Cardiovascular: CV Pathology

Question 0

Angina Pectoris Treatment

Answer 0

Supplemental O2, NTG, rest
Chronic/Recurring: 
  Long-acting nitrates
  Beta blockers
  Calcium channel blockers
Angioplasty with stenting of coronary arteries or CABG if needed

Question 1

Angina Pectoris

Answer 1

Transient precordial sensation of pressure/discomfort from myocardial ischemia
Inadequate blood flow and O2 of heart muscle mostly from CAD
Sternum, neck, back, jaw, shoulders, arms
Possibly associated with difficulty breathing, n/v, sweating, anxiety, fear
Triggered by exertion or strong emotion, subsides with rest

Question 2

Stable Angina

Answer 2

Occurs at predictable level of exertion, exercise, or stress

Responds to rest or NTG

Question 3

Unstable Angina

Answer 3

Any one or combination of the following:
  More intense
  Lasts longer
  Precipitated with less exertion
  Spontaneously at rest
  Progressive

Question 4

Prinzmetal (Variant) Angina

Answer 4

Due to coronary artery spasm

Often associated with CAD

Question 5

Atherosclerosis

Answer 5

Damage/injury to inner wall of vessel (HTN, high cholesterol, smoking, DM)
Fatty plaques accumulate and harden at site of injury, narrowing vessel

Question 6

Atherosclerosis Signs/Symptoms

Answer 6

Coronary Arteries: 
  Angina Pectoris
Cerebral Arteries: 
  Numb/weak extremities
  Difficulty speaking/slurred speech
  Drooping face muscles
Peripheral Arteries: 
  Intermittent claudication

Question 7

Atherosclerosis Treatment

Answer 7

Antihypertensives, antiplatlets, antihyperlipidemics
Angioplasty, endarterectomy, bypass surgery
Exercise, diet, stress management, smoking cessation

Question 8

Cardiomyopathy

Answer 8

Group of conditions affecting myocardium, impairing ability of heart to contract and relax
Causes include CAD and VHD

Question 9

Cardiomyopathy Signs/Symptoms

Answer 9

None in early stages
Progressive stages include:
  Breathlessness on exertion or rest
  LE swelling
  Abdominal bloating from fluid buildup
  Fatigue
  Irregular heartbeat
  Dizziness
  Lightheadedness
  Fainting

Question 10

Dilated Cardiomyopathy

Answer 10

Possible common treatments:
  ACE inhibitors
  Beta blockers
  Digoxin
  Diuretics
  Biventricular pacemaker
  Implantable cardioverter-defibrillator for risk of serious arrhythmias

Question 11

Hypertrophic Cardiomyopathy

Answer 11

Possible common treatments:
Meds to slow HR and stabilize its rhythm:
Lopressor
Calcium channel blockers
Septal myectomy (remove thickened interventricular septum)
Septal alcohol ablation (destroy interventricular septum via alcohol injection)
Pacemaker
Implantable cardioverter-defibrillator

Question 12

Restrictive Cardiomyopathy

Answer 12

Possible common treatments:
  Meds to improve symptoms:
    Diuretics
    Antihypertensives
    Antiarrhythmics
  Surgical options for severe cases:
    Ventricular assist device
    Heart transplant

Question 13

CVI

Answer 13

Veins and valves in LEs become damaged and unable to keep blood flowing toward the heart
Weak or damaged valves risk increased with age, female, obesity, pregnancy, and prolonged sitting/standing

Question 14

CVI Signs/Symptoms And Treatment

Answer 14

Signs/symptoms:
  LE swelling
  Varicose veins
  Aching, heaviness, or cramping
  Itching
  Redness
  Skin ulcers of legs/ankles
Treatment:
  Compression garments
  LE elevation
  Varicose vein stripping in persistent leg pain/skin ulcers from poor circulation

Question 15

Atrial Septal Defect (ASD)

Answer 15

Hole in the wall separating atria
Foramen ovale in fetus, normally closes at birth
ASD persists, blood flows R to L atria, and L to R atria in severe cases

Question 16

Atrial Septal Defect (ASD) Signs/Symptoms

Answer 16

Small - moderate size:
  No symptoms, or symptoms arise after 30 years
Large or long-standing:
  SOA especially with exercise
  Fatigue
  Swelling of legs, feet, or abdomen
  Heart palpitations
  Frequent lung infections
  Stroke
  Cyanosis of skin

