module 5: cardiovascular disorders Flashcards

Question

describe the distinctive diagnostic clinical features of unstable angina regarding: the effect of exercise and emotional stress on the signs/symptoms

Answer 1

chest pain is not in response to exertion or stress, but is spontaneous

Answer 2

requires immediate hospitalization for rest, observation, and treatment: nitrates (vasodilator)

Answer 3

a spectrum of ischemic heart diseases ranging from unstable angina to myocardial infarction

Answer 4

* atherosclerotic plaque is still in the coronary artery * small portions of the plaque can break off = small thromboses * small thromboses move through circulation = blockages in blood vessels

Answer 5

sometimes thrombus disintegrates before complete tissue necrosis = only sub endocardium affected * don't see ST elevation because thrombus in blood vessel sometimes disintegrates before complete damage

Answer 6

most serious heart attack * the clot lodges permanently in the vessel and the entire thickness of the myocardium becomes ischemic * requires immediate emergency intervention

Answer 7

* chest pain sudden and unpredictable * pain generally more severe, lasting longer than 20 minutes

Answer 8

chest pain is not in response to exertion or stress, but is spontaneous

Answer 9

requires immediate hospilization: nitrate (vasodilator)

Answer 10

sometimes thrombus disintegrates before complete tissue necrosis: only sub endocardium affected * lasts over 20 minutes

Answer 11

can happen at rest

Answer 12

not relieved by GTN

Answer 13

* serious: requires immediate emergency intervention * duration over 20 minutes

Answer 14

pain occurs at rest

Answer 15

not relieved by GTN

Answer 16

* non-STEMI: sometimes transient ST elevation, the T wave inversion * STEMI: ST segment elevation on ECG

Answer 17

markers produced when there's nectrotic tissue * if seen in lab, it means there's necrotic tissue going on * ex: troponin T

Answer 18

* both Non-STEMI and STEMI present cardiac biomarkers * different MI to angina since biomarkers are able to distingush necrotic tissue

Answer 19

* abrupt onset * severe and crushing pain, usually substernal, radiating to the left arm, neck, or jaw * gastrointestinal complaints * complaints of fatigue and weakness * tachycardia, anxiety, restlessness, feelings of doom * pale, cool, and moist skin * a “silent MI” occurs when the person is asymptomatic

Answer 20

* GI complaints * complaints of fatigue and weakness * tachycardia, anxiety, restlessness, feelings of doom * pale, cool, and maist skin

Answer 21

occurs when a person doesn't experience any symptoms or has atypical symptoms

Answer 22

1. decreased cardiac output 2. fibrillation of the heart 3. rupture of the heart most common cause of death: VF = ventricular fibrillation

Answer 23

decreased cardiac output → cardiogenic shock * pumping ability reduced * maybe exacerbated by “systolic stretch” = dead muscle * when the heart goes to contract, there's dead muscle= no contraction = bulge & pooling of blood * when cardiac output is inadequate to the needs of tissues heart failure and peripheral ischemia result = cardiogenic shock

Answer 24

* main cause of death in STEMI is VF = ventricular fibrillation * cardiac output is zero * due to erratic electrical impulses and abnormal conduction pathways in damaged myocardium * dangerous periods of VF to occur are after first 10 minutes then after 1 hour or so

Answer 25

* can occur several days after infarct as muscle fibres necrose and degenerate and the heart wall stretches thin * systolic stretch increases to the point when finally the heart ruptures * one way of assessing severe MI is by cardiac imaging to monitor the degree of systolic stretch

Answer 26

* nitroglycerin (GTN)- fast acting vasodilator * bed rest * pain relief - morphine * 12 lead ECG and ECG monitoring * oxygen therapy - to increase oxygen * beta blockers - slows HR, lengthen diastole * beta adrenergic receptor antagonists * anticoagulant therapy

Answer 27

less strain on the heart 1. cellular death determines by: * degree of ischemia due to infarct * workload on the heart since it increases O2 demand * lower workload = lower injury from ischemia 2. when the heart becomes highly active, coronary arteries dilate to supply healthy muscles with O2 and nutrients * this reduces collateral circulation that may be assisting the damaged muscle during recovery = not good

