Cardio III

Question 1

fibrous pericardium

Answer 1

dense connective tissue attached to great vessels and diaphragm

Question 2

serous pericardium

Answer 2

parietal layer- adheres to fibrous pericardium. Simple squamous epithelium.

Visceral layer (epicardium)- covers outside of heart. Simple squamous epithelium areolar connective tissue and fat.

Question 3

pericardial cavity

Answer 3

contains a small amount of serous fluid to lubricate serous membranes

reduces friction during contraction

Question 4

pericarditis: acute

Answer 4

inflammation of the pericardium

acute- viral infection is most common cause

reults in increased capillary permeability, allowing plasma proteins to enter the pericardial space

Question 5

Pericarditis: manifestations

Answer 5

chest pain- sharp pain may radiate to neck, back, abdomen, or side. Pain worse with deep breathing, coughing, swallowing

pericardial friction rub- highly pitched or scratchy

Question 6

Pericardial effusion

Answer 6

accumulation of fluid in the pericardial cavity

injury, inflammation, altered capillary filtration pressures

Question 7

Cardiac tamponade

Answer 7

compression of heart due to accumulation of pericardial fluid

Question 8

Coronary blood flow: Left

Answer 8

left divides into left anterior descending (LAD) and circumflex

• LAD supplies left ventricle and anterior portion of interventricuar septum
• circumflex supplies left lateral wall of left ventricle

Question 9

Coronary blood flow: right

Answer 9

Right coronary artery and its posterior descending artery (PDA)

• right supplies the right ventricle
• PDA supplies posterior portion of heart, including posterior interventricular septum

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Question 10

Assessment of blood flow: Electrocardiography (ECG, EKG)

Answer 10

as result of membrane injury, parts of the myocardium are unable to conduct, are more difficult to excite, or are overly excitable

ischemia can lead to ST elevations and depressions

Question 11

Assessment of blood flow: Echocardiography

Answer 11

“ultrasound”

reflected (echos) in response to changes in resistance

Question 12

Assessment of blood flow: stress testing

Answer 12

treadmill or bicycle

monitor blood pressure, ECG, arrhythmias, chest pains, SOB

couple with nuclear imaging

Question 13

Assessment of blood flow: pharmacologic stress testing

Answer 13

used for persons who cannot participate in active stress testing

Question 14

Assessment of blood flow: cardiac catheterization

Answer 14

one of the most widely used invasive procedures

for left heart and coronary arteries, catheter is inserted through a peripheral artery to the aorta

fluoroscopic images then taken after injection

Question 15

Coronary artery disease: Atherosclerosis

Answer 15

predominates in first few centimeters of left anterior descending and left circumflex, or length of right coronary

Question 16

Coronary artery disease: Atherosclerosis (unstable plaque)

Answer 16

often has a thin fibrous cap overlying a large lipid core

Question 17

Angina pectoris: stable angina

Answer 17

precordial or substernal pain described as constricting, squeezing or a suffocating sensation (may radiate to left shoulder, jaw, arm, or elsewhere)

caused by fixed coronary obstruction that leads to ischemia when there are increased demands on the heart

Question 18

Acute coronary syndrome

Answer 18

includes:

unstable angina, non ST segment elevation myocardial infarction (NSTMI), and ST elevation MI (STMI)

Question 19

ST segment elevation myocardial infarction (STMI)

Answer 19

Heart attack

• ischemic death of myocardial tissue
• most infarcts are transmural, involving the free wall of the left ventricle

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Question 20

Myocardial infarction

Answer 20

ischemic death of myocardial tissue

-pain typically severe and crushing, usually substernal (can radiate to left arm, neck, or jaw)

may be assoc with n/v

Question 21

Revascuarization: Percutaneous Coronary Intervention (PCI)-Percutaneous Transluminal Coronary Angioplasty (PTCA)

Answer 21

dilation of atherosclerotic artery with an inflatable balloon

stretches and tears plaque

stent (wire mesh) inserted to prevent restenosis

Question 22

Revascularization: Drug eluting stents (DES)

Answer 22

developed to reduce restenosis

Question 23

Revascularization: Bypass

Answer 23

Coronary artery bypass grafing

• saphenous vein graft between the aorta and the affected coronary artery (one to five anastomoses are common)
• internal (thoracic) mammary artery can be used to revascularize left anterior descending artery