Week 5- Cardiac Flashcards
Name layers of the heart from the outside
Pericardium (fibrous)
Myocardium (cardiac muscle)
Epicardium
What sign shows pathological issues of the heart
Altered cardiac output
Leaks in system (plumbing)
Obstruction to flow
Valve problems
Electrical conduction
Most cardiovascular;ar form a complex interplay of genetics and environment
What is congenital heart disease
Structural or functional abnormalities sin the heart that are present at birth
Results in shunting of blood between right and left circulation or cause outflow of blood
Name classifications. of heart failure
Acute cardiac failure= heart attack
Chronic or congestive heart failure = mechanisms trying to maintain CO
What is the difference between systole failure and diastole failure
S= CONTRACTION
D= RELAXATION
S=Ventricles loose ability to contract
normally
D=Ventricles loose ability to relax
S= Myocardium; thin, dilated, compliant
D=myocardium, fibrotic, stuff, thickened and non compliant
S= Stasis of blood behind weakened
ventricle
D=can progress to systolic failure
• Examples:
Myocardial infarction
Dilated cardiomyopathy
M & T valve regurgitation, arrythmia
D= myocardial infarction
Aortic stenosis
Constricted pericarditis
Signs of left sided heart failure
Tired
Cynotic (bluish colour)
High hr
Body not getting enough o2
Pulmonary odema- shallow breath
Increased breathing rate, normal range is 12-20 breaths pm
Night sweats
Confusion
In exercise rapid hr
Dizziness when stand up
What is left sided heart failure caused by
Ischiameic heart disease
Aortic and mitral valve disease
List clinical effects of left SIded heart failure
Statins in left chambers
Passive congestion
Blood backing upo in pulmonary circulation
Inadequate perfusion to downstream tissues leading to organ dysfunction
What is right sided heart failure caused by
Left sided heart failure
Occurs in patients with lung disorders
Clinical effects of right sided hf
Kidney and brain affected
Systemic venous congestion can lead to odema
Signs of right sided heart failure
Fatigue
Odema in ankles and spleen
Struggle to breath due to deoxygenated blood and co2 not unloading
Weight gain
Anorexia and GI distress
Distended jugular veins
Ascites
Enlarged liver and spleen
Peripheral venous pressure incraesed
What is ischaemica heart disease/ coronary artery disease
Imbalance between myocardial supply and cardiac demand for oxygenated blood
If coronary arteries are blocked local ischaemia is where heart muscle isn’t getting enough o2. Leads to that part of heart mot contracting
Years later fibrotic and wont contract. Restricted HB
Name four clinical presentations of ischameic heart disease
Angina pectoris
Myocardial infarction
Chronic IHD
Sudden cardiac death
Name four clinical presentations of ischameic heart disease
Angina pectoris
Myocardial infarction
Chronic IHD
Sudden cardiac death
List angina pectoris
- Stable= induced by activities that increase requirement , pain
- Prinzmental is uncommon caused by a coronary artery spasm not related to energy
- Unstable= increasingly frequent and prolonged over 20min low levels of exercise. Prelude to heart attack
Nitroglycerin is a vasodilator med
What is a myocardial infarction
Heart attack
Prolonged ischameic causes death of cardiac muscle
Increases with age and sex (more common in males)
Aetiology of myocardial infarction
Increased myocardial metabolic demand
Physical exertion
Severe hypertension
Severe aortic stenosis
High BP
Decreased delivery of o2 and nutrients to the myocardium via the coronary circulation
Atherosclerosis or dynamic coronary artery sclerosis
Clinical presentation of myocardial infarction
Sudden chest pain
Radiation of pain in to left jaw, teeth, shoulder, arm and back
Sweating
Impairment of cognitive function
Unusual tired
What is chronic ischameic heart disease
Caused by accumulated ischameic myocardial damage or inadequate response due to long standing atherosclerotis obstruction