Question 17

Atrial Septal Defect (ASD) Treatment

Answer 17

Surgical closure:
  Large defect
  Heart swelling
  Symptoms occur
Non-surgical:
  Closure device in heart and across ASD using catheter

Question 18

Coarctation Of The Aorta

Answer 18

Narrowing of aorta near the ductus arteriosus
May not be detected until adulthood
Usually presents with other congenital defects:
Patent ductus arteriosus
Ventricular septal defect
Bicuspid aortic valve

Question 19

Coarctation Of The Aorta Signs/Symptoms

Answer 19

Infants with severe narrowing (soon after birth):
  Pale skin
  Sweating
  SOA
Older children and adults:
  HTN in arms, low BP in legs
  SOA with exercise
  Intermittent claudication
  Weakness
  HA

Question 20

Coarctation Of The Aorta Treatment

Answer 20

Surgical repair:
  Resection
  Patch
  Bypass
Balloon angioplasty

Question 21

Patent Ductus Arteriosus (PDA)

Answer 21

Shunts blood from pulmonary artery to descending aorta in utero 
Normally closes after birth
Risk factors:
  Premature
  Other heart defects
  Family history
  Pregnancy with:
    Rubella infection
    DM
    Alcohol
    Drugs
    Chemicals
    Radiation

Question 22

Patent Ductus Arteriosus (PDA) Signs/Symptoms

Answer 22

Small:
  Asymptomatic
Large:
  Tachycardia
  Respiratory distress
  Poor eating
  Weight loss
  CHF

Question 23

Patent Ductus Arteriosus (PDA) Treatment

Answer 23

Non-surgical:
  Diuretics
  Indomethacin
Surgical repair:
  Large ductus
  Initial management fails
Untreated:
  Pulmonary HTN
  Heart failure

Question 24

Ventricular Septal Defect (VSD)

Answer 24

``` Hole in septum separating ventricles Large = Too much blood pumped to lungs = Heart failure Risk Factors: Pregnancy with: Rubella DM Alcohol Drugs Chemicals Radiation Treatment: Surgical patching or stitching ```

Question 25

Ventricular Septal Defect (VSD) Signs/Symptoms

Answer 25

``` Small: No symptoms May close as interventricular wall grows Large: Cyanosis (skin, lips, fingernails) Poor eating, FTT Fast breathing or breathlessness Fatigue Swelling (legs, feet, or abdomen) Rapid HR (tachycardia) ```

Question 26

Tetralogy Of Fallot

Answer 26

``` VSD, pulmonary stenosis, right ventricular hypertrophy, aorta overriding VSD Risk factors: Poor maternal nutrition Viral illness Genetic disorders ```

Question 27

Tetralogy Of Fallot Signs/Symptoms

Answer 27

``` Depend on obstruction of blood flow from right ventricle, may include: Cyanosis of skin SOA and rapid breathing especially when feeding Fainting Clubbing of fingers and toes Poor weight gain Tire easily during play Irritability and prolonged crying Heart murmur ```

Question 28

Tetralogy Of Fallot Treatment

Answer 28

``` Surgery: Patch over VSD Widen pulmonary valve Widen pulmonary arteries Untreated: Infective endocarditis Death or disability by early adulthood ```

Question 29

Cor Pulmonale

Answer 29

Pulmonary Heart Disease: Hypertrophy of right ventricle from altered structure or function of the lungs Pulmonary HTN from chronic increase of resistance in pulmonary circulation Treatment: Supplemental O2 SaO2 > 90% and/or PaO2 > 60 mmHg Diuretics Anticoagulation

Question 30

Cor Pulmonale Signs/Symptoms

Answer 30

``` Progressive SOA, especially with exertion Fatigue Palpitations Atypical chest pain LE swelling Dizziness Syncope ```

