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Cardiac Module
Cardiac Module
51
Medical
Undergraduate 3
03/09/2012

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Term
Arteries
Definition
Carry blood filled with nutrients away from the heart to all parts of the body. The blood is sometimes compared to a river, but are more like a river in reverse. Thick walled tubes with a circular covering of yellow, elastic fibers, which contain a filling of muscle that absorbs the tremendous pressure wave of a heartbeat and slows the blood down. This pressure can be felt in the arm and wrist- it is in the pulse. Eventually divide into smaller arterioles and then into even smaller capillaries, the smallest of all blood vessels.
Term
Arteriole
Definition
One can serve a hundred capillaries. Here, in every tissue organ, blood work is done when it gives up what the cells need and takes away the waste products that they don't need.
Term
Capillaries
Definition
Join together to form small veins, which flow into larger  main veins, and these deliver deoxygenated blood back to the heart.
Term
Veins
Definition
Thin, slack walls, because the blood has lost the pressure which forced it out of the heart, so the dark, reddish-blue blood which flows through is on its way to the lungs oozing along very slowly to be reoxygenated. At the heart, enter a special vessel, called the pulmonary arteries, into the wall at the right side of the heart. Flows along the pulmonary arteries to the lungs to collect oxygen, then back to the heart's left side to begin its journey around the body again.
Term
Right Side of Heart
Definition
Blood enters the heart through the two large veins, the inferior and superior vena cava, emptying oxygen-poor blood from the body into the right atrium. Blood flows from your right atrium into your right ventricle through the open tricuspid valve. When the ventricles are full, the tricuspid valve shuts. This prevents blood from flowing backward into the atria while the ventricles contract (squeeze). Blood leaves the heart through the pulmonic valve, into the pulmonary artery and to the lungs.
Term
Left Side of Heart
Definition
The pulmonary veins empties oxygen-rich blood, from the lungs into the left atrium. Blood flows from your left atrium into your left ventricle through the open mitral valve. When the ventricles are full, the mitral valve shuts. This prevents blood from flowing backward into the atria while the ventricles contract (squeeze). Blood leaves the heart through the aortic valve, into the aorta and to the body. This pattern is repeated, causing blood to flow continuously to the heart, lungs and body.
Term
Chronic Stable Angina
Definition
Associated with a fixed coronary obstruction that produces a disparity between coronary blood flow and metabolic demands of the myocardium. Initial manifestation of ischemic heart disease in half of persons wih CAD. Most have atherosclerotic heart disease. Precipitated by situations that increase the owrkload of the heart, such as physical exertion, exposure to cold, and emotional stress. Pain described as: constricting, squeezing, or suffocating sensation; usually is steady, increasing in intensity only at the onset and end of the attack; located in the precordial or substernal area of the chest, may radiate to the left shoulder, jaw, arm, or other areas of the chest. Provoked by exertion or emotional stress and relieved in minutes by rest or the use of nitro. Chronic occlusion of a coronary vessel.
Term
Variant (Vasospastic) Angina
Definition
Also known Prinzmetal angina. May result from endothelial dysfunction, hyperactive sympathetic nervous system responses, defects in the handling of calciumby vascular smooth muscle, or from an alteration in nitric oxide production. In some it is associated with hypercontractility of vascular smooth muscle and is associated with migraines or Raynauds. Usually occurs at rest or with minimal exercise and frequently occurs nocturnally (between midnight and 8am). Arrythmias occur when pain is severe. ST-segment elevation or depression, T-wave peaking, inversion of U waves, and rhythm disturbances. High risk of sudden death.
Term
Unstable Angina
Definition
No evidence of serum markers for myocardial damage. Development of unstable plaque that ruptures, acute ischemic event, long-term risk of recurrent events that remain after acute event. Acute ischemic event can be caused by an increase in myocardial oxygen demand precipitated by tachycardia or hypertension, or more commonly by a decrease in oxygen supply related to a reduction in coronary lumen diameter due to platelet-rich thrombi or vessel spasm. Pain: occurs at rest or with minimal exertion, lasts more than 20 minutes (if not interrupted by nitro); severe and described as frank pain and of new onset; severe, prolonged, or frequent than previously experienced.
Term
Aortic Valve Stenosis
Definition
Results in obstruction to the outflow of blood from the left ventricle. It is characterized by a large left ventricular–to–aortic pressure gradient and a crescendo-decrescendo murmur during systole that radiates to the neck. The extra pressure work can lead to left ventricular hypertrophy and failure.Increased resistance to ejection of blood from the left ventricle into the aorta. Causes: congenital valve malformations and acquired calcification of a normal tricuspid valve. Associated with the normal "wear and tear" of either a previous normal aortic valve or congential bicuspid valve. Calcific: slow progression; valves changes range from mild thickening without obstruction to severe calcificationwith impaired leaflet motion and obstructed left ventricular outflow. More common in men, older persons, and with hypercholesteremia and derive in part from an active inflammatory process. Left ventricular wall becomes thicker, or hypertrophies. Diagnosed: loud systolic ejection murmur or single or paradoxically split second heart sound. Symptoms of angina, syncope, and heart failure develop. Subtle signs of decrease in exercise tolerance or exertional dyspnea should be followed closely. Initial compliant is fatigue.
Term
Aortic Valve Regurgitation
Definition

