Unit 2 - Chapter 12 - Cardiovascular System Disorders Flashcards
what is the circulatory system composed of
- vessels
- fluid
- pumps
where is the heart located
mediastinum
what is located in the pericardial sac
- parietal pericardium
- epicardium
- pericardial cavity
- myocardium
- endocardium
What are the 2 types of heart valves
atrioventricular valves
semilunar valves
what are the 3 waves of an electrocardiogram
- p wave
- qrs wave
- t wave
what happens in the p wave of an electrocardiogram
depolarization of atria
what happens in the qrs wave of an electrocardiogram
depolarization of ventricles
what happens in the t wave of an electrocardiogram
repolarization of ventricles
expand on the cardiac control center in medulla oblongata
- controls rate and force of contraction
- located in the medulla
expand on baroreceptors
- detech changes in blood pressure
- located in the aorta and internal carotid arteries
what does sympathetic stimulation (cardiac accelerator nerve) do
increases heart rate (tachycardia)
what does parasympathetic stimulation (cranial nerve or vagus nerve) do
decreases heart rate (bradycardia)
what are factors that increase heart rate
- Increased thyroid hormones or epinephrine
- Elevated body temperature, infection
- Fever
- Increased environmental temperature
- Especially in high humidity
- Exertion or exercise
- Smoking
- Stress response
- Pregnancy
- Pain
expand on the right and left coronary arteries
- branch of aorta immediately distal to the aortic valve
- part of the systemic circulation
what does the left coronary artery divide into
- left anterior descending or interventricular artery
- left circumflex artery
what does the right coronary artery branch into
- right marginak artery
- posterior interventricular artery
- many small branches extend from these arteries to supply the myocardium and endocardium
- collateral circulation is extremely limited
what is diastole
relaxation phase of the heartbeat
- relaxation of myocardium required for filling chambers
what is systole
contraction phase of the heartbeat
- contraction of mycocardium provides increase in pressure to eject blood
explain the cardiac cycle step by step
- atria relaxed, filling with blood
- av valves open
- blood flows into ventricles
- atria contract, remaining blood forces into ventricles
- atria relax
- ventricles contract
- av valves close
- semilunar valves open
- blood into aorta and pulmonary artery
- ventricles relax
expalin the lubb-dub heart sound
- lubb is the closure of av valves
- dubb is the closure of semilunar valves
what are murmurs caused by
incompetent valves
what is a pulse deficit
difference in rate between apical and radial pulses
what is cardiac output (CO)
- the blood ejected by a ventricle in 1 minute
CO = stroke volume x heart rate
what is stroke volume (sv)
volume of blood pumped out of ventricle in a contraction
what is a preload
amount of blood delivered to heart by venous return
what is a afterload
force required to eject blood from ventricles
- determined by peripheral resistance in arteries
what causes changes in blood pressure
- sympathetic branch of ANS (increased output means vasoconstriction and increased BP / decreased output means vasodilation and decreased BP)
- when BP is directly proportional to blood volume
- hormones such as antidiuretics, aldosterone and renin-angiotensin-aldosterone
what is electrocardiography used for
- the initial diagnosis and monitoring of dysrhythmias, myocardial infraction, infection and pericarditis
what does auscultation determine
- determines valvular abnormalities or abnormal shunts of blood that cause murmurs
- detected by listening through a stethoscope
what is echocardiography used for
used to record heart valve moments, vlood flow and cardiac output
what are exercise stress tests used for
used to assess general cardiovascular function
what are chest x-rays used for
used to show shape and size of the heart
- examples are nuclear imaging and tomographic studies
what is cardiac cathterization used for
- measuring pressure and assessing valve and heart function
- also determines central venous pressure and pulmonary capillary wedge pressure
what is an angiography used for
visualization of blood flow in the coronary arteries
what are doppler studies used for
- assessing blood flow in peripheral vessels
- records sounds of blood flow or obstruction
what are blood tests used for
- assessing levels of serum triglycerides, cholesterol, sodium, potassium, calcium and other electrolytes
what is arterial blood gas determination used for
- checking the current oxygen level and acid-base balance
expand on dietary modifications as a treatment measure for cardiac disorders