Question 31

CAD

Answer 31

``` Damage/injury to inner wall of coronary artery, fatty plaques accumulate If plaque ruptures, platelets clump to repair and can block artery, causing MI Risk factors: High LDL Low HDL T2DM Smoking Obesity Inactivity Genetics, HTN, and hypothyroidism ```

Question 32

CAD Signs/Symptoms And Treatment

Answer 32

May not be felt until > 70% of lumen is occluded: Angina SOA Others Treatment: Smoking cessation, weight loss, heart-healthy diet, regular exercise, modify serum lipids, control HTN and DM Antiplatlets, ACE inhibitors, angiotensin II receptor blockers and statins Percutaneous angioplasty and CABG for high mortality risk

Question 33

Endocarditis

Answer 33

Inflammation of endothelium lining heart and cardiac valves Bacteria enters blood from catheters/needles, dental procedures, gum disease, STDs, or IBD Risk factors: Damaged heart valve Artificial heart valve Other heart defects

Question 34

Endocarditis Signs/Symptoms And Treatment

Answer 34

``` May develop slowly, depends on cause of infection and if heart affected: Fever Chills Heart murmur Fatigue SOA Weight loss Blood in urine Petechiae Treatment: Antibiotics Surgery if persistent infections or replace damaged heart valve ```

Question 35

Heart Failure

Answer 35

CHF: Cannot maintain CO, develops after other conditions damage/weaken heart Ventricles weaken and dilate, cannot pump efficiently Right, left or both sides, usually starting with left ventricle Blood backs up into liver, abdomen, LEs, and lungs Etiology: CAD HTN DM MI Abnormal heart valves Cardiomyopathy

Question 36

Heart Failure Signs/Symptoms

Answer 36

``` SOA Fatigue Weakness Swelling in legs, feet, and abdomen Rapid irregular heartbeat with S3 or S4 Persistent cough or wheezing Weight gain ```

Question 37

Heart Failure Treatment

Answer 37

``` Treating underlying pathology may correct (heart valve or rhythm) Meds: Anticoagulants Antihypertensives Digitalis Surgery/Devices: CABG Heart valve repair ICD Biventricular pacemaker LVAD Heart transplant ```

Question 38

Heart Murmur

Answer 38

``` Innocent: Blood flows rapidly through heart from activity, pregnancy, fever, or anemia Abnormal: Turbulent blood flow through damaged/narrow heart valve or hole in a heart wall Treatment: Digoxin Anticoagulants Diuretics Antihypertensives Valve replacement Patching atrial or VSDs ```

Question 39

Heart Murmur Signs/Symptoms

Answer 39

``` Signs/symptoms: Innocent: Not usually associated with any Abnormal: Cyanosis LE edema SOA Enlarged neck veins Weight gain Chest pain Dizziness Fainting ```

Question 40

HTN Values

Answer 40

Normal <120 <80 Prehypertensive 120-139 80-89 Stage 1 HTN 140-159 90-99 Stage 2 HTN 160+ 100+

Question 41

HTN

Answer 41

``` Adults: 140/90+ Children/adolescents: systolic and/or diastolic 95th percentile+ Primary/essential: Etiology unknown Secondary: Often renal involvement Signs/symptoms: S4 an early sign CNS (confusion, cortical blindness, hemiparesis, seizures) CV (chest pain, dyspnea) ```

Question 42

HTN Treatment

Answer 42

``` Aerobic 30min/day most days BMI 18.5-24.9 Diet Diuretics Beta blockers Calcium channel blockers ACE inhibitors Angiotensin II receptor blockers Direct vasodilators ```

Question 43

Lymphedema

Answer 43

Primary: Rare, inherited, problems with lymph vessel development Secondary: Condition damaging/obstructing lymph nodes/vessels Signs/symptoms: Swelling with restricted motion Aching and heaviness or fullness Brawny, fibrous, non pitting edema

Question 44

MI Treatment

Answer 44

``` Anticoagulants Thrombolytics Pain relievers Antihypertensives Coronary angioplasty with stenting CABG ```

Question 45

Myocarditis

Answer 45

Inflammation and weakness of myocardium causing it to thicken and swell with HF symptoms possible Etiology: Viral infection (influenza, coxsackie virus, adenovirus) Bacterial infection (polio, rubella, Lyme)

Question 46

Myocarditis Signs/Symptoms

Answer 46

``` Signs/symptoms: Arrhythmias Chest pain SOA Fatigue Fever signs (HA, muscle aches, sore throat, diarrhea or rashes) Treatment: Antibiotics Anti-inflammatories Diuretics Beta blockers Calcium channel blockers VAD IABP ```

