Patho - Exam 3 Alterations In Cardiac Function

Front 1

ischemic heart disease:

Back 1

-disorder of myocardial blood flow due to coronary atherosclerotic plaques

Front 2

What disease is the #1 cause of death in the U.S.?

Back 2

cardivascular disease

Front 3

5 factors that affect coronary perfusion:

Back 3

1. coronary atherosclerosis
2. platelet aggregation and thrombus formation
3. coronary spasm
4. nonatherosclerotic coronary disease
5. hemodynamic alterations

Front 4

What are the 2 types of CAD?

Back 4

chronic ischemic heart disease and actue coronary syndrome

Front 5

What are the 3 types of chronic ischemic heart disease?

Back 5

1. stable angina
2. variant angina
3. silent myocardial ischemia

Front 6

Causes of nonatherosclerotic coronary disease:

Back 6

1. SLE
2. polyarteritis nodosa
3. cocaine vasospasm (can cause hole in septum)

Front 7

polyarteritis nodosa:

Back 7

-a serious blood vessel disease
-Small and medium-sized arteries become swollen and damaged when they are attacked by rogue immune cells

Front 8

SLE:

Back 8

= Systemic Lupus Erythematosus
-an inflammatory disease of connective tissue
-primarily in women
-characterized especially by skin rash, arthritis and inflammation of different organs

Front 9

List the 4 ischemic syndromes:

Back 9

1. angina pectoris
2. myocardial infarction
3. chronic ischemic heart disease
4. sudden cardiac death

Front 10

angina pectoris:

Back 10

-chest pain form intermittent myocardial ischemia
-no cell death occurs
-referred pain is felt-neck, jaw, arm

Front 11

What are the 3 patterns of angina pectoris?

Back 11

1. stable angina
2. Prinzmetal's variant angina
3. unstable angina

Front 12

stable angina:

Back 12

-most common
-stenosed arteries dilate poorly
-occurs during stressed situation
Tx: rest and nitroglycerin

Front 13

Prinzmetal's variant angina:

Back 13

-unpredictable attacks
-unrelated to emotion
-significant atherosclerosis
Tx: Ca channel blockers

Front 14

unstable angina:

Back 14

-increasing frequency and severity
-close to causing death of myocaridal tissue

Front 15

What is the risk of a myocardial infarction in males?

Back 15

> 1 in 5 by age 65

Front 16

What is the risk of a myocardial infarction in females?

Back 16

the risk gradually equalizes to males after menopause

Front 17

Describe the morphology of a myocardial infarction?

Back 17

1. occlusion of left (40-50%) or right (30-40%)anterior descending artery occurs
2. changes are generally not detectable for 6-12 hrs
3. fibrous scar tissue in 6 wks

Front 18

Causes of a myocardial infartion:

Back 18

1. coronary atherosclerosis
2. plaque usually has caused at least 75% obstruction prior to MI
3. plaque rupture causing a thrombus

Front 19

Symptoms of an MI:

Back 19

1. pain and shortness of breath
2. ECG wave and location changes
3. can also be known as "silent MI"
4. does not dertermine extent of injury
5. enzyme indication

Front 20

What enzymes are indicated with an MI?

Back 20

SGOT and SGPT (nonspecific), AST, CK, LDH

Front 21

Why do most pts with MI die prior to the hospital?

Back 21

pt has either V-fib or a severe heart attack

Front 22

List the 5 main complications of an MI.

Back 22

1. arrhythmias
2. CHF
3. cardiogenic shock
4. ventricular ruture
5. thromboembolism

Front 23

What is the mortality rate of MI's?

Back 23

35% mortality within one year

Front 24

Tx for an MI:

Back 24

-rest and pain relief (morphine), oxygen, sympathetic antagonists and nitrates, thrombolytics, balloon angioplasty (w/in 90 minutes), or CABG

Front 25

sudden cardiac death:

Back 25

-caused by a lethal arrhythmia
-ischemia, fibrosis and scarring, and electrolyte imbalance

Front 26

What is a pt with chronic ischemic heart disease most likely to die from?

Back 26

CHF

Front 27

endocardial diseases:

Back 27

-causes inflammation and scarring and calcification
-congenital
-mainly affects mitral and aortic valves (mostly left side)
-common with stenosis and regurgitation

Front 28

List the disorders of the mitral valve.

Back 28

1. stenosis
2. insufficiency
3. prolapse

Front 29

mitral stenosis:

Back 29

-Rh fever
-increases LA pressure
-causes pulmonary HTN, LA hypertrophy, atrial arrhythmias, diastolic murmurs
-decrease of stroke volume dt inadequate filling

Front 30

mitral valve insufficiency:

Back 30

-S/S similar to mitral stenosis
-LV dilates and hypertrophies trying to compensate

Front 31

mitral valve prolapse:

Back 31

-valve balloons into LA during systole
-mainly in women ages 20-40
-usually asymptomatic
-sometimes assoc with regurgitation

Front 32

Name the (rare) complications of a mitral valve prolapse:

Back 32

endocarditis
regurgitation
arrhythmias

Front 33

What are the 2 aortic valve disorders?