Thick, fibrosis
Grow new muscular wall
What is sudden cardiac death
Unexpected death from cardiac causes either without symptoms of within 1 to 24 hours of symptom onset
Too much demand on eart
Coronary artery disease is the leading cause
What is arrhythmias
Deviations from normal heart beat pattern
Abnormalities in origin, rate, rhythm, conduct, velocity and seuqnce of atrial and ventricular activation
Sustained or sporadic
Any flutter- get it checked
Pathogenesis of arrythmiasd
Pathological heart disease
Electrolyte disturbance or acid- base imbalances
Physical and chemical factors or toxicosis (alcoholism and drugs)
Systemic disease
Heritable conditions like congenital abnormalities, hyoertiohc and cardiomyopathy
What does systemic mean
Systemic= affects all part of the body
What is hypertensive heart disease
Increase demands placed on heart by hp=hypertension causing pressure overload and ventricular hyoertiphy
No1 cause of death associated with high bp
What is pulmonary (r-sided) hypertrophic heart disease
Right ventricular pressure overload
Hypertrophy, dilation, r-sided failure
Caused by disordered of the lungs
Decreased benticlar space
Increased cardiac muscle
Why do we look on the palm of the hands
Xanthomas - hypercholesterolaemia. Deposits of cholesterol
Olsers nodes- lesions of the fingers
Tanning staining- smoking
What is schemroth window test
Get the patient to form a heart with index. If there’s a little diamond there is a negative sign
Positive sign= no diamond. Digital clubbing
CV. Disease
In a heart exam what do we observe
Shortness of breath, cyanosis (blue), pallor (colour, pink in knuckles and palm), odema
Why do we look palm down
Peripheral cyanosis (congenital heart disease or heart failure)
Splinter haemorrhages in nail (visualities or infective endocarditis)
What is a collapsing pulse
Radial pulse and lift arm in air. Forecdul and knocking sensation indicated aortic valve regurgitation
When we do heart exam, why do we check their eyes
Eyes= xanthelasma yellow bump on or near eyelid. Cholesterol deposit
Cornea arcus(white ring around eye) high cholesterol
Conjunctival pallor
White under eye sign of anaemia
In heart exam why do we inspect the mouth
Bad dental hygein
High arched palate
Angular stomatosis (inflamed around the mouth, sores)
Central cyanosis (bluish colour)
Why would we check chest wall in heart exam
Chest wall deformities
Scars for pacemaker, sternotomy
How to stethoscope
2nd rib on right- aortic
2nd rib on left - pulomarfy
Max area- central between 3rf and 4th rib
Tricuspid- 4th
Mitral-between 5th and 6th left
List vital signs
Blood pressure 120/80
Oxygen saturation
Heart rate and rhythm 60-100bpm
Over= tachycardia
Under=bradycardia
Temperature 37c 37.7c
List vital signs
Blood pressure 120/80
Oxygen saturation
Heart rate and rhythm 60-100bpm
Over= tachycardia
Under=bradycardia
Temperature 37c 37.7c
Tachycardia vs bradychardia
T= 100+
Fever
Anxiety
Dehydration
Infection
Arrythmiuas
Medication
Endmia
Symptoms= dizziness, chest pain, fainting, palpitations
B= <60
Aging
Heart disease
Hypothyroidism
Electrolyte imbalances
Medications
Hypothermia
Symptoms= fatigue
Dizziness
Fainting
Shortness of breath
Chest pain
Confusion
What is Virchow Triad
3 primary factors which contribute to formation of thrombus (blood clot) in veins and arteries,
- Stasis of blood flow
-blood flow which is slow or stagnant is a risk factor. It allows platelets and clotting factors to accumulate.
-immobility, heart failure and varicose veins can affects this. - Endothelial injury
-damage to endothelial from trauma, surgery or inflammation can trigger the clotting process
-atherosclerosis (plaque build up) high bop can affect this. - Hypercoagubility
-heightened tendency of blood clot. Hormones, medications, inflammation and dehydration can affect this.
In a heart exam, what should heart beat sound like
A clear, rhymic noise
Lub dub
If there was fluid this heart beat will not be clear