Question 47

Pericarditis

Answer 47

Increased fold between 2 layers of pericardium (pericardial effusion) Acute or chronic, can disrupt heart rhythm and/or function, possibly death (rare) Etiology: Viral infections (coxsackie, influence, HIV) Bacterial or fungal infections MI Chest trauma Surgery Immunosuppressives Chest radiation

Question 48

Pericarditis Signs/Symptoms

Answer 48

``` Chest pain SOA Dry cough Anxiety Fatigue Fever ```

Question 49

Pericarditis Teatment

Answer 49

Most are mild, resolve with time or rest and simple treatment Pain: analgesics or anti inflammatories Bacterial infection: antibiotics Cardiac tamponade: Pericardial effusion - pressure on heart - prevents normal blood filling, less blood leaves heart - low BP Prevention: pericardiocentesis (needle/catheter removes excess fluid)

Question 50

PAD

Answer 50

Stenotic, occlusive, or aneurysmal diseases of aorta and peripheral arteries Atherosclerosis and thromboembolic processes altering structure and function of aorta and its branches Signs/Symptoms: Fatigue Aching, numbness, or pain (buttocks, thigh, calf, or foot at rest or walking) Poorly healing wounds (legs or feet) Distal hair loss Trophic skin changes Hypertrophic nails

Question 51

PAD Treatment

Answer 51

Asymptomatic: smoking cessation, lipid lowering meds, control DM and HTN (beta blockers) Disabling intermittent claudication: Revascularization Angioplasty Stent lasers Atherectomy devices Aortobifemoral bypass Aortoiliac bypass Aorta femoral bypass Iliofemoral bypass Supervised exercise 30-45min/day, 3+days/week, 12+weeks

Question 52

Rheumatic Fever

Answer 52

``` Inflammatory disease, complication of untreated or poorly treated strep throat Can lead to heart valve damage or HF Signs/symptoms: From inflammation of heart, joints, skin, or CNS Red, swollen, fever, painful joints Heart palpitations Chest pain SOA Skin rash Treatment: Antibiotics, anti inflammatories ```

Question 53

Valvular Heart Disease

Answer 53

``` Regurgitation (blood leaks backward) or stenosis (inadequate blood flow) Etiology: Congenital, calcific degeneration, infective endocarditis, CAD, MI, rheumatic fever Signs/symptoms: Palpitations SOA Chest pain Coughing Ankle swelling Fatigue ```

Question 54

Valvular Heart Disease Teatment

Answer 54

``` Moderate: Reduce workload of heart, regulate heart rhythm, prevent clotting Digitalis Diuretics Antiplatlets Anticoagulants Beta blockers Calcium channel blockers Severe: Balloon valvuloplasty Surgery to repair or replace valve ```

Question 55

ARDS

Answer 55

``` Sudden respiratory failure from fluid accumulation in alveoli In critically ill, severe SOA with hrs/days, fatal 25-40%, full lung function 1yr+ Etiology: Fluid leaks from small blood vessels in lungs into alveoli - inflammation of protective membrane allows leakage Pneumonia Sepsis HF Blood transfusions Head or chest injury Long bone fx cause fat embolism Large volumes supplemental O2 Inhale vomit, chemicals, or smoke Near drowning Adverse drug reaction, OD Shock ```

Question 56

ARDS Signs/Symptoms And Treatment

Answer 56

``` Signs/symptoms: Severe SOA Labored and rapid breathing Hypotension Confusion Extreme fatigue, cough, and fever Treatment: O2 Mechanical vent Meds: infection, pain, sedation, blood clot ```

Question 57

Asthma

Answer 57

``` Chronic inflammation of airways from airway hypersensitivity to stimuli Etiology: Respiratory infections Allergens Cold air/sudden temp change Smoke Excitement/stress Exercise ```

Question 58

Asthma Signs/Symptoms

Answer 58

``` Mild attack: Wheezing Chest tightness Slight SOA Severe attack: Dyspnea Flaring nostrils Diminished wheezing Anxiety Cyanosis Inability to speak Untreated: respiratory failure ```