Answer 28

* normally we cannot “feel” our heart - but ischemic myocardium can produce severe “crushing” pain * believed to releate to release of lactic acid (anaerobic respiration) and mediators of inflammation * ex: histamine, kinins * pain rrlief in itself is important for comfort, but also because pain increases stress = cardiac output = increase workload on the heart

Answer 29

* in large vessles, thrombus formation could lead to hypertension or emboli and weakening of the vessel wall could lead to aneurism * in smaller blood vessels, can also get weakening of vessel wall = bursting of wall (on top of thrombus/emboli)

Answer 30

in medium-sized arteries, mainly ischemia and infarction due to vessel occlusion * coronary = heart attack * cerebral - stroke

Answer 31

can cause significant pain and disability * especially prevalent in diabetics

Answer 32

CAD (coronary artery diseasse) caused by atherosclerosis is the major cause of myocardial ischemia

Answer 33

* hypertesion = a consistent elevation of systematic arterial blood pressure * \>/= 140/90 * increased risk for MI, kidney disease, and stroke * commonly divided into categories of primary (idiopatheic) or secondary (resulting from another disorder)

Answer 34

primary (95%) due to a combination of genetics and the environment

Answer 35

* family history * age * gender * race * high dietary sodium intake * insulin resistance * cigarette smoking * obesity

Answer 36

1. increase in circulating blood volume (volume of blood gone up) 2. increased peripheral resistance (blood vessels are constricted/extra resistant to the amount of blood coming in)

Answer 37

1. sympathetic nervous system - increases heart rate and vasoconstriction 2. overactivity of renin-angiotension-aldosterone system (RAAS) - increases blood volume and pressure (retain water in kidneys), increases vasoconstriction 3. chronic inflammation results in smooth muscle contraction

Answer 38

* “silent disease” = early stages have no symptoms/signs, other than elevated blood pressure * damage due to sustained hypertension: * coronary heart disease * kidney disease * CNS dysfunction (stroke) * impaired vision

Answer 39

* diagnosis: * several BP measurements at different times * 3-5 visits depending on the measurement * complete blood count (CBC) * urinalysis * blood chemistry * ECG * treatment: * exercise * lose weight * stop smoking * diuretics * other antihypertensives

Answer 40

1. pre-existing: present before pregnancy, or appears before 20 weeks of pregnancy 2. gestational: occurs at or after 20 weeks of pregnancy - due to the pregnancy

Answer 41

* unknown: thought to be due to a decrease in placental blood flow = release of toxic compounds that causes changes in blood vessel walls throughout the body * conditions: risk for development of many pathological effects * preeclampsia = danger zone * liver failure * kidney failure * heart disease * respiratory distress * DIC * generalized edema

Answer 42

1. hypertension - once you see hypertension, have to check for proteinuria and other conditions 2. proteinuria - protein high in the urine 1. liver beinf affected 2. kidney is being affected 3. adverse conditions such as persistent or new headache, visual disturbances, persistent abdominal pain, elevated liver enzymes, etc.

Answer 43

* eclampsia = the occurence of convulsions (CNS shuts down) and possible coma * possibly brought about through the development of blood clots in cerebral vessels

Answer 44

* decrease in placental blood flow * results in infants who are small for gestational age, and the frequent need for early delivery

Answer 45

birth of baby and accompanying delivery of placenta

Answer 46

* specific decrease in blood pressure within 3 mins of moving to a standing position, causing dizziness, fainting, etc.

