lec-9-cardio path-1

Question 1

route of blood flow through heart

Answer 1

1. Right atrium-deoxygenated blood returning from body
2. Tricuspid valve
3. right ventricle
4. pulmonic valve
5. pulmonary arteries-only arteries carry deoxy blood in body
6. Pulmonic veins
7. left atrium
8. Mitral valve
9. left ventricle
10. aortic valve
11. aorta-blood leaves to systemic circ o2 rich

Question 2

S1 sound

Answer 2

due to closing of atriventricular valves (Mitral and tricuspid) tricuspid right side, mitral left

Question 3

s2 sound

Answer 3

aortic and pulmonic closing then blood fills during dystole, atria contract blood go to ventricles which is s2 sound aortic valve sits behind pulmonic valve

Question 4

Left Coronary artery braches

Answer 4

LAD left anterior descending artery and circumflex

Question 5

LAD supplies?

Answer 5

Supplies blood to the front and bottom of the left ventricle and the septum
*anterier wall 2/3 septum

Question 6

Circumflex artery supplies

Answer 6

supplies blood to left atrium and side and back of left ventricle
*lateral supply

Question 7

Right coronary art supplies?

Answer 7

Right atrium right ventricle and bottom portion left ventricle and back of the septum
*posterier wall and 1/3 septum

Question 8

Congestive Heart Failure (CHF)

Answer 8

CHF affects nearly 5 million individuals and is the leading discharge diagnosis in patients over 65 years of age in the United States.
CHF occurs when the heart is unable to pump blood at a rate sufficient to meet the metabolic demands of the tissues or can do so only at an elevated filling pressure.
It can appear during the end stage of many forms of chronic heart disease.

Question 9

CHF defininition

Answer 9

CHF is characterized by variable degrees of decreased cardiac output and tissue perfusion, as well as pooling of blood in the venous system which may cause pulmonary edema, peripheral edema, or both.

Question 10

common causes CHF

Answer 10

Coronary artery disease (due to athroschelosis)

High blood pressure (thickening in left ventricle is result)

Question 11

systolic HF

Answer 11

EF

Question 12

severe HF

Answer 12

EF

Question 13

NORMAL EF

Answer 13

50-70% AVERAGE 60%

Question 14

EF

Answer 14

EF= SV/EDV * 100

Question 15

SV

Answer 15

asmount og blood leaving ventricles with each beat

Question 16

EDV

Answer 16

amount of remianing blood end of dystole

Question 17

CF systole dysfunction

Answer 17

heart becomes dialated/enlarged in ventricles, EDV is greatly increased (more volume so lower EJ) at end of dystole, and duringn systole SV less pumps out less than 40-50% EJ result = low EJ end systole

Question 18

CF dystole dysfunction

Answer 18

ventricle walls are thickened (hypertension) and ridid so can’t fill with as much blood volume during dystole but pumps normally (normal SV) during systole so EF unchanged looks normal (60%), but total volume of blood pumped cant meet metabolic demand, still in failure

Question 19

Stage A CHF

Answer 19

Patients at high risk for developing HF in the future but no functional or structural heart disorder.

Question 20

Stage B CHF

Answer 20

: a structural heart disorder but no symptoms at this stage.

Question 21

Stage C CHF

Answer 21

previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment.

Question 22

Stage D CHF

Answer 22

advanced disease requiring hospital-based support, a heart transplant or palliative care.

Question 23

most common marker used to identify HF

Answer 23

Naturetic B peptide >100 indicates HF, can get as high as 800 in severe dosease

Question 24

Left sided heart disease

Answer 24

*produce symptoms history important, breathing issues, lungs filling with Serous fluid, patient reports experience

Pulmonary congestion and edema (heart failure cells)
Dilation of the left atrium and increases the risk of atrial fibrillation
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea
Reduction in renal perfusion and CNS (Severe Lt sided CHF)
**heart failure cells
**thrombosis left atrial appendage

Question 25

Right sided heart disease

Answer 25

*produce signs we can measure, PE imortant Cor pulmonale usually due to conditions resulting in pulmonary hypertension Blood backs up into the venous system – JVD, pitting edema congestive hepatosplenomegaly, pleural, pericardial, or peritoneal effusions Congestion of kidney and CNS

Question 26

Biventricular CHF

Answer 26

Mi in left side heart can cause pulm edema and hypertension eventually causing right vent hf too, cross of symptoms / signs

Question 27

CHF treatment

Answer 27

``` Diuretics Angiotensin converting enzyme inhibitors β1-adrenergic blockers Mechanical assist Cardiac Transplant (advanced, irreversible heart failure) ```

Question 28

Ischemic Heart Disease (IHD

Answer 28

Ischemic heart disease (IHD) is the leading cause of death worldwide for both men and women. Due to an imbalance between the supply (perfusion) and demand of the heart for oxygenated blood. In more than 90% of cases reduced blood flow due to obstructive atherosclerotic lesions in the coronary arteries (coronary artery disease - CAD).

Question 29

NMRF IHD

Answer 29

age male genetic issue -hypercholest etc familial history- MI

Question 30

Modifiable risk factors

Answer 30

``` hypertension cholesterol diabeites smoking***#1 for athro c-reactive pro-inflammation minor include obesity, inactivity, stress ```

Question 31

pathogenesis IHD

Answer 31

Insufficient coronary perfusion relative to myocardial demand, due to chronic, progressive atherosclerotic narrowing of the epicardial coronary arteries, and variable degrees of superimposed acute plaque change, thrombosis, and vasospasm

Question 32

Chronic Atherosclerosis

Answer 32

Develops over decades The varied clinical manifestations of IHD cannot be explained by the anatomic disease burden alone. Generally, obstructing 75% or greater of the lumen is generally required to cause symptomatic ischemia and 90% of the lumen can lead to inadequate coronary blood flow even at rest. Multiple coronary vessels can be involved.

Question 33

Vulnerable plaque

Answer 33

Soft w/ lipid filled core; Most often eccentric; Most often only 40-60% stenotic. Prone to rupture (shoulder region) due to plaque hemorrhage or to fibrous cap disruption Thrombotic occlusion of coronary artery and acute myocardial ischemia/infarction. Moderately stenotic, vulnerable complex plaques are difficult to detect and treat prophylactically. * Eccentric= don’t involve entire lumen just a portion, vessel expands until it cant