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S7- Cardiopulmonary > Week 2- KEY SLIDES > Flashcards

Week 2- KEY SLIDES Flashcards

1
Q

PART 1: HEART FAILURE (HF)

A

PART 1: HEART FAILURE (HF)

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2
Q

What are the (3) main portions of the O2 supply chain?

A
  • Tissue
  • Heart
  • Airway/lungs
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3
Q

Cardinal S/Sx of cardiac dysfunction. (6)

A
  1. ) Inappropriate fatigue and/or weakness
  2. ) Dyspnea (SOB)
  3. ) Exercise intolerance
  4. ) Rapid/irregular heartbeat
  5. ) Bilateral LE swelling
  6. ) Persistent cough
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4
Q

Basic Facts:

  • The heart generates almost all of its energy needed to drive its primary function (pumping blood) through ________ metabolism (O2 requiring process).
  • Does the heart have an energy storage?
  • Are O2 needs constant?
  • Inability to match energy __________ and _________ compromises cardiac function.
A
  • aerobic metabolism
  • No, the heart matches its energy needs with energy synthesis.
  • No, O2 needs are variable. (exercise!)
  • energy synthesis and energy expenditure
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5
Q

CO = ___ x ___

A

CO = SV x HR

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6
Q

What are the (3) contributing factors to SV?

A
  1. ) Preload
  2. ) Contractility
  3. ) Afterload
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7
Q

HR is influenced by _________ and __________ tone.

A

parasympathetic and sympathetic

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8
Q

Wiggers Diagram

A

Wiggers Diagram

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9
Q
  • Patients with Left Sided HF have compromised __________.

- What is the impact of L Sided HF? (3)

A

-CONTRACTILITY

  1. ) Reduced SV, EF, and CO. →
  2. ) Blood flow (O2 delivery) to the body is reduced. →
  3. ) Fatigue, exercise intolerance, SOB
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10
Q

L Sided HF S/Sx. (10)

A
  1. ) Exertional Dyspnea (SOB)
  2. ) Fatigue, tiredness
  3. ) Paroxysmal Nocturnal Dyspnea
  4. ) Orthopnea (SOB w/ recumbent position)
  5. ) Tachycardia
  6. ) Cyanosis
  7. ) Confusion
  8. ) Restlessness
  9. ) Elevated Pulmonary Capillary Wedge Pressure
  10. ) Pulmonary Congestion
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11
Q
  • Patients with Right Sided HF have compromised __________.

- What is the impact of R Sided HF?

A
  • CONTRACTILITY

- Accumulation (congestion) of blood in RV, RA, and the SYSTEMC CIRCULATION resulting in systemic S/Sx.

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12
Q

R Sided HF S/Sx. (9)

A
  1. ) Fatigue
  2. ) ↑ Peripheral Venous Pressure
  3. ) Ascites (Fluid in abdomen)
  4. ) Spleen/Liver Enlargement
  5. ) Possible secondary to chronic pulmonary problems
  6. ) JVD
  7. ) Anorexia & Complaints of GI Distress
  8. ) Weight Gain
  9. ) Dependent Edema (systemic accumulation)
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13
Q

What is CHF?

A

Congestive Heart Failure

  • A clinical condition in which the heart is unable to pump enough blood to meet the metabolic needs of the body because of pathological changes in the myocardium.
  • Type of HF most commonly seen.
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14
Q

Describe the (5) stages of CHF.

A

Normal
-No symptoms, normal exercise, normal LV function.

Asymptomatic LV Dysfunction
-No symptoms, normal exercise, abnormal LV function.

Compensated CHF
-No symptoms, ↓ exercise, abnormal LV function.

Decompensated CHF
-Symptoms, ↓↓ exercise, abnormal LV function.

Refractory CHF
-Symptoms not controlled w/ treatment.

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15
Q

HFrEF vs HFpEF.

A

HFrEF (Systolic HF)
-LV contractility recuded, in turn reducing EF and O2 delivery. Net effect is reduced delivery of blood to systemic circulcation.

HFpEF (Diastolic HF)
-Ventricles lose ability to relax normally and become stiffer/less compliant. Heart chambers cannot fill normally during diastole.

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16
Q
  • Is HFrEF more common in men or women?

- Is HFpEF more common in men or women?

A
  • men

- women

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17
Q

NYHA HF Classifications. (4)

A

Stage 1
-Cardiac disease, but no symptoms or limitations in ordinary physical activity.

Stage 2
-Mild symptoms and slight limitations during ordinary activity.

Stage 3
-Significant limitations in activity due to symptoms. Comfortable only at rest.

Stage 4
-Severe limitations. Symptoms even while at rest.

