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HLSC 222 > Cardiovascular system part 1 (Heart disease) > Flashcards

Cardiovascular system part 1 (Heart disease) Flashcards

1
Q

List the 4 major coronary arteries & their locations

A
  • Right coronary artery (Back of the heart)
  • Left main coronary (divided into 2 branches, leftanteriordescending
    & left circumflex artery) –> Any blockage here will affect the left ventricular
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2
Q

Which term refers to the amount of blood pumped by each ventricle in 1 min?It’s the product of stroke volume. (Volume/min)

List the which 2 variables affect this term (formula)

& what is the normal value of said term?

A

Cardiac output

  • Cardiac output= Stroke volume x Heart rate* e.g. 4800ml = 60ml x 80 per/min
  • Normal CO = 4.2 – 7 L/min
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3
Q

Which term refers to the the amount amount of blood pumped in 1 heart rate (Volume/beat)

An increase in said term results in…

& what is the normal value of said term?

A

Stroke volume

  • An increase I stroke volume results in an increase in cardiac output & vice versa.
  • Normal stroke volume is 60-100 ml/beat
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4
Q

Which term refers to number of beats in 1 min? (beats/min)

An increase in said term results in an increase in…

What is the normal value for said term?

A

Heart rate
- An increase I heart rate results in an increase in cardiac output & vice versa
- Normal heart rate is 70 beats per min

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5
Q

Which term refers to how the ventricles don’t eject all of the blood in one beat, in a typical example the ventricle is filled with about 100ml of blood but only 60ml is ejected during contraction, resulting in…? Or can be described as the measurement of the percentage of blood leaving your heart each time left ventricle contracts.

Where the 100 ml in the example being the..?

And the 40ml in the example being..?

What the formula involving these 2 variables and the stroke volume?

A

Ejection fraction (EF)
- An ejection fraction of 60%
- End-diastolic volume (EDV), meaning at the end of diastole/filling
- End-systolic volume (ESV), meaning at the end of systole/contraction.
- Stroke volume = EDV -ESV

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6
Q

(Factors that influence stroke volume)

Which factor that influences stroke volume refers to the force of the contraction of the heart muscle, where the more forceful the contraction, the more blood it ejects?

Which factor that influences stroke volume is related to end-diastolic volume, and is the degree of stretch of cardiac myocytes at the end of ventricular filling, but since this parameter is not readily measurable in patients, EDV is used instead? & describe the balloon analogy

Which factor that influences stroke volume refers to the resistance that the ventricle must overcome to eject blood? It contains 2 major components, (1) which is the pressure in the left ventricle must be greater than the systemic pressure for the aortic valve to open. Similarly, the pressure in the right ventricle must exceed pulmonary pressure to open the pulmonary valve. & provide an example. & (2) ___

A
  • Contractility:
  • Preload: Just like a balloon, the more air it contains, the more stretched it becomes. According to the Frank-Starling mechanism, the greater the stretch, the greater the force of contraction. In the balloon analogy, the more inflated the balloon, the more forceful it releases air when deflated
  • After load: (1) Vascular pressure, where in hypertension for example higher vascular pressures make it more difficult for the valves to open, resulting in a reduced amount of ejected blood. & (2) Damage to the valves, such as stenosis, also presents higher resistance and leads lower blood output.
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7
Q

(Factors that influence stroke volume)

Increased preload results in…?

Increased afterload results in..?

Increased in contractility/inotropy results in..?

A
  • Increased SV (increased EDV)
  • Decreased SV (Increased ESV)
  • Increased SV (Decreased EDV)
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8
Q

Which term refers to the leading cause of death in Canada, and is related issues with the small coronary arteries that supply the cardiac tissue?

& what is the main issue/cause of said condition?

