Chapter 18 Exam 3 Flashcards Preview

Pathophysiology > Chapter 18 Exam 3 > Flashcards

Flashcards in Chapter 18 Exam 3 Deck (47):

Unstable Angina enzymes*

- no cardiac enzymes created, but chest pain will be very strong


Angina Pectoris*

- chest pain associated with intermittent myocardial ischemia
- no permanent damage occurs to the heart
- crackles/rales are indicative of left side congestion, they are bubbling and rattling of buildup of fluid in the lungs


3 patterns of Angina Pectoris *

- stable, unstable, and prinzmetal



dilates the coronary arteries


Stable Angina *

- most common
- characterized by stenoic atherosclerotic coronary vessels
- relived by rest and nitroglycerin


Unstable or crescendo angina*

-can progress to acute ischemia
- very similar to nonSTEMI heart attack, only difference is absence of serumbiomarker troponin


Prinzmetal/Variant angina*

- unpredictable
- vasospastic
- caused by coronary artery occlusions
- calcium channel blocking agents used for treatment


Acute Coronary Syndrome*

- Myocardial infarction (MI) or unstable angina
- ECG and biomarkers used for diagnosis


ACS ECG changes*

- t wave inversion or s wave depression
- ST elevation in case of a heart attack; also known as STEMI (st elevation; myocardial infarction)
- Q wave means old heart attack
- T wave inversion with biomarkers is a nonSTEMI
- segment depression means ischemia


Treatment of ACS with drugs*

- antiplatelets and statin drugs are the best thing for ACS with nonSTEMI/unstable angina
- reperfusion therapy is best thing for ACS with STEMI
- morphine, oxygen, nitrates, and aspirin together treat acs


Acute occulsion*

- blockage in an artery, vein, or within the heart
- can cause a range of cellular events depending on the availability and adequacy of collateral blood flow, relative workload, & length of time that flow is interrupted


Diagnosis of ACS*

depends on
- signs and symptoms
- electrocardiographic changes
- elevatioins of specific marker proteins in the blood


Signs and symptoms of ACS*

- sever crushing, excruciating chest pain that may radiate to the arm, shoulder, jaw, or back
- nausea
- vomiting
- diaphoresis (sweating)
- shortness of breath
* diabetics and elderly may not have pain due to neuropathy


More ACS info: Asymptomatic MI *

- lasts more than 15 min and is not relieved by rest or nitroglycerin
- can be asymptomatic MI (silent MI) which is typical in women, the elderly, and patients with diabetic neuropathies
- ECG for asymptomatic includes st segment elevation, large Q waves, and inverted T waves


ACS serum marker changes*

- myoglobin
- lactate dehydrogenase
- creatine kinase
- increased CK-MB and troponin I and T


ACS Treatment Steps

- Decreasing myocardial oxygen demand (rest, heart rate control, pain relief, afterload reduction)
- Increasing myocardial oxygen supply (thrombolysis, angioplasty, coronary bypass grafting)
- Monitoring and managing complications (early detection and management of dysrhthmias and conduction disorders, continuous ECG monitoring)
- beta blockers are given


Sudden Cardiac Arrest

- also called sudden cardiac death
- unexpected death from cardiac causes within 1 hour of symptom onset
- lethal dysrhythmia is usually primary case


Chronic Ischemic Cardiomyopathy

- heart failure develops insiduously due to progressive ischemic myocardial damage
- typically have history of angina or MI
- appears to be a consequence of slow, progressive apoptotic death of myocytes from chronic ischemia
- more common in older adults


Endocardial and Valvular Disease

endocardial & valvular structures may be damaged by:
- inflammation and scarring
- calcification
- congenital malformations
causes altered hemodynamics of the heart and increase myocardial workload
- will include stenosis. regurgitation, and prolapse



failure of the calve 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


Mitral Stenosis*

- blood flow from the left atrium to left ventricle is impaired during ventricular diastole
- increased pressure of the left atrium leads to atrial chamber enlargement and hypertrophy


Results of Mitral Stenosis *

-chronic pulmonary hypertension
- right ventricular hypertrophy
- right sided heart failure


Signs and symptoms of Mitral Stenosis *

- low pitched, rumbling diastolic murmur
- opening snap (sound)
- atrial dysrhythmias
- atrial clots
- exertional dyspnea


