Week 2 - Cardiovascular system

Question 1

Coronary Artery Disease

Answer 1

Starts with damage to the epithelium, damage results in inflammatory process. Cholesterol binds to the damaged area, macrophages attach to try to break down plaque that shouldn’t be there then they die, cap forms over the top to contain it. This narrows the coronary artery disrupting blood flow to the heart.

Increases risk for thrombus and MI.

Question 2

Stable angina pectoris

Answer 2

Chest pain that is “stable” or predictable. Happens regularly with exercise but never at rest.

Question 3

Unstable angina

Answer 3

Plaque deposits in the coronary artery rupture and exposes necrotic WBC and cholesterol to the blood. Platelets bind to the damaged area resulting in a thrombus. The thrombus can wave back and forth with blood flow looking flow through the vessel intermittently. Can have chest pain at rest.

Question 4

Thrombus

Answer 4

Blood clot

Question 5

Thrombosis

Answer 5

Clot that blocks a blood vessel

Question 6

Embolization

Answer 6

Anything that obstructs an artery, typically a thrombus or air

Question 7

Preload

Answer 7

The amount of stretch of the ventricles exhibit at the end of ventricular filling. More volume=more stretch.

Question 8

Causes of decreased preload

Answer 8

1. Hemorrhage
2. Cardiac tamponade
3. Dehydration

Question 9

Cardiac Tamponade

Answer 9

Compression of the heart by an accumulation of fluid in the pericardial sac

Question 10

Cardiac output

Answer 10

The amount of blood the heart pumps out in 1 minute.

CO= HRxSV

Question 11

Cor pulmonale

Answer 11

Right ventricular failure secondary to pulmonary hypertension.

1. Increased vascular pressure (after load)
2. Increased ejection force of the R ventricle
3. Decreased RV EF
4. Increase in blood remaining in RV
5. Inability of the RA to eject the same amount of blood into the RV
6. Increase in blood remaining in the RA
7. Increased atrial preload
8. Blood backs up into SVC & systemic veins
9. jugular distention and R side HF
10. Increased blood to the liver and spleen causes hepatosplenomegaly
11. Increased BP forces fluids out of circulation and into the tissues causing peripheral edema.
12. Increase pressure to L side of the heart.

Question 12

Stroke Volume

Answer 12

The volume of blood pumped out of the left ventricle during each systolic cardiac contraction

Question 13

Afterload

Answer 13

The force (load) with which the heart muscle must contract agains in order to pump blood. For example systemic vascular resistance.

Question 14

Causes of Cor Pulmonale

Answer 14

1. Pulmonary disease resulting in pulmonary hypertension (most common)
2. RV MI
3. RV hypertrophy
4. Tricuspid valve damage
5. Secondary to L HF

Question 15

High Output Heart Failure

Answer 15

Inability of the heart to pump enough blood to meet the circulatory needs of the body despite normal blood volume and cardiac contractility. Anemia impairs oxygen delivery to the tissues.

Question 16

Causes of High Output Heart Failure

Answer 16

1. Nutritional deficiencies (thiamine) causing decreased function and output.
2. Hyperthyroidism, fever, sepsis
   
   • increase basal rate, increase oxygen demands, not enough 02 causes hypoxia

Question 17

Compensated Heart Failure

Answer 17

The heart dries to compensate and the SNS is activated which stimulates increased heart rate (faster) and increased stroke volume (harder). Preload is increased and the heart needs more oxygen which isn’t available. Heart cells start to die off. To compensate for dead cells the remaining cells bulk up to maintain CO, they also need more oxygen and start to die off. Heart chambers become smaller due to hypertrophy

Question 18

Decompensated Heart Failure

Answer 18

1. Overuse of the SNS means receptors are lost and there is a lowered response.
2. Increased preload causes cell death and lack of oxygen
3. Hypertrophy causes cell death due to lack of oxygen.

Question 19

Four Stages of Heart Failure

Answer 19

Stage A - no limit on physical activity, no HF symptoms
Stage B - Slight limit on physical activity, activity results in symptoms
Stage C - Clinical development of Heart Failure
Stage D - No physical activity without symptoms, symptoms at rest.

Question 20

Sounds of Aortic Regurgitation

Answer 20

1. Early diastolic murmur, high pitched at left sternal border
2. Diastolic rumbling at apex
3. Systolic crescendo-decrescendo at left upper sternal border

Question 21

Sound of Aortic stenosis

Answer 21

Mid systolic crescendo-decrescendo murmur with an S4 gallop

Question 22

Sound of Mitral regurgitation

Answer 22

Blowing, pan-systolic murmur

Question 23

Sound of mitral stenosis

Answer 23

Rumbling, decrescendo murmur at apex of the heart

Question 24

Aortic Stenosis

Answer 24

Tight aortic valve resulting in blood backing up into the left ventricle and poor perfusion of body tissues.

Question 25

Aortic stenosis is caused by

Answer 25

1. Bicuspid aortic valve - genetic, two valves instead of three
2. Age related calcification
3. Rheumatic fever

Question 26

Aortic regurgitation

Answer 26

When the aortic valve becomes floppy allowing blood back from the aorta into the ventricle when filling

Question 27

Causes of Aortic Regurgitation

Answer 27

1. Aneurysm of the aortic annuals (tissue and valve)
2. Endocarditis - vegetation on the valve
3. Rheumatic fever

Question 28

Mitral valve regurgitation

Answer 28

Floppy mitral valve allowing fluid to backup into the pulmonary system and lungs.

Question 29

Mitral valve

Answer 29

Valve between the left atria and ventricle

Question 30

Tricuspid valve

Answer 30

Valve between the right atrium and right ventricle

Question 31

Aortic valve

Answer 31

Valve between the left ventricle and aorta

Question 32

Pulmonary Valve

Answer 32

Valve between the right ventricle and pulmonary artery.

Question 33

Causes of mitral valve regurgitation

Answer 33

1. Anything that leads to left ventricle dilation including:
   - remodeling post MI
   - dilated cardiomyopathy
   - papillary muscle dysfunction
   - chordae tendonae

Question 34

Mitral valve prolapse

Answer 34

Mitral valve bulges into the left atrium (like an aneurysm)

Question 35

Causes of mitral valve prolapse

Answer 35

1. Idiopathic (unknown cause)
2. Secondary to connective tissue disorder

Question 36

Mitral valve stenosis

Answer 36

Tightened mitral valve

Question 37

Causes of mitral valve stenosis

Answer 37

1. Rheumatic fever
2. Endocarditis (inflammation/infection of mitral valve)