A

Coronary Artery Disease

  • Atherosclerosis, due to the characteristics of the coronary arteries being very small and spiralling.
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9
Q

List some modifiable and non-modifiable risk factors for coronary artery disease

A

Modifiable: Dyslipidemia, hypertension, cigarette smoking, diabetes mellitus, obesity, sedentary lifestyle, atherogenic diet

Non-modifiable: Age, gender, & family history

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10
Q

(Myocardial ischemia) Which term refers to an angina that is coming and going, usually occurring during exertion, due to the gradual narrowing of the coronary arteries; such as during exercise where you experience pain but when you rest the pain goes away?

& provide an example

A

Stable angina
- You usually drive to work, but I change my routine and go for a 30 min run, which is out of norm; the heart is under stress, the heart load work goes up, and the perfusion doesn’t go up, and you feel pain

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11
Q

(Myocardial ischemia)
Which term refers to if an angina happens all of a sudden & can happen during rest, or waking up in the morning, & It is not during exertion? Its also not unpredictable as its not related to any activities?

A

Unstable angina

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12
Q

(Myocardial ischemia) Which term refers to an angina that happens due to the spasm of the coronary arteries not a blockage? Nicotine can cause this when smoking, or when you’re very angry due to psychological stress, or even in cold. Can happen in rest, it comes and goes.

A

Prinzmetal angina

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13
Q

(Myocardial ischemia) Which term refers to an angina that is asymptomatic, without any specific manifestations, where it doesn’t present as a typical angina, common with people with diabetes?

This type of ischemia is the most dangerous, since they are not treated. Happening mostly in ppl with diabetes, since they don’t feel pain. They don’t feel chest pain due to neuropathy, a complication of diabetes. They have fatigue, shortness of breath, sweating (non-specific signs & symptoms). Causing them to not come to the hospital.

A

Silent ischemia

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14
Q

Which term refers to gradual narrowing of stable plaques, activated by physical exertion or stress where the narrowing does not allow enough coronary blood flow?

These patients experience referred pain, such as substernal chest discomfort where they feel sensations of heaviness or pressure, this may radiate to the neck, lower jaw, left arm, & shoulder.

Risk factors include:
-Uncontrolled Diabetes, dyslipidemia, obesity
- Hypertension
- Increased LDLs (low density lipoproteins)
- Decreased HDLs (High Density Lipoproteins )
- Sedentary lifestyle
- High BMI
- Genetics

A

Stable angina pectoris

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15
Q

Which term also known as variant angina, can presents no evidence of coronary artery disease, and is unstable, unpredictable, & can occur at rest? Where the main cause is vasospasm of coronary arteries with or without atherosclerosis.

It usually occurs at night, where it can cause dysrhythmias

It is also associated with decreased vagal activity, hyperactivity of the SNS

How is it treated?

A

Prinzmetal angina

  • Calcium channel blockers
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16
Q

Which term refers to condition without typical symptoms, including fatigue, dyspnea, feeling of unease & can occur alone or with angina?

What is the % of myocardial ischemia are symptomatic & asymptomatic?

What are the causes for said conditon?

A

Silent ischemia

  • 40% are silent ischemia
  • Diabetes mellitus, cardiac transplant, mental stress, surgical denervation
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17
Q

List some signs & symptoms of angina

Also, diabetics, older people, and women may not show typical signs & symptoms of angina.

Traditionally women don’t show signs & symptoms. Whereas men typically have the classical presentation

A

Substernal chest discomfort, sensation of heaviness or pressure, pain may radiate to neck, lower jaw, left arm and shoulder, pallor, diaphoresis, & dyspnea

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18
Q

What is the leading cause of death among Canadian women?

Since, women present with atypical symptoms such as palpations, anxiety, weakness, & fatigue - 42% of women do not experience chest pain! Where they are presented with more fatigue & right sided chest pain Briefly read chart on p.g. 17 of notes

A

Heart disease & stroke

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19
Q

How are patients evaluated for angina? Such as stable angina

& which method is the most accurate

A
  • ECG – critical tool – needs to be done when patient exercising – stress test ST, looking for ST segment depression , T wave inversion, & ST segment elevation
  • Stress test ST elevation/depression/flipped T = ischemia
  • Inversion & flipped Ts = inner wall
  • The most accurate is cardiac catheterization
20
Q

What are the treatment types for coronary obstruction or heart attacks?

