Cardio III Flashcards
(23 cards)
fibrous pericardium
dense connective tissue attached to great vessels and diaphragm
serous pericardium
parietal layer- adheres to fibrous pericardium. Simple squamous epithelium.
Visceral layer (epicardium)- covers outside of heart. Simple squamous epithelium areolar connective tissue and fat.
pericardial cavity
contains a small amount of serous fluid to lubricate serous membranes
reduces friction during contraction
pericarditis: acute
inflammation of the pericardium
acute- viral infection is most common cause
reults in increased capillary permeability, allowing plasma proteins to enter the pericardial space
Pericarditis: manifestations
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
Pericardial effusion
accumulation of fluid in the pericardial cavity
injury, inflammation, altered capillary filtration pressures
Cardiac tamponade
compression of heart due to accumulation of pericardial fluid
Coronary blood flow: Left
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
Coronary blood flow: right
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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Assessment of blood flow: Electrocardiography (ECG, EKG)
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
Assessment of blood flow: Echocardiography
“ultrasound”
reflected (echos) in response to changes in resistance
Assessment of blood flow: stress testing
treadmill or bicycle
monitor blood pressure, ECG, arrhythmias, chest pains, SOB
couple with nuclear imaging
Assessment of blood flow: pharmacologic stress testing
used for persons who cannot participate in active stress testing
Assessment of blood flow: cardiac catheterization
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
Coronary artery disease: Atherosclerosis
predominates in first few centimeters of left anterior descending and left circumflex, or length of right coronary
Coronary artery disease: Atherosclerosis (unstable plaque)
often has a thin fibrous cap overlying a large lipid core
Angina pectoris: stable angina
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
Acute coronary syndrome
includes:
unstable angina, non ST segment elevation myocardial infarction (NSTMI), and ST elevation MI (STMI)
ST segment elevation myocardial infarction (STMI)
Heart attack
- ischemic death of myocardial tissue
- most infarcts are transmural, involving the free wall of the left ventricle
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Myocardial infarction
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
Revascuarization: Percutaneous Coronary Intervention (PCI)-Percutaneous Transluminal Coronary Angioplasty (PTCA)
dilation of atherosclerotic artery with an inflatable balloon
stretches and tears plaque
stent (wire mesh) inserted to prevent restenosis
Revascularization: Drug eluting stents (DES)
developed to reduce restenosis
Revascularization: Bypass
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
