Chapter 23 Cardiovascular

Question 1

Coronary Artery Disease (the most common cause is atherosclerosis)

Answer 1

Any vascular disorder that narrows or occludes the coronary arteries leading to myocardial ischemia (decreased oxygen)

Question 2

Lipoprotein

Answer 2

refers to lipids particularly cholesterol and triglycerides according to atherosclerosis

Question 3

LDL vs HDL

Answer 3

LDL is bad cholesterol: < 100
HDL is good cholesterol: 40-60
Total cholesterol should be less than 200

Question 4

Chylomicrons

mainly composed of triglycerides

Answer 4

Necessary for fat to be absorbed in small intestines

Question 5

Nonmodifiable vs Modifiable risk factors of coronary artery disease

Answer 5

Nonmodifiable: Increased age, Family history, Male gender or female gender post-menopause

Modifiable: Dyslipidemia: has to do with lipoproteins (LDL and HDL), Hypertension, Cigarette smoking (vasoconstriction–>limiting oxygen supply), Diabetes mellitus, Obesity/sedentary lifestyle, Atherogenic diet

Question 6

C-reactive protein and ESR

Answer 6

(Nonspecific)made in the liver; measurement of plaque-related information

Indicates there is a lot of inflammation somewhere but doesn’t indicate where

Question 7

Myocardial ischemia

Answer 7

due to plaques; oxygen content of coronary blood is insufficient to meet the metabolic demands of the myocardial (heart cells) cells, ecludes blood flow to coronary arteries

Question 8

ischemia

Answer 8

decreased oxygen or lack of

Question 9

angina (2 types)

Answer 9

chest pain related to cardiac ischemia

Question 10

Stable Angina vs Prinzmetal Angina

Answer 10

Stable: Gradual luminal narrowing and hardening of arterial walls
-pain radiates, diaphoretic(sweaty), dyspnea, chest pain will go away with meds,
Prinzmetal (unpredictable): due to vasospasm; Unpredictable occurrence and often at rest

Question 11

Silent ischemia

Answer 11

due to the release of inflammatory mediators but does not show any symptoms

Question 12

Angina Treatment (MONA)

Answer 12

Treatment seeks to decrease myocardial oxygen demand and increase oxygen supply

Question 13

Myocardial Infarction (MI: heart attack) (part of heart has died due to lack of O2)

Answer 13

an area of the heart is permanently destroyed caused by decreased blood flow in the coronary artery

SLIDE 27

Question 14

Signs and Symptoms of MI

Answer 14

-Sudden severe chest pain; may radiate
-Nausea, vomiting
-Diaphoresis
-Dyspnea
Complications: Sudden cardiac arrest due to ischemia, left ventricular dysfunction, and electrical instability

Question 15

What are disorders of the heart wall?

Answer 15

Acute pericarditis: inflammation of the pericardium
Pericardial effusion(effusion means fluid build up): the buildup of fluid in the pericardial sac. Tamponade-fluid accumulates rapidly causing cardiac compression resulting in decreased cardiac output

Question 16

Signs and Symptoms for pericarditis

Answer 16

fever for a few days, chest pain when lying in recumbent position makes it worse and also when taking deep breaths, the assessment will indicate friction rub of parietal and visceral layers

Question 17

Cardiomyopathies

Answer 17

enlarged heart

Question 18

Stenosis

Answer 18

narrowing of valves; reduces or blocks blood flow from heart

Question 19

Regurgitation

Answer 19

valves do not completely close resulting in too much blood or backflow of blood

Question 20

Rheumatic Fever

Answer 20

• can be a result of a pharyngeal strep infection

- delayed response starts with fever, joint pain, heart pain as a result of recent infection

Question 21

Rheumatic Fever Contin.