In terms of ↑coronary blood flow,↓myocardial oxygen consumption, & modification of risk factors (Diet, exercise, lipid lowering meds, & quitting smoking)

& what is the type procedure called that is used when the narrowed arteries are re-expanded using a catheter ?

A
  • Increase coronary blood flow by reverse vasoconstriction (medication)
  • Decrease myocardial oxygen consumption – manipulate HR, BP, contractility & ventricular volume – nitrates, betablockers, & calcium channel blockers
  • Percutaneous coronary intervention (angioplasty)
21
Q

Which term describes a range of conditions associated with sudden, reduced blood flow to the heart?

And which 2 types can it be?

Explain the term

A

Acute coronary syndrome

  • It can be either unstable angina or myocardial infarction
  • Plaque is rupturing in unstable angina – not totally blocking off artery – but potential could and then become a myocardial infarct
22
Q

(Acute coronary syndrome) To summarize acute coronary syndrome

Which term refers to prolonged ischemia causing irreversible damage to the heart muscle?

Which term refers to atherosclerotic plaque build up that is prone to rupture, clinically silent until they rupture, where plaque rupture activates the clotting cascade & the thrombus forms quickly ?Also, prolonged damage = myocardial infarction

Which term refers to damage that is limited to the myocardium directly below the endocardium with ST wave depression and T wave inversion?

Which term refers to damage extends from endocardium to epicardium – presents with ST elevation – risk for serious complications?

A
  • Myocardial infarction
  • Unstable angina
  • NSTEMI
  • STEMI
23
Q

(Acute coronary syndrome)

MI involves the left ventricle causes….

MI involves the right ventricle causes…

A
  • Pulmonary venous congestion
  • Increase in system venous pressures
24
Q

How are myocardial infarctions diagnosed?

A
  • Health history exam, ECG result (12 lead ECG can localize the affected area – ‘Q’ wave appears hours after event), & Troponin levels (Troponin is releases when cardiac cells are dead, which increases in blood serum during cardiac infarction)
25
Q

(Disorders of the heart wall)

Which term refers to a disease of the heart muscle that makes it harder for your heart to pump blood to the rest of your body, independent of ischemia?

What are the 3 different types called? & what are the causes of said condition?

A

Cardiomyopathies

  • Dilated, hypertrophic, or restrictive
  • Causes: Viral infection (Covid-19), ), ischemia, hypertension, nutritional deficiencies, or idiopathic
26
Q

(Disorders of the heart wall)

Which type of cardiomyopathy refers to ischemic heart disease with impaired impaired systolic function leading in increased intracardiac volume - ventricular dilation – reduced injection fraction?

Which type of cardiomyopathy refers to thickening of septal wall due to hypertrophy?

Which type of cardiomyopathy refers to acondition where the chambers of the heart become stiff over time, though the heart is able to squeeze well, it’s not able to relax between beats normally?

A
  • Dilated cardiomyopathy
  • Hypertrophic cardiomyopathy
  • Restrictive cardiomyopathy
27
Q

(Disorders of the heart wall)

Which term refers to an inflammation of the heart muscle (myocardium), usually caused by a viral infection, where it can affect muscle (reducing your heart’s ability to pump) & electrical system (arrhythmias)?

A

Myocarditis

28
Q

(Disorders of the heart wall)

Which term refers to stenosis or regurgitation of all of your heart valves?

Most common ones are aortic stenois which is ….
& mitral stenosis which is..

The mechanism of action here is that the aortic valve narrows causing resistance to blood flow- back of blood causes left ventricle hypertrophy – increased myocardial oxygen demand - angina

& which term refers to the inability of aortic valve to close properly or prolapse of mitral valve? Usually caused by chronic hypertension, rheumatic heart disease, bacterial endocarditis

A

Valve dysfunction

  • Aortic stenosis – valve between left ventricle
  • Mitral stenosis – valve between left atria and left ventricle – most common in rheumatic heart disease
  • Aortic or Mitral regurgitation
29
Q

(Heart failure) Manifestation, causes & risk factors of heart failure?

