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Cardiovascular PathoPhysiology
Powerpoint Study
92
Physiology
Graduate
06/20/2016

Additional Physiology Flashcards

 


 

Cards

Term
Why did the amount of death rates from heart disease decrease from 1950-2002
Definition
Less incidence of smoking and treatment options for atherosclerosis
Term
Hydraulic Equation
Definition

BP = CO x PVR

 

CO = HR X SV

Term

Cardiac Output

 

How would you reduce CO?

Definition

Herat Rate, Contractility, Filling Pressure

 

reduce HR, contractiilty, and venous return (blood volume) *Diuretics*

Term

Peripheral Resistance (PVR)

 

How do you reduce PVR?

Definition

Arterial Diameter, Arterial Length, Elasticity (decreases with age)

 

Vasodilation: CNS action and relax musculature on vessels

Term
Sympathetic Nervous System
Definition

Renin from the kidney increases angiotensin II

angiotensin II produces aldosterone in the adrenal gland

aldosterone holds onto Na+ and blood volume will increase

Term
Sympathetic Nervous System Input
Definition

Alpha 1 vascular receptors

Beta 1 cardiac receptors

Term
Angio-Aldostrone System
Definition

Blood Pressure Falls

Kidney releases renin... which produces angtiotensinogen --> angiotensin I --> angiotensin II --> tells the adrenal gland to produce aldosterone which raises blood pressure 

Term
Angiotensin II
Definition

Causes Vasoconstriction

Triggers aldosterone production and release

Term
Aldosterone
Definition

natural mineralocorticoid

helps with Na+ and fluid retention

cardiac growth factor: ventricular size and strength*

Term
How would you treat hypertension?
Definition

Sympathetic receptor blocker

 

Renin-Angiotensin-Aldosterone inhibitor

 

Reduce Blood volume via diuretics

Term
Atherosclerosis
Definition

related closesly to lipid metabolism

especially cholesterol

lipid collects in the intima

Term
Sources of Cholesterol
Definition

Exogenous: dietary consumption and absorption

 

Endogenous: production of cholesterol in the liver

Term
Lipoproteins
Definition

macromolecule consisting of lipid and specialized protein

- cholesterol has to be carried in the blood by a carrier

Term
LDL - Low Density Lipoproteins
Definition

Transporter of Endogenous cholesterol

 

Lowering LDL = reduces risk of atherosclerosis

Term
HDL - High Density Lipoproteins
Definition

Reverse cholesterol transport

removes LDL- cholesterol and TG

 

HIGH HDL= reduced risk

however drugs which raise HDL don't seem to reduce risk

weight loss and ex. raise HDL

Term
Foam cells
Definition
monocytes become macrophages which ingest oxidized LDL
Term
Monocytes
Definition

produce macrophages and oxidize LDL 

triggers an inflammatory response making it harder for LDL to get in so it accumulates on the outside

Term
*Role of Inflammation*
Definition

Unifying theme in the pathogenesis of the disease

inflammatory markers correlate with risk : C-reactive protein (Crp)

Term
Risk Factor
Definition
Cigarette smoking, hypertension, diabetes, family history, age, High LDL, low LDL, obesity, inactivity
Term
Plaque Rupture
Definition

MI and Strokes are caused by plaque ruptures

 

athermous plaque

Term
Plaque Rupture
Definition

MI and Strokes are caused by plaque ruptures

 

athermous plaque

Term
Lipid Lowering Agent
Definition

HMG - CoA Reductase inhibitors

*STATINS*

Term

Statins

 

What are the adverse effects?

 

What is the double edged sword problem with statins?