- to decrease total fat intake
- general weight reduction
- reduce salt intake
expand on a regular excercise program as a treatment measure for cardiac disorders
- increases high-density lipoprotein levels
- lowers serum lipid levels
- reduces stress levels
expand on cessation of smoking as a treatment measure for cardiac disorders
- decreases risk of coronary disease
expand on vasodilators as a treatment measure for cardiac disorders
- reduced peripheral resistance
expand on beta blockers as a treatment measure for cardiac disorders
- treatment for hypertension and dysrhythmias
- reduces occurence of angina attacks
expand on calcium channel blockers as a treatment measure for cardiac disorders
- decreases cardiac contractility
- antihpertensives and vasodilators
- prophylactic against angina
expand on digoxin as a treatment measure for cardiac disorders
- treats heart failure
- antidysrhythmic drug for atrial dysrhythmias
expand on antihypertensive drugs as a treatment measure for cardiac disorders
- used to lower blood pressure
expand on adrenergic blocking drugs as a treatment measure for cardiac disorders
- acts on SNS centrally or on the periphery
expand on angiotensin-converting enzyme inhibitors as a treatment measure for cardiac disorders
- blocks conversion of angiotensin I to angiotensin II
expand on diuretics as treatment measures for cardiac disorders
- removes excess sodium and/or water
- treats high blood pressure and congestive heart failure
expand on anticoagulants as a treatment measure for cardiac disorders
- reduced risk of blood clot formation
expand on cholesterol-lowering drugs as a treatment measure for cardiac disorders
- reduces low density lipoprotein and cholesterol levels
what is arteriosclerosis
general term for all types of arterial changes such as
- degenerative changes in small arteries and arterioles
-
what happens in arterioschlerosis
- lumen gradually narrows and may become obstructed
- causes increased blood pressure
what is atherosclerosis
- presence of atheroma’s in large arteries
- atheroma’s such as plaques consisting of lipids, calcium and possible clots
- atherosclerosis is related to diet, exercise and stress
how are lipids transported
in combination with proteins
expand on low-density lipoprotein (LDL)
- transports cholesterol from liver to cells
- major factor contributing to atheroma formation
expand on high-density lipoprotein (HDL)
- transports cholesterol away from the peripheral cells to liver - “good” lipoprotein
- catabolism in liver and excretion
what are nonmodifiable risk factors for atherosclerosis
- age
- gender
- genetic or familial factors
what are modifiable risk factors for atherosclerosis
- obesity
- sedentary lifestyle
- cigarette smoking
- diabetes mellitus
- poorly controlled hypertension (blood pressure)
- combo of oral contraceptives and smoking
what do serum lipid level diagnostic tests test for
- low density lipoprotein
- high density lipoprotein
what does exercise stress test diagnostic tests test for
- arterial obstruction
what does nuclear medicine studies diagnostic tests test for
the degree of tissue perfusion
what are treatment options for atherosclerosis
- Weight loss
- Increase exercise
- Dietary modification
- Reduction of sodium intake
- Control hypertension
- Control of primary disorder
- Cessation of smoking
- Antilipidemic drugs
- Surgical intervention
what is angina pectoris and when does it occur
-Recurrent, intermittent brief episodes of
substernal chest pain
- when there is a deficit of oxygen to meet myocardial needs
what are the 3 patterns that chest pain can occur in angina pectoris
- classic or exertional angina
- variant angina (vasospasm occurs at rest)
- unstable angina (prolonged pain at rest - may precede myocardial infraction)
expand on angina pectoris attacks
-Attacks vary in severity and duration but become more frequent and longer as disease progresses.
how can angina pectoris attacks be relieved
- by rest and administration of coronary vasodilators
what are signs and symptoms of angina pectoris
- pallor
- diaphoresis (excessive sweating)
- nausea
- chest pain
what are emergency treatment options for angina
- stop activity and rest
- have patient seated in upright position
- administer nitroglycerin sublingually
- check pulse and respiration
- administer oxygen if necessary
- if patient is known to have angina then give a second dose of nitroglycerin
- if patient doesn’t have a history of angina then give emergency medical aid
when does a myocardial infraction occur
- when the coronary artery is totally obstructed
expand on myocardial infractions
- Atherosclerosis is most common cause.