Answer 47

* more frequently observed in elderly (age) * mechanisms that increase BP decline as we age * medications * other medical conditions

Answer 48

* common cause = certain medications * treatment = alleviating the cause (aka change the meds) * can be managed by learning ways to cope

Answer 49

local outpouring of vessel or heart chamber, usually in the abdominal aorta

Answer 50

* atherosclerosis * hypertension

Answer 51

* depends where the aneurism is * involve the production of pressure on local structures * depends where the weakness is in order to see different effects * rupture causes exteme pain and hypotension

Answer 52

* thrombus = blood clot * caused by any condition that promotes activation of coagulation * can occlude the artery/vein, or can break off to form an embolus

Answer 53

obstruction of a vessel by an embolus * no matter how times, it will eventually lodge in a vessel

Answer 54

* pulmonary emboli- arise from the venous side, or in the right heart (goes to the lungs) * arterial emboli - arise from the left heart and are associated with thrombi that occur after heart trauma * go back through coronary artery = MI * go back to the brain = stroke

Answer 55

veins in which blood pooled, producing distended (widen), tortuous (twisted), and palpable vessels

Answer 56

1. there are no valves in the inferior vena cava or the common iliac veins = veins in the legs responsible for supporting the blood in these vesels = increase pressure in abdomen = increase strain on valves 2. standing for long periods of time puts extra strain the these valves since leg muscles are not being used to pump blood back to the heart

Answer 57

* pressure from the valve damage increases pressure down to the legs because of gravity * vein swells = edema in the surrounding tissues * edema = damage to the remaining upstream valves in the vein * damage to upstream valves = unable to maintain normal venous pressure

Answer 58

* standing long periods * crossing legs at knee * age * females * family history * obesity * pregnancy * deep venous thrombosis * previous leg injury

Answer 59

* compression stockings * physical exercise * surgical ligation (clipping off vein) * vein stripping

Answer 60

* CVI = chronic venous insufficiency * inadequate venous return over a long period of time, which impairs blood flow to the area

Answer 61

* complications * impaired tissue nutrition * edema and venous hypertension = inflammation in the vessels and tissue * symptoms * darkening of the skin of the feet and ankles

Answer 62

when circulation becomes so poor that any trauma or pressure can lower the delivery of oxygen to the tissues to the point of causing necrosis

Answer 63

trauma or pressure can lower the delivery of oxygen to the tissues to the point of causig necrosis (stasis ulcer) and infection

Answer 64

* DVT = deep venous thrombosis * the development of a thrombus in deep vein- occurs primarily in lower extremit * risk factors: * venous stasis = not able to move a lot because muscle can'y help w/o movement * impaired cardiac function = not enough pressure to extremeties to get blood back up in the end * venous endothelial damage * hypercoagulable states

Answer 65

1. clotting fators and platelets accumulate and form a thrombus 2. inflammation around the thrombus promotes further platelet aggregation and the thrombus grows 3. because the vein is deep in the leg, it is usually asymptomatic

Answer 66

* most thrombi will eventually dissolve, but are associated with higher risk of pulmonary embolism * hard to detect, so prevention is important

Answer 67

* pericarditis = acute inflammation of the pericardium = pain and fever * causes: * idiopathic * infection * surgery, etc.

Answer 68

diverse group of diseases the primarily affect the myocardium itself

Answer 69

* **ex 1: dilated cardiomyopathy** * ventricles are widening = muscle layer very thin = impairment of the systolic function of one or both ventricles (blood can't get through the body) * ⅓ of cases are inherited * effects = orthopnea reduced exercise capacity * **ex 2: hypertrophic cardiomyopathy** * thickening of septum = decrease in left ventricular size = obstruct the outflow of the left ventricle * one of the most common types of cardiomyopathies and inherited * most people asymptomatic * effects = angina, dyspnea, reduced exercise capacity

Answer 70

through rheumatic heart disease * initial infection with streptococcus pyogenes, followed by molecular mimicry

Answer 71

* aortic and mitral valve * because these valves are between the body (aorta) and atrium or lungs (mitral) and left ventricle..? IDEK

Answer 72

* stenosis: narrowing of valve opening, causing turbulent flow and enlargement of emptying chamber * incompetent (regurgitant) valve: permits backward flow

Answer 73

sounds made by abnormal flow

Answer 74

range from occasional “missed” or rapid beats to serious disturbances that impair the pumping ability of the heart * problem with conduction pathway