Characterized by a high systolic and low diastolic blood pressure and a bounding pulse. The murmur of aortic regurgitation occurs during diastole. Left ventricular failure may result because of the high-volume work.

                Result of an incompetent aortic valve that allows blood to flow back to the left ventricle during diastole, thus increasing the left venrticle stroke volume. Causes: RF, idiopathic dilation of the aorta, congenital abnormalities, IE, Marfans, HTN, trauma, and failure of prosthetic valve. Characterized by the presence of a sudden, large regurgitant volume to a left ventricle of normal size that has not had time to adapt to the volume overload. Heart responds with use of the Frank-Starling mechanisms and an increase in heart rate, fail to maintain CO. Severe elveation in left ventricular end-diastolic pressure, culminating in pulmonary edema. Decrease in CO leads to sympathetic stimulation and a resultant increase in heart rate and peripheral vascular resistance that cause regurgitation to worsen.Death from pulmonary edema, ventricular arrhythmias, or circulatory collapse is common in severe cases. Disease progresses: exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Complaint of uncomfortable awareness of heartbeat, when lying down. Tachycardia with stress or exertion. Major findings: widening of arterial pulse pressure, rapid rise and fall (Corrigan pulse), elevated systolic and low diastolic. Carotid pulsation in the neck, throbbing of peripheral pulses.