- Thrombus from atheroma may obstruct artery.
- Vasospasm is caused in a small percentage.
- Size and location of the infarct determine the damage
what are the warning signs of a heart attack
- Feeling of pressure, heaviness, or burning in chest—especially with increased activity
- Sudden shortness of breath, weakness, fatigue
- Nausea, indigestion
- Anxiety and fear
- Pain may occur and, if present, is usually
( Substernal, Crushing, Radiating)
what are possible complications if your serum enzyme levels change
- Sudden death
- Cardiogenic shock
- Congestive heart failure
- Rupture of necrotic heart tissue/cardiac
tamponade
-Thromboembolism causing cerebrovascular accident (CVA; with left ventricular MI)
what is the treatment for out of what serum enzyme levels
- Reduce cardiac demand
- Oxygen therapy
- Analgesics
- Anticoagulants
- Thrombolytic agents may be used.
- Tissue plasminogen activator
- Medication to treat: Dysrhythmias, hypertension, congestive heart failure
what are cardiac dysrhythmias (arrhythmias)
- deviations from normal cardiac rate or rhythm (caused by electrolyte abnormalities, fever, hypoxia, stress, infection, drug toxicity)
- when there is a reduction of the efficiency of the hearts pumping cycle
how can heart abnormalities such as arrhythmias be detected
using electrocardiography they can be detected and monitored
what is the treatment for cardiac dysrhythmias (arrhythmias)
- change of drugs as drugs could be the cause
- pacemaker
- antiarrhythmic drugs such as beta-adrenergic blockers, calcium channel blockers and digoxin
what are the 4 Sinus node abnormalities
- sa node
- bradycardia
- tachycardia
- sick sinus syndrome
expand on the SA node
- pacemaker of the heart
- rate can be altered
what is bradycardia
- regular but slow heart rate
what is tachycardia
regular rapid heart rate
what is sick sinus syndrome
- marked by altering bradycardia and tachycardia
- often required mechanical pacemaker placement
what are the 3 atrial conduction abnormalities
- premature atrial contractions or beats
- atrial flutter
- atrial fibrillation
what is premature atrial contractions or beats
- extra contraction or ectopic beats
- irritable atrial muscle cells outside conduction pathway
what is atrial flutter
- atrial heart rate of 160 to 350 beats per minute
- av node delays conduction - ventricular rate slower
what is atrial fibrillation
- rate over 350 beats per minute
- causes pooling of blood in atria
- thrombus formation is a risk
what are the 4 atrioventricular node abnormalities
- heart blocks
- first degree block
- second degree block
- third degree block
what is heart block
- conduction excessively delayed or stopped at av node or bundle of his
what is first degree block
conduction delay between atrial and ventricular contractions
what is second degree block
every second to third atrial beat dropped at av node
what is third degree block
no transmission from atria to ventricles
what are the 4 ventricular conduction abnormalities
- bundle branch block
- ventricular tachycardia
- ventricular fibrillation
- premature ventricular contractions
what is bundle branch block
- interference with conduction in one of the bundle branches
what is ventricular tachycardia
- likely to reduce cardiac output as reduced in diastole occurs
what is ventricular fibrillation
- muscle fibers contract independently and rapidly
- cardiac standstill occurs if not treated immediately
what is premature ventricular contractions
- additional beats from ventricular muscle cell or ectopic pacemaker, may lead to ventricular fibrillation
what is the treatment for cardiac dysrhythmias
- Cause needs to be determined and treated.
- Antidysrhythmic drugs are effective in many cases.
- SA nodal problems or total heart block require pacemaker.