Answer 75

1. abnormal rate of impulse generation from thr SA node or other pacemaker 2. abnormal conduction of impulses through the heart's conduction system 1. SA node working properly, but problem elsewhere

Answer 76

the rhythm of your heartbeat, determined by the sinus node of your heart

Answer 77

slower than normal heart rate

Answer 78

faster than normal heart rate

Answer 79

a changing sinus node rate with the respiratory cycle, on inspiration and expiration irregular heartbeat

Answer 80

* AFib = 400-600bpm * completely disorganized and irregular atrial rhythm accompanied by completely irrgular ventricular rhythm * greatest danger: causes pooling of blood in atria = risk for blood clot * may be asymptomatic because ventricular filling is not totally dependent on atrial contraction

Answer 81

* atria contract ok, but AV node may be paused too long * “first, second, or third degree” = depends how long the pause is at AV node.. longer = worse * heart block occurs when ocnduction is excessively delayed or stopped at the AV node or bundle of His

Answer 82

* conductions not going through ventricles = not contracting * ventricles quiver but do not contract = ineffective in ejecting blood * death within minutes if not corrected

Answer 83

* no electrical activity in the heart/absence of a heartbeat * “flatline” * worst case scenario

Answer 84

when the heart is unable to generate an adequate cardiac output

Answer 85

1. stroke volume 2. heart rate * cardiac output = stroke volume x heart rate * decrease in stroke volume

Answer 86

* preload * afterload * myocardial contractility

Answer 87

1. inadequate perfusion of tissues 2. increased pulmonary capillary pressures \*\*or both

Answer 88

* coronary artery disease * hypertension * dilated cardiomyopathy * valvular heart disease risk factors: * ischemic heart disease * hypertension * T2DM * obesity * older age * lack of exercise * smoking * hyperlipidemia

Answer 89

volume of blood in the ventricle at the end of diastole * two factors * amount of blood entering ventricle during diastole * blood left in ventricle after systole

Answer 90

the more stretched the ventricle wall, the greater the force of the contraction (up to a maximum value) = the more blood in the ventricles, the stronger the contraction = greater stroke volume

Answer 91

afterload = resistance to ejecion of blood from the left venricle (blood easy to push out = good) * peripheral vascular resistance is usually a good index of afterload

Answer 92

* inotropy synonym = **contractility** (how good can your muscle fibres contract) * the ability of actin and myosin of the heart muscle to interact and shorten against a load

Answer 93

1. ventricular hypertrophy increases contractility 2. myocardial infarction decreases contractility

Answer 94

myocardial contractility is imparied, leading to a decrease in ejection fraction = decrease in cardiac output * normal = 65% * dysfunction = 40%

Answer 95

* decrease in ejection fraction = more blood left in the ventricle after contraction * more blood in the ventricle = increase of pre-load * increased pre-load = too much pressure in ventricles all the way to the lungs * increased pre-load = pulmonary/peripheral edema

Answer 96

* decreased contractility = due to MI, cardiomyopathy * volume overload = due to valvular incompetence * pressure overload = due to hypertension

Answer 97

* decrease in cardiac output that occurs on the left side * caused by decreased diastolic relaxation so that less blood enters the ventricle

Answer 98

* decrease expansion of the ventricle = ex: pericardial effusion (pressure on the heart) * increase wall thickness and reduce chamber size = ex: hypertrophic cardiomyopathy (not able to pull as much blood) * delay diastolic relaxation (myocardial ischemia) = decreased energy for calcium pumps

Answer 99

* result = pulmonary edema * happens as blood backs up into pulmonary circulation = increasing pulmonary pressure

Answer 100

* definition: decreased output to systemic circulation * commonly called congestive heart failure * can be systolic, diastolic, or both

Answer 101

* consequence = pulmonary edema 1. blood accumulates in the left side, then in the pulmonary circulation = increased pulmonary venous pressure 2. if this exceeds osmotic pressure in capillaries, fluid enters the lung tissue 3. fluid enters lung tissue = pulmonary edema

