Chapter 24 Cardiovascular Disorders

Question 1

What is anemia?

Answer 1

A reduction in either RBC volume (hematocrit) or the hemoglobin concentration
Caused by impaired RBC formation, excessive loss or destruction of RBCs
RDA – men 8 mg/day, women 18 mg/day, important to consume 2000-3000 kcal/day
Reduces maximum aerobic capacity, decreases physical work capability at sub-max level, increases lactic acidosis, increase fatigue, decreases exercise time to exhaustion

Question 2

What are predisposing factors for anemia?

Answer 2

family history of anemia/bleeding disorders, chronic disease, jaundice, excessive menstrual flow, chronic blood loss, drugs/toxins, childbirth, poor diet, cancer, blood donor

Question 3

What is stage I anemia?

Answer 3

iron depletion characterized by less than 12mg per mL of ferritin, other components remain normal

Question 4

What is stage II anemia?

Answer 4

several months of iron depletion, decreased levels of circulating iron but hemoglobin and hematocrit remain normal

Question 5

What is stage III anemia?

Answer 5

several weeks of iron-deficient erythropoiesis hemoglobin production diminishes, individual develops clinically recognized iron-deficiency anemia

Question 6

What is iron-deficiency anemia?

Answer 6

Childhood – inadequate diet
Adult – blood loss through heavy menstrual period, bleeding through GI ulcers, polyps, hemorrhoids, cancer
Endurance athletes and individuals who maintain a lower % body fat
S/S – fatigue, tachycardia, blood in feces, pallor, epithelial abnormalities, cardiac heart murmurs, loss of hair, pearly sclera, muscle burning, nausea, vomiting, appetite for substances of low nutritional value, scry scaling of lips, inflammation of tongue
Management – supplements, avoid caffeine

Question 7

What is exercise-induced hemolytic anemia?

Answer 7

Runner’s anemia – occurs during exercise when RBCs are destroyed and hemoglobin is liberated into the medium in which the cells are suspended
Foot-strike hemolysis – hard foot strike destroys RBC
Intravascular hemolysis – muscle contraction, acidosis, increased body temperature destroys RBC
Management – rarely severe enough to cause loss of iron

Question 8

What is sickle cell anemia?

Answer 8

Abnormalities in hemoglobin structure producing a sickle or crescent-shaped RBC that is fragile and unable to transport oxygen
Sickle cells clump together and block blood vessels
S/S – may be asymptomatic, swollen, painful and inflamed hands and feet, irregular heart beat, fatigue, headache, pallor
Management – no treatment but avoid dehydration

Question 9

What is hemophilia?

Answer 9

Bleeding disorder characterized by a deficiency of selected proteins in the body’s blood-clotting system
Procoagulant proteins help to form clots, anticoagulant proteins prevent the formation of clots, fibrinolytic proteins help to dissolve clots that have formed
A and B occur in males, C in males and females, all caused prolonged bleeding
Emergency situation – suspected bleeding into the head, neck, or digestive tract, pain/swelling and warmth of extremity muscles and large joints such as knees, elbows, hips and shoulders, persistent bleeding from an injury

Question 10

What is Reye Syndrome?

Answer 10

2-16 years old, rare but serious
Always follows an upper respiratory viral infection (type B influenza and varicella, common cold)
Cause unknown, using aspirin to treat the viral illness can trigger it by disrupting body’s urea cycle
Accumulation of ammonia and acidity in the blood while level of sugar drops, liver swells and develops fat deposits, brain edema

Question 11

What is stage 1 Reye syndrome?

Answer 11

Lethargy, vomiting, hepatic dysfunction followed by a few days of recovery

Question 12

What is stage 2 Reye’s syndrome?

Answer 12

hyperventilation, delirium and hyperactive reflexes

Question 13

What is stage 3 Reye’s syndrome?

Answer 13

coma and rigidity of organ cortices

Question 14

What is stage 4 Reye’s syndrome?

Answer 14

deepening coma, large and fixed pupils, loss of cerebral function

Question 15

What is stage 5 Reye’s syndrome?

Answer 15

seizures, loss of deep tendon reflexes, flaccidity and respiratory arrest

Question 16

What is lymphangitis?

Answer 16

Inflammation of the lymphatic channels that occurs as a result of infection at a site distal to the channel
Pathogenic organisms invade lymphatic vessels directly or as a complication of an infection
S/S – red streaks, fever, chills

Question 17

What is Syncope?

Answer 17

Sudden, transient LOC, fainting, occurs in health individuals
Presyncope – sense of impending LOC, light-headedness or weakness, more frequently than syncope
Decrease blood flow can occur – (1) the heart fails to pump the blood, (2) the blood vessels don’t have enough tone to maintain BP to deliver the blood to the brain (3) not enough blood or fluid within the blood vessels (4) combination of these reasons
Sudden drop of BP that reduces blood circulation to the brain and leads to LOC
Reflex (neurally mediated) Syncope – vasovagal (emotional distress), situational (cough, sneeze, GI stimulation, micturition, post-exercise)
Syncope due to orthostatic hypotension – primary autonomic failure, secondary autonomic failure, drug-induced, volume depletion
Cardiac syncope - arrythmia (bradycardia, tachycardia, structural diseases

Question 18

What is shock?

Answer 18

Occurs if the heart is unable to exert adequate pressure to circulate enough oxygenated blood to the vital organs – results from damaged heart that pumps poorly that leads to blood pooling, lack of oxygen at cellular level
S/S – Rapid weak pulse, BP drops, breathing rapid and shallow, cool/clammy moist skin, profuse sweating, disoriented, dizziness, pupils dilated

Question 19

What is hypovolemic shock?