- Defibrillator may be implanted for conversion of ventricular fibrillation.
what is cardiac arrest
- cessation of all heart activity (no conduction of impulses and flat ECG)
What are the causes of cardiac arrest
- Excessive vagal nerve stimulation
- Potassium imbalance
-Cardiogenic shock - Drug toxicity
-Insufficient oxygen - Respiratory arrest
- Blow to heart
expand on congestive heart failure
- heart is unable to pump out sufficient blood to meet metabolic demands of the body
- usually a complication of another cardiopulmonary condition
- various compensation mechanisms maintain cardiac output
what happens in congestive heart failure when the heart cannot maintain pumping capability
cardiac output or stroke volume decreases
- less blood reached the various organs
- decreased cell function
- fatigue and lethargy
- mild acidosis develops
backup and congestion develop as coronary demands for oxygen and glucose are not met
- output from ventricle is less than the inflow of blood
- congestion in venous circulation draining into the affected side of the heart
what are the effects of left-sided congestive heart failure
- left ventricle weakens and cannot empty
- decreased cardiac output to system
- decreased renal blood flow stimulated renin-angiotensin and aldosterone secretion
- backup of blood into pulmonary vein
- high blood pressure in pulmonary capillaries leads to pulmonary congestion or edema
what are the effects of right-sided congestive heart failure
- right ventricle weakens and cannot empty
- decreased cardiac output to system
- decreased renal blood flow stimulates renin-angiotensin and aldosterone secretion
- backup of blood into systemic circulation
- increased venous pressure results in edema in legs and liver and abdominal organs
- very high venous pressure causes distended neck vein and cerebral edema
what are signs and symptoms ( forward effects) of congestive heart failure
- decreased blood supply to tissues, general hypoxia
- fatigue and weakness
- dyspnea and shortness of breath
what are the signs and symptoms (compensation mechanisms) of congestive heart failure
- tachycardia
- cutaneous and visceral vasoconstriction
- daytime oliguria
what are the signs and symptoms (backup effects of left-sided failure) of congestive heart failure
- related to pulmonary congestion
- dyspnea and orthopnea
- cough
- paroxysmal nocturnal dyspnea (indicates the presence of acute pulmonary edema, develops in sleep)
what are the signs and symptoms (systemic backup of right-sided failure) of congestive heart failure
- Dependent edema in feet, legs, or buttocks
- Increased pressure in jugular veins leads to distention.
- Hepatomegaly and splenomegaly
(Digestive disturbances) - Ascites ( Complication when fluid accumulates in peritoneal cavity, Marked abdominal distention)
- Acute right-sided failure (Flushed face, distended neck veins, headache, visual
disturbances)
expand on young children with congestive heart failure
- Often secondary to congenital heart disease
- Feeding difficulties often first sign (Failure to gain weight or meet developmental guidelines)
- Short sleep periods
- Tripod position to play
- Cough, rapid grunting respirations, flared nostrils, wheezing
- Radiographs show cardiomegaly.
- Arterial blood gases used to measure hypoxia
what are cardiac anomalies
structural defects in the heart that develop during the first 8 weeks of embryonic life
expand on congenital heart disease
- Valvular defects
- Septal defects
- Detected by the presence of heart murmurs
- If untreated, child may develop heart failure.
what are signs and symptoms of congenital heart disease
- pallor
- tachycardia
- dyspnea on exertion
- squatting position in toddlers and older children
- clubbed fingers
- intolerance for exercise and exposure to cold weather
- delayed growth and development
what are the diagnostic tests for congenital heart disease
- Radiography
-Diagnostic imaging - Cardiac catheterization
- Echocardiography
- Electrocardiography
what is the treatment for congenital heart disease
surgical repair
expand on ventricular septal defect
- most common congenital heart defect
- opening in the interventricular septum may vary in size and location
- if untreated usually leads to higher pressure in left ventricle, shunt from left to right
what is the treatment for ventricular septal defect
Surgical procedures
- Open heart surgery
- Catheter procedure
- Hybrid procedure
Medical procedures to
- Increase strength of contractions
- Decrease amount of fluid in circulation
- Keep a regular heartbeat
expand on valvular defects
- usually affect aortic and pulmonary valves
- may be classified as stenosis or valvular incompetence (failure of valve to close completely, blood regurgitates or leaks backward)
- mitral valve prolapse (abnormally large and floppy valve leaflets)
- surgical replacement (mechanical or animal tissue)
expand on tetralogy of fallot
- most common cyanotic (right to left shunt) congenital heart condition
- cyanosis occurs because shunt bypasses the pulmonary circulation
- alters pressures in heart and alters blood flow
what are the 4 abnormalities found in tetralogy of fallot
- involves heart as well as joints
- vsd
- dextroposition of the aorta
- right ventricular hypertrophy
expand on rheumatic fever
- acute systemic inflammatory condition
- may result from an abnormal immune reaction
- can occur a few weeks after an untreated infection
- involves heart as well as joints
- usually occurs in children 5 to 15
- long term effects are rheumatic heart disease and infective endocarditis and heart failure
expand on the acute stage of rheumatic fever
inflammation of the heart
- pericarditis
- myocarditis
- endocarditis and incompetent heart valves
expand on other sites of inflammation in rheumatic fever
- large joints
- erythema marginatum
- nontender subcutaneous nodules
- involuntary jerky movement of the face, arms, legs
what are signs and symptoms of rheumatic fever
- Low-grade fever
- Leukocytosis
- Malaise
- Anorexia, and fatigue
- Tachycardia
- Heart murmurs
- Epistaxis and abdominal pain may be present.
