Screening for Cardiopulmonary Disorder Lecture Flashcards

Question

What is ischemic heart disease?

Answer 1

Occurs when the cardiac muscle does not get enough blood to meet its demands. Note that ischemia refers to lack of nutrients brought by the blood in addition to oxygen

Answer 2

Over 90% of IHD cases are due to atherosclerosis of the coronary arteries. For this reason it is often called "coronary heart disease" - HTN - Smoking - Uncontrolled diabetes - Hypercholesterolemia

Answer 3

Most common in older people Men are more commonly affected--except in the very elderly

Answer 4

Fixed obstruction: 75% occlusion = angina pectoralis - Stable angina Plaque instability plaque rupture, fissure, hemorrhage - Thrombus formation - Embolus formation

Answer 5

Usually 70% or greater occlusion Occurs after exercise Treatment--nitroglycerin

Answer 6

Occurs at rest Probably due to coronary artery spasm Treatment--nitroglycerin

Answer 7

Attacks with increased frequency and severity Usually due to thrombus formation on a plaque Often a precursor of infarction

Answer 8

Balloon angioplasty--a catheter is inserted into the affected coronary artery and, when in place, a "balloon" at its tip is expanded. This compresses the arthroma and enlarges the lumen of the vessel Coronary stent - Bare metal stent--a mesh tube that is inserted after balloon angioplasty holds the vessel open. Endothelium grows over the wire mesh preventing contact with blood - Drug eluting stents--are impregnated with anti-proliferation drugs that prevent restenosis. These are being closely watched as some research indicates that the drugs prevent the endothelium from covering the stent resulting in late thrombosis Coronary bypass surgery--affected coronary arteries are replaced by veins or synthetic vessels

Answer 9

Most common cause of death in industrialized nations 1.5 million/year in U.S: 1 in 3 die 5 times as common in middle aged men than women

Answer 10

Most acute cases are caused by coronary artery thrombosis which is commonly due to the rupture of an atherosclerotic plaque Roughly 1/2 of all infarcts involve the anterior interventricular artery (left anterior descending coronary artery) which is the major supply to the left ventricle and the anterior portion of the interventricular septum Stages of injury: - Coagulation necrosis - Inflammation - Formation of granulation tissue - Fibrosis and scar formation Subendothelial and transmural infarcts

Answer 11

First stage of infarction is coagulation necrosis. Dead cardiac myocytes are highly eosinophilic (red is dead). The spaces between the cells are filled with edema fluid and nuetrophils

Answer 12

A 3-4 ay old infarct shows coagulation necrosis and infiltration by numerous neutrophils

Answer 13

After a week, necrotic tissue removed and fibroblasts are invading infarct

Answer 14

After 3 weeks, infarct area is filled with granulation tissue

Answer 15

Healed infarct showing blue stained fibrous scar tissue on a slide

Answer 16

EXTERNAL RUPTURE OF THE WALL OF THE HEART - Usually occurs during first week when the damaged myocardium is being replaced by granulation tissue - Occurs in 10% of patients who die in the hospital of MI - Death is due to cardiac tamponade (fluid around the heart) RUPTURE OF THE IV SEPTUM - Usually occurs during the first week when the damaged myocardium is being replaced by granulation tissue - Occurs in 1% of patients with MI - Results in left-to-right shunt and CHF PAPILLARY MUSCLE RUPTURE - Results in severe valvular dysfunction VENTRICULAR ANEURYSM - Develop at the site of a healed infarct - Frequently contain mural thrombi - Non-contractile

Answer 17

SEVERE, CRUSHING SUB-STERNAL PAIN that may radiate to the left shoulder and arm, neck and jaw, and/or epigastric region. Pain lasts for hours-days and is not helped by nitroglycerin PULMONARY CONGESTION AND EDEMA which may lead to dyspnea ECG ABNORMALITIES and ARRHYTHMIAS SUDDEN DEATH--25% of MI sufferers never make it to the hospital

Answer 18

Left ventricular hypertrophy

Answer 19

Usually affects the mitral valve and leads to stenosis of the left atrioventricular orifice and/or regurgitation

Answer 20

Rheumatic heart disease Sensile calcification Non-infective inflammation Inflammation Congenital defects

Answer 21

Inflammatory swellings that contain inflammatory cells, necrotic tissues, and may include microorganisms