Answer 102

* hypertension * acute MI * cardiomyopathy

Answer 103

inability of right ventricle to move deoxygenated blood from systemic circulation into the pulmonary circulation

Answer 104

* consequences: * peripheral edema and congestion of the viscera 1. right ventricle unable to movr deoxyginated blood to pulmonary circulation = pressure rise in systemic venous circulation 2. pressure rise in systemic venous circulation = peripheral edema and congestion of the viscera

Answer 105

* most commonly caused by left heart failure 1. left heart failure increased pulmonary pressure 2. backs up into the right ventricle which is poorly equipped to compensate = dilate and fail

Answer 106

* cor pulmonale = when right heart failure occurs independently of left heart failure, in response to pulmonary disease * diseases: * COPD * cystic fibrosis * ARDS (acute respiratory distress syndrome)

Answer 107

1. sympathetic nervous system activation 2. RAAS activation 3. hypertrophy

Answer 108

* to increase blood pressure and cardiac output * harm: the increase in HR and contractility actually put more strain on the already weakened heart

Answer 109

* RAAS= renin-angiotensin-aldosterone-system * activated due to decreased cardiac output (decreased amount of blood going through kidney due to a decrease in BP) * aldosterone and ADH released = increase of vasoconstriction & blood volume = increase BP * harm: * vasoconstriction increased afterload = increases resistance to pushing blood out of the heart = heart working harder * increase blood volume = increase preload = heart working harder

Answer 110

* depending on the stimulus * heart working harder = disproportionate thickening of walls due to increase of muscle = ischemia or thinning of ventricular walls * ischemia or thinning of ventricular walls = dilations and impairment of heart contraction

Answer 111

heart failure worsening

Answer 112

* dyspnea - SOB due to pressure on lungs * orthopnea- sitting up helps relive dyspnea (pressure on lungs) * fatigue and tires easily - reduction in blood flow = decrease oxygen to tissues * decreased urine output - kidney function * edema (especially in lower extremities) - fluid build up

Answer 113

* salt restriction and diuretics, weight management - concentrates on decreasing preload and afterload * digitalis (improves stroke volume), beta-blockers, oxygen therapy

Answer 114

an acute failure of the circulatory system to supply the body with an adequate blood supply, resulting in cellular hypoxia

Answer 115

* lack of oxygen to cell = switch to anaerobic respiration = decrease ATP production * lack of ATP = cell's sodium/potassium pump operates poorly * sodium/potassium pump affected & calcium not maintained = problems with functioning of nervous and muscular systems

Answer 116

* failure in circulation * losing water from interstitial fluid due to Na+ attracting water into the cell * lack of interstitial fluid = **water being pulled from the vascular system** * lack of fluid from vascular system = drop in BP * drop in BP and blood volume = lack of blood to tissues

Answer 117

* lysosomal enzymes are released, damaging tissues.. 2 ways: 1. disruption of cell membrane = cellular swelling = burst cell = release of enzymes 2. increase acidity due to increase lactic acid = change in pH = cells bursting = release lysosomal enzymes * lysosomal enzymes attack surrounding cells = inflammatory response = increase to tissue damage = further damage to cellular metabolism

Answer 118

* lactic acid buildup = lower pH * lower pH = decreased affinity (AKA binding ability) with o2 to hemoglobin * decrease of o2 binding to hemoglobin = decreased o2 carrying capacity of our blood = anemia

Answer 119

hypotension * arterial pressure below 60mmHg * normal = 70-110mmHg

Answer 120

* symptoms can be conflicting in nature * being sick * weak * cold * hot * dizzy * confused * afraid * thirsty * SOB depends on the type of shock

Answer 121

* enough blood volume but decreased cardiac output due to decreased contractility increased preload, and increased afterload * as the heart is contracting, it is not able to pump blood to tissues efficiently * decrease in BP causes compensatory responses = increase o2/nutrient demand on the heart * increase o2/nutrient demand = further strain on the heart * further strain on heart = incapable of pumping an adequate volume of blood to the heart