what are the diagnostic tests used for rheumatic fever
- elevated serum antibody level tests
- heart function test
- electrocardiography
- aso titer
what is the treatment for rheumatic fever
- prophylactic antibacterial agents
- antiinflammatory agents
what is subacute infective endocarditis
streptococcus viridans
- insidious onset of increasing fatigue, anorexia, cough and dyspnea
what is acute infective endocarditis
staphyloccocus aureus
- sudden, marked onset of spiking fever, chills and drowsiness
expand on the basic effects of infective endocarditis
- they are the same regardless of the organism
what are factors that predispose you to infective endocarditirs
- presence of abnormal valves in heart
- bacteremia
- reduced host defenses
what are signs or infective endocarditis
- low grade fever
- fatigue
- anorexia
- splenomegaly
- congestive heart failure in severe cases
expand on pericarditis
- usually secondary to another condition
- classified by cause or type of exudate
expand on acute pericarditis
- may involve simple inflammation of the pericardium
- may be secondary to open heart surgery, myocardial infarction, rheumatic fever, systemic lupus erythematosus, cancer, renal failure, trauma and viral infection
- effusion may develop (large volume of fluid accumulates in pericardial sac which leads to distended neck veins, faint heart sounds)
what are the effects of pericardial effusion
- fluid around heart compresses heart wall
- heart cannot expand to fill
- backup into systemic circulation
- decreased blood flow to lungs
- decreased output to body
expand on chronic pericarditis
- Results in formation of adhesions between the pericardial membranes
- Fibrous tissue often results from tuberculosis or radiation to the mediastinum.
- Limiting movement of the heart during diastole and systole → reduced cardiac output
- Inflammation or infection may develop from adjacent structures.
- Causes fatigue, weakness, abdominal discomfort (Caused by systemic venous congestion)
what is hypertension
- high blood pressure which is common, can occur in any age group and more common in individuals of african decent
- sometimes classified as systolic or diastolic
expand on primary hypertension (high blood pressure)
- essential hypertension
- blood pressure consistently above 140/90 mm HG
- increase in arteriolar vasoconstriction
- over long period of time there can be damage to arterial walls (blood supply to involved area is reduced and ischemia/necrosis of tissues)
expand on secondary hypertension
- results from renal or endocrine disease, pheochromocytoma (benign tumor of the adrenal medulla)
- underlying problem must be treated to reduce blood pressure
expand on malignant or resistant hypertension
- uncontrollable, severe, and rapidly progressive form with many complications
- diastolic pressure is extremely high
what are areas most frequently most damaged by hypertension
- kidneys
- heart
- brain
- retina
what are predisposing factors to hypertension
- incidence increases with age
- men affected more frequently and more severely
- incidence in women increases after middle age
- genetic factors
- sodium intake, excessive alcohol intake, obesity, smoking, prolonged or recurrent stress
expand on the first signs of hypertension
- often asymptomatic
- fatigue, malaise, morning occipital headache
what are the steps that essential hypertension is treated in
- lifestyle changes
- reduction of sodium intake
- weight reduction
- reduction of stress
- drugs
expand on atherosclerosis (peripheral vascular disease)
- disease in arteries outside the heart
- increased incidence in people with diabetes
what are the most common sites that atherosclerosis occurs
- abdominal aorta
- carotid arteries
- femoral and iliac arteries
what are the diagnostic tests performed for atherosclerosis
- blood flow assessed by doppler studies and arteriography
- plethysmography measures the size of limbs and blood volume in organs or tissues
what are the signs and symptoms of atherosclerosis
- increasing fatigue and weakness in the legs
- intermittent claudication (leg pain)
- associated with exercise caused by muscle ischemia
- sensory impairment (tingling, burning, numbness)
- peripheral pulses distal to occlusion become weak
- appearance of the skin (marked pallor or cyanosis, skin dry and hairless, toenails thick and hard)
what is the treatment for atherosclerosis
- Maintain control of blood glucose level
- Reduce body mass index
- Reduce serum cholesterol level
- Platelet inhibitors or anticoagulant medication
- Cessation of smoking
- Increase activity and exercise
- Maintain dependent position for legs
- Peripheral vasodilators
- Observe skin for breakdown and treat promptly.
