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Semester 4 > Systemic pathology 400 (CV path 2) > Flashcards

Systemic pathology 400 (CV path 2) Flashcards

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1
Q

valvular disease

A

Any heart valve can become stenotic (narrowed) or incompetent/insufficient (doesn’t close properly)

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2
Q

what changes take place long before SSx appear when valves stenose?

A

Causes hemodynamic changes long before symptoms

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3
Q

do valvular insufficiencies occur simultaneously in multiple valves?

A

Most often valvular stenosis or insufficiency occurs in isolation in individual valves,

but multiple valvular disorders may coexist

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4
Q

mitral valve and valvular disease

A

Mitral regurgitation

Mitral stenosis

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5
Q

insufficiency vs stenosis

A

insufficiency means that your valve doesn’t fully close

stenosis means that your valve is narrowed and doesn’t open fully

opposite but related (?)

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6
Q

mitral regurgitation

A

incompetency (insufficiency) of the mitral valve (bicuspid) causing backflow (reflux) from the left ventricle into the left atrium

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7
Q

Mitral stenosis

A

narrowing of the mitral valve impeding blood flow from the left atrium to the left ventricle

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8
Q

valvular disease and AORTIC VALVE

A

Aortic regurgitation

Aortic stenosis

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9
Q

Aortic regurgitation

A

incompetency of the aortic valve causing backflow from the aorta into the left ventricle

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10
Q

Aortic stenosis

A

narrowing of the aortic valve obstructing blood flow from the left ventricle to the ascending aorta

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11
Q

valvular disease etiology / risk factors

A

rheumatic heart disease

endocarditis

congenital valvular disease

autoimmune disorders

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12
Q

valvular disease – pathogenesis

A

Abnormalities in valves causes back flow of blood

Back flow of blood overburdens chambers

Overburdening causes hypertrophy of chamber

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13
Q

also related to pathogenesis of valvular disease

A

HTN (hypertension)

decreased systemic bloodflow (as a result)

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14
Q

valvular disease clinic manifestations, SSx

A

Angina

Dyspnea

Heart failure

Arrhythmia

Palpitations

Heart murmur

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15
Q

valvular disase Dx, Tx, Px

A

Echocardiogram, auscultation

Tx:
Valve replacement, medication

Px:
Variable

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16
Q

ischemic heart disease

A

Major disorders of the heart due to insufficient blood supply

AKA coronary heart disease (CHD) or coronary artery disease (CAD)

—-> MI, angina, cardiac arrest

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17
Q

ischemic heart disease epidemiology

A

CAD/IHD is the leading cause of death globally

CAD is the most common cause/type of cardiovascular disease

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18
Q

ischemic heart disease pathogenesis

A

Ischemic heart disease that develops as a result of slowly progressive narrowing of the coronary arteries results in hypoperfusion of myocardium and slowly evolving pump failure (congestive heart failure)

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19
Q

ischemic heart disease pathogenesis 2

A

Ischemic heart disease can develop due to sudden occlusion of a major coronary artery resulting in an infarct

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20
Q

ischemic heart disease risk factors

A

Age
Gender
Family history
Ethnicity
Infection
Smoking
High cholesterol
HTN
Alcohol

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21
Q

ischemic heart disease risk factors 2

A

Diet
Obesity
Physical inactivity
Diabetes
Hormonal status
Medication
Excessive alcohol consumption
Stress

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22
Q

ischemic heart disease clinical manifestations

A

Variable – depending on rapidity and extent of blockage and which arteries are blocked

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23
Q

can ischemic heart disease be asymptomatic

A

yes

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24
Q

ischemic heart disease other clinical manifestations and SSx

A

Asymptomatic
Pain
Angina pectoris
Breathlessness (dyspnea)
Palpitations
Congestive heart failure
MI
Death