Definition

Reduce endogenous cholesterol synthesis

Lowers LDL levels and reduces risk of heart disease

 

Liver damage, Muscle damage (myopathy and rhabdomyolysis)

don't do it during pregnancy or in children/teens

 

Statins cause muscle weakness which results in reduced activities = decrease HDL levels

Term
New approach to hyperlipidemia
Definition

PCSK 9 Inhibitor

produce lower levels of LDL than statins

sub cu injections every 2 weeks

Term
Pre-Hypertension
Definition

Systolic of >130

Diastolic >80

 

especially in pt. with diabetes

Term
Pheochromocytoma
Definition

rare tumor of adrenal medulla or sympathetic ganglia

- secretes high levels of NE

they are sweaty and anxious

- severe headaches, diaphoresis, palpitations, tremor, anxiety

Term
How does someone know they have hypertension?
Definition

Usually "silent killer"

- headaches, malaise, fatigue, complications

Term
HTN treatment strategies
Definition

1. Reduce CO

- block beta 1 sympathetic action, reduce blood volume

2. Reduce peripheral vascualr resistance

- block alpha 1 sympathetic action and dilate vasculature

Term
Diuretics
Definition

Lower blood volume

- loop diuretics

K+ sparring

Term
Sympatholytic Drugs
Definition
beta blockers, centrally acting, alpha antagonist
Term
Direct Vasodilators
Definition

Reduce peripheral vascular resistance

Ca++ channel blockeres

arterial and venous

Term
Inhibitors of Renin-angiotensin-aldosterone
Definition

Reduce blood volume and peripheral resistance

ACE inhibitors

Aldosterone antagonist

Renin inhibitor

Term
What's the risk of blood pressure getting to low??
Definition

ORTHOSTATIC HYPOTENSION

BP changes dramatically with change in position

Toxicity and side effects from drugs

Term
Ischemia
Definition

typically due to vessel stenosis or occlusion

Vasospasm

Pump Failure

*Key= oxygen transport*

Term
Chronic Ischemia
Definition

Low Cardiac output

Dyspnea

Orthopnea

Edema

Term
Classification of CHD
Definition

- acute coronary syndromes

-Stable angina pectoris

- Congestive Heart failure

Term
Acute Coronary Syndromes
Definition

STEMI (elevated ST segments MI)

NSTEMI (non-elevated ST segments MI)

UA (Unstable Angina) = pain @ rest 

Term
Myocardial Infarction
Definition

Initial Event is usually plaque rupture

happens due to abrupt reduction in coronary blood flow

Atherosclerosis is usually present

1.1 mill per year 20-40% are fatal

Term
Acute MI
Definition

Diagnosed by a comibnation of history in PE, EKG, and lab tests

*More common in early morning=Cortisol is increased in the morning (salt retaining), vasculature is more viscous 

pt. c/o of chest pain in midsternum

can radiate to left side or GI upset

up to 30% have no pain

Term
AMI in women
Definition

- women more likely to have atypical presentation

- misdiagnosed as gastritis, peptic ulcer, esophageal reflux

Term
ECG
Definition

P Wave = R/L atrium contracting and pushing blood into ventricles

QRS = blood into ventricle

T= resetting contraction

Term
STEMI vs. NSTEMI
Definition

STEMI= transmural ischemia = involves full thickess of cardiac wall

 

NSTEMI= more common = *subendocardial rather than transmural*

Term
NSTEMI Treatment
Definition

Anticoagulation: Heparin, ASPIRIN

Rest, O2, sedation,

Term
STEMI Treatment
Definition

Reperfusion: PCI... catherization and thrombolytic therapy

*Catheraization PCI is preferred... needs to be EARLY treatment

O2, reduce O2 demand on myocardium

Term
What are the 2 effects of MI mortality?
Definition

1. Cardiac arrhythmia: Ventricular fib

 

2. Massive infarction: cardiogenic shock

Term
How do you prevent MI?
Definition
Beta blockers, Statins (lipid lowering agents), ACE inhibiter, anti-platelet drugs (Aspirin)
Term
Angina Pectoris
Definition

Stable Angina:brought on by stress or exertion, relieved by rest

Unstable: occurs with min activity or at rest

Variant (Prinzmetal's) = atypical characteristics extreme fatigue with minimal exertion

Term

Stable Angina

 

What's the treatment?

