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Patho Quiz 4
Pathophysiology Quiz 4: Cario and Shock
317
Nursing
Undergraduate 3
03/07/2012

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Cards

Term
B1 receptors influence:
Definition

heart rate

conduction

force of contractions

Term
A1 stimulation does what to vessels?
Definition
vasoconstriction
Term
B2 stimulation does what to vessels
Definition
vasodilation
Term
Intropy
Definition
contractility
Term
Stroke Volume
Definition
amount of blood ejected from heart
Term
End diastolic volume
Definition
amount of blood in ventricle at end of diastole
Term
End stroke volume
Definition
Amount of blood left in ventricle after systole
Term
Ejection Fraction
Definition
SV/EDV. Normal is 60-80%
Term
Central venous pressure
Definition
mean right atrial pressure; indicator of heart's blood volume
Term
Diastolic blood pressure
Definition
lowest arterial pressure (just before semilunars open)
Term
Systolic Blood Pressure
Definition
maximum arterial pressure during systole
Term
Autoregulation
Definition
Continuous adjustment of vessel diameter
Term
When does blood flow to the coronary arteries?
Definition
diastole
Term
What happens to coronary blood flow when HR increases?
Definition
Reduced coronary blood flow as diastolic time is reduced
Term
What cardiac cells are capable of generating action potential?
Definition
Cardiac myocytes
Term
CO = ___ x ____
Definition
CO = HR x SV
Term
Blood flow through heart
Definition

Vena Cava

Right Atrium

Tricuspid Valve

Right ventricle

Plumonic valve

pulmonary artery

lungs

pulmonary veins

left atrium

mitral valve

lft ventrile

aortic valve

aorta

Term
Name the 4 heart valves
Definition

tricuspid

pulmonic

mitral

aortic

Term
Name the vessles which supply the heart
Definition
  • inferior/superior vena cava
  • pulmonary veins

 

Term
Name the vessles that supply the body
Definition

aorta

pulmonary arteries

 

Term
When does the blood fill the coronary arteries?
Definition

Diastole

 

A faster heart rate reduces diastolic time and decreases coronary blood flow

Term
What is normal ejection fraction?
Definition
60-80%
Term
What is normal cardiac output?
Definition
5-6 L/minute
Term
What is lymphedema?
Definition
When the normal flow of lymph is blocked or altered
Term
Describe the clinical presentation of lymphedema
Definition

lymph collects in the interstitium

inflammation of subQ adipose tissue

fibrotic changes over time

congestion with thick, brown color

Term
BP = ____ X ____
Definition
BP = CO X PVR
Term
Ischemia creates a context for injury via 3 mechanisms, what are they?
Definition
  • oxygen free radicals
  • excitatory amino acids
  • inflammation
Term
HDL
Definition

High Density Lipoproteins

 

Good cholesterol

 

Picks up excess, unused cholesterol from cells and brings to liver to process and remove from the body

Term
LDL
Definition

Low density lipoproteins

 

Bad cholesterol

 

carries cholesterol to the cells

 

deposited in walls to become plaque

Term
3 Systems that transport blood
Definition

arteries

veins

lymphatics

Term
Myocardial ischemia, like any ischemia, is associated with metabolic...
Definition
acidosis
Term

Normally, pressure is higher in which side of the heart?

Definition

Left (ventricle): must overcome pressure on aorta and supply entire body with blood

Term
What do B1 receptors do?
Definition

influence heart rate

conduction

force of contractions

Term
What do B2 receptors do?
Definition

dilate small coronary arteries, increase cardiac output (minor compared to B1), stimulation cause vasodilation in bronchi

Term
Where do coronary arteries stem from?
Definition
aorta
Term
Influx of which electrolytes allows cardiac myocytes to contract?
Definition

Na+

Ca2+

 

K+ efflux

Term
Where is the SA node located?
Definition
located in right atrium near superior vena cava inlet
Term
Where is the AV node located?
Definition
Posterior septal wall of the right atrium just behind the tricuspid valve.
Term

 

Under normal conditions, the heart rate is under PSNS or SNS control?

