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Flashcards in Screening for Cardiopulmonary Disorder Lecture Deck (102)
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1

Symptoms of Cardiac disease include...

Chest pain or discomfort

Palpitation

Dyspnea

Cardiosyncope

Fatigue

Cough

Cyanosis

Claudication

Vital signs

2

What are the three categories of cardiac diseases?

Heart muscle

Heart valves

Cardiac nervous system

3

What are certain conditions which affect the heart muscle?

Obstruction or restriction

Inflammation

Dilation of distension

4

What is the epidemiology of atherosclerosis?

Contributes to 1/2 of all deaths in the western world

Can lead to ischemic heart disease (IHD), cerebral infarct, kidney failure, aneurysms, and peripheral vascular disease resulting in gangrene

5

What are some risk factors for atherosclerosis and ischemic heart disease?

Cigarette smoking
- smoking 1 or more packs/day increases mortality by 200%

High fat (especially cholesterol) diet
- hypercholesterolemia (familial or dietary) is a major risk factor for atherosclerosis
- cholesterol is found in high levels in animal fat, butter, and egg yolks

Hypertension
- Males aged 45-62 whose pressure is 169/95 or higher have 500% greater risk of ATH than those whose pressure is 140/90

Uncontrolled diabetes mellitus
- DM induces hypercholestrolemia

Age
- ATH is more common in middle age or older people

Sex
- Men are more commonly affected

Genetics
- Many factors leading to HTN/hypercholesterolemia

6

What is the pathogenesis of atherosclerosis? (Fatty streak)

Many think the first indication of vessel disease, which may progress to ATH, is the deposition of lipids in the tunica intima of arteries.

Streaks are particularly noticeable around the openings of vessels

They are thought to be due to the stresses on the endothelium caused by the loss of laminar flow near openings of vessels

All children have fatty streaks by the time they are 10 years old

7

What are the steps of atherosclerosis pathogenesis?

1. Chronic endothelial "injury"
- Hyperlipidemia
- HTN
- Smoking
- Homocysteine
- Hemodynamic factors
- Toxins
- Viruses
- Immune reactions

2. Endothelial dysfunction
- Increased permeability, leukocyte adhesion, monocyte adhesion and emigration

3. Smooth muscle emigration from media to intima. Macrophage activation

4.

5. Smooth muscle proliferation, collagen and other ECM deposition, extracellular lipid

8

What are atheromas capable of doing?

Occlude the lumen of the vessel

Cause thrombus formation

Erode into the media leading to development of an aneurysm

Produce emboli

9

What is the epidemiology of HTN?

In its early stages, HTN is asymptomatic, but it can lead to:

Cardiac hypertrophy
Heart failure
Aortic dissection
Renal failure

Most of the time the cause is unknown

Often due to kidney disease

25% of general adult population is HTNsive

Most common in African Americans

10

What is the formula for blood pressure?

BP = Cardiac output x Peripheral resistance

11

How is blood pressure regulated?

Slide 18

12

What is the vascular pathology in HTN?

Athromas can occlude the renal arteries. Juxtaglomerular complex detects low BP and secretes renin. BP is raised by the angiotensin-aldosterone pathway

LEADING TO OR CAUSED BY:

Increased BP causes hemodynamic disturbances of the blood flow and the formation of athromas

13

What is an aneurysm?

Localized bulging of a blood vessel or of the heart

Due to weakening of the wall of the vessel

Major cause is atherosclerosis

HTN can cause aneurysm formation in a weakened artery

Can burst leading to sudden severe blood loss, or can cause damage by pressing on surrounding tissues

14

What is a dissection?

Occurs when blood enters the wall of a vessel, separating its layers. It usually (but not always) is a complication of aneurysm

15

Where is the most common site of aneurysm?

Lower abdominal aorta

16

What are varicose veins?