Term
Atherosclerosis
Definition
Type of arteriosclerosis or hardening of the arteries. Formation of fibrofatty lesions in the intimal lining of the large and medium-sized arteries such as the aorta and its branches, the coronary arteries, and the large vessels that supply the brain. Complications: ischemic heart disease, stroke and peripheral vascualr disease. Manifestations do not become evident for 20-40 years. Major risk factor: hypercholesteremia, advanced age, males, familial,hyperlipidemia, DM, smoking, HTN, obesity. Incidence increases with age. Lesions: fatty streak, fibrous atheromatous plaque, complicated lesion. Fatty streaks: thin, flat, yellow intimal discoloration that progressively enlarge by becoming thicker and slightly elevated as they grow in length. Fibrous atheromatous: basic lesion; accumulation of intracellular and extracellular lipids, proliferation of vascular smooth muscle cells, formation of scar tissue, and calcification; gray to pearly white lesion. Complicated: hemorrhage, ulceration, and scar tissue deposits. Thrombosis is the most important complication. Important cause of PAD. S/S: vessel obstruction, production of ischemia. infarction, trhombosis, formation of emboli, aneurysm.
Term
Arteriosclerosis
Definition
Stiffening of the arteries. Any hardening (or loss of elasticity) of medium or large arteries. PAD sometimes referred to as arteriosclerosis obliterans. Superficial femoral and popliteal arteries are the most commonly affected vessels. Lesions develop in lower leg and foot, tibial, peroneal, or pedal vessels. Common in men in their 60-70.
Term
Myocardial Infarction
Definition
Serum biomarkers: troponin, myoglobin, and creatine kinase. Also known as heart attack. Characterized by the ischemic death of myocardial tissue associated with atherosclerotic disease of the coronary arteries. Are of infarction id determined by the coronary artery that is affected and by its distribution of blood flow. Extent depends on the location and extent of occlusion, amount of heart tissue supplied by the vessel, duration of the occlusion, metabolic needs of the affected tissue, extent of collateral circulation, heart rate, blood pressure, and cardiac rhythm. May involve the endocardium, myocardium, epicardium, or combination. Pain is more prolonged and not relieved by rest or nitro, narcotics required. GI complaints common: epigastric distress, nausea and vomiting. Sudden death occurs within 1 hour of onset attributed to fatal arrythmias. A drop in CO as a result triggers a number of compensatory responses, including sympathetic activation. The sympathetic nervous system increases the heart rate, contractility, and blood pressure, all of which increase myocardial workload.
Term
Heart Failure
Definition
Systolic dysfunction represents a decrease in cardiac myocardial contractility and an impaired ability to eject blood from the left ventricle, whereas diastolic dysfunction respresents an abnormality in ventricular relaxation and filling. Right sided: failure of the right ventricle to move unoxygenated blood from the venous system into the pulmonary circulation, with an eventual backup in the systemic venous circulation. Left sided: failure of the left ventricle to move oxygenated blood from the pulmonary circulation into the arterial circulation with eventual backup of blood in the lungs. Both types result in decreased forward flow, resulting in poor circulation of oxygenated blood in the body. Causes: CAD, HTN, dilated cardiomyopathy and valvular heart disease.
Term
Dilated Cardiomyopathy
Definition
Characterized by progressive cardiac hypertrophy and dilation and impaired pumping ability of one or both ventricles. Although all four chambers of the heart are affected, the ventricles are more dilated than the atria. enlarged, weakened left ventricle struggles to pump enough blood to meet the body's needs. The most common initial manifestations are those related to heart failure. The most striking symptoms are: dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, weakness, fatigue, ascites, and peripheral edema. Common cause of heart failure and the leading indicaton for heart transplantation. Commonly familial. Other causes: infections, toxins, alcoholism, chemo agents, metals and multiple other disorders. Often no cause found, referred to as idiopathic DCM. Characterized by ventricular enlargment, reduction in ventricular wall thickness. and impaired systolic function of one or both ventricles, atrophic and hypertrophic myocardial fibers and interstitial fibrosis.Treatment: reducing work of the heart relievng heart failure symptoms, diuretcs, beta blockers, afterload reducing agents, ace inhibitors, anticoagulants and antiarrythmias, biventricular pace maker, ICD, cardiac transplantation. Avoid causative agents: myocardial depressants, including alcohol, pacing rest.
Term
Restrictive Cardiomyopathy
Definition
 Rare form of heart muscle disease in which ventricular filling is restricted because of excessive rigidity of the ventricular walls. Idiopathic or associated with distinct diseases that affect the myocardium, principally radiation fibrosis, amyloidosis, sarcoidosis, or metastatic tumors.Walls of the ventricles become stiff, but not necessarily thickened. S/S: dyspnea, paroxysmal nocturnal dyspnea, orthopnea, peripheral edema, ascites, fatigue, and weakness.  Advanced form: all signs of heart failure present except for cardiomegaly. Least common in Western countries. With this type of cardiomyopathy ventricular filling is restricted because of excessive rigidity of the ventricular walls, although the contractile properties of the heart remain relatively normal. Symptoms include dyspnea, paroxysmal nocturnal dyspnea, orthopnea, peripheral edema, ascites, fatigue, and weakness.
Term
Hypertrophic Cardiomyopathy
Definition
Characterized by an abnormality that involves excessive ventricular growth or hypertrophy. Although the hypertrophy occurs in both ventricles, there is a disproportionate growth of the ventricular septum producing intermittent left ventricular outflow obstruction. Unexplained left ventricular hypertrophy with disproportionate thickening of the ventricular septum, abnormal diastolic filling, cardiac arrhythmias, intermittent left ventricular outflow obstruction. Most common types of cardiomyopathy. Common cause of sudden cardiac death in young athletes, genetic. Other complications: atrial fibrillation, stroke, and heart failure. Autosomal dominant. Appears as myocyte hypertrophy with myofibril disarray and increased caridac fibrosis. S/S: atrial dysrhythmias, dyspnea, chest pain, fatigue and syncope. Some individuals may not experience symptoms but experience sudden cardiac death.
Term
Cor Pulmonale
Definition
When the right heart failure occurs in response to chronic pulmonary disease resulting from primary lung disease or pulmonary HTN. Increased pressures and work result in hypertrophy and eventual failure of the right ventricle. Signs include venous congestion, peripheral edema, short of breath, productive cough, plethora(redness), cyanosis, warm moist skin, drowsiness, altered consciousness. Management focuses on the treatment of the lung disease and heart failure. Low-flow oxygen therapy may be used to reduce the pulmoary hypertension and polycythemia.
Term
Mitral Valve Stenosis
Definition
Characterized by a large left atrial-to-left ventricular pressure gradient during ventricular diastole. Can lead to left atrial and pulmonary congestion. Represents the incomplete opening of the mitral valve during diastole, with left atrial distention and impaired filling of the left ventricle. Commonly the result of RF. Less frequently, the defect is congenital and manifests during infancy or early childhood. Continuous, progressive, lifelong disorder consisting of a slow, stable course in the early years and progressive acceleration in later years. Characterized by fibrous replacement of valvular tissue, along with stiffness and fusion of the valve apparatus. S/S: depend on the severity of the obstruction and are related to the elevation in left atrial pressure and pulmonary congestion, decreased CO owing to impaired left ventricular filling, and left atrial enlargment with development of atrial arrhythmias and mural thrombi; pulmonary congestion, nocturnal paroxysmal dyspnea and orthopnea, palpitations, chest pain, weakness, and fatigue. Murmur is heard during diastole when blood is flowing through the constricted valve orifice, low pitched, rumbling at apex of heart.
Term
Mitral Valve Prolapse
Definition