 

Definition

Parasympathetic, but...

 

Parasympathetic and sympathetic nervous systems are both controlling the heart in normal conditions (homeostasis)

 

Term
What is autoregulation in relation to blood pressure?
Definition

continuous adjustment of vessel diameter

happens second to second
• Vessels dilate = BP decreases
• Vessels constrict = BP increases

Term
_________ is a potent vasodilator produced in endothelial cells of coronary arteries.
Definition
Nitric oxide
Term
When norepi stimulates A1, what happens to vessels?
Definition
vasoconstriction
Term
When norepi stimulates B2 receptors, what happens to vessels?
Definition
vasodilation
Term
What are the 4 mechanisms that can alter BP?
Definition
  • autonomic nervous system
  • baroreceptors
  • chemoreceptors
  • renal antiotensin adldosterone system & renal function
Term
How does the autonomic nervous system affect BP?
Definition

balance between sympathetic and parasympathetic.

Alpha 1 receptors stimulate in smooth muscle will cause vasoconstriction, decrease vessel diameter, increase BP (ANS)

Term
How do baroreceptors affect BP?
Definition
Baroreceptors sense changes in stretch/BP. When an increase in stretch is detected a signal is sent to the vasomotor center which will initiate changes to lower BP by increaseing PSNS.
Term
What are baroreceptors sensitive to?
Definition

Changes in mean arterial pressure.

 

ex: increased mean arterial pressure there will be increased stretch

Term
What side of the heart pumps unoxygenated blood?
Definition
right
Term
What side of the body pumps oxygenated blood?
Definition
left
Term
What are the two types of heart valves?
Definition
  • atrioventricular valves (AV)
  • ventricular / semilunar valves
Term
What type of valves are the mitral and tricuspid valves?
Definition
AV valves
Term
What type of valves are the aortic and pulmonic (pulmonary) valves?
Definition
semilunar / ventricular
Term
Where do the three main coronary arteries originate from?
Definition
aorta
Term
Which coronary artery branches into the left anterior descending and circumflex arteries?
Definition
left main (located on the front)
Term
Which coronary artery travels down the anterior portion of the septal groove between the right and left ventricles and branches several more times to supply blood to the anterior portion of the septum and the anterior muscle mass of the left ventricle?
Definition
left anterior descending (located on teh front)
Term
Coronary artery that travels in the area between the left atrium and ventricle, on the posterior surface, and supplies blood to the latral wall of the left ventrical
Definition
left circumflex artery
Term
Coronary artery that travels in the groove between the right atrium and the ventricle and branches off to supply blood to the posterior portions of the heart (including posterior interventricular septum)
Definition
Right coronary artery (located in the front)
Term
Coronary artery located on the posterior right ventrical, this artery eventually branches from the right coronary artery.
Definition
Right posterior descending artery (located on the back)
Term
What two coronary arteries are located on teh posterior of the heart
Definition
  • left circumflex
  • right posterior descending
Term
What vessel supplies coronary blood flow?
Definition
aorta
Term
Path of coronary blood flow
Definition
  • left bentrical
  • coronary arteries
  • coronary veins
  • drains into right atrium
Term
_______ reduces diastolic time and decreases coronary blood flow.
Definition
Faster heart rate
Term

3 receptors stimulation affects

 

(the three of 4 we need to know for patho at this point)

Definition
  • B1
  • B2
  • A1
Term

Stimulation of B2 affects what one thing?

