Week 2- KEY SLIDES Flashcards
1
Q
PART 1: HEART FAILURE (HF)
A
PART 1: HEART FAILURE (HF)
2
Q
What are the (3) main portions of the O2 supply chain?
A
- Tissue
- Heart
- Airway/lungs
3
Q
Cardinal S/Sx of cardiac dysfunction. (6)
A
- ) Inappropriate fatigue and/or weakness
- ) Dyspnea (SOB)
- ) Exercise intolerance
- ) Rapid/irregular heartbeat
- ) Bilateral LE swelling
- ) Persistent cough
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
5
Q
CO = ___ x ___
A
CO = SV x HR
6
Q
What are the (3) contributing factors to SV?
A
- ) Preload
- ) Contractility
- ) Afterload
7
Q
HR is influenced by _________ and __________ tone.
A
parasympathetic and sympathetic
8
Q
Wiggers Diagram
A
Wiggers Diagram
9
Q
- Patients with Left Sided HF have compromised __________.
- What is the impact of L Sided HF? (3)
A
-CONTRACTILITY
- ) Reduced SV, EF, and CO. →
- ) Blood flow (O2 delivery) to the body is reduced. →
- ) Fatigue, exercise intolerance, SOB
10
Q
L Sided HF S/Sx. (10)
A
- ) Exertional Dyspnea (SOB)
- ) Fatigue, tiredness
- ) Paroxysmal Nocturnal Dyspnea
- ) Orthopnea (SOB w/ recumbent position)
- ) Tachycardia
- ) Cyanosis
- ) Confusion
- ) Restlessness
- ) Elevated Pulmonary Capillary Wedge Pressure
- ) Pulmonary Congestion
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.
12
Q
R Sided HF S/Sx. (9)
A
- ) Fatigue
- ) ↑ Peripheral Venous Pressure
- ) Ascites (Fluid in abdomen)
- ) Spleen/Liver Enlargement
- ) Possible secondary to chronic pulmonary problems
- ) JVD
- ) Anorexia & Complaints of GI Distress
- ) Weight Gain
- ) Dependent Edema (systemic accumulation)
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.
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.
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.
16
Q
- Is HFrEF more common in men or women?
- Is HFpEF more common in men or women?
A
- men
- women
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.
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.
19
Q
PART 2: ISCHEMIC HEART DISEASE
A
PART 2: ISCHEMIC HEART DISEASE
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.
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.
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
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
- ) CAD (plaque build up)
- ) Angina (due to blood flow difficulty)
- ) Heart Attack (plaque breaks off and blocks artery)
25
IHD Risk Factors. (10)
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
What is angina pectoris?
Intermittent chest pain caused by transient but reversible myocardial ischemia.
27
Describe the difference between unstable and stable angina.
- 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
Describe the (4) functional classifications of angina.
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
MI- "_____ is _________"
"Time is Tissue"
| -If ischemic insult is sufficiently long, tissue damage and death results.
30
- What is a natural unexpected death secondary to cardiac causes with rapid loss of consciousness?
- What percentage of CAD deaths do they make up?
- Sudden Cardiac Death
| - Make up 50% of CAD deaths.
31
Sudden Cardiac Death Anatomical Findings. (3)
- Acute Coronary Plaque Rupture of Thrombosis
- Clinically quiet MI
- No acute lesions but >60% stenosis of a coronary artery. (often LAD)
32
PART 3: HTN
PART 3: HTN
33
What is Poiseuille's Law?
-Q=ΔP X r4
| Flow=pressure gradient* radius^4
34
- 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?
- increases
- decreases
-Increase ΔP which means the heart has to work harder.
35
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.
- maximum
| - minimum
36
- What is double product?
| - What is the equation for it?
- Double product is an index of myocardial O2 consumption.
| - DP = HR*SBP
37
Describe each of the following BP categories:
- Normal
- Elevated
- HTN Stage 1
- HTN Stage 2
- Hypertensive Crisis
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
Only 20% of patients take ALL HTN medications. What are some reasons for this? (7)
- Unpleasant side effects
- Interference with sexual function
- Cost
- Doesn't change the way a patient feels
- Increased age
- Gender (female), Race (African American)
39
-What are the (2) types of HTN and which one has no known cause?
-
- Essential (90%) HTN (no known cause)
| - Secondary (10%) HTN (caused by conditions that affect kidneys, arteries, heart or endocrine system)
40
Explain how HTN can lead to kidney disease. (3 steps)
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
Explain how kidney disease can lead to HTN.
1. ) As kidneys become increasingly dyfunctional they lose ability to regulate BP.
2. ) Pt becomes hypertensive by same process as stated before.
42
Can diabetes lead to HTN? If so, how?
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
What is Cor Pulmonale?
- Enlargement/dysfunction of RV caused by a primary pulmonary disorder.
- PULMONARY HTN
44
Why can the R side of the heart move the same blood volume as the L side? (4)
1. ) Shorter length of tubing
2. ) More compliant vessels
3. ) Much lower impact of gravity on blood flow
4. ) Q=𐤃P * r⁴
45
Assessment Criteria for Taking BP. (11)
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
PART 4: CARDIOMYOPATHIES
PART 4: CARDIOMYOPATHIES
47
Cardiomyopathy:
- What is cardiomyopathy?
- Is decline in cardiac function reversible?
- Are these patients appropriate for heart transplants?
- 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
What is the most powerful risk stratifier for cardimyopathy?
LVEF
49
What are the (3) types of cardiomyopathies?
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
- Restrictive Cardiomyopathy
50
Dilated Cardiomyopathy:
- What is it? What does this lead to?
- _______ heart weight.
- _______ walls.
- Impaired _______ function with cardiac enlargement.
- _________
- 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
What are some causes of Dilated Cardiomyopathy? (6)
- ETOH/toxic substances
- Poor nutrition (B1 deficiency)
- Idiopathic, family Hx
- AIDS
- CT
- Cancer therapies
52
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?
- 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
Restrictive Cardiomyopathy:
- What is it? What does this lead to?
- _____ and ____ are normal.
- _________
- Characterized by restricted diastolic filling due to wall loss of compliance. Leads to diminished EDV and compromised SV.
- EDV and EF normal
- fibrosis
54
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?
- Diastolic (Hypertrophic, Restrictive), Systolic (Dilated)
- Hypertrophic Cardiomyopathy
- Restrictive Cardiomyopathy
- Dilated Cardiomyopathy
55
Myocarditis:
- What is it?
- What is it usually caused by?
- What can it lead to?
- Inflammation of the myocardium.
- Usually caused by viral infection.
- Can lead to HF, arrhythmia, and sudden death.
56
What are the (4) types of aneurysms? Describe each.
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.