Answer 22

An inflammatory response that develops in a small number of patients after strep throat. Some strains of strep seem more likely to lead to rheumatic fever than others. Rheumatic fever develops 3-4 weeks after pharyngitis and may be acute or chronic. It is thought that anti-strep antibodies react to connective tissue elements normally found in the heart and other tissues

Answer 23

Bacterial infection

Answer 24

Drastic narrowing of the vessel

Answer 25

See ppt (61)

Answer 26

See ppt (62)

Answer 27

See ppt (63)

Answer 28

See ppt (64)

Answer 29

Stenosis of the pulmonary trunk Ventricular septal defect Overriding aorta Enlarged right ventricle

Answer 30

see ppt (65)

Answer 31

Collapsed lung Asthma COPD - Emphysema - Chronic bronchitis Restrictive lung diseases - ARDS (acute respiratory distress syndrome) - Chronic restrictive lung diseases Vascular lung diseases - Thromboembolism - Hemorrhage - Infarction pulmonary HTN Pulmonary infections Lung cancer

Answer 32

Edema Bronchoconstriction Excessive mucous prodction Thick mucous Chemotaxis of eosinophils

Answer 33

Type I Hypersensitivity reaction

Answer 34

3 million Americans have symptomatic emphysema COPD is 4th leading cause of mortality in America (100k deaths/yr) Beginning in 2000, women exceeded men in COPD deaths

Answer 35

Smoking #1 cause Air pollution is a rising cause Hereditary emphysema caused by deficiency of alpha-1-antitrypsin, but is only a fraction of the total number of cases

Answer 36

Exposure to second-hand smoke Age Occupational exposure to chemical fumes Air pollution HIV infection

Answer 37

Stimulus increases number of macrophages which secrete chemoattractants for neutrophils. Neutrophils accumulate in the alveolar lumen and interstitium 1. Neutrophils release elastase into the alveolar lumen 2. Serum alpha-1 antitrypsin neutralizes elastase and prevents its destructive effect on the alveolar wall 3. Persistent stimulus continues to increase the number of neutrophils and macrophages in the alveolar lumen and interstitium 4. Neutrophils release elastase into the alveolar lumen and interalveolar space 5. Serum alpha-1-antitrypsin levels decrease and elastase starts the destruction of elastic fibers, leading to the development of emphysema. Damaged elastic fibers cannot recoil when stretched

Answer 38

Wall of respiratory bronchioles is destroyed by elastases and other proteases

Answer 39

Wall of respiratory bronchioles, alveolar ducts, and alveoli are destroyed by elastases and other proteases

Answer 40

Alveolar septa are destroyed resulting in the formation of large air spaces. In bullous emphysema, large hollow "bubbles" replace normal lung architecture

Answer 41

First sign of emphysema is usually dyspnea Cough and wheezing Weight loss "Barrel chest" due to accumulation of air in the lung In late stages of disease, especially when accompanied by chronic bronchitis, patients become cyanotic and obese. They are commonly called "blue bloaters"

Answer 42

STOP SMOKING Supplemental oxygen Protein therapy for hereditary cases Antibiotics and vaccination to treat/prevent associated infections Surgery for some cases Aerobic exercise to increase fitness

Answer 43

20-25% of all men ages 40-65 have chronic bronchitis Common in cigarette smokers and often occurs with emphysema

Answer 44

Persistent cough with sputum production that occurs several times/week for a minimum of three months in two consecutive years

Answer 45

Emphysema Heart failure Metaplasia, dysplasia, cancer

Answer 46

Exposure to smoke and/or other pollutants results in inflammation first of the large airways Irritants of smoke cause hypersecretion of mucous from epithelium and underlying mucosal glands With continued irritation, respiratory epithelium undergoes metaplasia to stratified squamous epithelium resulting in the loss of the "ciliary elevator" that moves particulate matter out of the lungs Submucosal mucous glands hypertrophy

Answer 47

Presents with a chronic cough with sputum production May progress to emphysema Loss of "ciliary elevator" resulting in even more lung infections

Answer 48

Diseases which make it difficult for the lungs to inflate (reduced compliance) Sometimes called interstitial lung diseases because the CT interstitium becomes prominent

Answer 49

Sudden onset Pulmonary edema Inflammation

Answer 50

Chronic inflammation Interstitial fibrosis

Answer 51

Injury to respiratory membrane and type II alveolar cells resulting in increased vascular permeability and decreased surfactant production Injury is thought to be due to an imbalance between pro-inflammatory and anti-inflammatory cytokines Neutrophil infiltration of the alveoli, interstitium, and vessels leads to the release of proteases, LTs, reactive oxygen molecules, and P.A.F.