Question 59

Asthma Treatment

Answer 59

``` Anti inflammatories: Interrupt bronchial inflammation, preventive Inhaled corticosteroids Cromolyn sodium Leukotriene modifiers Bronchodilators: Relax bronchial smooth muscle to dilate airways Beta-adrenergic agonists Methylxanthines Anticholinergics ```

Question 60

Atelectasis

Answer 60

``` One or more areas of lung collapse or do not inflate properly Etiology: Post-op pain Pleural effusion Tumor ARDS Asthma COPD Cystic fibrosis Signs/symptoms: None if small area of lung Cyanosis, SOA, increased RR and HR ```

Question 61

Atelectasis Treatment

Answer 61

Manual: Deep breathing, position changes, airway clearance techniques Devices: PEEP, CPAP Meds: O2, nebulized bronchodilators, mucolytics Surgery: Bronchoscopy to remove foreign objects or mucous plugs

Question 62

Bronchial Carcinoma

Answer 62

Any epithelial carcinoma in the bronchial tree Small cell and non-small cell (squamous cell carcinoma, adenocarcinoma, large cell carcinoma) Smoking, unknown

Question 63

Bronchial Carcinoma Signs/Symptoms And Treatment

Answer 63

``` Signs/symptoms: New cough or changes in chronic cough Hemoptysis SOA Wheezing Weight loss Bone pain Treatment: Wedge or segmental resection Lobectomy or pneumectomy Chemo/radiation ```

Question 64

Bronchiectasis

Answer 64

Progressive obstructive disease, abnormal dilation of bronchus, irreversible Chronic infections, aspiration, cystic fibrosis or immune system impairment Bronchial walls weaken over time from infection, permanently dilating bronchi and bronchioles Etiology: Pneumonia Whooping cough Measles TB Fungal infections

Question 65

Bronchiectasis Signs/Symptoms And Treatment

Answer 65

``` Signs/symptoms: Consistent productive cough Hemoptysis Weight loss Anemia Crackles Wheezes Loud breath sounds Treatment: Antibiotics Bronchodilators Expectorants Mucolytics ```

Question 66

Bronchitis

Answer 66

Inflammation of bronchi Hypertrophy of mucous secreting glands, increased mucous secretions, insufficient oxygenation from mucous blockage Chronic = productive cough 3 months over 2 consecutive years Acute = cold virus, smoke, air pollutant. Chronic = cigarette, pollutants, dust, toxic gases

Question 67

Bronchitis Signs/Symptoms

Answer 67

``` Signs/Symptoms: Persistent cough Thick sputum Accessory muscles Wheezing Dyspnea Cyanosis Increased PAP Chronic: Cough worse in am and damp weather, frequent respiratory infections ```

Question 68

Bronchitis Treatment

Answer 68

``` Acute: Rest Fluids Warm and moist air Cough suppressants Acetaminophen or aspirin Chronic: Antibiotics Anti inflammatories Bronchodilators ```

Question 69

COPD

Answer 69

``` Narrowing of bronchial tree blocks airflow Damage caused by asthmatic bronchitis Alveolar destruction, air trapping Increased RV and TLC Etiology: Smoke, pollution, fumes ```

Question 70

COPD Signs/Symptoms

Answer 70

``` Excessive mucous Chronic productive cough Wheezing SOA Fatigue Reduced exercise capacity ```

Question 71

COPD Treatment

Answer 71

``` Bronchodilators Inhaled steroids O2 Antibiotics Surgery Lung volume reduction Bullectomy Transplant ```

Question 72

Cystic Fibrosis

Answer 72

``` Autosomal recessive Exocrine glands of lungs, pancreas, liver, intestines, sinuses, and sex organs Etiology: Chromosome 7 Produce thick sticky mucus Lung infections Pancreas obstruction (-) Digestion/food absorption ```

Question 73

Cystic Fibrosis Signs/Symptoms

Answer 73

``` Salty skin Persistent productive cough Frequent lung infections Wheezing SOA Poor growth/weight gain with good appetite Greasy, bulky stools ```

Question 74

Cystic Fibrosis Treatment

Answer 74

``` Antibiotics Pancreatic enzyme replacement Mucolytics Bronchodilators Airway clearance Breathing techniques Assisted cough Ventilatory strategies Strength/endurance ```