- If gangrene develops, amputation is required
what is aortic aneurysm
- Localized dilation and weakening of arterial wall
- Develops from a defect in the medial layer
what are the different shapes of aortic aneurysm
- Saccular (Bulging wall on the side)
- Fusiform (Circumferential dilation along a section of artery)
- Dissecting aneurysm (Develops when there is a tear in the intima of the wall and
blood continues to dissect or separate tissues)
expand on etiology of vascular disorders
- atherosclerosis
- trauma
- syphilis and other infections
- congenital defects
what are signs and symptoms of vascular disorders
- Bruit (a blowing sound) may be heard on
auscultation. - Pulse may be felt on palpation of abdomen.
- Frequently asymptomatic until they become large or rupture.
- Rupture may lead to moderate bleeding but usually causes severe hemorrhage and death.
what is the treatment for the etiology of vascular diseases
- Maintain blood pressure at normal level
- Prevent sudden elevations caused by exertion
- Prevent stress, coughing, constipation
- Surgical repair
expand on varicose veins
- Irregular, dilated, tortuous areas of superficial veins
- Familial tendency
- Increased body mass index, parity, and weight lifting are risks
expand on vericose veins in the legs
- May develop from defect or weakness in vein walls or valves
- Appear as irregular, purplish, bulging structures
expand on the treatment for vericose veins
- Keep legs elevated, support stockings
- Restricted clothing, crossing legs to be avoided
- Can be surgically removed
what is thrombophlebitis
Thrombus development in inflamed vein
what is phlebothrombosis
Thrombus forms spontaneously without prior inflammation; attached loosely.
what are the factors for thrombus development
- Stasis of blood or sluggish blood flow
- Endothelial injury
- Increased blood coagulability
what are the signs and symptoms for Thrombophlebitis and Phlebothrombosis
- Often unnoticed
- Aching, burning, tenderness in affected legs
- Systemic signs—fever, malaise, leukocytosis
what is the complication for Thrombophlebitis and Phlebothrombosis
pulmonary embolism
what is the treatment for Thrombophlebitis and Phlebothrombosis
- Preventive measures (Exercise, elevating legs)
- Anticoagulant therapy
- Surgical intervention
expand on hypovolemic shock
loss of circulating blood volume
expand on cardiogenic shock
inability of heart to maintain cardiac output to circulation
expand on Distributive, vasogenic, neurogenic, septic, anaphylactic shock
Changes in peripheral resistance leading to pooling of blood in the periphery
what are early manifestation of shock
- anxiety
- Tachycardia
- Pallor
- Light-headedness
- Syncope
- Sweating
- Oliguria
expand on the compensation mechanisms for shock
-SNS and adrenal medulla stimulated—increase heart rate, force of contraction, systemic vasoconstriction.
- Renin secretion increases
- Increased ADH secretion
- Secretion of glucocorticoids
- Acidosis stimulates increased respiration ( With prolonged shock, cell metabolism is diminished, waste not removed—leads to lower pH)
what are complications of shock
- Acute renal failure
- Shock lung, or adult respiratory distress syndrome
- Hepatic failure
- Paralytic ileus, stress or hemorrhagic ulcers
- Infection or septicemia
- Disseminated intravascular coagulation
- Depression of cardiac function