Answer 21

• Systemic, inflammatory disease caused by a delayed immune response to pharyngeal infection by the group A beta-hemolytic streptococci (usually 1-4 weeks later)
• Febrile illness
  - Inflammation of the joints, skin, nervous system, and heart
• If left untreated, rheumatic fever causes damage to valves, rheumatic heart disease
• Can be prevented with antibiotic treatment of the strep throat

Question 22

Infective Endocarditis (pg 630–> risk factors)

Answer 22

systemic: Infection and inflammation of the endocardium
The main cause is bacteria
Could be due to a prosthetic valve or a person with a history of IV drug use

Must have prophylactic antibiotic before any dental procedure is conducted to prevent any further infection from occurring

Question 23

What are the skin lesions specific to Infective Endocarditis and what are other sign and symptoms

Answer 23

Osler nodes: painful erythematous nodules on the pads of the fingers and toes)
and Janeway lesions: nonpainful hemorrhagic lesions on the palms and soles

*Fever, New or changed cardiac murmur, Petechial lesions of the skin, conjunctiva, and oral mucosa

Question 24

Dysrhythmias (Arrhythmias)

Answer 24

the heart is out of its normal rate and rhythm

Question 25

**Heart Failure** Pg. 632

Answer 25

results in inadequate perfusion of the tissues. ventricles cant pump blood out resulting in decreased cardiac output and leftover blood in the ventricles that shouldn't be there

Question 26

Remodeling

Answer 26

refers to changes in the size, shape, structure, and function of the heart. This can happen as a result of exercise (physiological remodeling) or after an injury to the heart muscle (pathological remodeling). The ventricle is unable to pump blood effectively resulting in a decreased cardiac output

Question 27

Left Sided heart failure deals with what type of symptoms

Answer 27

Those that are related to the lungs, not enough blood is being ejected from the left ventricle leaving a backup of blood Ex: shortness of breath(dyspnea), frothy, foamy sputum that is tinted pink, orthopnea(lying flat and unable to breathe; must be elevated), swelling, oliguria(decreased urine output), pulmonary edema, paroxysmal nocturnal dyspnea

Question 28

Right-Sided Heart Failure

Answer 28

*Severe peripheral edema* | Ascites: swelling in the abdomen

Question 29

what does decreased contractility correlate to

Answer 29

decreased cardiac output

Question 30

Shock

Answer 30

The cardiovascular system fails to perfuse the tissues adequately; rest of the body is unable to get enough oxygen --Leads to impaired cellular metabolism Impaired oxygen use Impaired glucose use --Manifestations vary based on stage but often include hypotension, tachycardia, increased respiratory rate

Question 31

Types of Shock

Answer 31

--Cardiogenic Decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume, usually follow MI --Hypovolemic (low volume) -The person who is losing a lot of fluids -Caused by loss of whole blood (hemorrhage), plasma (burns), or interstitial fluid in large amounts --Neurogenic (vasogenic) -Result of widespread and massive vasodilatation that results from parasympathetic overstimulation and sympathetic under-stimulation may be seen in trauma to the spinal cord or medulla -heart rate will go down and so may blood pressure and cardiac output may be normal or could be really high

Question 32

Types of Shock (Pg 643, 651)

Answer 32

--Cardiogenic Decreased cardiac output and evidence of tissue hypoxia in the presence of adequate intravascular volume, usually follow MI --Hypovolemic (low volume) -The person who is losing a lot of fluids -Caused by loss of whole blood (hemorrhage), plasma (burns), or interstitial fluid in large amounts --Neurogenic (vasogenic) (spinal cord injury) -Result of widespread and massive vasodilatation that results from parasympathetic overstimulation and sympathetic under-stimulation may be seen in trauma to the spinal cord or medulla -heart rate will go down and so may blood pressure and cardiac output may be normal or could be really high

Question 33

decreased blood pressure and increased heart rate what does that mean

Answer 33

A patient is a high risk for hypovolemic shock

Question 34

Types of Shock Contin..

Answer 34

- -Anaphylactic: Results from widespread hypersensitivity reaction (anaphylaxis) - -Septic: Begins with an infection that progresses to bacteremia, then systemic inflammatory response syndrome (SIRS) with sepsis, then severe sepsis, then septic shock

Question 35

What is Multiple Organ Dysfunction Syndrome?

Answer 35

Progressive dysfunction of two or more organ systems resulting from an uncontrolled inflammatory response to severe illness or injury