Characterized by large V waves in the left atrial pressure tracing and a loud systolic murmur that radiates to the left axilla. Mitral regurgitation increases the work of the left atrium and ventricle and can lead to left-sided heart failure.

                Referred to as the floppy mitral valve syndrome. More frequent in women, familial. Autosomal trait. Associated with Marfans, osteogenesis imperfecta, and other connective tissue disorders, and with cardiac, hematologic, neuroendocrine, metabolic, and psychological disorders. Myexedematous (mucinous) degeneration of mitral valve leaflets that causes them to become enlarged and floppy so that they prolapse or balloon back into the left atrium during systole. Asymptomatic and discovered during physical. Some have chest pain mimicking angina, fatigue, anxiety, palpitations, and light-headedness.

Term
Mitral Valve Regurgitation
Definition
Characterized by large V waves in the left atrial pressure tracing and a loud systolic murmur that radiates to the left axilla. Increases the work of the left atrium and ventricle and can lead to left-sided heart failure. Incomplete closure of the mitral valve, with the left ventricle stroke volume being divided between the forward stroke volume that moves into the aorta and the regurgitant stroke volume that moves back into the left atrium during systole. Mitral valve prolapse is common cause. Enlarged left ventricle. S/S: SOB especially with exercise or at rest, fatigue, cough often at night in bed, palpitations, fluttering heart beat, a-fib, swollen feet or ankles, heart murmur, muffled heart beat, excess urination. 
Term
Arterial Insufficiency
Definition

Causes ischemia. Arterial insufficiency is decreased blood flow or lack of blood flow through your arteries. Arteries are blood vessels that carry blood away from your heart, out to your tissues and organs. Arterial insufficiency occurs when your arteries become narrowed or blocked by an underlying disease or condition. This decreases blood flow and oxygen delivery to the cells, tissues and organs being supplied by your arteries. Without adequate blood flow and oxygen, cells and tissues may not function properly and may even begin to die. The most common cause of arterial insufficiency is atherosclerosis, or hardening of the arteries. Plaques narrow your arteries and may eventually block blood flow through them. Plaques can also rupture and cause a blood clot to develop in the artery. This can lead to a life-threatening condition, such as a heart attack or stroke.

Arterial insufficiency can also be caused by emboli. Emboli are blood clots that travel through the blood until they become lodged in an artery and block blood flow. This can also cause a life-threatening condition, such as a pulmonary embolism. Pain: yes, worsens with exercise, worse in am and gradually improves as day progresses; DON'T ELEVATE. Pulse: may be absent or decreased. Color: Pale, mottled. Edema: NO. Temperature: Cool to touch. Capillary Refill: No, may be sluggish. Long term effects: skin thin with shiny appearance, hairless, muscles atrophy, local pain and then progresses to numbness, risk of ulceration, prone to gangrene.

Arterial insufficiency can affect many areas of your body. The symptoms of arterial insufficiency will depend on the arteries and the areas of the body that are affected. It can result in symptoms of a heart attack, such as chest pain and shortness of breath, when it affects the arteries around the heart. When arteries to the brain are affected, you may experience symptoms of a transient ischemic attack (TIA) or stroke. This includes dizziness, numbness, vision problems, or difficulty walking or talking.