Back 33

stenosis and insufficiency

Front 34

aortic stenosis:

Back 34

-high LV systolic pressure
-left hypertrophy
-SYSTOLIC murmur
-surgery needed for this condition
-age related calcification

Front 35

aortic insufficiency:

Back 35

-left heart failure
-DIASTOLIC murmur

Front 36

Rheumatic heart disease:

Back 36

aka Rh fever
-caused by an infection of beta-hemolytic streptococcus
-an auto-immune disease
-antibiotic therapy
-can also affect joints and kidneys

Front 37

infective endocarditis:

Back 37

-vegitations found on endocardium and valves
-embolus formation
-strep and staph
-invasion of bloodstream by organisms (causes sepsis)

Front 38

Which form of endocarditis has a high mortality rate?

Back 38

acute endocarditis

Front 39

What are some causes of infective endocarditis?

Back 39

overt infection
surgical and dental precedures
IV drugs

Front 40

subacute endocarditis:

Back 40

-more insidious (spreadable)
-organisms less virulent
-occurs in hearts with preexisting cardiac disease

Front 41

Diagnosis for endocarditis:

Back 41

-positive blood cultures
-results vary according to the type and location of the damage

Front 42

treatment for endocarditis:

Back 42

-antibiotics
-valve replacement thereafter

Front 43

myocarditis:

Back 43

-inflammation of heart muscle
-dilation of all chambers occur
-caused mostly by viral infections and in immunosuppressed pts

Front 44

cardiomyopathy:

Back 44

-noninflammatory disorder, effects heart muscle
-primary or secondary

Front 45

3 types of primary cardiomyopathies:

Back 45

1. dilated or congestive
2. hypertrophic
3. restrictive (fibrosed, rigid)

Front 46

dilated cardiomyopathy:

Back 46

-decreased pumping ability of ventricles due to dilation
-slowly progressive heart failure
-heart transplantation may be necessary

Front 47

4 causes of dilated cardiomyopathy:

Back 47

1. alcohol toxicity
2. genetics
3. pregancy complications
4. postviral myocarditis

Front 48

3 causes hypertrophic cardiomyopathy:

Back 48

1. genetic
2. asymptomatic or outflow obstruction
3. uneven hypertrophy

Front 49

Tx for hypertrophic cardiomyopathy:

Back 49

-little cardiac change to CHF
-Rx: Ca channel blockers and beta-adrenergic antagonists

Front 50

secondary cardiomyopathy:

Back 50

-many known origins
-clinically similar to dilated type of primary

Front 51

pericardial effusion:

Back 51

-accumulation of fluid in the pericardial cavity
-compresses heart chambers
-generally indicates underlying disease process

Front 52

cardiac tamponade:

Back 52

-life threatening type of pericardial effusion
-systemic venous congestion that reduced SV
-aspiration is necessary for removal of fluid, pus, blood

Front 53

2 types of pericarditis:

Back 53

acute and chronic

Front 54

chronic pericarditis:

Back 54

-increase in inflammatory exudates longer term than acute
-adhesive, constrictive
-pericardiectomy may be necessary

Front 55

exudates:

Back 55

-fluid released from the body with a high concentration of protein, cells, or solid debris
-classified as catarrhal, fibrinous, hemorrhagic, serous

Front 56

acute pericarditis:

Back 56

-sudden increase in inflammatory exudates
-accompanied by chest pain, pericardial friction rub, ECG changes

Front 57

How does an ECG change with an acute pericarditis?

Back 57

ST elevation

Front 58

causes of congenital heart disease:

Back 58

1. pregnant mother develops rubella w/in first trimester
2. drug and alcohol use by pregnant woman
3. genetic

Front 59

List 6 types of acyanotic defects:

Back 59

1. atrial septal defects
2. ventricular septal defects
3. patent ductus arteriosis
4. coarctation of aorta
5. pulmonary stenosis or atresia
6. aortic stenosis or atresia

Front 60

congenital heart defects:

Back 60

-produce their effects through abnormal shunting of blood and alterations in pulmonary blood flow
-classified as either acyanotic or cyanotic defects

Front 61

acyanotic defects:

Back 61

-generally asymptomatic as long as flow is from left to right
-requires surgical repair
Ex: left-to-right shunts

Front 62

cyanotic defects:

Back 62

-sufficient unoxygengated blood mixes with oxygenated blood in the left side of the heart
Ex: right-to-left shunts with obstruction

Front 63

ventricular defects:

Back 63

-most common
-frequently associated with other defects
-S/S depend on the size of the defect and shunting
-surgical repair is needed if it does not close

Front 64

patent ductus arteriosis:

Back 64

-shunts from pulmonary artery to aorta beyond prenatal period
-spontaneously closes within 24-72 hrs of birth
-systolic murmur (sounds like machinery)

Front 65

Which are more likely to have coarctation of aorta-males or females?

Back 65

males are 3-4 times more likely than females

Front 66

Which acyanotic defect is associated with "notched ribs"?

Back 66

coarctation of aorta

Front 67

atresia:

Back 67

-the absence or closure of a normal body orifice or tubular passage such as the anus, intestine, or external ear canal

Front 68

2 types of cyanotic defects:

Back 68

1. tetralogy of fallot
2. transposition of great arteries

Front 69

truncus arteriosis:

Back 69

-the arterial "trunk" frm the embryonic heart

Front 70

tricuspid atresia:

Back 70

-closure of the tricuspid valve
-congenital

Front 71

Tetralogy of fallot consists of 4 congenital heart defects:

Back 71

1. ventricular septal defect
2. overriding aorta
3. pulmonary stenosis
4. RV hypertrophy

Front 72

What is the treatment for tetralogy of fallot?

Back 72

surgery