Definition

- Caused by coronary atherosclerosis

unmet oxygen demand

 

vasodilate: Nitrate, Beta blockers, Ca++ channel blockers

Term
What does PCI do?
Definition

Uses a catheter to dilate narrow areas

PTCA= percutaneous transluminal coronary angioplasty

Term
What does CABG do?
Definition

Coronary Artery Bypass graft

- usually saphenous vein is used

Term
CHF- Congestive Heart Failure
Definition

CHRONIC

cardiac fxn is insufficient to meet metabolic and blood flow requirements

Ventricular Ejection fraction is reduced

Incidence is rising*

Term
Ejection Fraction
Definition

LVEF = (SV= EDV-ESV)/(EDV)

50-60% is normal

35-40% is CHF range

Term
CHF Viscious Cycle
Definition

- Remodeling occurs with results in progressive Cardiomegaly

- overstretching of the myocardium= fluid overload, increased BP and more ischemia 

Term
How do you DX CHF
Definition
Symptoms; dyspnea, orthopnea, edema, cardiomegaly through EKG, reduced EF through ECG, evidence of pulm edema through x-ray
Term
Dyspnea
Definition
shortenss of breath with minimal exertion
Term
Orthopnea
Definition

inability to sleep supine without dyspnea

graded as how many pillows

Term
CHF Treatment
Definition

1. Reduce cardiac workload: control hypertension, reduce weight

2. Reduce blood volume: restrict Na and give DIURETICS = Lasix

3. Reduce/prevent cardiac remodeling: aldosterone antagonist

4. Treat hyperlipidemia = STATINS

5. Agents proven to improve survival: Beta blockers ONLY WHEN CHF IS STABLE and no pulm. edema

ACE inhibitor

Term
Idiopathic Cardiomyopathy
Definition

- seen in young and healthy ppl

- usually follows a precipitating event (viral infection, pregnancy or delivery)

- severe cases may require cardiac transplantation

Term
Congenital Heart Disease
Definition

- Causes 2% of all cardiac diseases

- multifactorail inheritance

Term
Valvular Defects
Definition
myocardial stress and damage to ultimate CHF
Term
Shunts
Definition

- allow significant amounts of blood to bypass the lungs

- blood is under oxygenated 

- results in cyanosis, stunting of growth and shortness of breath

*more common than valve defects*

Term
Atrial Septal Defects
Definition

Foramen Ovale does not close

- BP is very low in the atrium

- thromboplebitis= blood clots that form in legs or arms

- clot could go all the way to lung and cause a pulm. embolism

Term
Ventricular Septal Defects
Definition

not a problem in utero

- after birth can lead to L ventricular being stronger and flow back into R Ventricle

Term
Fetal Circulation
Definition
Placenta brings in oxygenated blood --> ductus venosus --> inferior vena cava --> RA --> foramen ovale --> O2 rich blood goes direcly into L atrium
Term
Patent Ductus Arteriosus
Definition

Shunt that doesn't close

*we are loosing efficiency on both sides and less blood going to periphery* 

surgery or medications can close it 

Term
Coarctation of the aorta
Definition

High blood pressure before that point and low blood pressure after that 

- high BP in UE and low BP in LE

Term
Tetrology of Fallot
Definition

More common congenital shunt disease

R ventricular hypertrophy, R septal defect, Aorta is overriding, pulm stenosis 

Term
Pulmonary Thromboemoblism
Definition

venous thrombus that embolizes to a pulmonary aretry

 

70% of thrombus comes for large lower extremity vein... usually from pelvic or abdominal veins

Term
Virchow's Traid
Definition

Venous Stasis (hospitalized), Hypercoagulability, Vascular Injury

 

*Joint Replacement Procedures are susceptible**

Term
PE Treatment
Definition

Anticoagulant Drugs: Heparin, prevent new emboli

 

Thrombolytic Drugs: try to dissolve embolus

 