Term
Venous Insufficiency
Definition
(Stasis) Ulcers are caused by problems in the veins of the lower leg. Leaky valves, obstructions, or regurgitation disturbs the flow of blood from the lower extremities back to the heart. The blood collects in the lower leg, damaging the tissues and causing wounds. Venous Stasis Ulcer Characteristics: Ruddy color base, Surrounding skin is reddened or brown, Shallow depth, Irregular wound margins, Moderate to heavy exudate, Pitting or non-pitting edema, Skin temperature is warm to the touch (normal), Granulation tissue is present, Infection is not common, Minimal pain (unless infected), Peripheral pulses are present and palpable, Capillary refill is normal,  Usually located near the ankle or lower calf. Pain: minimal, progresses throughout the day, usually worsens in the pm, ELEVATE. Pulse: Good. Color: Normal or bright pink, may be mottles due to arterial occlusion from edema. Edema: yes. Temperature: warm to touch, may feel normal. Capillary refill: yes. Long term effects: skin becomes thickened, risk of ulceration, but no progression to gangrene, leg appears to be largrer in size. Physiologic consequences of DVT (most common cause), valvular incompetence, or a combination of both conditions. DVT causes deformity of the valve leaflets, rendering them incapable of closure. Impaired blood flow. Leads to tissue congestion, edema, and eventual impairment of tissue nutrition. Necrosis of subcutaneous fat deposits occur, followed by skin atrophy. Thin, shiny, bluish, brown, irregular pigmented skin. Lesions over ankle and lower leg, highest above the medial mallelous. Most common cause of lower leg ulcers. Treatment: compression therapy, aspirin and pentoxifylline, skin grafting, growth factors.  
Term
Peripheral Vascular Disease
Definition

Peripheral artery disease is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. When you develop peripheral artery disease (PAD), your extremities — usually your legs — don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication). Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs.Intermittent claudication symptoms include muscle pain or cramping in your legs or arms that's triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is most common. 

  • Painful cramping in your hip, thigh or calf muscles after activity, such as walking or climbing stairs (intermittent claudication)
  • Leg numbness or weakness
  • Coldness in your lower leg or foot, especially when compared with the other leg
  • Sores on your toes, feet or legs that won't heal
  • A change in the color of your legs
  • Hair loss or slower hair growth on your feet and legs
  • Slower growth of your toenails
  • Shiny skin on your legs
  • No pulse or a weak pulse in your legs or feet
  • Erectile dysfunction in men
Term
Deep Vein Thrombosis (DVT)
Definition
Is the formation of a blood clot ("thrombus") in a deep vein. It is a form of thrombophlebitis (inflammation of a vein with clot formation). Deep vein thrombosis commonly affects the leg veins (such as the femoral vein or the popliteal vein) or the deep veins of the pelvis. Occasionally the veins of the arm are affected. A DVT can occur without symptoms, but in many cases the affected extremity will be painful, swollen, red, warm and the superficial veins may be engorged. The most serious complication of a DVT is that the clot could dislodge and travel to the lungs, which is called a pulmonary embolism (PE). DVT is a medical emergency, so, all limb swellings, however trivial, should be regarded as a DVT until proven otherwise. Untreated lower extremity DVT has a 3% PE-related mortality rate.Presence of thrombus in a vein and the accompanying inflammatory response in the vessel wall. Most common and occurs in the lower extremities. Complicated by PE, recurrent DVT, development of chronic venous insufficiency. Isolated calf thrombi are often asymptomatic, untreated can lead to PE. Risk is increased with impaired cardiac function. Elder more susceptible. S/S: pain, swelling, and deep muscle tenderness, fever, general malaise, elevated WBC and ESR. Common site: venous sinuses in the soleus muscle, posterior tibial and peroneal veins. Tests: ascending venography, U/S, plasma D-dimer assessment. 15-20 degree elevation of legs prevents stasis. Elastic support for 3-6 months. Anticoagulant therapy.
Term
Primary (Essential) Hypertension
Definition
Blood pressure above 140mm Hg systolic and/or 90mm Hg diastolic in an adult. Chronic elevation in blood pressure that occurs without evidence of other disease. Constitutional risk factors: family history of HTN, race, and age, obesity, and excess sodium intake. High blood pressure without an identifiable cause; genetic predisposition is present, which can be influenced by environmental factors such as diet and lifestyle. Other factors: insulin resistance, hyperinsulinemia. AA more severe and prevalent. Lifestyle risk factors: high salt intake, obesity, excess alcohol consumption, low intake of potassium, calcium, and magnesium.  Usually asymptomatic. Risk factor for atherosclerosis.
Term
Secondary Hypertension
Definition
Elevation in blood pressure due to another disease condition. Can be corrected or cured by surgery or specific medical treatment. Younger than 30 and older than 50. Obstructive sleep apnea is an independant risk factor. Causes: kidney disease, adrenal cortical disorders, pheochromocytoma, and coarctation of the aorta, oral contraceptives, renal artery stenosis, renal failure, hyperthyroidism, hypersecretion of aldosterone or catecholamines, increased intracranial pressure, and certain drugs.
Term
Peripheral Edema
Definition

