Cardiopulmonary: Cardiovascular pathophysiology

Question 1

Functional classification of heart disease

Answer 1

Question 2

Atherosclerotic heart disease

Answer 2

• most common cause of CV disease
• more common in men than women
• characterized by irregular distributed lipid deposits in the intimal layer of medium and large Coronary arteries

Question 3

Modifiable risk facors for atherosclerosis

Answer 3

• elevated total cholesterol
• high LDL/vLDLs
• low HDL
• high triglycerrides
• obesity
• HTN
• smoking/tobacco
• excessive alcohol
• physcal inactivity

Question 4

Non-modifiable risk factors for atherosclerosis

Answer 4

• males
• age
• family history of CAD in male relative before 55 or female relative before 65

Question 5

how does an atherosclerotic lesion occur

Answer 5

• abnormal lipid metabolism and/or excessive intake of cholesterol and saturated fats
• atherosclerotic plaque
• fatty streak
• fibrous plaque

• atherosclerotic plaque: accumulation of intraellular anad extracellula lipids, connective tissue, smooth muscle cells, and glycosaminoglycans
• fatty streak: first detectable lesion; consists of lipid-laden foam cells
• foam cells: macropahges that have mirgated as monocytes from circulation into subendothelial layer of the intima

Question 6

Describe the lipid hypothesis: pathogenesis

Answer 6

• increased LDL levels result in penetration of LDL into the arterial wall
• leads to lipid accumulation in smooth muscle
• fatty streak evolves into fibrous plaque

Question 7

Describe chronic endothelial injurry hypothesis

Answer 7

• Endotheliam injury
• over time the plaque becomes calcified
• some plaques are stable but others may spontaneously fissue and ruptutre
• ruptured plaques stimulate thrombosis

Endotheliam injury produces loss of endothelium, adhesions of plateletes to subendothelium, aggegation of plateletes to subendothelium, aggrergation of plateletes, chemotaxix of monocytes, and T-cell lymphocytes + release of platelet-derived and monocyte derived growth factors

Question 8

What happens when a plaque ruptures

Answer 8

1. may emobilize
2. rapidly Occlude the lumen/cause MI or infarcation
3. gradually becomes incorporated into the plaque

Question 9

What is myocardial ischemia

Answer 9

• results with an imbalane between O2 supple and demand
• revesible
• comforable at rest and symptoms during mild-moderate exercise

Question 10

What is stable angina

Answer 10

• classic symptom= angina pecoris (heaviness, pressure or tightness in chest)
• may be precipitated by exertion, stess, emotion, heavy meals
• lasts for several minutes
• relieved by rest and nitroglycerin

Question 11

What is unstable angina

Answer 11

• change in angina pattern or angina at rest
• may last longer ot not respond
• typically caused by plaque rupture, ulceration or hemorrhage with subsequent thrombus forrmation

Question 12

What is prinzmeta angina

Answer 12

• unusual type of angina that occurs mostly at rest
• hypothesized that it is the result of transient increase in vasomotor tone or due to vasospam
• assoicated with ST elevation rather than depression on EKG
• may be assoicated with acute MIs, severe arrhythmias (Ventricular tachycardia or fibrillation)

Question 13

Asymptomatic/silent angina

Answer 13

• Angina that is asymptomatic
• factors include age, presence of CAD, or other disease process
• pts with DM have a high incidence of painless MIs and definite silent ischemia

Question 14

What are angina equivalents

Answer 14

• dyspnea
• fatigue
• lightheaded
• beltching brought on by exercise and relieved with rest or nitro

Question 15

What is the pathogenesis of a MI

Answer 15

• results from prolonged ischemia
• almost always in the left ventricle
• tissues become necrrotic in zone of infarction
• formation of fibrous scar within 6-8 weeks (inelastic)

Question 16

What is a transmural MI

Answer 16

• full thickness necorsis
• wall motion reduced (hypokinetic), abnormal (dsykinetic) or absent (akinetic)

Question 17

What is the zone of hypoxic injury

Answer 17

area where tissue may be able to return to normal but may become necrotic if blood flow is not restored

Question 18

How is an MI diagnosed

Answer 18

must have 2/3

1. hx of ischemic type chest discomfort
2. evolulationary changes on serially obtained ECG
3. rise and fall in serum cardiac enzymes

Question 19

Clinical presentation of MI

Answer 19

• crushing chest pain or pressure
• may radiate to arms, neck, throat/jaw, and back
• pain is constant and lasts >30 minutes
• pallor/SOB
• unrelieved pain w/ 3 doses of nitro
• diaphoresis
• nausea/vomitting
• Denial

Question 20

Diagnosis of MI via ECG

Answer 20

• peaked T-waves following
• ST-segment elevation
• q-wave development
• and finally T-wave inversion

Question 21

Diagnosis of MI with cardiac enzymes

Answer 21

• creatine kinase (MB specific to myocardium)
• myoglobin
• cardiac specific troponin
• lactic dehydrogenase
• serum glutamic-oxaloacetic transaminase