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18
Q

Last Words:

  • HF is now recognized as a __________ disease rather than simply heart disease.
  • Is HF exclusively a “cardio-centric” disease?
A
  • neuroendocrine disease
  • No, can have endothelial dysfunction, skeletal muscle damage, kidney dysfunction, and decreased systemic blood flow and accompanying increased total peripheral resistance secondary to excessive sympathetic stimulation causing vasoconstriction.
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19
Q

PART 2: ISCHEMIC HEART DISEASE

A

PART 2: ISCHEMIC HEART DISEASE

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20
Q
  • What is ischemia?
  • What is hypoxemia?
  • What is hypoxia?
A
  • Ischemia = A condition in which the blood flow (and thus O2) is restricted or reduced in a part of the body.
  • Hypoxemia = Low O2 in blood. (O2 sats!!)
  • Hypoxia = Low O2 at tissue.
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21
Q

What is ACS?

A

Acute Coronary Syndrome

-UMBRELLA term for a range of symptoms associated with sudden, reduced blood flow to the heart.

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22
Q

ACS diagnosis is dependent on Hx and examination. What will be found during each of these?

A

Hx

  • chest/left arm pain
  • Hx of CAD

Examination

  • Hypotension/diaphoresis
  • Pulmonary edema/rales
  • ECG changes
  • Elevated cardiac biomarkers
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23
Q

What is the most common diagnosis under the umbrella term ACS that is the most common cause of death in the US and western EU?

A

IHD

24
Q

Describe the (3) steps of progression of IHD?

A
  1. ) CAD (plaque build up)
  2. ) Angina (due to blood flow difficulty)
  3. ) Heart Attack (plaque breaks off and blocks artery)
25
Q

IHD Risk Factors. (10)

A
  1. ) Age/Gender
  2. ) Smoking Hx
  3. ) Family Hx
  4. ) Hyperlipidemia
  5. ) HTN
  6. ) Diabetes
  7. ) Obesity
  8. ) Poor diet
  9. ) Physical inactivity
  10. ) High levels of stress
26
Q

What is angina pectoris?

A

Intermittent chest pain caused by transient but reversible myocardial ischemia.

27
Q

Describe the difference between unstable and stable angina.

A
  • Stable angina occurs at a predictable HR.
  • Unstable angina onset is unpredictable.

-Both stable and unstable angina are brought on by exertion or other forms of stress and presents as crushing/squeezing substernal sensation w/ possible radiation to the arm.

28
Q

Describe the (4) functional classifications of angina.

A

Class I = occurs after prolonged exertion
Class II = walking >2 blocks or >1 flight of stairs
Class III = walking <2 blocks or <1 flight of stairs
Class IV = occurs at minimal exertion or rest

29
Q

MI- “_____ is _________”

A

“Time is Tissue”

-If ischemic insult is sufficiently long, tissue damage and death results.

30
Q
  • What is a natural unexpected death secondary to cardiac causes with rapid loss of consciousness?
  • What percentage of CAD deaths do they make up?
A
  • Sudden Cardiac Death

- Make up 50% of CAD deaths.

31
Q

Sudden Cardiac Death Anatomical Findings. (3)

A
  • Acute Coronary Plaque Rupture of Thrombosis
  • Clinically quiet MI
  • No acute lesions but >60% stenosis of a coronary artery. (often LAD)
32
Q

PART 3: HTN

A

PART 3: HTN

33
Q

What is Poiseuille’s Law?

A

-Q=ΔP X r4

Flow=pressure gradient* radius^4

34
Q
  • If the radius decreases, the resistance to blood flow __________ and blood flow _________.
  • How can we preserve blood flow if r decreases? What effect does this have on the heart?
A
  • increases
  • decreases

-Increase ΔP which means the heart has to work harder.

35
Q

Systolic BP is the ________ pressure exerted against the wall of a blood vessel, while diastolic BP is the _________ pressure exerted against the wall of a blood vessel.

A
  • maximum

- minimum

36
Q
  • What is double product?

- What is the equation for it?

A
  • Double product is an index of myocardial O2 consumption.

- DP = HR*SBP

37
Q

Describe each of the following BP categories:

  • Normal
  • Elevated
  • HTN Stage 1
  • HTN Stage 2
  • Hypertensive Crisis
A

Normal
-SBP <120, DBP <80

Elevated
-SBP 120-129, DBP <80

HTN Stage 1
-SBP 130-139, DBP 80-89

HTN Stage 2
-SBP >140, DBP >90

Hypertensive Crisis
-SBP >180, DBP >120

38
Q

Only 20% of patients take ALL HTN medications. What are some reasons for this? (7)

A
  • Unpleasant side effects
  • Interference with sexual function
  • Cost
  • Doesn’t change the way a patient feels
  • Increased age
  • Gender (female), Race (African American)
39
Q
A
  • Essential (90%) HTN (no known cause)

- Secondary (10%) HTN (caused by conditions that affect kidneys, arteries, heart or endocrine system)

40
Q

Explain how HTN can lead to kidney disease. (3 steps)

A
  1. ) Uncontrolled high BP can cause arteries in the glomeruli to narrow, weaken, or harden.
  2. ) These damaged arteries deliver less and less filtrate to the nephron.
  3. ) The kidneys perceive reduced filtration as a reason to increase water and Na+ reabsoprtion resulting in increased blood volume (preload) and therefore BP.
  4. ) Reduced filtration activates renin-angiotensin cascade which favors water and Na+ reabsorption.
  5. ) Net effect is ↑ preload, ↑ total peripheral resistance, and ↓ ability to control BP.
  • Creates downward spiral in kidney function.
  • KNOW BP OF ALL PATIENTS WITH KIDNEY DISEASE!
41
Q

Explain how kidney disease can lead to HTN.