 

Definition
vasodilation
Term
Stimulation of A1 affects what three things?
Definition
  • vasoconstriction
  • decreases vessel diameter
  • increased BP
Term
Name the effected receptor (B1, B2, or A1)

Vasodilation
Definition
B2
Term
Name the effected receptor (B1, B2, or A1)

Conduction

Definition
B1
Term
Name the effected receptor (B1, B2, or A1)

Force of Contractions
Definition
B1
Term
Name the effected receptor (B1, B2, or A1)

Decreased Vessel Diameter

Definition
A1
Term
Name the effected receptor (B1, B2, or A1)

Heart Rate

Definition
B1
Term
Name the effected receptor (B1, B2, or A1)

Vasoconstriction
Definition
A1
Term
Name the effected receptor (B1, B2, or A1)

Increased BP
Definition
A1
Term
During cardiac contraction, which electrolytes INFLUX?
Definition
  • Na+
  • Ca++
Term
During cardiac contraction, which electrolyte EFFLUXES?
Definition
K+
Term
Which risk factors can be changed by the patient?
Definition
Controllable
Term
Which risk factors can't be changed by the patient?
Definition
Uncontrollable

Term
3 Layers of Arteries/Veins

Definition

 

  • Tunica Intima
  • Tunica Media
  • Tunica Adventitia

 

Term
Do veins or arteries have a larger tunica media and why?
Definition

 

  • Arteries
  • Arteries are more "elastic" than veins, so the muscular portion is larger

 

Term
Middle Layer of Veins/Arteries and Composition
Definition

 

  • Tunica Media
  • Muscular Cells

 

Term
Outermost Layer of Veins/Arteries and Composition
Definition

 

  • Tunica Aventitia
  • Connective Tissue

 

Term
Innermost Layer of Veins/Arteries and Composition
Definition

 

  • Tunica Intima
  • Endothelial Cells

 

Term
Blood vessels that are capacitance vessels
Definition
Veins
Term
Blood vessels with ANS stimulation

Definition
Arteries
Term
Blood vessels with inflammatory mediators
Definition
Arteries
Term
Blood vessels that act as blood reservoirs
Definition
veins
Term
Blood vessels that vasodilate and vasoconstrict
Definition
arteries
Term
Blood vessels that contain one-way valves to prevent pooling of blood due to gravity
Definition
veins
Term
Blood vessels affected by skeletal muscle contraction
Definition
veins
Term
At rest ____% of blood supply can be in the veins
Definition
60%
Term
_____ are less elastic than _____
Definition
  • veins
  • arteries
Term
_____ carry O2-rich blood

Definition
Arteries (except pulmonary artery)

Term
Veins carry _____-rich blood

Definition
CO2 (O2 poor)
Term
Pulmonary artery carries ___ blood to the lungs
Definition

deoxygenated

(O2-poor)

Term
In lymphedema, lymph collects in the _____
Definition
Interstitium
Term
4 clinical manifestations of lymphedema
Definition

 

  • Inflammation
  • Hypertrophy of subQ adipose tissue
  • Fibrotic changes over time
  • Congestion with thick, brown skin 

 

Term
The ability of organs to retain a constant blood pressure despite factors that may change the flow of blood, either internally or externally
Definition
Autoregulation of BP
Term
PVR (as related to BP)
Definition
peripeheral vascular resistance
Term
Balance between SNS and PSNS systems
Definition
ANS input
Term
2 baroreceptors
Definition
  • aortic arch
  • internal carotids
Term
When are baroreceptors stimulated?
Definition
When the walls of the arteries are stretched by an increased BP
Term
Impulses from the baroreceptors inhibit the _____ center of the brain. This leads to _____ in the periphery and a drop in _____.

Definition
  • Vasomotor
  • Vasodilation
  • CO
Term
When the pH and/or PaCO2 are affected, what do the chemoreceptors do?

Definition
Stimulates the PSNS to decrease HR and dromotropy
Term
How do RAAS and renal function affect BP?
Definition
Preserve sodium volume, increasing fluid volume and increasing BP
Term
Risk factors for CHD
Definition

 

 

·         Uncontrollable risks:

 

o   Age

 

o   Gender

 

o   Family history

 

·         Controllable risks:

 

o   Hypertension

 

o   Cigarette smoking

 

o   Diabetes

 

o   Obesity

 

o   Physical inactivity

 

o   Poor diet (atherogenic)

 

o   Thrombogenic state

 

·         Lipid risk factors

 

o   Total cholesterol >200

 

o   LDL >130

 

o   Triglycerides >150

 

o   HDL <40

 

Term
Ischemia creates a context for injury via what triad?

