Unit 2 Day 3 (Thursday 4/9) Flashcards
Chest Radiograph
-chest x ray
Echocardiogram
- ultrasound
- use microbubbles to see if there is shunt (bubbles do not pass through pulmonary capillaries)
- info obtained: chamber size, function, structure, wall motion, valves, pressure and hemodynamics, shunts, murmurs, masses, bacterial endocarditis, pericardial disease
Cardiac MRI
- no ionizing radiation
- contraindications: metallic implants
Cardiac Catheterization and Cardiac Angiography
- catheter inserted into artery or vein, advanced to heart or coronary arteries
- measures: pressure, gradients, saturation, intracardiac shunt
Cardiac Stress Test
- precipitate ischemia by inc. myocardial oxygen demand
- evaluation for ischemia and functional capacity
- exercise treadmill test (don’t use if pt is unstable)
- pharmacologic test (vasodilator/dobutamine)
- best for identifiying L main, or 3 vessel CAD
- can image during test
Cardiac CT Angiography
-CT scan of heart
BNP
-B Type Natriuretic Peptide
-Found only in the cardiac ventricles
-Released in response to stretch, ↑ volume in the
ventricle
-also elevated in renal insufficiency
-higher in women and elderly
Atherosclerosis
- response to injury
- fibrofatty plaques on intima
- targets: coronary arteries, cerebral arteries, aorta
Arteroisclerosis
• Atherosclerosis
– Fibrofatty plaques on intima
• Mönckeberg’s medial calcific sclerosis – Calcification of media of muscular arteries – Does not encroach on vessel lumen
• Arteriolosclerosis (small arteries/arterioles)
– Most often associated with hypertension, diabetes
Aneurism
- weakening of a vessel wall
- repair of aneurism with stent
Vasculitis
-infection, irradiation, trauma or arthus reaction
• Polyarteritis nodosa
– Medium to small arteries
– All stages of activity may coexist
• Microscopic polyarteritis
– Arterioles, capillaries, venules
– All lesions tend to be at same stage
• Temporal arteritis (giant cell arteritis)
– Arteries of head, temporal arteries, ophthalmic branches
-May lead to blindness
– Granulomatous inflammation – Elderly people (> 50 years)
• Wegener’s granulomatosis
– Vasculitis + granulomas
– Can involve both lungs and kidneys
– If untreated, >90% mortality in 2 years
• Takayasu’s arteritis (pulseless disease)
– Affects aorta, main branches, pulmonary arteries • Narrows orifices of great vessels (pulseless, coldness, numbness of fingers and legs)
– Younger people (< 40 years), F > M
– Infancy and early childhood
– Fever, erythema of palms and soles, rash
– In most cases, coronary arteries are affected
• Buerger’s disease
– Male cigarette smokers, but female incidence increases with smoking
– Leads to thrombosis of medium-sized vessels, tibial
and radial arteries
-Can lead to gangrene
-Severe pain, even at rest, due to nerve involvement
Pseudo-Aneurism*
-hematoma forms on external surface of vessel, creating appearance similar to aneurism?
Thrombophlebitis
– Clots forming within deep leg veins- death from pulmonary emboli (saddle embolus)
• Prolonged bed rest, immobilization
• Cancer (hypercoagulability), Trousseau’s sign
Ischemic Heart Disease
- reduction in blood supply
- symptomatic disease due to critical stenosis
- demand ischemia
- syndromes: angina pectoris, MI, chronic ischemic heart disease, sudden cardiac death
Angina Pectoris
• Intermittent chest pain caused by reversible myocardial ischemia
– Typical (stable) angina pectoris (Episodic chest pain associated with exertion)
– Unstable angina pectoris (Increased frequency and intensity of attacks by less exertion, Harbinger of irreversible myocardial ischemia)
– Prinzmetal’s (variant) angina (Due to vasospasm, Chest pain that occurs at rest) (do not give these people BBs, instead tx with vasodilators)