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25
ischemic heart disease Dx, Tx
Echocardiogram Stress test Tx: Meds Surgery Prevention***
26
angina pectoris
Type of CAD/IHD Crushing chest pain, typically precipitated by exercise or strain and relieved by nitroglycerin (stable angina)
27
angina etymology
"strangling"
28
angina pectoris caused by
Caused by any condition that alters: Blood supply to myocardium Blood requirements of myocardium (--->circulatory disorders, blood loss)
29
angina pectoris -- pathogenesis
Narrowed or obstructed blood vessels limit blood supply to tissues When the cardiac workload exceeds oxygen supply to myocardial tissue, ischemia occurs causing temporary chest pain
30
Chronic stable angina (type)
Classic exertional angina Preceded by exercise or stress and relieved by rest or nitroglycerin Predictable and consistent
31
Prinzmetal’s angina (vasospastic or variant angina) (type)
Symptoms similar to typical angina Caused by coronary artery spasm Usually occurs early morning; unrelated to exertion
32
Decubitus angina (resting angina) (type)
Atypical Occurs at rest, worse when laying down (decubitus) Reduced when sitting or standing More prevalent in women
33
decubitus etymology
from Latin decumbere ‘lie down’, on the pattern of words such as accubitus ‘reclining at table’.
34
Unstable angina (progressive or crescendo angina)
Residual ischemia triggers angina Unpredictable
35
Angina Pectoris, Dx, Tx
Dx: History Clinical manifestation Angiogram Tx: Medications to treat symptoms or underlying conditions
36
MYOCARDIAL INFARCTION
Development of ischemia with resultant necrosis of myocardial tissue
37
MI is due to
Due to occlusion of a coronary artery Anterior descending branch of left coronary artery (50%) (LAD -- LEFT ANTEIROR DESCENDING) Right coronary artery (30-40%) Left circumflex artery (15-20%)
38
Myocardial Infarction -- risk factors
same as for CAD Age Gender Family history Ethnicity Infection Smoking High cholesterol HTN Alcohol Diet Obesity Physical inactivity Diabetes Hormonal status Medication Excessive alcohol consumption Stress
39
MI -- death occurs in what percentage of cases?
Death occurs in 25% of cases due to arrhythmia (ventricular fibrillation), heart block, pump failure, asystole (cardiac arrest)
40
can MI be asymptomatic?
Symptoms are variable but can be asymptomatic (rarely)
41
MI SSx
Can also include crushing pericardial pain, syncope, pallor, SOB, cold sweating, fatigue, referred pain (left arm), heartburn, nausea
42
syncope recall
temporary loss of consciousness caused by a fall in blood pressure. Syncope, commonly known as fainting or passing out, is a loss of consciousness and muscle strength characterized by a fast onset, short duration, and spontaneous recovery. It is caused by a decrease in blood flow to the brain, typically from low blood pressure
43
MI Dx
Diagnosis includes clinical history, clinical manifestation, ECG, blood tests (troponin or CK/CPK)
44
note ck test, cpk test, troponin test
Healthcare providers sometimes use a creatine kinase (CK) test to help diagnose a heart attack, though not very often CK testing used to be a common test for heart attacks, but healthcare providers now use another test, called troponin, which is better at detecting heart damage. The creatine phosphokinase (CPK) isoenzymes test measures the different forms of CPK in the blood. CPK is an enzyme found mainly in the heart, brain, and skeletal muscle.
45
MI Tx
Treatment – medications, surgery Resuscitation must be immediate or death will occur
46
MI can lead to
Can lead to cardiac arrest, cardiogenic shock, multisystem organ failure (brain, kidneys), myocardial rupture (cardiac aneurysm), mural thrombi
47
MI prevention
Prevention includes minimizing risk factors
48
Congestive Heart Failure
A condition in which the heart is unable to pump sufficient blood to supply the body’s needs Failure can occur on left or right, but predominantly affects the left Can be chronic or acute
