18 Alterations in Cardiac Function Flashcards by jessica quintos

Coronary Heart Disease [CHD]

common names

Ischemic Heart Disease

Coronary Artery Disease [CAD]

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Coronary Heart Disease [CHD]

-characterized by insufficient delivery of oxygenated blood to the myocardium due to atherosclerotic coronary arteries

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sequelae

a condition which is the consequence of a previous disease or injury

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Coronary Heart Disease [CHD]

sequelae

1 Angina Pectoris (3 types, myocardial infarction)
2 Dysrhythmias
3 Heart failure
4 Sudden cardiac death

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Coronary Heart Disease [CHD]

risk factors

atherosclerosis-main cause

microcirculation abnormalities

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how does atherosclerosis lead to cardiac ischemia/CHD

narrowing of arterial lumen can lead to thrombus formation, coronary vasospasm, endothelial cell dysfunction

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vulnerable plaques vs stable plaques

V: large lipid core, thin cap, high shear stress

S: more collagen + fibrin, stable cap

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vulnerable plaques may rupture and erode which stimulates…

clot formation on the plaque

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Ischemia

oxygen supply is insufficient to meet metabolic demands

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critical factors in meeting cellular demands for oxygen

1 rate of coronary perfusion

2 myocardial workload

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coronary perfusion can be altered by

1 large, stable atherosclerotic plaque
2 acute platelet aggregation + thrombosis
3 vasospasm
4 failure of autoregulation by microcirculation
5 poor perfusion pressure

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chronic occlusion of a coronary vessel leads to…

STABLE ANGINA

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acute occlusion leads to

plaque disruption + thrombus formation

-results in UNSTABLE ANGINA or MI

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Angina Pectoris

chest pain associated w intermittent myocardial ischemia

-no permanent myocardial damage occurs

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Angina Pectoris

symptoms

burning, crushing, squeezing, choking or referred pain

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Angina Pectoris may result in…

inefficient cardiac pumping w resultant pulmonary congestion + shortness of breath

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myocardial ischemia may UNCOMMONLY be caused by…

1 coronary vasospasm
[PRINZMETAL or VARIANT ANGINA]
2 hypoxemia
3 low perfusion pressure fr vol depletion or shock

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3 types of angina

Stable Angina (stable or typical or classic)
Unstable Angina
Prinzmetal or Variant Angina

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Stable or Typical or Classic Angina

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most common

- characterized by stenotic atherosclerotic coronary vessels

Stable or Typical or Classic Angina

onset + treatment

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onset of anginal pain is generally predictable + elicited by similar stimuli each time
relived by rest + nitroglycerin

Unstable or Crescendo Angina

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1 of 3 types of Acute Coronary Syndrome
similar to Stable Angino but NO RELIEF W/O MEDICAL HELP
may progress to acute ischemia

Prinzmetal or Variant Angina

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-unpredictable attacks of anginal pain

characterized by:

vasospasm,
atherosclerosis-induced hypercontractility,
abnormal secretion of vasospastic chem by local mast cells,
abnormal Ca flux across vascular smooth muscle

Prinzmetal or Variant Angina

onset

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onset of symptoms is UNRELATED to phys or emo exertion, heart rate, or other obvious causes of increased myocardial oxygen demand
UNPREDICTABLE

Acute Coronary Syndrome

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3 types; 1 is unstable angina

-caused by plaque rupture w acute thrombus dvlpt

Acute Coronary Syndrome | signs + symptoms

chest pain usually more severe, last longer than 15 mins, may radiate to limbs, jaw, back - nausea, vomiting, diaphoresis, shortness of breath - not relieved by rest or nitroglycerin - in unstable angina: occlusion is partial - in MI: occlusion is complete

Asymptomatic/Silent MI

- women, elderly, + patients w neuropathies | - atypical symptoms like fatigue, nausea, back pain, + abdominal discomfort

Acute Coronary Syndrome | diagnosis

**must have 2 out of 3** 1 S/S 2 electrocardiographic changes [ECG] 3 Biomarkers (elevation of spec. marker proteins in blood)

acute occlusion causes a range of cellular events depending on...

- availability + adequacy of collateral blood flow - relative workload - length of time that flow is interrupted

ultimate size of infarcted tissue depends on...

extent duration severity of ischemia

Acute Coronary Syndrome | histology

18-24 hrs: DEC BF: area of infarction becomes paler than surround ing tissues 5-7 days: NECROSIS/GANGRENE: turns yellow w soft rim of red vascular connectv tissue 1-2 wks: CLEARNCE: necrotic tissue degraded + cleared away; infarcted myocardium weakened + susceptible to rupture <6wks: REPAIRMNT: necrotic tissue replaced by tough fibrous scar tissue

Acute Coronary Syndrome | Serum Marker Changes for diagnosis

- intracellular becomes extracellular - myoglobin, troponin, lactate dehydrogenase, + creatine kinase - increased CK-MB + TROPONIN I + T

Acute Coronary Syndrome | ECG changes for diagnosis

1 ST-segment elevation 2 large Q waves 3 inverted T waved

ST-segment elevation for Acute Coronary Syndrome

STEMI: patients w chest pain + evidence of acute ischemia on ECG NON-STEMI/NSTEMI: patients presenting symptoms of unstable angina + NO ST elevation on ECG

treatments for 2 types of ST-segment elevations

STEMI: candidates for ACUTE REPERFUSION THERAPY NSTEMI: candidates for ANTIPLATELET DRUGS

MI leads to drop in CO which triggers...

compensatory response

Sympathetic nervous sytm activation leads to__ by__

leads to increased myocardial workload by increasing heart rate, contractility, BP

Acute Coronary Syndrome | treatment principals

1 decreasing myocardial oxygen demand 2 increasing myocardial oxygen supply 3 monitor + manage complications [SNS activation]

decreasing myocardial oxygen demand for treating ACS

- sympathetic antagonist, - rest, - heart rate control, - pain relief, - afterload reduction

increasing myocardial oxygen supply for treating ACS

- thrombolysis, - angioplasty, - coronary bypass grafting

monitor + manage complications [SNS activation] for treating ACS

- early detection + mgmt of dysrhythmias + conduction disorders - continuous ECG monitoring

clinical treatments for ACS

Morphine: pain (+dec O2 demand) Oxygen: ischemia Nitroglycerin: ischemia Anticoagulants: ischemia (platelet thinner or thrombolysis)

Stenosis****

failure of the valve to open completely | -results in extra pressure work for the heart

Regurgitation (Insufficiency)*****

inability of a valve to close completely | -results in extra volume work for the heart

Valvular Disease

congestion upstream + low blood supply downstream | 2 types: stenosis + regurgitation

Valvular Disease | clinical manifestations

- murmrs are common | - heart failure S/S

myocardial infarction biomarkers of choice****

troponin I + T

18 Alterations in Cardiac Function Flashcards

(46 cards)