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BHSC 2203 - Patho > Unit 5 - Cardiovascular Disorders 2 > Flashcards

Unit 5 - Cardiovascular Disorders 2 Flashcards

1
Q

Define Heart Failure

A

Inability to effectively PUMP the amount of blood delivered to the heart
(inability to eject what it is receiving)

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2
Q

What are 4 causes of heart failure?

A
  1. MI
  2. Chronic Ischemic Heart Disease
  3. Valvular Disease
  4. Cardiomyopathy
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3
Q

What is chronic ischemic heart disease? (in simple terms)

A

Heart is not receiving enough oxygen to pump away happily

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4
Q

What wrong with the heart during valvular disease?

A

Problems with the heart’s valves

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5
Q

What is cardiomyopathy?

A

Something is wrong with the heart muscle itself

- heart wall

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6
Q

What is wrong with the heart when there is systolic dysfunction?

A

The heart doesn’t have enough FORCE

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7
Q

What is more prevalent, systolic or diastolic dysfunction?

A

Systolic!

- 60% of patients with heart failure have systolic heart failure

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8
Q

What kind of heart dysfunction is characterized by an ejection fraction of < 40%?

A

Systolic dysfunction

- LOW ejection fraction

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9
Q

What kind of heart dysfunction is characterized by an ejection fraction of > 50%

A

Diastolic dysfunction

- NEAR normal ejection fraction!

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10
Q

How is ejection fraction calculated?

A

(SV/EDV) x 100
= should be 55 - 70%
Average is 65%

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11
Q

What is associated with systolic dysfunction (2)?

A
  • Poor contractility

- MI

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12
Q

What is associated with diastolic dysfunction?

A
  • Slow or poor relaxation

- Aging

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13
Q

What is diastolic dysfunction (in simple terms)?

A

Ventricular muscle doesn’t relax very well

  • poor distensibility
  • amount of filling will be decreased
  • CO will be decreased
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14
Q

What is it that causes the heart muscle as we get older to become less distensible?

A
  • Deposits of calcium in the heart muscle

- Change in connective tissues (less elasticity)

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15
Q

What happens “in front” of the pump in LEFT sided heart failure?

A
  • reduced ejection because there is less filling
  • CO will decrease
  • decreased oxygenation to the tissues
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16
Q

What happens “behind” the pump in LEFT sided heart failure?

A
  • blood backs up in the LEFT atrium
  • pressure is high in the veins of the lungs
  • results in FLUID IN THE LUNGS
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17
Q

If the left side of the heart fails, what else could fail?

A

RIGHT side of the heart

- because of the fluid backing up into the lungs

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18
Q

What happens “in front” of the pump in RIGHT sided heart failure?

A
  • not enough blood is going to reach the lungs
  • decrease in oxygenation
  • low cardiac output
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19
Q

What happens “behind” the pump in RIGHT sided heart failure?

A
  • blood back up in the RIGHT atrium

- peripheral edema (blood backs up into the body)

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20
Q

What is happening during systole in LEFT sided heart failure?

A

Left ventricle does not pump enough blood to the body

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21
Q

What is happening during diastole in LEFT sided heart failure?

A

Left ventricle does not accept enough blood from the lungs

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22
Q

What is happening during systole in RIGHT sided heart failure?

A

Right ventricle does not pump enough oxygen to the lungs

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23
Q

What is happening during diastole in RIGHT sided heart failure?

A

Right ventricle does not accept enough blood from body

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24
Q

True or False:

Left sided heart failure can cause right sided heart failure

A

True

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25
Q

True or False:

Right sided heart failure can cause left sided heart failure

A

False

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26
Q

What are some manifestations of left sided heart failure?

A
  • Activity intolerance
  • Decreased CO
  • Cyanosis
  • Signs of hypoxia
  • Cough with frothy sputum
  • Paroxysmal nocturnal dyspnea
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27
Q

In what kind of heart failure will a patient exhibit orthopnea? What is it?

A

Difficulty breathing
- hard to breathe when laying down
- easier when sitting up
LEFT sided heart failure

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28
Q

What is paroxysmal nocturnal dyspnea?

A
  • attacks of severe SOB and coughing that occur at night

- It usually awakens the person from sleep

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29
Q

What is ascites?

When is it seen?

A

Fluid collecting in the abdominal cavity

- Right sided heart failure

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30
Q

What are some manifestations of right sided heart failure?