Surgery: filter in vena cava

 

limit immobolization, avoid hyper coagulable states, Prophylactic anticoagulation

Term
Aortic Aneurysm
Definition

- Aneurysm: swelling or distention of Arterial segment

 

AAA = Abdominal Aortic Aneurysm = most susceptible

Term
Two main risks of AAA
Definition

Rupture = associated with weakness of wall and atherosclerosis = high mortality rate

and Dissection

Size determines risk of rupture or dissection <5 cm = 1-2% in 5 years >5 cm = 20-40% in 5 years
Term
Treating AAA
Definition
Trans-Abdominal Repair with artifial vessel

Endovascular repair: balloon catheter
Term
Cardiac Arryhthmias
Definition
Bradycardia

Tachycardia: sinus, A. flutter, SVT (super ventricular tachycardia)

Ectopic Depolarizations: PAC, PVC, and premature systoles

Deviant Pathways: Reentry : Wolfe-Parkinson-White
Term
Supraventricular

and treatment
Definition
Acute Supraventricular tachycardia = SVT

AV nodal Reentry: WPW

Treatment: Adenosine
Term
Ventricular

and treatment
Definition
acute ventricular tachycardia
ventricular fibrillation

Treatment: Lidocain, epinephrine
Term
Immediate causes of arrthyhmias
Definition
disturbance in impulse formation, conduction, or both
from....
ischemia, hypoxia, pH problems, excessive catecholamines, overstretching of cardiac fibers
Term
Classes of antiarrhythmic Agents
Definition
Class 1 = Na+ channel blockers
Class 2= Beta blockers
Class 3: K+ channel blockers
Class 4: Ca++ channel blockers
Term
Amiodarone
Definition
Useful in treatment of ventricular tachycardia/fibrillation
and Atrial fibrillation

Side effects:
pulmonary fibrosis (1% incidence)
Liver toxicity
Blocks T4 to T3 conversion
Photodermatitis
Thyroid Dysfunction
Term
ICD = Implantable cardioverter defibrillator
Definition
charges when a fibrillation is detected to pull heart out of a-fib
Term
Atrial Fibrillation
Definition
Most common tachycardia
- loss of normal atrial contraction causing drop of left ventricular output
- ventricular rate becomes rapid and irregular... irregularly irregular
- risk increases with age.
- linked to atrial enlargement
Term
Main risk of A. Fibrillation
Definition
MURAL THROMBI: clot development in enlarged L atria, can cause embolic stroke

Tachycardia to point of hypotension
Term
A fib Treatment
Definition
Rate control: Beta Blockers
Restore sinus rhythm: atrial ablation and cardioversion
Anticoagulation: Warfarin
Term
Peripheral Vascular Disease
Definition
occlusive disease

thromboangiitis obliterans

Vericose Veins

Arterial Aneurysms

Venous thrombophlebitis
Term
Claudication
Definition
Pain with exercise

Cramping-type: often severe calf muscle, thigh, buttock

relieved with rest
Term
Most common vessels occluded
Definition
Common Iliac, Internal or External Iliac, Femoral, Popliteal

- Fixed by aorto-femoral bypass graft
Term
Valves of the heart
Definition
aortic semilunar valve, pulmonary semilunar valve, tricuspid valve, bicuspid valve
Term
Valve Problems
Definition
Valve infection = endocarditis
regurgitation
mitral valve prolapse
narrowing = stenosis
Term
Aortic Stenosis
Definition
Most common form of valvular heart disease
symptoms: syncope, chest pain, dyspnea

Treatment: valve replacement
Term
Rheumatic Fever
Definition
complication of steptococcal infection
mitral valve most commonly affected***
more common in developing companies
Term
Mitral Valve Prolapse
Definition
pretty common and benign... usually thinner younger women
- produces distinctive murmur
Term
Infective Endocarditis
Definition
SBE : subacute bacterial endocarditis
bacteria lodge onto valve
PRESENTATION OF VALVULAR VEGETATION
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