Question 75

Emphysema

Answer 75

Alveolar walls gradually destroyed Alveoli large irregular pockets with gaping holes in walls Elastic fibers keeping bronchioles open destroyed Bronchioles collapse in exhale, air not escaping Alveoli permanently overinflated, increasing dead space Etiology: Smoking, Low protein alpha-1-antitrypsin = enzymes cause progressive lung damage

Question 76

Emphysema Signs/Symptoms

Answer 76

``` SOA Wheezing Chronic cough Orthopnea Barrel chest Accessory muscles Increased RR Fatigue Reduced exercise capacity ```

Question 77

Emphysema Treatment

Answer 77

``` Bronchodilators Inhaled steroids O2 Antibiotics Lung volume reduction Bullectomy Transplant ```

Question 78

Pleural Effusion

Answer 78

Fluid buildup between lungs and chest cavity Can push pleura against lung making it hard to breathe Can cause atelectasis Fluid can get infected, turn into abscess - called empyema Etiology: Pleuritis from virus, pneumonia, PE, autoimmune diseases (RA, lupus)

Question 79

Pleural Effusion Signs/Symptoms

Answer 79

``` SOA Infected Fluid: Dry cough Fever Chills ```

Question 80

Pleural Effusion Treatment

Answer 80

Bacterial: Antibiotics Viral: Time S/S: NSAIDs Excessive Fluid: Chest tube to drain

Question 81

Pneumonia

Answer 81

``` Inflammation of lungs Etiology: Bacteria, virus, fungus, parasite S/S: Fever Cough SOA Sweating Shaking chills Chest pain fluctuate w breathing HA Muscle pain Fatigue ```

Question 82

Pulmonary Edema

Answer 82

Fluid collects in alveoli Difficult to breathe Acute = medical emergency Etiology: L ventricle not pumping enough blood L atrial then pulmonary veins pressure increases Fluid pushed through capillary walls into alveoli From pneumonia, toxins, meds, smoke inhalation, RDS, high elevation

Question 83

Pulmonary Edema Signs/Symptoms

Answer 83

``` Extreme SOA, difficulty breathing Suffocation/drowning feeling Wheezing/gasping Anxiety Restlessness Apprehension Coughing Frothy, blood-tinged sputum Chest pain Rapid irregular pulse ```

Question 84

Acute Pulmonary Edema

Answer 84

``` Medical Emergency Extreme SOA or difficulty breathing with diaphoresis Bubbly, wheezing or gasping sound Cough frothy (bloody) sputum Cyanotic Rapid irregular pulse Severe BP drop ```

Question 85

PE Signs/Symptoms

Answer 85

``` Sudden SOA Chest pain worse with deep breath/cough/eating/bending Cough up bloody sputum Wheezing LE swelling Diaphoresis Rapid irregular pulse Lightheadedness or fainting ```

Question 86

Pulmonary Fibrosis

Answer 86

Microscopic damage to alveoli Irreversible scarring of interstitial tissue Tissue stiff, thick Alveoli less flexible, breathing difficult Etiology: Chronic silica dust, asbestos, sugar cane, bird/animal droppings, chemo/radiation, antiarrhythmias, antibiotics

Question 87

Pulmonary Fibrosis Signs/Symptoms

Answer 87

``` SOA especially during/after activity Dry cough (permanent damage) Fatigue Unexplained weight loss Aching muscles/joints ```

Question 88

Pulmonary Fibrosis Treatment

Answer 88

Corticosteroids Immunosuppressives Lung transplant O2

Question 89

Restrictive Lung Dysfunction

Answer 89

``` Reduction of lung expansion and pulmonary ventilation Abnormal Lung Parenchyma: Atelectasis Pneumonia Pulmonary Fibrosis Pulmonary Edema ARDS Abnormal Pleura: Pleural Effusion Pleural Fibrosis Pneumothorax Hemothorax Ventilatory Pump Function Decreased respiratory drive Neurological, muscle diseases Thoracic deformity/trauma Thoracic joints CT disorders Pregnancy Obesity Ascites ```

Question 90

Restrictive Lung Dysfunction Signs/Symptoms

Answer 90

``` DOE Persistent nonproductive cough Increased RR Hypoxemia Decreased VC Abnormal BS Reduced exercise tolerance ```