Definition
  • Oxygen Free Radicals
  • Excitatory Amino Acids
  • Inflammation
Term

Which intracellular electrolyte accumulates in the face of ischemia?

Definition
Calcium
Term
Which cholesterol is "good"?
Definition
HDL
Term
Which cholesterol is "bad"?
Definition
LDL
Term
What does HDL stand for?
Definition
High density lipoproteins
Term
What does LDL stand for?
Definition
Low density lipoproteins
Term
Picks up excess, unused cholesterol from cells and brings it back to the liver for processing and removal from the body

Definition
HDL
Term
Carries cholesterol to cells
Definition
LDL
Term

Deposited in walls to become plaque
Definition
LDL
Term
What is the significance of foam cells in artherosclerosis?
Definition
Foam cells form lipid core with fibrous cap
Term
What do foam cells produce that are considered the first sign of artherosclerosis?

Definition
Fatty streaks
Term
As the vessel lumen narrows, explain the roles of platelets, clotting cascade, and thrombus risk

Definition
Platelets cluster around the arterial wall and recruit more platelets. Vasoactive enzymes activate the clotting cascade which can cause a thrombus to form.
Term
Who is at greatest risk for a silent MI?
Definition
Diabetics
Term

Name 5 causes of endothelial injury that can lead to atherosclerosis

 

Definition
  • Smoking
  • HTN
  • Hyperlipidemia
  • Viruses
  • Immune Reactions
Term
State of transient myocardial ischemia without cell death
Definition
Angina Pectoris
Term
What is the difference between angina pectoris and MI?
Definition
Cell death occurs in MI, but not angina pectoris
Term
Cardiac myocytes store how much ATP?
Definition
Very little
Term
How long can cardiac myocytes withstand hypoxia?
Definition
20 minutes
Term
Unpredictable Angina

Definition
Prinzmetal Variant Angina
Term
Prinzmetal variant angina is unrelated to _____ or _____

Definition
  • exercise
  • stress
Term
Difference between prinzmetal and regular angina
Definition
Atherosclerosis is not necessarily present in prinzmetal

Term
Cause of prinzmetal variant angina
Definition
Vasospasm

Term
Clinical manifestations of angina
Definition
  • Substernal Chest Pain
  • Increased HR and BP
  • EKG Changes Can be Present
  • Usually Precipitated by Physical Activity

 

Term
What changes might be present in EKG?
Definition

 

  • STEMI
  • Non-STEMI

 

Term
ST segment elevation
Definition
STEMI
Term
Which EKG change indicates that reperfusion therapy might work?
Definition
STEMI

Term
What does ST segment elevation tell the clinician?
Definition
STEMI that might benefit from reperfusion therapy
Term
Another Name for Acute Coronary Syndrome
Definition
MI
Term
Ischemic myocardial necrosis resulting from a reduction in blood supply to a portion of the myocardium

Definition
MI/ACS
Term
Most MIs are caused by what?

Definition
  • Thrombotic occlusion related to severe coronary atherosclerosis
  • Instability of already-formed plaques
  • Plaque rupture

 

Term
MI related to entire thickness of ventricular wall
Definition
Transmural MI
Term
MI related to subendocardial infarct

Definition
Non-Q Wave MI
Term
How much of the ventricular wall is involved in a Non-Q Wave MI?
Definition
1/3-1/2
Term
Cause of Transmural MI
Definition
Thrombi/Occlusion

Term
Cause of Non-Q Wave MI

Definition
reduced blood flow
Term
In the context of ACS, time is _____!
Definition
Muscle
Term
What is the first action if a patient feels chest pain?