Answer 52

EARLY DISEASE (0-7 days) - Grossly lungs are dark red, heavy, airless (look like liver) - Microscopically, lungs are congested, epithelium is necrotic, interstitial and alveolar edema, hemorrhage - Hyaline membranes (fibrinous edema fluid and cellular debris) PROLIFERATIVE PHASE (1-3 weeks) - Proliferation of type II alveolar cells - Phagocytosis of hyaline membranes

Answer 53

80% of patients develop ARDS within 72 hours of injury Mortality has been reduced to ~40% from 100% by treatment methods Patients who survive and do not develop chronic sequelae, return to normal function in 6-12 months

Answer 54

IMMUNOLOGIC: - SLE - RA - Systemic sclerosis OCCUPATIONAL OR ENVIRONMENTAL PNEUMOCONIOSES: - Asbestosis - Silicosis - Coal worker's pneumoconiosis ("black lung disease") DRUG OR TREATMENT RELATED: - Chemotherapeutic agents - Ionizing radiation - Oxygen

Answer 55

Caused by inhalation and deposition of mineral dusts in the lungs Generally taken 20-40 years for development of clinical effects Early pneumoconiosis is usually asymptomatic, but advanced disease results in disability and early death There is no effective treatment for these diseases Between 1968 and 2000, there were 124,846 deaths listed as being due to pneumoconiosis Comparing 1968-1981 with 1982-2000, there has been a decline in silicosis (-70%) and coal worker's pneumoconiosis (-36%), but an alarming increase in asbestos (+400%)

Answer 56

Caused by inhalation of airborne crystalline silica Most common form of crystalline silica used is ground quartz Silica is used in concrete and asphalt, ceramics and pottery, electronics, and as abrasives If the silica is powdered and aerosolized, it can be inhaled where it lodges in the alveoli Silicosis takes years to develop and symptoms are not present until late in the disease when decreased respiratory function may severely limit activity Silica crystals initially deposit in the upper lobes of the lungs May be phagocytized by macrophages, but commonly kill the cells Before dying, the macrophages release cytokines and other mediators that stimulate fibrosis

Answer 57

Occurs as a result of the inhalation of coal dust and takes three forms: 1. Asymptomatic anthracosis--accumulation of coal with no cellular reaction 2. Simple coal worker's pneumoconiosis (CWP)--macrophages congregate around the coal with no pulmonary dysfunction 3. Complicated coal worker's pneumoconiosis AKA "progressive massive fibrosis (PMF)"--severe fibrosis occurs and pulmonary function is compromised From 1968-1998, CWP was the most commonly diagnosed pneumoconiosis, but it has recently declined due to safety equipment in mines Antharcosis is seen in city-dwellers, smokers, and coal workers Inhaled carbon is engulfed by macrophages and accumulates in the connective tissue of the lung CWP is seen in both smokers and coal workers May progress to centrilobar emphysema or to PMF (10% of cases) In the absence of smoking, CWP does not progress to cancer PMF takes many years to develop PMF is characterized by multiple black scars 2-10 cm in diameter

Answer 58

Asbestos is the commercial name given to any of 6 silica-based minerals that form long fibers Because of its resistance to abrasion and heat, it is used to manufacture various insulation materials and auto brakes There are types of asbestos, defined by the shape of the fibers: 1. Chrystolite--form long, flexible, curly fibers (used in most of industry) 2. Amphibole--more toxic Takes 20-40 years to develop Smokers exposed to asbestos have a 55% greater chance of developing asbestosis than non-smokers

Answer 59

Straight fibers align with the airways and can be carried all the way to the alveoli They easily break into many small pieces