It is unable to generate an adequate __ __

Causes: Dysfunction of __ __

Risk factors: Ischemic heart disease & ___, valvular heart disease, __, __, congenital heart disease, __ __,
age, obesity, diabetes, & __ ___ __

A
  • Cardiac output
  • Left ventricle
  • Hypertension; cardiomyopathies; myocarditis; renal failure; excessive alcohol use
30
Q

(Left-sided heart failure)

Manifestations: ___ is a forward symptom of left side heart failure, ___, loss of concentration, issues with skin, & __ ___ ___

In left sided heart failure with a decreased ejection fraction of <40%, the heart is unable to perfuse tissues. Decreasing ___, increasing ___, and increasing ___ (seen with hypertension
75% of Left Ventricle Heart Failure have hypertension) develops, causing progressive worsening of symptoms.

& what are the causes of said state?

A
  • Fatigue; paleness; low cardiac output
  • Contractility; preload; afterload (seen with hypertension, 75% of Left Ventricle Heart Failure have hypertension) develops, causing progressive worsening of symptoms.
  • Can happen in a myocardial infarction, myocarditis, cardiomyopathies
31
Q

(Left sided heart failure)

In left heart failure with preserved ejection fraction (Diastolic heart failure), which is less common, still blood is backed up into the pulmonary system which results in pulmonary congestion, while heart is able to maintain the ejection fraction.

Caused by decreased __ __ compliance meaning that __ ___ is not able to fill properly with blood during the ___.

Cardiac ___ is intact & so is the ejection fraction. However, as the cardiac preload is decreased there is a reduction in the __ __ & __ ___.

A
  • Left ventricular; left ventricle; diastolic.
  • Contractility; stroke volume; cardiac output.
32
Q

Which term refers to not being able to pump blood effectively to the lungs, with back fluid in the vena cava – backed up into circulation?

Manifestations include: ___ again (since the blood cannot go into pulmonary system to get oxygenated.), ___ in lower body at the beginning (the more progressive, the upper body will have ___ as well), also ___ in abdominal cavity & ___ of abdominal organs.

Which term refers to enlargement, dilatation hypertrophy or failure of the right ventricle?

A
  • Right sided heart failure
  • Fatigue; edema; acid; congestion
  • Cor Pulmonale
33
Q

Pulmonary hypertension & left ventricular failure (since left ventricular filling pressure is reflected back in to the pulmonary circulation) are both potential causes of what?

And what is the treatment for said condition?

A

Right sided heart failure

  • Manage the left ventricular failure
34
Q

Left sided heart failure is usually a…

Right sided heart failure is usually a…

A
  • Systemic issue
  • Pulmonary issue
35
Q

Feeling unwell, weak, cold or hot, nauseous, dizzy, confused, thirsty, SOB, hypotension, decreased CO & urine output, RR increased (respiratory alkalosis). & ultimately anaerobic metabolism, acidosis, sodium-potassium pump fails, cell membrane permeability, cellular edema, cell death are all signs & symptoms of what?

What are the 3 types of said condition called? & what do they all cause?

A
  • Shock
  • Hypovolemic, cardiogenic, distributive (neurogenic, septic & anaphylactic are distributive)– all cause vasodilation
36
Q

Shock is based on which 3 rules?

A
  1. Cardiac output –> CO=SV x HR
  2. Peripheral resistance
  3. Blood volume
37
Q

Superficially

Hypovolemic shock refers to …?

Cardiogenic shock refers to…?

Neurogenic shock refers to…?

Anaphylactic shock refers to…?

Septic shock refers to…?