Definition
Call 911!!!!
Term
Most cell death from MI is _____ and ____ (percentages)
Definition
  • 80% apoptosis
  • 20% necrosis
Term
Explain the role of baroreceptors in compensation during MI

Definition
  • Reduced impulses by baroreceptors
  • Baroreceptors stimulate SNS (Epi/NE)
  • SNS leads to vasoconstriction and/or increased HR, increased dromotropy, incresed inotropy
  • This leads to increased ventricular tension/cardiac hypertrophy, which leads to increased SV and CO
Term
Explain the role of RAAS in compensation during MI

Definition

 

  • RAAS leads to fluid retention, increased preload, increased ventricular tension/cardiac hypertrophy
  • These lead to increased SV and increased CO

 

Term
If SNS leads to vasoconstriction, where do baroreceptors and RAAS intersect?
Definition
Increased Preload (at which point, baroreceptors increase ventricular tension/cardiac hypertrophy, which leads to increased SV and CO)

Term
8 Clinical Manifestations of MI
Definition
  • Prolonged Chest Pain (> 30 minutes)
  • Pallor or Cyanosis, SOB, Diaphoresis, Nausea, Restlessness, Feeling of Apprehension/Doom
  • Radiating Pain
  • EKG Changes (ST or T changes)
  • BP Changes
  • Crackles in Lungs
  • Coronary Angiography Reveals Lesions
  • Depressed LV Function

 

Term
What causes a Q wave?

Definition
Infarcted cells become electrically silent
Term
Is a Q wave instantaneous in development?
Definition
No, it takes time to develop
Term
What can a Q wave tell us?

Definition
If previous MI
Term
When do AV valves open?
Definition

Open passively during diastole when atrial pressure > ventricular pressure
Term
When do AV valves close?

Definition
When contraction causes the ventricular pressure to be > than atrial pressure

Term
When do ventricular valves open?
Definition
When ventricular pressure > aorta/pulmonary pressures
Term
When do ventricular valves close?
Definition
When ventricular pressure is < than aorta/pulmonary pressures
Term
What is the pressure gradiant of mitral stenosis?
Definition
Atrial pressure > ventricular pressure
Term
Explain the progression of mitral stenosis
Definition
Thickening of LA (mitral valve leaflets) > Chamber enlarges > Hypertrophy > Incr pulmonic vascular pressure > Chronic pulmonary HTN > RV hypertropy > Right HF
Term
Mitral stenosis causes failure of which side of the heart?

Definition
right
Term
Mitral Valve Disease is a disease of which side of the heart?

Definition
left
Term
What is the hallmark symptom of mitral stenosis?

Definition
Pulmonary congestion
Term
In mitral stenosis, which part of the heart changes to compensate?
Definition
left atrium enlargement and hypertrophy
Term
In mitral stenosis what happens to the mitral valve?
Definition
The orafice narrows to 1 cm2
Term
During mitral regurg, which part of the heart changes to compensate?
Definition
Backflow from Left Ventricle to Left Atrium. Both Left Atrium and Left Ventricle dilate/hypertrophy to compensate

Term

What happens to the mitral valve during prolapse?

Definition
Balloons up into the Left Atrium
Term
What causes aortic stenosis?
Definition
  • Age-related Calcification
  • Obstruction of aortic outflow from Left Ventricle  (systole)
Term

Which part of the heart changes to compensate during aortic stenosis?

Definition
Left Ventricle Hypertrophy
Term

What happens to the heart during aortic stenosis?
Definition
Increase afterload leads to left Heart Failure and pulmonary complications

Term

Which side of the heart fails from aortic stenosis?

Definition

Left
Term
What causes aortic regurg?
Definition

 

 

o   Blood leaks back into left ventricle from aorta

 

o   Left ventricle volume overload leads to hypertrophy, dilation, increase systolic blood pressure

 

Term

Which side of the heart fails during aortic regurg and why?

Definition
  • Left
  • Increased workload
Term
What is a hallmark symptom of aortic regurg during ausculation?

Definition
High-pitched blowing murmur heard during ventricular diastole
Term
Which portion of BP incr because of aortic regurg?
Definition

Systolic

Term

What causes Rheumatic HD?
Definition
B-hemolytic Strep
Term

What is rheumatic HD?

