Mitral Stenosis

Flow of blood from left atrium into the left ventricle is impaired.

Atrial pressure higher than ventricular pressure throughout diastole.

Enlarged atrial chamber and hypertrophy.

Untreated may result in chronic pulmonary HTN, RV hypertrophy and right-sided heart failure.

Aortic Stenosis

Cause: calcium deposits on the aortic cusps.
Result: obstruction to aortic outflow from the LV into the aorta during sytole.

LV produces high SBP to overcome resistance of the stenotic aortic valve.

May lead to left-sided heart failure.

Symptoms: syncope, fatigue, low SBP and faint pulses.

Mitral Regurgitation

Backflow of blood from LV to the LA during ventricular systole.

LV must pump greater volume of blood to compensate for regurgitant flow.

LA and LV dilate and hypertrophy.

Untreated: left-sided heart failure.

Symptoms: chronic weakness/fatigue due to pulmonary congestion and poor cardiac output.

Aortic Regurgitation

Incompetent aortic valve allows blood to leak back into LV during diastole.

LV becomes volume overloaded

Outcome: Increased SV and SBP.

Untreated: Left-sided heart failure.

Rheumatic Heart Disease

Uncommon, yet serious S/E of rheumatic fever.

Immune attack on body's own tissues.

Occurs primarily in children.

Symptoms: fever/sore throat.

Prompt antibiotic therapy is wanted.

Infective Endocarditis

Dilated Cardiomyopathy

Cardiac failure ass. w/ dilation of one or both ventricular chambers.

Cause: alcohol toxicity, genetic abnormality, pregnancy, postviral myocarditis.

Tx: Heart transplant.

Hypertrophic Cardiomyopathy

Thickened ventricular muscle mass.

Can be transmitted genetically.

Causes ventricular outflow obstruction and impaired diastolic filling.

Death is usually sudden.

Restrictive Cardiomyopathy

Stiff, fibrotic ventricle with impaired diastolic filling.

Most common cause is amyloidosis.

Rare form of cardiomyopathy.

Pericardial Effusion

Accumulation of noninflammatory fluid in the pericardial sac.

Usual composition of fluid:

serous, serosanguineous, chylous, blood

Cardiac Tamponade

External compression of the heart chambers such that filling is impaired.

S/S: dec. SV, inc. HR, muffled heart sounds, dull chest pain

Systemic venous congestion occurs (JVD)

Tx: Aspirate offending fluid.

Acute Pericarditis

Inflammation of the pericardium.

Most cases are idopathic and viral.

Usually resolves with NSAID tx.

S/S: fever, leukocytosis, malaise, tachycardia, chest pain, dysphagia.

Atrial Septal Defect

Congenital heart defect that enables blood flow through the L and R atria via the interatrial septum.

Defect allows blood to flow from the L to R side of the heart.

Result: mixing of atrial and venous blood.

Usually occurs at the formen ovale.

May lead to HTN, RV hypertrophy, right-sided heart failure.

Ventricular Septal Defect

Most common congenital cardiac anomaly.

Usually located in the membranous septum.

Functional significance depends on size of defect.

Shunt is intially left-right becase left-sided heart pressures are higher.

HTN and RV hypertrophy may cause reversal of shunt.

May be apparent at birth.

Patent Ductus Arteriosus

Neonate's ductus arteriosus fails to close after birth.

S/S: Inc. work in breathing, poor wt. gain.

May lead to CHF if untreated.

Tx: surgery.

Coarctation of the Aorta

Narrowing or stricture that may impede blood flow.

3-4x more common in males.

Results in high work load for R side of heart.

Usually accompanied by systolic murmurs and ventricular hypertrophy.

Untreated: Lead to CHF, hemorrhage, aortic rupture

Tx: surgery.

Tetralogy of Fallot

4 defining features:

Ventricular septal defect.

Aorta positioned above the ventricular septal opening.

Pulmonary stenosis that obstructs RV outflow

RV hypertrophy

P wave

atrial depolarization assoc. w/ atrial contraction.

QRS wave

Ventricular depolarization.

T wave

Ventricular repolarization.

Echocardiography

Evaluates the structure and function of the heart.

Used to detect valvular disease.

Hematocrit

Measure of RBC # and volume.