49
CHF, epidemiology
Common complication of ischemic heart disease and hypertension 500,000 new cases per year in US Most common cause of hospitalization in the elderly Increasingly common
50
MOST COMMON CAUSE OF HOSPITALIZATION IN ELDERLY
CONGESTIVE HEART FAILURE
51
CHF pathogenesis
“Failing” heart keeps working, but is less effective Inability to pump blood out of heart decreases blood returning to the heart
52
where is edema common in CHF
Edema, especially in LE (dependent edema)
53
dependent edema define
Dependent edema is specific to parts of the body that that are influenced by gravity, such as your legs, feet, or arms. Edema may be a side effect of medications for conditions such as high blood pressure or diabetes.
54
why is edema common in lower extremity in CHF
esp because of gravity
55
CHF pathogenesis (continued)
Inability to pump blood out of heart increases blood in the chambers and lungs SOB, especially in recumbent position
56
CHF --- what is the result involving kidney response?
Decreased peripheral blood flow causes kidney to release renin ---> End result = increased blood volume ---> Heart can’t keep up = more edema and HTN
57
what does renin do?
The renin-angiotensin-aldosterone system is a series of reactions designed to help regulate blood pressure. When blood pressure falls (for systolic, to 100 mm Hg or lower), the kidneys release the enzyme renin into the bloodstream.
58
CHF --- What then happen to left ventricle?
Left ventricle pumps harder to try to get more blood to tissues, leading to left ventricular hypertrophy
59
resulting in (which adverse effect involving the coronary arteries?)
Coronary arteries cannot meet demand of overworked heart
60
which can result in?
Can lead to ischemia, angina, and/or MI
61
how can this entire cycle be classified?
Positive feed back loop
62
why positive feedback loop?
the more it becomes challenging to send blood to periphery (hypoperfusion) the more renin-angiotensin-aldosterone pathway attempts to regulate BP (INCREASE BLOOD VOLUME) The more blood volume increases, the more edema and HTN = The more heart can't keep up (has to work harder) = the more left ventricle hypertrophy = the more difficult it is to circulate blood and so on
63
CHF Tx
Diet, exercise, and lifestyle modifications Medications
64
CHF Px
Poor
65
Cor Pulmonale
Cor pulmonale is right ventricular hypertrophy secondary to a lung disorder. Right ventricular heart failure follows.
66
Cor Pulmonale Etiology (Chronic)
Chronic cor pulmonale is usually caused by COPD. (Chronic Obstructive pulmonary disorder)
67
Cor Pulmonale Etiology (Acute)
Acute is caused by pulmonary embolism
68
COPD
"Chronic obstructive pulmonary disease (COPD) is a common lung disease causing restricted airflow and breathing problems. It is sometimes called emphysema or chronic bronchitis." "Chronic obstructive pulmonary disease (COPD) is a chronic disease characterized by shortness of breath, cough and sputum production"
69
Cor Pulmonale Pathogenesis
Pulmonary disorders lead to hypertension in pulmonary artery ---> Blood backs up in RV RV dilates and hypertrophies RV fails
70
Cor Pulmonale clinical manifestations
Dyspnea Exertional fatigue Heart murmurs Lower Extremity edema
71
can Cor Pulmonale be asymptomatic?
yes
72
Why lower extremity edema in Cor Pulmonale
since Right side is congested blood becomes held back in veins esp as a result of gravity, lower extremity is most often affected
73
Cor Pulmonale Dx
History Examination ECHO
74
Cor Pulmonale, Tx
Medications
75
Pulmonary Embolism
The occlusion of one or more pulmonary arteries by thrombi that originate elsewhere, typically in the large veins (DVT) of the lower extremities or pelvis, break free of the vessel, and circulate to the lungs.
76
pulmonary embolsim is cause of
acute cor pulmonale
77
pulmonary embolism etiology and risk factors (DVT)
DVT – iliofemoral (50%), deep calf veins (5%), subclavian vein (20%)