Answer 60

Pleural effusion Pleural fibrous plaques Bronchogenic carcinoma Mesotheliomas

Answer 61

Macrophages can not "digest" asbestos fibers--septa becomes thick with fibrosis

Answer 62

Belongs to the orthomyxoviridae family of viruses Three types: A, B, & C which can all infect humans Some type A also affects birds, pigs, horses, and seals Typically in humans, it is type A which causes "the flu"

Answer 63

Abrupt onset characterized by high fever, chills, chest pain, productive cough

Answer 64

CHF, COPD, and diabetic patients Immunosuppressed (AIDS, transplant patients) Decreased splenic function (sickle-cell or post splenectomy patients)

Answer 65

Strep (most common) Haemophilus influenzae (most common pneumonia in COPD patients) Moraxella catarrhalis (seen in COPD patients and the elderly) Staph (most common secondary pneumonia after virus) Legionella pneumophilia ("Legionnaire's disease" associated with air condition) Enterobacteriaceae (seen in the malnourished)

Answer 66

Infects 1/3 of the world's population and kills 3 million people/yr After introduction of antibiotics, the incidence declined in industrialized countries New, drug-resistant strains have emerged and TB is on the rise again

Answer 67

Caused by mycobacterium tuberculosis or M. bovis, aerobic bacili M. Tuberculosis evades killing by macrophages and induces delayed hypersensitivity reactions It can live in phagosomes

Answer 68

Organism is inhaled and carried to the lungs where it is taken up by alveolar macrophages Organism grows and reproduces in phagosomes of macrophages, ultimately killing the cell Released bacteria then spreads to other cells Primary infection is the GHON COMPLEX which consists of a subpleural lesion (usually along the oblique fissure) shown here at the upper pale arrow, and enlarged caseous lymph nodes draining the lesion shown at the lower dark arrows Cellular immunity develops after a few weeks T-cells kill M. tuberculosis in two ways: 1. CD4 cells secrete interferon-gamma which activates macrophages to kill the bacteria through reactive nitrogen intermediates (NO, NO2, HNO3) 2. CD8 cells secrete toxins that lyse infected macrophages and kill the bacteria resulting in caseous necrosis Most cases are asymptomatic, but in children or immunosuppressed adults, TB can either become dormant forming a latent infection or progress to disseminated TB Latent infections can be reactivated to produce a massive secondary infection of the lungs, which erodes the bronchioles causing cavitation Either a primary or secondary TB can become disseminated by traveling through the lymphatics to infect other organs Common sites of spread are to the bone marrow, liver, spleen, and retina. This is termed TB

Answer 69

Most common cause of cancer deaths in both men and women Peak incidence is from 55-65 years of age At diagnosis, 75% already have metastases - 50% have distant metastases - 25% have metastases to regional lymph nodes

Answer 70

TOBACCO SMOKING - The amount of daily smoking - The tendency to inhale - Duration of the smoking habit Average smokers have a 10x greater risk; heavy smokers have a 20x greater risk than non-smokers

Answer 71

Nearly all lung cancers develop from respiratory epithelium Most lesions originate at branch-points where inhaled particles impact on the epithelium

Answer 72

Squamous cell carcinoma Adenocarcinoma Small cell carcinoma (Oat cell carcinoma) Large cell carcinoma

Answer 73

Closely correlated with smoking history Arises in larger bronchi Rapidly progresses through squamous metaplasia, dysplasia, to carcinoma

Answer 74

Most common type in non-smokers (but 75% are in smokers) More peripherally located and slower growing than squamous cell carcinoma

Answer 75

Closely related to smoking history (only 1% in non-smokers) Highly malignant, most aggressive, metastasizes widely, incurable by surgery Cells look like large lymphocytes (oat cells) Probably derived from neuroendocrine cells of the epithelium

Answer 76

Probably represent squamous cell and adeno- carcinomas that are so undifferentiated they cannot be classified

Answer 77

PRESENTING COMPLAINTS: - Cough - Weight loss - Chest pain - Dyspnea 5 YEAR SURVIVAL RATE - Squamous cell carcinoma and adenocarcinoma 10% - Large cell (undifferentiated) carcinoma 3% - Small cell (oat cell) carcinoma 0% (1 year with treatment) ONLY 20-30% are operable 30-40% survival for surgical removal of solitary tumors < 4 cm (uncommon since most tumors have already metastasized when diagnosed)

Screening for Cardiopulmonary Disorder Lecture Flashcards

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