CK-MB will increase with 4-8 hours and retunr to normal withiin 2-3days

Question 22

Treatments of MI

Answer 22

Medical: pharmocologic agents to

• decrease O2 demand
• increase O2 supply
• improve or maintain myocadial function

Surgical:

• thrombolysis
• intra-aortic ballon pump
• angioplasty and stent placement

some drugs that dissolve a thrombus (lysis) may be delievered surgically via catheter

Question 23

What determines systolic dysfunction

Answer 23

• end-diastolic volume/preload
• afterload
• contracile state of myocardium (contractility)
• heart rate (chronotrophy)

heart function may be impaired as a esult in alterations of any four of these

Question 24

What is predominant distolic dysfunction

Answer 24

• filling of ventricle is impaired due to hypetrophy or changes in myocardium composition

Question 25

What are some cardia adaptations that occur with heart failure

Answer 25

- stroke volume is decreased = pressure/end diastolic pressure is increased - condition is chronic can cause ventricular dilation

Question 26

What are some common causes of left sided heart failure

Answer 26

- ASHD - cardiomyopathy - HTN - valve disease - congential defects

Question 27

What happens with left sided heart failure

Answer 27

- systolic dysfunction => decrease SV and increase end-diastolic volume and reduced ejecion fraction - atrial volume will begin to expand => atrial dilation due to higher EDP - blood will be reflected back to lungs

Question 28

Clinical manifestations of left sided heart failure

Answer 28

- progressive dyspnea - orthopnea - PND - fatigue and weakness - pulmonary rales - S3 gallop - enlarged heart

Question 29

Causes of right sided heart failure

Answer 29

**increased pulmonary artery pressure** caused by - left ventricle failure - mitral valve regurgitation - chronic/acute pulmonary disease | *may undergo cardiac hypertrophy or not*

Question 30

clinical manifestations of right sided heart failure

Answer 30

- dependent edema - hepatomegaly - ascites - fatigue - anorexia - nausea/bloating - rright sided S3 or S4 - accentuated P2 - murmurs w/ pulmonary or tricuspid insufficiency - jugularr venous distension - weight gain - cyanosis

Question 31

what is primary dilated cardiomyopathy

Answer 31

- increased cardiac mass - dilation of chambes - little to no systolic function - results from infections or non-infectious inflammatory processes, toxins, pregnancy, and metabolic disorders

Question 32

How does primary dilated cardiomyopathy affect normal heart function

Answer 32

- decreased stroke volume - compensated at rest by increased heart rate - reduced exercise tolerance

Question 33

Signs and symptoms of pimary dilated cardiomyopathy

Answer 33

- similar to heart failure

Question 34

Hypertrophic cardiomyopathy

Answer 34

- increased cardiac mass that can be symmetrical or asymmetrical without dilation - normal or increased systolic function

Question 35

Hypertrophic obstructive cardiomyopathy

Answer 35

- left ventricular outflow is obstructed - results in diastolic dysfunction - type of hypertrophic cardiomyopathy

Question 36

Restrictive cardiomyopathy

Answer 36

- restricted ventricular filling due to endocardial or myocardial disease - ventricle walls lose compliancce and become excessively rigid - causes a reduced ventricular filling => creates back up pressure in the atria causing atrial enlargement

Question 37

# Other cardiac disorders: Acute myocarditis: | what is it/signs and symptoms

Answer 37

- inflamation of myocardium often caused by streptococcal infections - can also be caused by bacterial, rickettsial, fungi, or parasites/other inflammatory processes - signs and symptoms: fatigue, palpitations, dyspnea, pericardial discomfort ## Footnote - often accompanied by pericarditis

Question 38

# Other cardiac disorders: pericarditis

Answer 38

- inflammation of the pericaardium - caused by viral infections typically

Question 39

# Other cardiac disorders: pericarditis: signs and symptoms

Answer 39

- wide range - progress simplease inflammation with no cardiovascular compromise to pulmonary effesions and cardiac temponade - initiall no symtpoms - chest pain - elevated temp - dyspnea - higher resting HR - pain is relieved by leaning forward, kneeling on all fours or sitting upright

Question 40

# Other cardiac disorders: pericardial effusion

Answer 40

- fluid accumulation within pericadial sac - painful and result from acute inflammation - pericardial friction rub may occur

Question 41

# Other cardiac disorders: pericardial effusion: signs and symptoms

Answer 41

- large effusions that develop slowly may cause no symptoms - small effusions that develop rapidly may cause tamponade - painful - dyspnea/cought

Question 42

# Other cardiac disorders: pericardial effusion: cardiac tamponade

Answer 42

- elevated intrapericardial pressure that restricts venous return and ventricular filling - stroke volume and pulse pressure fall - heart rate/venous pressure rise

Question 43

# Other cardiac disorders: rheumatic heart disease

Answer 43

- systemic immune process that may result from a throat infection - leads to an infection of the endocardium/valves

Question 44

# Other cardiac disorders: Infective endocarditis

Answer 44

- bacterial/fungal infection of the heart valves - interferes with normal opening and closing - any abnormality of the heart valves or blood flow through the valves increase ones risk - clinical manifestations = flulike symptoms