78
pulmonary embolism etiology and risk factors
Immobility Surgery Pregnancy
79
pulmonary embolism more risk factors / etiology
LE fractures Malignancy
80
more risk factors PE
Blood stasis Endothelial injury Hypercoagulable states
81
other risk facotrs PE
Previous PE
82
more
CHF CHD (CAD) COPD Obesity Smoking Catheterization Oral contraceptives HRT Neurological disability
83
can pulmonary embolism be asymptomatic
yes
84
other clnical manifestations of pulmonary embolism
Cardiac arrest Dyspnea Chest pain Apprehension Cough Tachypnea Rales Tachycardia Fever Hemoptysis Edema Murmur Cyanosis
85
rales
"to rattle" an abnormal crackling or rattling sound heard upon auscultation of the chest, caused by disease or congestion of the lungs.
86
Pulmonary embolism, Dx, Tx, Px
Dx: History and S&S Rule out other pathologies Imaging as a last resort Tx: Medications Variable ---> Mortality ranges from 0.5% if treated early to 25% if untreated
87
Dysrhythmia
Aka – arrhythmia Disturbance of heart rate or rhythm Caused by an abnormal rate of electrical impulse generation, abnormal conduction of electrical signal, tissue death
88
can arrhythmia be caused by tissue death
yes
89
arrhythmia classification
via speed via location
90
Classified according to origin (atria or ventricles) and speed (slow or fast)
..
91
Tachycardia – HR > 100 Bradycardia – HR < 60
..
92
what does clinical significance of arrhythmia depend on?
Clinical significance depends on effects on cardiac output and BP
93
Atrial fibrillation (arrhythmia)
Fibrillation - rapid, uncoordinated heart beats The most common chronic arrhythmia Rapid, involuntary irregular muscle contraction of atrial myocardium
94
potential result of atrial fibrillation
Blood remains in atria after contraction ---> Ventricles don’t fill properly Heart races but blood flow diminishes
95
important note about last semester notes
( NOTE THAT IN LAST SEMESTER'S NOTES, ATRIAL FIBRILLATION NOT CONSIDERED A SERIOUS EMERGENCY, B/C VENTRICLES STILL FILLED PASSIVELY DESPITE DYNSFUNCTIONING ATRIAL CONTRACTION)
96
atrial fibrillation SSx
S&S: asymptomatic, SOB (dyspnea), palpitations, fatigue, death (rare)
97
can atrial fibrillation be asymptomatic
yes
98
what does atrial fibrillation usually occur secondary to
Usually occurs secondary to heart disease
99
ventricular fibrillation
Electrical phenomena that results in involuntary, uncoordinated muscular contractions of the ventricular muscle Frequent cause of cardiac arrest Treatment includes depolarizing the muscle
100
note
ventricular fibrillation considered a much more serious medical emergency b/c absence of ventricle's pumping capability leads to quick hypoperfusion of vital organs whereas the ventricles can still fill passively in the absence of the pumping capability of the atria
101
Heart block (AV block)
Interruption in passage of impulses through the heart’s electrical system May occur because SA (node??) misfires or because impulses are not transmitted properly
102
1st vs 2nd vs 3rd degree heart block
With first-degree heart block, you might not need treatment. With second-degree heart block, you may need a pacemaker if symptoms are present or if Mobitz II heart block is seen. With third-degree heart block, you will most likely need a pacemaker. "Key Points. There are 3 degrees of AV block: first, second, and third. First- and second-degree blocks are partial and third-degree block is complete. First-degree AV block is rarely symptomatic and no treatment is required."
103
heart block causes
Can be caused by heart disease or increased heart meds Can cause fatigue, dizziness, fainting Treatment includes meds or pacemaker
104
paroxysmal tachycardia
An abnormally rapid heart rate that begins and ends suddenly
105
Ectopic Beats
An electrical activation of the heart that originates outside the SA node.
106

Semester 4 (30 decks)

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