swelling of tissues, usually in the lower limbs, due to the accumulation of fluids.

The condition is commonly associated with aging, but can be caused by many other conditions, including congestive heart failure, trauma, alcoholism, altitude sickness, pregnancy, hypertension, or merely long periods of time sitting or standing without moving. Some medicines (e.g. amlodipine, pregabalin) may also cause or worsen the condition.

 

Term
Pulmonary Edema
Definition

Excess fluid in the lungs. This fluid collects in the numerous air sacs in the lungs, making it difficult to breathe. Fluid can accumulate for other reasons, including pneumonia, exposure to certain toxins and medications, and exercising or living at high elevations. Develops suddenly (acute) is a medical emergency requiring immediate care. Treatment varies depending on the cause, but generally includes supplemental oxygen and medications. S/S of acute:

  • Extreme shortness of breath or difficulty breathing dyspnea) that worsens when lying down
  • A feeling of suffocating or drowning
  • Wheezing or gasping for breath
  • Anxiety, restlessness or a sense of apprehension
  • A cough that produces frothy sputum that may be tinged with blood
  • Excessive sweating
  • Pale skin
  • Chest pain, if pulmonary edema is caused by heart disease
  • A rapid, irregular heartbeat (palpitations) 
  • S/S of chronic:
  • Having more shortness of breath than normal when you're physically active.
  • Difficulty breathing with exertion, often when you're lying flat as opposed to sitting up.
  • Wheezing.
  • Awakening at night with a breathless feeling that may be relieved by sitting up.
  • Rapid weight gain when pulmonary edema develops as a result of congestive heart failure, a condition in which your heart pumps too little blood to meet your body's needs. The weight gain is from buildup of fluid in your body, especially in your legs.
  • Swelling in your legs and ankles.
  • Loss of appetite.
  • Fatigue.
  • High altitude S/S:
  • Headache
  • Insomnia
  • Fluid retention
  • Cough
  • Shortness of breath
Term
Tricuspid Valve
Definition
Also known as the right atrioventricular valve, is on the right dorsal side of the heart, between the right atrium and the right ventricle. Usually has three leaflets and three papillary muscles. They are connected to the papillary muscles by the chordae tendineae, which lie in the right ventricle. Will not always consist of three leaflets and may also occur with two or four leaflets; the number may change during one's lifetime.
Term
Pulmonic Valve
Definition

Control the movement of blood out of the ventricles. Controls the flow of blood into the pulmonary circulation. Also referred to as semilunar valve, that lies between the right ventricle and the pulmonary artery and has three cusps. Similar to the aortic valve, the pulmonary valve opens in ventricular systole, when the pressure in the right ventricle rises above the pressure in the pulmonary artery. At the end of ventricular systole, when the pressure in the right ventricle falls rapidly, the pressure in the pulmonary artery will close the pulmonary valve.

The closure of the pulmonary valve contributes the P2 component of the second heart sound (S2). The right heart is a low-pressure system, so the P2 component of the second heart sound is usually softer than the A2 component of the second heart sound. However, it is physiologically normal in some young people to hear both components separated during inhalation.