Answer 19

excess blood/fluid loss leading to inadequate circulation and oxygen supply to all body organs (hemorrhage, dehydration, multiple trauma, severe burns)

Question 20

What is respiratory shock?

Answer 20

insufficient oxygen in the blood as a result of inadequate breathing (spinal injury to respiratory nerves, airway obstruction, chest trauma)

Question 21

What is neurogenic shock?

Answer 21

peripheral blood vessels dilate, and insufficient blood volume cannot supply oxygen to the vital organs (spinal or head injury)

Question 22

What is psychogenic shock?

Answer 22

temporary dilation of blood vessels resulting in the draining of blood from the head with pooling of blood in the abdomen

Question 23

What is cardiogenic shock?

Answer 23

occurs when the heart muscle is no longer able to sustain enough pressure to pump blood through the system (heart injury or heart attack)

Question 24

What is metabolic shock?

Answer 24

severe loss of body fluids because of untreated illness that alters biochemical equilibrium (insulin shock ,diabetic coma, vomiting, diarrhea)

Question 25

What is septic shock?

Answer 25

severe, bacterial infection whereby toxins attack the walls of small blood vessels, causing them to dilate decreasing BP

Question 26

What is anaphylactic shock?

Answer 26

severe allergic reaction of the body to a foreign protein that is ingested

Question 27

What is hypertension?

Answer 27

Sustained elevated BP – SBP greater than 140 mmHg and DBP greater than 90 mmHg Causes – prescribed medications, oral contraceptives, anabolic steroids, amphetamines, chronic alcohol use, NSAIDs, sleep apnea, chronic kidney disease, thyroid disease Risk factors – age, diabetes, heredity, high blood lipids, obesity, race, sex, smoking Primary or essential hypertension – chronic, progressive disorder with no identifiable cause that often attacks the heart, brain, kidneys and eyes – treated with medication Secondary hypertension – identified cause (renal disease, renovascular disease, coarctation)

Question 28

What is the systolic and diastolic for a normal BP?

Answer 28

<120/<80

Question 29

What is the systolic and diastolic for prehypertension BP?

Answer 29

120-139/80-89

Question 30

What is the systolic and diastolic for stage 1 hypertension?

Answer 30

140-159/90-99

Question 31

What is the systolic and diastolic for stage 2 hypertension?

Answer 31

>160/>100

Question 32

What is hypotension?

Answer 32

BP lower than normal, inadequate blood is circulated to the heart, brain and other vital organs  collapse of bodily function Decrease of 20 mmHg or more in an individual’s normal SBP Caused by – shock, acute hemorrhage, dehydration, orthostatic hypotension, postural hypotension, overtreatment of hypertension Reduce effects of orthostatic hypotension Avoid prolonged standing, vigorous exercise, alcohol, hot environments, hot showers Execute slow, careful position changes Eat multiple small meals PA in PM Increase salt and fluid intake

Question 33

What is hypertrophic cardiomyopathy?

Answer 33

Abnormal thickening of the left ventricle wall (2-4 cm thick, up to 15 cm) Typically goes undetected Abnormal thickness – electrical problems, abnormal rhythms Suspected in young athletes with exertional dyspnea, chest pain, unexplained syncope, heart murmur

Question 34

What is mitral valve prolapse?

Answer 34

Redundant tissue is found on one or both leaflets of the mitral valve Ventricular contraction  redundant tissue on the mitral valve pushes back beyond the normal limit  abnormal sound Chest pain, palpitations, fatigue with exertion, dyspnea Can engage in sport unless Prior syncope – arrhythmogenic in origin Tachyarrhythmias Mitral regurgitation LV systolic dysfunction Prior embolic event Family history of sudden death

Question 35

What is myocarditis?

Answer 35

Inflammatory condition of the muscular walls of the heart that can result from a bacterial or viral infection Infiltration of inflammatory cells into myocardium leading to an abnormally enlarged left ventricle SCD – inflammatory changes in the myocardium lead to degeneration or death of adjacent muscle cells resulting in electrical instability and life-threatening arrythmias S/S – fever, body aches, fatigue, cough, vomiting, palpitations, syncope Withdrawal from sport until – LV function/wall motion/cardiac dimensions return to normal, arrhythmias absent, markers of inflammations normal, ECG normal

Question 36

What is acquired valvular heart disease?

Answer 36

Stems from a defect or insufficiency in a heart valve that can lead to improper blood flow through the heart Valvular stenosis – narrowing of orifice around cardiac valves Regurgitation – backward flow of blood Mild-to-moderate – can participate in PA, evaluate individually

Question 37

What is coronary artery disease?

Answer 37

An excessive build-up of cholesterol within the coronary arteries narrows the diameter of the arteries and impedes the flow of blood, reducing the amount of oxygen supplied to the heart Angina – subsequent to diminished oxygen Build up of cholesterol – at risk for a myocardial infarction

Question 38

What is Marfan syndrome?

Answer 38

Genetic disorder of the connective tissue that can affect the skeleton, lungs, eyes, heart and blood vessels Mutant gene linked to conditions Tall in stature, long extremities, hypermobility, sunken chest, scoliosis, increased incidence of hernias

Question 39

What is long QT syndrome?

Answer 39

hereditary disorder of the heart’s electrical system, arrhythmias  insufficient contraction of the heart

Question 40

What is right ventricular dysplasia?

Answer 40

formation of adipose or fibrous tissue extending from the epicardium to the endocardium, increases risk of ventricular fibrillation

Question 41

What is wolfe-parkinson-white syndrome?

Answer 41

abnormality of cardiac rhythm that manifests as an SVT, associated with an accessory electrical pathway in the heart proximal to the ventricles that can spontaneously produce episodes of rapid twitching of the atrium muscle fibers

Question 42

What is congenital coronary artery anomalies?

Answer 42

abnormal origin of left coronary artery