Mitral Regurgitation*

- backflow of blood from left ventricle to the left atrium during ventricular systole
- mitral valve should snap open and then close, but it does not snap closed and the blood experiences backflow


Results of Mitral Regurgitation *

- left atrium and ventricle dilate and hypertrophy due to the extra volume
- may lead to left sided heart failure


Signs and symptoms of Mitral Regurgitation*

- high pitched, pansystolic blowing murmur
- giant V waves
- chronic weakness and fatigue


Mitral Valve Prolapse*

- displacement (ballooning) of the mitral valve leaflets into the left atrium during ventricular systole
- women are affected more than men
- typically asymptomatic


Signs ad symptoms of Mitral Valve Prolapse *

- Midystolic click or systolic murmur
- palpitations
- rhythm abnormalities
- diziness
- fatigue
- dyspnea
- chest pain
- or depression and anxiety


Aortic Stenosis

- predominant cause is age related calcium deposits on the aortic cusps
- results in obstruction of the aortic outflow from the left ventricle into the aorta during systole


Signs and Symptoms of Aortic Stenosis

- left ventricle hypertrophy may result in ischemia and left sided heart failure
- crescendo-decrescendo murmur during ventricular systole with prominent S4 (s3 follows s2, S4 proceeds S1, s4 is indicative of a stiff left ventricle)
- syncope
- fatigue
- angina


Aortic Regurgitation

- incompetent aortic valve allows blood to leak back from the aorta into the left ventricle during diastole
- causes include abnormal aortic valve or aortic root dilation
- leafs to left ventricular hypertrophy and dilation with eventual left sided heart failure


Signs and symptoms of Aortic Regurgitation

- high pitched blowing murmur during ventricular diastole
- high systolic blood pressure
- diastolic blood pressure usually low
- palpitations


Rheumatic Heart Disease

- acute inflammatory disease that follows infection with group a beta hemolytic streptococci
- damage is due to immune attack on individuals own tissues
- damage occurs in CT of joints, heart, and skin
- occurs mainly in children


Signs and symptoms of Rheumatic Heart Disease

- fever
- sore throat
- joint inflammation
- involuntary movements (sydenham chorea)
- distinctive truncal rash


Infective endocarditis

- invasion and colonization of endocardial structures by microorganisms with resulting inflammation - vegetations
- most common bacteria are strep and staph
- Can be acute (poor prognosis) or subacute (predisposing risk factors typically present)



- inflammatory disorder of the heart muscle characterized by necrosis and degeneration of myocytes
- clinical course is acute or stormy with recovery or death from cardiac failure occurring weeks to months after onset of symptoms



- classified by cause or functional impairment
- primary: dysfunction or unknown cause
- Secondary: known cause
- Functional classifications: dilated, hypertrophic, restrictive


Dilated Cardiomyopathy

- cardiac failure associated with dilation of one or both ventricular chambers
- can be related to alcohol toxicity, pregnancy, postviral myocarditis, or genetic abnormality
- slow progression of biventricular heart failure with low ejection fraction ( ejection fraction less than 40% is heart failure



Implantable Cardioverter Defribrillator


Hypertrophic Cardiomyopathy

- thickened, hyperkinetic ventricular muscle mass
- septum may be affected, leading to idiopathic subaortic stenosis
- caused by a genetic abnormality
- can be asymptomatic or show signs of dyspnea and angina


Restrictive Cardiomyopathy

- Rarest form
- stiff, fibrotic, rigid, noncompliant ventircle with impaired diastolic filling
- mosy commonly associated with amyloidosis
- decreased cardiac output and left sided heart failure can result
- exerrcise intolerance, dyspnea, and weakness


Pericardial Diseases

Typically sequelae of other disorders such as
- systemic infection
- trauma
- metabolic derangement
- neoplasia


Pericardial Effusion

- accumulation of noniflammatory fluid in the pericardial sac
- composition of usual fluids includes serous, serosanguineous, chylous(fatty), and blood


Cardiac Tamponade

- when fluid accumulation in the pericardial sac is large/sudden it can lead to external compression of the heart chambers such that filling is impaired (basically a medical emergency in which there is a sudden build up of fluid in the lungs)


Manifestations of Cardiac Tamponade and treatment

- reduced stroke volume
- compensatory increases in heart rate
- pulsus paradoxus
- jugular venous distension
- Beck's Triad
- Treatment is pericardiocentesis



- acute or chronic inflammation of the Pericardium