Term
Varicose Veins
Definition
Veins that have become enlarged and tortuous. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards (retrograde). Leg muscles pump the veins to return blood to the heart, against the effects of gravity. When veins become varicose, the leaflets of the valves no longer meet properly, and the valves do not work. This allows blood to flow backwards and they enlarge even more. Varicose veins are most common in the superficial veins of the legs, which are subject to high pressure when standing. Besides cosmetic problems, varicose veins are often painful, especially when standing or walking. They often itch, and scratching them can cause ulcers.Or dilated, tortuous veins of the lower extremeties are common and often lead to secondary problems of venous insufficiency. Primary originate in the superficial saphenous veins, secondary result from impaired flow in the deep venous channels.Development of secondary are inevitable when flow in thses deep channels is impaired or blocked. Most common cause of secondary is DVT, other causes include congenital or aquired arteriovenous fistulas, congenital venous malformations, and pressure on the abdominal veins caused by pregnancy or a tumor. More common after age 50, obesity, and women. Primary contributing factors: prolonged standing and increased intra-abdominal pressure; edema subsides at night with elevation. Trendelenburg test: tourniquet applied to affected leg while it is elevated and the veins are empty, person stands and tourniqet removed, if superficial veins are involved the veins distend quickly.
Term
Hemoptysis
Definition
Coughing up blood or blood-stained sputum. Cardiac causes like congestive heart failure and mitral stenosis should be ruled out. Pink frothy sputum is consistent with PE.
Term
Ischemia
Definition
Holding back of blood. Reduction in arterial flow to a level that is insufficient to meet the oxygen demands of the tissues. Occurs when the heart's demand for oxygenated blood exceeds its supply. In most cases, is a result of impaired blood flow through the coronary arteries.
Term
Aneurysm
Definition
 Abnormal localized dilatation of a blood vessel. They can occur in arteries or veins but are most common in the aorta. There are two types of aneurysms: true and false. A true aneurysm involves all layers of a vessel with an increase in diameter of 50%. A false aneurysm involves a tear or dissection in the inner wall of an artery causing an extravascular hematoma that causes vessel enlargement. Aneurysms are classified according to their cause, location, and anatomic features and include berry (a small, spherical dilatation of the vessel at a bifurcation, commonly seen in the Circle of Willis in the cerebral circulation), fusiform (involves the entire circumference of the vessel and is characterized by a gradual and progressive dilatation of the vessel), saccular (extends over part of the circumference of the vessel and appears saclike, and dissecting ( a false aneurysm resulting from a tear in the intimal layer of the vessel that allows blood to enter the vessel wall, dissecting its layers to create a blood-filled cavity; S/S: excrutiating pain, anterior chest pain, back pain, BP and pulse unobtainable in one or both arms, syncope, hemiplegia, or paralysis of LE, heart failure). Assessment: Aortic aneurysm-U/S, ECG, CT, MRI; Dissection-H&P, aortic angiography transesophageal, CT, MRI, ECG.
Term
Coronary Heart Disease
Definition
Associated with coronary atherosclerosis. Risk factors are the same as for atherosclerosis of other arteries and include advancing age, male gender, family history, hyperlipidemia, diabetes, smoking, HTN, and obesity. Endothelial injury and inflammation and lipid accumulation in the intima are thought to be the primary initiators of coronary atherosclerosis.
Term
Angina
Definition
Characterized by intermittent bouts of chest pain brought on by exertion and generally relieved by stress. No permanent myocardial damage occurs.
Term
Hyperlipidemia
Definition

Abnormal concentrations of serum lipoproteins in a high level of LDL

(low density lipoproteins) or "bad" cholesterol and/or a low level of HDL (high density lipoproteins) or "good cholesterol".