Superficial leg veins which do not cause serious problems and even though they are usually thrombosed, they do not often throw an emboli

Deep leg veins, on the other hand, when thrombosed (thrombophlebitis) do form emboli

Factors contributing to thrombophlebitis include:
- Cardiac failure
- Prolonged bed rest
- Immobilization
- Obesity
- Pregnancy
- Neoplasia

17

When does congestive heart failure (CHF) occur?

When the heart is unable to pump out as much blood as enters (or tries to enter) it

18

What are the most common causes of CHF?

HTN--peripheral resistance too great to pump against

Mitral or aortic valve disease--when the heart pumps , blood flows both forward into the aorta and backward into the heart chambers

Ischemic heart disease--lack of blood supply to the heart muscle reduces its capacity to pump

Infarction--a healed infarct leaves scar tissue that reduces the ability of the heart to pump

Primary diseases of the myocardium

19

What is the pathogenesis of CHF?

As the heart fails, several adaptive responses occur:

Increase in sympathetic stimulation--increasing heart rate and force of contraction

Hypertrophy of the individual heart muscle cells occur most commonly in situations of increased pressure (HTN)

DILATION of the heart chambers occurs most commonly when there is an increase in volume (as in valvular disease)

20

What is the pathogenesis cascade of CHF?

Hypertrophy often leads to dilation--enlarged cells need more oxygen. If the coronary blood supply cannot enlarge fast enough, the hypertrophied heart becomes ischemic, preventing it from performing adequately and leading to increased heart failure. The increased pressures generated stretch the muscle cells causing dilation

Compensated CHF--the hypertrophied and dilated heart can meet the needs of the body

Decompensated CHF--the heart cannot meet the needs of the body

21

What is the pathogenesis of CHF associated with the lungs?

Failure of the left side of the heart causes pulmonary HTN and congestion of the pulmonary venous system. The increased pressure leads to pulmonary edema in which edema fluid fills the interstitial tissue and ultimately the alveoli. Pulmonary HTN can also cause right side heart failure as the right ventricle tries to push more blood into the pulmonary circulation

22

What is the pathogenesis of CHF pertaining to the kidneys?

Kidney reacts to decreased perfusion as it would to HTN. To increase the BP, it releases renin activating the renin-angiotensin system. Sodium and water are resorbed and more fluid is added to the already overburdened heart

23

What is the pathogenesis of CHF pertaining to the liver?

The venous HTN causes congestion in liver. Lack of oxygen due to pulmonary edema affects the cells in the central part of each liver lobule and may lead to their death. A liver with this pattern of cell death is called a "nutmeg liver"

24

What are the clinical features of CHF?

Dyspnea--SOB due to pulmonary edema. In severe cases the patient may feel as though he/she is drowning. The dyspnea may be more severe during physical activity or when lying down. A patient with pulmonary edema may need to sleep with his head elevated

Atrial fibrillation--leading to an "irregularly irregular" heartbeat. The pulse is extremely erratic

Soft tissue edema due to venous congestion. Fluid retention and edema are very common in CHF. Unlike inflammatory edema, CHF edema has a low protein content. The edema may affect dependent areas such as the feet and legs, cause ascites, or be generalized

Cyanosis due to poor oxygenation and delivery of the blood

The average length of time from diagnosis of CHF to death in 5 years

25

What is ischemic heart disease?

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

26

What is the etiology of ischemic heart disease?

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

27

What is the epidemiology of IHD?

Most common in older people

Men are more commonly affected--except in the very elderly

28

What is the pathogenesis of IHD?

Fixed obstruction: 75% occlusion = angina pectoralis
- Stable angina

Plaque instability plaque rupture, fissure, hemorrhage
- Thrombus formation
- Embolus formation

29

What is stable angina?

Usually 70% or greater occlusion

Occurs after exercise

Treatment--nitroglycerin

30

What is prinzmetal angina?

Occurs at rest

Probably due to coronary artery spasm

Treatment--nitroglycerin