A
  • Insufficient intravascular fluid volume
  • Heart failure
  • Neural alteration of vascular smooth muscle tone
  • Immunological process
  • Infection
38
Q

Which term refers to an acute medical condition associated with a fall in blood pressure, caused by such events as loss of blood, severe burns, bacterial infection, allergic reaction, or sudden emotional stress, and marked by cold, pallid skin, irregular breathing, rapid pulse, and dilated pupils?

Developed when intravascular fluid has decreased by 15%

A

Shock

39
Q

Which term refers to shock due to either loss of whole blood due to a hemorrhage, loss of plasma due to burns, or loss of interstitial fluid due to diarrhea, diuresis (diabetes insipidus), or emesis (vomitting)?

Manifestations include: Mental status deterioration, rapid & thready pulse BUT decreased BP, & high systematic vascular resistance (trying to keep low volume central, thirst, oliguria, cold grey skin)

A

Hypovolemic shock

40
Q

Which term refers to situation when your heart cannot pump enough blood and oxygen to the brain and other vital organs, caused by by myocardial dysfunction resulting in reduced CO and inadequate tissue perfusion? Characterized by decreased cardiac contractility & low cardiac output & tissue hypoxia

Causes include myocardial infarct, congenital heart anomalies, cardiomyopathy, myocarditis, arrhythmias, & drug toxicity

Manifestations: Dyspnea, __, venous & pulmonary ___, dusky skin colour, ___, ___, & ileus (lack of movement in bowel)

A

Cardiogenic shock

  • Tachypnea; edema; hypotension, oliguria (scant urine),
41
Q

Which term refers to widespread vasodilation caused by any factor that could overstimulate parasympathetic or inhibits (under stimulate) sympathetic stimulation of smooth muscle (damage or trauma to the spinal above the level of the 6th thoracic vertebra)?

Which term refers to loss of muscular tone or the inadequate distribution of blood volume between the central and peripheral compartments – systemic vascular resistance is too low to get blood back to the heart? (Blood volume is unchanged, but the SVR is decreased)

A

Neurogenic Shock

  • Relative hypovolemia
42
Q

Which term refers to a severe reaction to an allergen causing an acute multisystem allergic reaction, which causes arterial & venous vasodilation; increased capillary permeability & pulmonary vasoconstriction, which increase right ventricular afterload, reduces pulmonary blood flow, decreases left ventricular preload, & reduces CO?

This state is a sudden onset, where death is imminent without intervention

Manifestations: ___, dizziness, difficulty breathing, ___, wheezing pruritus with hives, swollen __ & ___, & abdominal cramping

A

Anaphylactic Shock

  • Anxiety; stridor; Lips & tongue
43
Q

Which term refers to a life-threatening condition that happens when your blood pressure drops to a dangerously low level after an infection?

Infection → bacteremia (bacteria in blood) → systemic inflammatory response syndrome - sepsis → severe sepsis (organ dysfunction) → septic shock → multiple organ dysfunction syndrome (altered organ function homeostasis cannot be maintained without intervention

A

Septic shock

44
Q

(Congenital heart defects)
In a child with ___, blood can travel across the hole from the left pumping chamber (left ventricle) to the right pumping chamber (right ventricle) and out into the lung arteries. If the___ is large, the extra blood being pumped into the lung arteries makes the heart and lungs work harder and the lungs can become congested – high pressure in lungs. Dyspnea – shortness of breath and can lead to infection – endocarditis – aortic valve may develop leakage as well.

& which congential heart defect is the most common?

A

Ventricular septal defect (VSD), its the most common as well

45
Q

(Congenital heart defects) An asymptomatic condition of pulmonary over circulation & slow growth – (Shortness of breath on exertion) SOBOE – where right ventricle becomes less compliant with age? This may be closed surgically as well

& which term refers to the failure of the fetal ductus arteriosus to close within 15 hours of birth, where the ductus allows blood to detour away from the lungs before birth? Also, respirations are faster & harder than normal, there is an audible murmur, fatigue, & poor eating

A

Atrial septal defect

  • Patent ductus arteriosus

HLSC 222 (19 decks)

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