Definition
  • Inflammatory
  • Acute
  • Carditis on all layers

 

Term
Where is inflammation in rheumatic HD (2 areas)?
Definition

 

  • Joints
  • Truncal Rash

 

Term

What does the inflammation cause in RHD?
Definition
  • Valvular Swelling
  • Erosion
  • Platelet/Fibrin Clumps on Valve Leaflets
Term

The responsible organism in RHD is B-hemolytic strep, but what causes the damage?

Definition
Auto-immune Attack
Term
Where are signs of inflammation seen in RHD?

Definition
Joints
Term

Who is at risk for infective endocarditis?
Definition
  • History of RHD
  • Congenital HD
  • MVP
  • Prosthetic Valves

 

Term

What are the complications of infective endocarditis?

Definition
  • Embolization
  • Valvular Insufficiency
  • Myocardial Abscess
  • Renal Disease

 

Term
Inflammation of the myocardium
Definition
Myocarditis
Term
What causes myocarditis?

Definition
Usually viral, but also from penicillin hypersensitivity and autoimmune activation

Term
What causes the damage in myocarditis?
Definition
Autoimmune response causing Ab attack against own heart tissue
Term
Generic name for cardiac dysfunction
Definition

Cardiomyopathy
Term

Cardiomyopathy is the leading cause of _____

Definition
Heart Transplants
Term
2 Types of Cardiomyopathy
Definition
  • Dilated (Congestive) CM
  • Hypertrophic CM

 

Term
Causes of Dilated/Congestive CM
Definition
  • All 4 chambers dilated
  • Can occur after childbirth in young women
  • Alcohol-related (metabolites are toxic to cardiac muscle)
  • Post-viral
Term

Causes of Hypertrophic CM
Definition
  • Thickened, hyperkinetic ventricular mass
  • Genetic? Defective myosin, toponin genes

 

Term
Which type of CM could be genetic?
Definition
Hypertrophic

Term
Non-inflammatory fluid fills the pericardial sac
Definition
Pericardial Effusion
Term
Fluids that might accumulate in the sac during pericardial effusion

Definition
  • Serous
  • Serosanguinous
  • Chylous (lymph)
  • Blood (secondary to penetrating trauma)

 

Term
What is the normal volume of fluid in the pericardial sac?

Definition
30-50 mL
Term
During effusion, how much fluid might be in the pericardial sac?

Definition
Up to 500 mL
Term
Large, sudden accumulation of fluid in pericardial sac

Definition
Cardiac Tamponade
Term
In cardiac tamponade, fluid causes _____ and filling is impaired
Definition
External Compression of Chambers

Term
Clinical manifestations of cardiac tamponade
Definition

 

  • Systemic Venous Congestion (distended neck vein)
  • Decreased SV
  • Increased HR
  • Pulsus Paradoxus

 

Term
Waxing/waning of BP with respiration
Definition
Pulsus Paradoxus

Term

In pulsus paradoxus, how much does the BP fluctuate?
Definition
Systolic that is ≥ 10 mmHg between inspiration and expiration (sign of decreased Left Ventricular output and Heart Rate is usually slightly increased)

Term
Acute and chronic inflammation in the pericardium

Definition
Pericarditis
Term
Pericarditis that is secondary to MI
Definition
Acute
Term
Clinical signs of acute pericarditis
Definition
  • Fever
  • Pericardial Friction Rub
Term

Fluid inolved in acute pericarditis

Definition
  • Serous
  • Fibrinous
  • Purulent
  • Hemorrhagic
  • Caseous
Term

Pericarditis caused from healed acute pericarditis

Definition
Chronic Pericarditis

Term
3 Causes of Chronic Pericarditis

Definition
  • Healed Acute Pericarditis
  • Adhesive Mediastinopericarditis
  • Constrictive

 

Term
What causes adhesive mediastinopericarditis
Definition

 

  • Pericardial sac destroyed and heart adheres to mediastinum
  • Can happen after heart surgery

 

Term
What causes constrictive pericarditis
Definition
Secondary to TB, with caseous involvement
Term

What is the treatment for constrictive pericarditis?