A
  • Edema
  • Ascites
  • Lack of appetite
  • Impaired liver function
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31
Q

Explain why during RIGHT sided heart failure, a patient does not feel hungry.

A

Blood vessels in the GI tract are not being cleared

- signals for hunger are depressed as a result of lack of drainage

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32
Q

What is the pericardium?

A

Membrane enclosing the heart

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33
Q

What are the two layers of the pericardium?

A
  1. Parietal layer - outer layer

2. Visceral layer - inner layer

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34
Q

What is the endocardium continuous with?

A

Endothelium

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35
Q

What is between the parietal and visceral layer of the pericardium?

A

Pericardial cavity

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36
Q

What are the 3 classifications of heart wall disorders?

A
  1. Infectious (Rheumatic) Heart disease
  2. Cardiomyopathies
  3. Valvular disorders
37
Q

What are the 3 kinds of Rheumatic Heart Disease?

A
  1. Endocarditis
  2. Myocarditis
  3. Pericarditis
38
Q

What are two common ways that pericarditis can be caused?

A
  • Dental work

- Urinary catheterization

39
Q

What is pericarditis?

A

Inflammation of the pericardium

- restricts heart’s expansion

40
Q

What does pericarditis cause?

A
  • pain

- restriction of the heart’s movement due to exudate accumulation in pericardium

41
Q

What is cardiac tamponade?

A

Rapid accumulation of exudate in the pericardial sac that compresses the heart

42
Q

What happens to cardiac output if there is pericarditis?

A
  • excess fluid in the envelope of the heart
  • decreased filling
  • EDV will decrease
  • SC will decrease
  • CARDIAC OUTPUT will decrease
43
Q

What happens during constrictive pericarditis?

A

Fibrous scar tissue has formed by persistent presence of bacteria

  • chronic inflammation
  • decreased stretch of surface of the heart
44
Q

What happens when inflammation goes from the pericardium and into the myocardiyum?

A

It will affect the electrical transmission in the heart

- affect ECG

45
Q

What two things are caused by fibrous scar tissue in constrictive pericarditis?

A
  1. Frictional rub

2. Adhesions

46
Q

What are the consequences of the LEFT and RIGHT ventricles of the heart not accepting enough blood due to pericardial effusion?

A 
Left ventricle:
- decreased cardiac output
- decreased blood pressure and shock
Right ventricle:
- increased venous pressure
- jugular distention
47
Q

What are the 3 ways that malfunctioning heart muscle can cause heart failure (myocardial disorders)?

A
  1. Ventricles are too thick (not enough room for blood inside)
  2. Ventricles are too stiff to stretch
  3. Ventricles are too weak to pump out blood that is in them
48
Q

If the heart muscle wall was thickened, what kind of heart dysfunction would it result in (systolic or diastolic)?

A

Diastolic dysfunction

  • poor relaxation
  • hypertrophy of the cardiac muscle
49
Q

If the ventricles are too stiff to stretch, what kind of heart dysfunction would it result in (systolic or diastolic)?

A

Diastolic dysfunction

50
Q

If the ventricles are too weak to pump out the blood that is in them, what kind of heart dysfunction would it result in (systolic or diastolic)?

A

Systolic dysfunction

- result of MI

51
Q

What happens during myocarditis?

A

Ventricular muscle becomes too weak

52
Q

What are the 3 kinds of cardiomyopathies?

A
  1. Dilated
  2. Hypertrophic
  3. Restrictive
53
Q

What are dilated cardiomyopathies?

A

Muscle mass is small, the inside space of the heart is large (aka large cavity)

54
Q

What are hypertrophic cardiomyopathies?

A

Thicker heart muscle, the inside space of the heart is small

- small cavity = SV is small = CO is small

55
Q

What are restrictive cardiomyopathies?

A

Heart becomes stiff, heart size is normal, muscle wall isn’t thick or thin

  • just stiff
  • results in less relaxation; subejct to diastolic failure
56
Q

What is the cause behind hypertrophic cardimyopathy?

A

Defects in the contractile proteins of the heart

  • makes cells too weak
  • they hypertrophy to do the same amount of work as normal cells
  • bigger cells need more oxygen and perform less efficiently
57
Q

What is the name of the valve between the right atrium and right ventricle?

A

Tricuspid valve

- AV valve

58
Q

What is the name of the valve between the left atrium and left ventricle?

