pressure – “the heart has to work harder to pump blood into the systemic and/or pulmonary circulation”.

b. Valvular disease
Examples:
Acquired (Rheumatic fever)
Congenital

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5
Q

stenosis

A

restricted or narrowed opening
results in increased mycardial workload as the heart works to pump blood through the narrowed aorta

valve becomes stiff and non compliant

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6
Q

insufficiency

A

valve does not close properly and allows blood to flow in a retrograde (backwards) direction

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7
Q

rheumatic heart disease

A

typically occurs in childhood, caused by group A beta hemolytic streptococcus bacteria

damage to heat valves, scarred/stiff

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8
Q

mitral valve prolapse

A

congenital disorder characterized by a tendency for the mitral valve leaflets to buckle up into the LA as the ventricle contracts

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9
Q

s/s of mitral valve prolapse

A 
Murmur
Palpitations
Tachycardia
Shortness of Breath
Note: MVP is fairly common and does not typically result in serious complications.
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10
Q

initial ventricular hytrophy - starling curve

A

with increased filling (EDV) of the heart, the muscle fibers are stretched which allows for a more optimal arrangement and increases contractility and stroke volume

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11
Q

dilated cardiomyopathy and risk factors

A

impaired contraction/relaxation of myocardial muscle fibers secondary to significant dilation of the ventricle

risks: black men 40-60yrs, alcohol abuse, rheumatic fever, mx dystrophy, sarcoidosis

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12
Q

myocarditis

A

inflammation of the heart muscle

- from viral or bacterial infection, radiation, drugs, sarcoidosis, lupus

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13
Q

myocardial ischemia

A

chronic O2 deprivation can result in depressed pump function

can increase risk of CHF

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14
Q

progressive ventricular dilation law of LaPlace

A

T= P x R

T=wall tension
P= descending pressure
R=radius

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15
Q

left sided vs right sided components

A

“Forward” = Decreased Perfusion
blood is unable to pump hard enough to go through the capillaries isn’t working

“Backward” = Passive Congestion
heart isn’t pumping hard enough so it can come back up

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16
Q

left sided HF etiology

A

AMI
Systemic HTN
Mitral/Aortic Valve Disease
Coarctation of the Aorta

17
Q

HF “fun facts”

A 
Most common Hosp. Discharge Dx.
Incidence is increasing due to better management of MI’s (decreased mortality) and HTN
> 30 billion in costs annually
>5 million patients
500,000 new diagnoses/yr
12-15 million office visits/yr
18
Q

systems affected by left sided heart failure

A 
Lungs
- Passive congestion
- Pulmonary edema
- Orthopnea
- Paroxysmal Nocturnal 			- Dyspnea
Kidneys
- Decreased renal perfusion
- Sodium and Water Retention

Anasarca (generalized massive edema)
Pedal edema (Pitting)
Facial edema

19
Q

Left sided vasoconstriction

A

due to reduced renal perfusion with subsequent increase in renin release and formation angiotensin II, a potent vasoconstrictor. Renin also leads to increased aldosterone release from the adrenal glands which promotes reabsorption of sodium and water in the renal tubules

20
Q

left sided hyper/hypotension

A

hypertension is usually seen earlier on, with hypotension occurring as the CHF worsens and pump function deteriorates.

21
Q

additional left sided HF s/s

A

Pulsus Alterans (alternating strong and weak pulse beats)
Fever & Pallor
Cardiac Cachexia
3rd heart sound

22
Q

right sided HF etiology

A 
85% of those patients diagnosed with right sided failure have COPD
AMI - Right Ventricle
Pulmonary HTN
Tricuspid/Pulmonic Valve 		Disease
Pulmonary Artery Stenosis
23
Q

right sided systems affected

A

Lungs

  • Increased pulmonary vascular resistance
  • No Pulmonary Edema
  • No Passive Congestion

Spleen & Liver

  • Passive Congestion
  • Splenomegaly
  • Hepatomegaly
  • Ascites

Kidneys

  • Decreased perfusion
  • Sodium/Water retention
  • Generalized Edema

Anasarca
Pedal Edema/Pitting
Facial Edema

24
Q

orthostatic hypotension

A

Drop in SBP > 20 mmHg and/or drop in DBP > 10mmHg, with reflexive increase in HR (10-20%) as individual transitions from supine or sitting to a standing position.

25
Q

orthostatic hypotension causes

A 
Autonomic dysfunction
Volume depletion
Prolonged immobility
Venous pooling
Meds
Starvation/malnutrition
26
Q

orthostatic hypotension PT/OT implications

A

Caution with whirlpool/Hubbard tank
Emphasize post exercise cool-down period
Avoid prolonged stationary standing
Advise caution when transitioning from supine to sit and from sit to stand
Abdominal binders and elastic stockings may aid venous return

27
Q

cardiomyopathy

A

Impaired ability of the cardiac muscle fibers to contract and relax.

28
Q

classifications of cardiomyopathy

A

Dilated (most common)
Hypertrophic
Restrictive

ALSO
Left Ventricular Non-Compaction Cardiomyopathy (LVNC)
Arrhythmogenic Right Ventricular Dysplasia (ARVD)

29
Q

pathogenesis of cardiomyopathy

A

The exact pathogenesis is often unknown – “idiopathic”

30
Q

cardiomyopathy risk factors

A 
Familial/genetic predisposition – common!
Radiation therapy
Chemotherapeutic agents
Rheumatic fever
Viral illness
Alcohol abuse
Sarcoidosis
Obesity
HTN
Smoking
31
Q

congenital heart disease

A

Def: Anatomic defect in the heart that is present at birth.

Incidence: about 8 per 1000 babies born will have some form of congenital hear disease.

Symptoms: commonly include cyanosis and CHF

Classification: the congenital disorders of the heart are broadly classified as cyanotic, and acyanotic

32
Q

arrhythmias

A

Def: Irregular heart rhythm.

Implications: Ranges from totally benign to potentially life threatening.

Cause is often unknown, but myocardial ischemia, MI, and CHF all increase the risk of arrhythmia.
Certain arrhythmias, such as atrial fibrillation, occur more frequently in older individuals (“atrial –fibrillation”)

33
Q

pericarditis

A

Def: Inflammation of the pericardium (“membrane sack surrounding the heart”)

Cause: Idiopathic (85%), viral/bacterial infections, MI, cardiac trauma, other

Treatment: - correct underlying cause if known (antibiotics). May need to drain fluid (“pericardiocentesis”). If untreated, may lead to cardiac tamponade, with resulting cardiac failure.

34
Q

aneurysm

A

Def: Abnormal stretching of the wall of an artery, vein, or the heart, with the diameter being at least 50% greater than normal

Aneurysm risk factors include:
Age
Smoking
Atherosclerosis
Male gender
Family Hx

Treated surgically if threshold size is reached (“5 to 51/2cm diameter for AAA)
Rupture is often catastrophic

35
Q

peripheral vascular disease

A
  • may be caused by several pathologic conditions of blood vessels
  • inflammatory, occlusive, vasomotor
  • affects LE’s more, which can lead to ischemic pain called “claudication”

Pathophysiology (27 decks)

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