Definition
Pericardectomy
Term
What might one hear on auscultation with pericarditis?

Definition
Pericardial friction rub

Term
In the embryonic heart, what is the function of the foramen ovale and ductus arteriosus?
Definition
Permit blood flow to bypass the lungs
Term
Where is the foramen ovale located and what is the direction of blood flow?

Definition

 

  • Between the Right Atrium and Left Atrium
  • Flow is Right Atrium to Left Atrium

 

Term
Where is the ductus arteriosus located and what is the direction of blood flow?
Definition
  • Connects Pulmonary Artery and Aorta
  • Flow is Pulmonary Artery to Aorta

 

Term
What happens to cause the closure of the foramen and ductus in a fetus (besides birth)?
Definition
Pressure gradient reverses when lungs inflate (changes from R-L to L-R). This reversal of pressure helps with closure.

Term


Abnormal path of blood wich allows unoxygenated blood from right heart to enter left heart and systemic circulation without passing through the lungs first. You see cyanosis and decreased PaO2

Definition
Right-to-Left Shunt

Term

Abnormal path of blood which allows oxygenated blood from left heart (aorta) to enter right side

Definition
Left-to-Right Shunt
Term
Which shunt deals with unoxygenated blood?

Definition
Right-to-Left Shunt

Term
Which shunt deals with oxygentated blood?
Definition
Left-to-Right Shunt

Term
2 manifestations with Right-to-Left Shunt

Definition
  • cyanosis
  • decreased PaO2
Term
Why is there no cyanosis with Left-to-Right shunt?

Definition
Recirculated through lungs

Term
What happens with a Left-to-Right shunt over time?

Definition

over time leads to right ventricular hypertrophy due to increased right heart pressure

Term

In which shunt would we see cyanosis?

Definition
Right-to-Left
Term

4 Acyanotic Defects

Definition
  • Atrial-Septal Defect (ASD)
  • Ventricular-Septal Defect (VSD)
  • Coarctation of the Aorta
  • Patent Ductus Arteriosus (PDA)

 

Term
Which acyanotic defect is the most common?
Definition
Ventricular-Septal Defect (VSD)
Term
Foramen Ovale stays open to some degree
Definition
Atrial-Septal Defect (ASD)

Term
L>R pressure after birth leads to right HF

Definition

Ventricular-Septal Defect (VSD)
Term

Narrowing/stricture impedes blood flow
Definition
Coarctation of the Aorta

Term
Pulmonary artery (deoxy) remains connected to aorta (oxy)
Definition
Patent Ductus Arteriosus (PDA)
Term
2 Cyanotic Defects
Definition
  • Tetrology of Fallot
  • Transposition of Great Arteries

 

Term
4 Defects in Tetrology of Fallot
Definition
  • VSD
  • Over-riding Aorta
  • Pulmonary Stenosis
  • RV Hypertrophy

 

Term

Cyanosis from over-riding aorta that receives deoxy blood
Definition

Tetrology of Fallot
Term
Aorta positioned above the VSD opening

Definition
Over-riding Aorta
Term

Obstructs RV outflow
Definition
Pulmonary Stenosis

Term
2 separate, but non-communicating, circulations
Definition
Transposition of the Great Arteries
Term
In transposition of the great arteries, from where do the aorta and pulmonary artery arise?
Definition

 

  • Aorta - arises from RV, not LV
  • Pulmonary - arises from LV, not RV

 

Term
Is transposition of great arteries fatal?
Definition
Yes, unless septal defects are also present
Term
Cyanotic or acyanotic?

Atrial-Septal Defect

Definition
Acyanotic
Term
Cyanotic or acyanotic?

Coarctation of the Aorta

Definition
Acyanotic
Term

Cyanotic or acyanotic?

Tetrology of Fallot
Definition

Cyanotic
Term
Cyanotic or acyanotic?

Ventricular-Septal Defect

Definition
Acyanotic
Term
Cyanotic or acyanotic?