% of total blood volume made up by RBC's.

Hemoglobin

Iron-containing, oxygen transport protein in RBC's.

CK-MB

Enzyme found in heart muscle.

Serum CK is elevated when muscle is injured.

Inc: shock, hyperthermia, myopathies, myocarditis.

Troponin

Markers for cardiac disease.

Proteins in skeletal/cardiac muscle

More specific than CK-MB for cardiac muscle injury.

Clinical manifestations of Anemia.

Dec. in O2 carrying capacity

Tissue hypoxia

Compensatory mechanisms to restore tissue O2.

Inc. in HR, CO, circulatory rate and blood flow to vital organs to inc. oxygenated blood flow.

Iron Deficiency Anemia

Unavailability of iron for hemoglobin synthesis.

Due to: low intake, diminished absorption, pregnancy, excessive loss, CRF, hemodialysis.

Common cause in MEN: Occult GI bleed.

WOMEN: menorrhagia

Dec. RBC, H/H

Inc: TIBC

WBC/platelets normal.

Tx: Inc. oral iron.

Pernicious Anemia

Dec. in B-12 or folate.

Disrupts synthesis of RBC in bone marrow.

Lab values all dec.

S/S: paranoid, dementia, confusion, dec LOC, irritable, parethesias of extremities.

Tx: parenteral B-12, oral folate.

Aplastic Anemia

Dec. in hematopoietic tissue in bone marrow and pancytopenia.

Cause: toxins, radiation, HIV.

S/S: weak, lethargic, dizzy, fatigue, palpitation, dyspnea

Tx: Reverse causative disease process, bone marrow transplant, prevent infection/bleeding

Sickle Cell Anemia

Genetically defective HGB causes RBC to morph to sickle shapes when O2 is low.

Many organs become infarcted/necrotic.

S/S: splenomegaly, heptomegaly, cirrhosis, fever, pain, sudden death.

Inc. in bilirubin (jaundice)

Tx: supportive, stem cell transplant, prevent dehydration.

Isovolumic Contraction

Heart is full of preload; ventricles start to contract.

Ventricular Ejection

Blood will force open pulmonic/aortic valves.

Isovolumic Relaxation

Closing of pulmonic/aortic valves.

(semilunar valves)

S1

closure of mitral/tricuspid valves

S2

Closure of pulmonic/aortic valves

Cardiac Output

HR x SV

Inotrope

Strength of contraction

(heart beats more strongly)

Dromotrope

Speed of conduction

Chronotrope

Heart rate

Beta1 receptors in the heart

Inc. HR and contractility

Stimulated by epinephrine and NE release from adrenal medulla.

Beta2 receptors

Cause bronchodilation and mild vasodilation.

Alpha receptors

Vasoconstriction.

Electrolytes to monitor w/ heart issues

Ca, K, Mg

Preload

Amt. of blood in ventricles

Contractility

How well the heart pumps

Afterload

Pressure of aorta that the heart is pumping against to eject blood out of chamber.

3 components of SV

Preload, Contractility, Afterload

Stable Angina

Stenotic atherosclerotic coronary vessels that reduce coronary blood flow to a critical level.

Generally relieved by rest and nitro, which causes vasodilation, dec. in preload and dec. in workload.

Prinzmetal Angina

Unpredictable attacks of anginal pain.

Vasospasm is probable cause.

Tx: Ca channel blockers.

Unstable Angina

More severe, longer lasting angina.

Plaque rupture and acute thrombosis development occurs.

Partial occlusion of vessel.

Dx: no elevations of cardiac necrosing markers.

Tx: antiplatelet drugs.

MI

Plaque rupture and acute thrombosis development occurs.

Complete occlusion of vessel.

Thrombus can cause necrosis of cardiac tissue.

Elevated cardiac necrosing markers indicative of MI

Pts w/ chest pain, acute ischemia and STEMI eligable for reperfusion therapy.

Tx: Inc. supply and Dec. demand for O2.

Anterior MI

Obstruction in LAD artery.

Most Common.

Posterior MI

Obstruction in R Coronary Artery

Post. wall of LV.

Lateral MI

Obstruction in L Circumflex

Inferior MI

Obstruction in R Coronary Artery