Term
Congestive Heart Failure(CHF)
Definition
Dysfunctional cardiac pumping that results in congestion of blood behind the cardiac pump. Right-sided heart failure is associated with systemic venous congestion. Left-sided heart failure is associated with pulmonary congestion. Potential consequence of most cardiac disorders. The most common cause are myocardial ischemia from coronary artery disease and hypertension. Other, less common causes include dilated cardiomyopathy, congenital heart defects, valvular disorders, respiratory diseases, anemia, and hyperthyroidism. The pathophysiologic state of heart failure results from impaired ability of myocardial fibers to contract (systolic failure), relax (diastolic failure), or both. Differentiation of the two groups is based on left ventricular ejection fraction. Systolic failure occurs as the primary dysfunction in 60-70% of cases of CHF. Diastolic failure is the primary problem in 30-40% of cases overall; it may occur more commonly in elderly patients. Characterized by the effects of forward failure (reduced CO) and backward failure (congestion behind the pump). Left sided heart failure is characterized by pulmonary congestion, manifested by dyspnea, orthopnea, crackles, cough, pulmonary edema, and hypoxemia. Right sided heart failure is characterized by systemic venous congestion, which may be indicated by jugular venous distention, hepatomegaly, splenomegaly, and peripheral edema. Left sided heart failure often leads to development of right sided heart failure; with biventricular failure, congestive S/S are found in both the pulmonary and systemic venous circulations.
Term
Right Sided Heart Failure
Definition
Also known as Cor Pulmonale. S/S: fatigue, increased peripheral venous pressure, edema, ascites, enlarged liver and spleen, may be secondary to chronic pulmonary problems, distended jugular veins, anorexia and complaints of GI distress, swelling in hands and fingers, dependent edema of feet, weight gain, dyspnea, exercise intolerance, hepatomegaly and splenomegaly. Causes: infarction of right ventricle, pulmonic valve stenosis, pulmonary disease. Basic effects: decreased CO, systemic congestion. Compensaton by the body: tachycardia, polycythemia, daytime oliguria.
Term
Left Sided Heart Failure
Definition
S/S: Paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, pulmonary congestion (cough, crackles, wheezes, blood-tinged sputum, tachypnea), restlessness, confusion, orthopnea (leads to serious pulmonary complications), tachycardia, exertional dyspnea, fatigue, cyanosis, weakness, dyspnea, activity intolerance, productive cough, hemoptysis. Cause: infarction of left-ventricle, aortic valve stenosis, HTN, hyperthyroidism. Basic effects: decreased CO, pulmonary congestion. Compensations by the body: tachycardia, polycythemia, daytime oliguria (results from decreased blood flow during waking hours from an upright position).
Term
Cardiomyopathy
Definition
A condition in which a ventricle has become enlarged, thickened and/or stiffened. As a result, the heart's ability to pump is reduced. Characterized as dilated, hypertrophic, or restrictive.
Term
Valvular Disorders
Definition
Two primary types. Failure of stenotic valves to open properly causes an abnormal pressure gradient across the valve and increases the pressur work of the heart. Regurgitant valves allow blood to flow backward across the valve and result in extra volume work for the heart.
Term
Rheumatic Heart Disease
Definition
Results from immune-mediated damage to the endocardium after group A beta-hemolytic streptococcal infection.
Term
Acute and Subacute Infective Endocarditis
Definition
Results in the growth of bacterial-laden vegetations on heart valves. In addition to valvular erosion and scarring, embolization may occur.
Term
Endocarditis
Definition
Infection of the innermost layers of the heart. It may occur in people with congenital and valvular diseases, and those who have had rheumatic fever.
Term
Cardiac Tamponade
Definition
Medical Emergency. A build-up of blood or other fluid in the pericardial sac puts pressure on the heart, which may prevent it from pumping effectively. S/S: tachycardia, hypotension, anxiety, restless, chest pain, difficulty breathing, rapid breathing, palipitation, swelling of abdomen, peripheral weak or absent pulses,  dizzy or drowsy, cardiac rub. Treatment: pericardialcentesis
Term
Sustained High Blood Pressure
Definition

Cardiac effects: left ventricle undergoes hypertrophy as a result of increased workload, resulting in increased myocardial oxygen demand; when the myocardial oxygen demand exceeds the supply, ischemia develops and heart failure may ensue.

Vascular effects: the development of atherosclerosis in the aorta and medium-to

-large sized arteries is accelerated, resulting in isolated systolic HTN in elderly patients and contributing to cerebral infarction; atherosclerosis in the smaller arteries and arterioles contributes to cerebrovascular disease and peripheral vascular disease. May be without symptoms; when S/S do occur, they may signify advanced high blood pressure and respresent damage to target organs. Findings may include: HA, fatigue, angina, retinopathy, left ventricular failure (crackles, dyspnea, extra heart sound), evidence of left ventricular hypertrophy on chest radiographs and ECG; HTN may also be associated with myocardial infarction, seizures and coma.

Term
Malignant Hypertension
Definition
Very high blood pressure that comes on suddenly and quickly. The lower (diastolic) blood pressure reading, which is normally around 80mmHg, is often above 130mm Hg. It also occurs in people with: Collagen vascular disorders, kidney probelms, toxemia of pregnancy. You are high risk for malignant HTN if you have had: kidney failure, renal HTN caused by renal artery stenosis. Symptoms: blurred vision, change in mental status, anxiety, confusion, decrease alertness, decrease ability to concentrate, fatigue, restlessness, sleepiness, stupor, lethargy, chest pain (feeling of crushing or pressure), cough, HA, N/V, numbness (arms, legs, face, or other areas), reduce urine, seizure, SOB, weakness (arms, legs, face, or other areas)
Term
Dyslipidiemia
Definition
Abnormal levels of lipids and lipoproteins, often due to diet and lifestyle. Cause: prolonged elveation of insulin levels.
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