A 
Bicuspid valve (mitral)
- AV valve
59
Q

What is the name of the valve leaving the left ventricle?

A

Aortic valve

- semilunar valve

60
Q

What is the name of the valve leaving the right ventricle?

A

Pulmonary valve

- semi lunar valve

61
Q

What are the valves of the heart a part of (continuous with)?

A

Endocardium of the heart

62
Q

What are two types of valve defects?

A
  1. Stenosis

2. Regurgitation

63
Q

What happens during stenosis?

A

Valve will not open all the way

  • it is harder to force blood through it
  • valve is too STIFF
64
Q

What happens during regurgitation?

A

Valve will not close all the way

  • it leaks when it should be closed
  • blood flowing in opposite direction
65
Q

What is physiologically similar to regurgitation?

A

Valve prolapse

66
Q

What does stenosis sound like?

A

Whistling

- high-pitched

67
Q

What does regurgitation sound like?

A

Whooshing

- low-pitched

68
Q

True or False:

Left sided heart problems happen more often than right sided heart problems

A

True

- because there is more pressure

69
Q

What are examples of left sided valvular disorders?

A
  1. Mitral (stenosis or regurgitation)

2. Aortic (stenosis or regurgitation)

70
Q

What will we see in aortic valve stenosis?

A
  • perfusion is down
  • cyanosis can develop
  • weak pulse
  • VENTRICULAR HYPERTROPHY!
  • low CO
71
Q

What will we see in mitral (bicuspid) valve stenosis?

A
  • Blood pooling in left atria

- low CO

72
Q

What will we see in aortic valve regurgitation?

A
  • blood is being drawn from the aorta back into the left ventricle
  • left ventricle is congested
  • low CO
73
Q

What will we see in mitral (bicuspid) valve regurgitation?

A
  • blood backing up into the left atrium
  • blood pooling in the left atria
  • low CO
74
Q

What is shock?

A

Inability to maintain adequate pressure in the peripheral circulation
- perfusion of tissues is compromised

75
Q

What are 4 kinds of shock?

A
  1. Cardiogenic
  2. Hypovolemic
  3. Distributive
  4. Septic
76
Q

What is cardiogenic shock?

A

Heart is not producing enough force to circulate the blood

  • heart is the problem
  • low CO
77
Q

What is hypovolemic shock?

A

Patient doesn’t have enough fluid in the body, even if the heart is okay

  • you don’t have enough pressure to circulate properly
  • low volume = low CO
78
Q

When does distributive shock occur?

A

When peripheral resistance is TOO LOW

  • MAP = CO x TPR
  • blood vessels are TOO WIDE, doesn’t matter if CO is sufficient
79
Q

What kind of shock is septic shock categorized as?

A

Distributive

80
Q

What is a long term complication of MI?

81
Q

Explain the feedback system that responds to cardiogenic shock

A
  1. Heart fails to pump blood adequately
  2. Decreased CO lowers BP
  3. Sympathetic system responds
  4. Vasoconstriction increases resistance to blood flow
  5. Increased workload on heart worsens heart failure
82
Q

Explain what is happening during distributive shock

A
  1. Blood vessels dilate
  2. Not enough blood to fill the circulatory system
  3. Blood flow decreases
  4. Less blood is returned to the heart
  5. Less blood is circulated to the body
83
Q

What are some CAUSES of distributive shock?

A
  • decreased sympathetic activity
  • brain or spine injury
  • anesthetics
  • insulin shock
  • vasodilators
  • anaphylactic shock
  • sepsis
  • vessel damage from severe hypovolemia
84
Q

What is another term for anaphylactic shock?

A

Type 1 hypersensitivity

- blood pressure drops

85
Q

Why can sepsis cause distributive shock?

A

Blood vessels dilate, and blood pressure drops

86
Q

What is another term for septic shock?

A

SIRS

  • Systemic inflammatory response syndrome
  • 40 % mortality
  • inflammatory mediators increase the metabolic rate of tissues, so they need more oxygen
87
Q

What are 2 complications of shock?

A
  1. Acute renal failure

2. Acute respiratory distress syndrome

88
Q

Why does shock cause renal failure?

A

Pressure in the blood in the kidneys can be too low
= CANNOT filters
- cannot get rid of wastes in the blood

89
Q

Why does shock cause respiratory failure?

A

Cannot pump enough blood to the lungs to get enough oxygen

- they will be gasping for air

BHSC 2203 - Patho (13 decks)

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