A
  1. ) As kidneys become increasingly dyfunctional they lose ability to regulate BP.
  2. ) Pt becomes hypertensive by same process as stated before.
42
Q

Can diabetes lead to HTN? If so, how?

A

Yes

  • Chronically elevated glucose levels damage glomerular filtration, thereby reducing it.
  • Kidney responds by reabsorbing more water and Na+, increasing fluid volume and BP.
43
Q

What is Cor Pulmonale?

A
  • Enlargement/dysfunction of RV caused by a primary pulmonary disorder.
  • PULMONARY HTN
44
Q

Why can the R side of the heart move the same blood volume as the L side? (4)

A
  1. ) Shorter length of tubing
  2. ) More compliant vessels
  3. ) Much lower impact of gravity on blood flow
  4. ) Q=𐤃P * r⁴
45
Q

Assessment Criteria for Taking BP. (11)

A
  1. ) Resting for 5m prior
  2. ) legs uncrossed
  3. ) feet on floor
  4. ) arm supported
  5. ) correct cuff size
  6. ) cuff placed over bare arm
  7. ) no talking
  8. ) no phone or reading
  9. ) BP taken in both arms
  10. ) correctly identifying BP from arm with higher reading
  11. ) correctly identifying which arm to use for future readings (one with higher BP)
46
Q

PART 4: CARDIOMYOPATHIES

A

PART 4: CARDIOMYOPATHIES

47
Q

Cardiomyopathy:

  • What is cardiomyopathy?
  • Is decline in cardiac function reversible?
  • Are these patients appropriate for heart transplants?
A
  • Disorder within the cardiac myocytes themselves which resulting in decreased cardiac performance.
  • No, typically leads to irreversible decline in cardiac function.
  • Yes, often long-term cardiomyopathy patients are appropriate for transplantation.
48
Q

What is the most powerful risk stratifier for cardimyopathy?

A

LVEF

49
Q

What are the (3) types of cardiomyopathies?

A
  • Dilated Cardiomyopathy
  • Hypertrophic Cardiomyopathy
  • Restrictive Cardiomyopathy
50
Q

Dilated Cardiomyopathy:

  • What is it? What does this lead to?
  • _______ heart weight.
  • _______ walls.
  • Impaired _______ function with cardiac enlargement.
  • _________
A
  • Abnormal cardiac morphology (chamber dilation) and contractile impairment resulting in decreased EF and/or SV.
  • increased heart weight
  • thinned walls
  • impaired systolic function
  • fibrosis
51
Q

What are some causes of Dilated Cardiomyopathy? (6)

A
  • ETOH/toxic substances
  • Poor nutrition (B1 deficiency)
  • Idiopathic, family Hx
  • AIDS
  • CT
  • Cancer therapies
52
Q

Hypertrophic Cardiomyopathy:

  • What is it? What does this lead to?
  • ___ gene defects which cause defects in sarcomeric proteins.
  • What is most often the first clinical manifestation?
  • Majority of cases are ___________.
  • What are the 2 types?
A
  • Thickened LV wall with non-dilated LV chamber leading to hypertrophy out of proportion to hemodynamic load and decreased functional capacity.
  • 9
  • sudden death
  • asymptomatic
  • Obstructive and Nonobstructive HCM
53
Q

Restrictive Cardiomyopathy:

  • What is it? What does this lead to?
  • _____ and ____ are normal.
  • _________
A
  • Characterized by restricted diastolic filling due to wall loss of compliance. Leads to diminished EDV and compromised SV.
  • EDV and EF normal
  • fibrosis
54
Q

Cardiomyopathy:

  • Which type of cardiomyopathies have diastolic dysfunction? Which ones have systolic dysfunction?
  • Which is the single most common cause of death in healthy young people?
  • Which is the most rare form?
  • Which is the most common?
A
  • Diastolic (Hypertrophic, Restrictive), Systolic (Dilated)
  • Hypertrophic Cardiomyopathy
  • Restrictive Cardiomyopathy
  • Dilated Cardiomyopathy
55
Q

Myocarditis:

  • What is it?
  • What is it usually caused by?
  • What can it lead to?
A
  • Inflammation of the myocardium.
  • Usually caused by viral infection.
  • Can lead to HF, arrhythmia, and sudden death.
56
Q

What are the (4) types of aneurysms? Describe each.

A

True

  • Saccular = unilateral outpouching
  • Fusiform = bilateral outpouching
  • Dissecting = bilateral outpouching w/ vessel wall separation creating a cavity.

False
-False = Wall ruptures and blood clot is retained in outpouching of tissue.

S7- Cardiopulmonary (24 decks)

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