Answer 122

myocardial infarction

Answer 123

* not enough blood volume * caused by a loss of whole blood (hemorrhage), plasma (burns), or interstitial fluid (diarrhea/diuresis in large amounts * amount of volume of blood in your vascular system decreases by 20% = starts to get issues w/hypovolemic shock

Answer 124

* HR and vasoconstriction increase * interstitial fluid moves into blood * liver and spleen add to blood volume * RAAS is activated, as is ADH

Answer 125

* right amount of volume, but blood vessels are dilated throughout the body = ineffective movement of blood * ineffective movement of blood = lower BP and lack of nutrients to tissues

Answer 126

1. neurogenic 2. anaphylactic 3. septic

Answer 127

* result of massive vasodilation resulting from overstimulation of parasympathetic nervous system and under stimulation of the sympathetic nervous system * rare and usually transitory * causes: * trauma to the spinal cord or medulla * anesthetic agents * severe pain

Answer 128

* results from a widespread hypersensitivity reaction * cause: * release of histamine by mast cells = type 1 hypersensitivity * type 1 hypersensitivity = vasodilation and vascular permeability * vasodilation and vascular permeability = peripheral pooling and tissue edema * smooth muscle constriction can result in laryngospasm, bronchospasm, and diarrhea * treatment: * epinephrine to cause vasoconstriction and reverse airway constriction

Answer 129

* the most common type of vasodilatory shock * happens from infection * huge inflammatory response to microorganisms itself and antigens OR from toxins being released by microorganisms OR both * common cause of death in ICUs * skin is warm and flushed since septic shock produces dilation

Answer 130

skin is warm and flushes because septic shock produces dilation

Answer 131

* results from mechanical obstruction of the flow of blood through the central circulation (large veins) * most common cause = pulmonary embolism * elevated right heart pressure occurs * significant decrease in cardiac output * often classified under cardiogenic shock

Answer 132

* must remove the underlying cause * know what type of shock we're looking at/what is causing it * IV fluid to expand blood volume * because all shock has low BP * once positive feedback loops have been established, intervention is very difficult

Answer 133

* Heart failure: tired and weak (due to lack of blood supply to the body * Left side failure: trouble breathing (due to pulmonary edema as a result of backup of pressure from the left side of the heart into the lungs, increasing blood pressure in lungs) * Right side failure: swollen feet and legs (due to peripheral edema as a result of back-up of pressure from the right side of the heart into the veins of the body)

Answer 134

Left sided failure -\> back-up of pressure into lungs -\> increased venous pressure in lungs -\> edema in lungs (difficulty in breathing) -\> back-up of pressure into right ventricle -\> right sided failure -\> back-up of pressure into body -\> increased venous pressure -\> increased edema.

Answer 135

* age * obesity * smoking * previous MI * male

Answer 136

* An ACE inhibitor would very likely be included in the treatment of Mr. S’s condition * Angiotensin II causes increased vasoconstriction of arteries, leading to increased BP * Angiotensin II also causes release of aldosterone by adrenal cortex. Aldosterone causes kidney to retain sodium (water follows). This increases the blood volume, which increases BP

Answer 137

* Preload – the volume of blood in the ventricle at the end of diastole. * Afterload – the force required to pump blood out of the heart, most easily connected to peripheral resistance. * Inotropy - ability of actin and myosin to interact and shorten against a load (force of contraction independent of Frank-Starling law).

Answer 138

* Preload – increase * Afterload - increase

Answer 139

Pre-load. The Frank-Starling law of the heart is: the greater the stretch on the ventricle wall (the more blood contained in the ventricle prior to contraction), the greater the force of contraction, up to a maximum value. Preload is the volume in the ventricle just before contraction. As volume increases, stretch increases and the force of the contraction would increase

Answer 140

* It is systolic – failure in the ability of the heart to contract (caused in this case by a MI). * Diastolic – decreased volume (filling) in the left ventricle during diastole.

module 5: cardiovascular disorders Flashcards

(164 cards)