Transposition of the Great Arteries
Definition
Cyanotic
Term

Cyanotic or acyanotic?

Patent Ductus Ateriosus

Definition
Acyanotic

Term
Heart can't meet metabolic demands, due to impaired systole (contraction), diastole (relaxation), or both
Definition

Heart Failure
Term
Left/Right Forward/Backward Effects?
Results in insufficient CO with diminished delivery of O2 and nutrients to peripheral tissues and organs
Definition

Left Heart Failure Forward Effects

Term
Left/Right Forward/Backward Effects?
Due to congestion in the systemic venous system

Definition
Right Heart Failure Backward Effects
Term
Left/Right Forward/Backward Effects?
Cause low output to left ventricle leading to low CO
Definition

Right Heart Failure Forward Effects
Term
Left/Right Forward/Backward Effects?
Results in accumulation of blood within the pulmonary circulation, pulmonary congestion, and edema
Definition

Left Heart Failure Backward Effects
Term

List Left HF Forward Effects
Definition
  • Fatigue
  • Oliguria
  • Incr HR
  • Faint Pulses
  • Restlessness
  • Confusion
  • Anxiety
Term

List Left HF Backward Effects
Definition

 

  • Dyspnea on Exertion
  • Orthopnea
  • Cough
  • Proxysmal Nocturnal Dyspnea
  • Cyanosis
  • Casilar Crackles

 

Term

List Right HF Forward Effects
Definition

 

§  Fatigue

 

§  Oliguria

 

§  Increased heart rate

 

§  Faint pulses

 

§  Restlessness

 

§  Confusion

 

§  Anxiety

 



Term
List Right HF Backward Effects
Definition
  • Hepatomegaly
  • Ascites
  • Splenomegaly
  • Anorexia
  • SubQ Edema
  • Jugular Vein Distension
Term

Decreased myocardial contractility occurs in which type of HF?

Definition
Systolic HF
Term

Ineffective filling occurs in which type of HF?

Definition
Diastolic HF
Term
Is systolic HF more or less common than diastolic HF
Definition
More Common

Term

Systolic HF is considered forward or backward failure?

Definition
Forward Failure

Term
Diastolic HF is considered forward or backward failure?

Definition
Backward Failure
Term
Systolic HF leads to what?
Definition
  • Decreased inotropy
  • Decreased contractile force
  • Decreased EF
Term
In systolic HF, the heart is unable to eject adequate amounts of blood into circulation and does not empty itself sufficiently, resulting in _____

Definition
Diminished Tissue Perfusion
Term
During diastolic HF, the _____ can be normal
Definition
EF

Term
In diastolic HF, the ventricles cannot relax enough to fill adequately, leading to decreased CO and _____
Definition

Congestion where the blood came from

Term
Is the EF reduced or increased in systolic HF?

Definition
Reduced
Term
4 Compensations in HF
Definition
  • Incr SNS
  • Incr RAA Stimulation
  • Shift from Aerobic to Anaerobic Metabolism
  • Hypertrophy/Ventricular Remodeling

 

Term

Incr SNS leads to what 3 things?

Definition
  • Incr Inotropy
  • Incr Chronotropy
  • Vasoconstriction (through Epi/NorEpi)

 

Term
Incr RAA stimulation leads to what?

Definition
  • Fluid retained
  • Helps incr preload and incr force of contraction
Term
What principle helps RAA stimulation incr preload and force of contraction?

Definition
Starling Principle
Term
When the shift from aerobic to anaerobic metabolism occurs, what does this do to the Hgb dissociation curve and why?

Definition

Right shift, causing Hgb to release more O2
Term
What is the significance of the Starling principle?

Definition
Attempts to pump the incr blood, but if it can't pump it all out, LV and end-diastolic volume incr, which stretches the myofibril cells. This stretching causes the heart to enlarge.
Term
Pulmonary stenosis or pulmonary HTN can lead to HF in which side?
Definition
Right
Term
What causes shock?
Definition
Metabolic Acidosis
Term
What happens to autoregulatory mechanisms in shock?

Definition
Failure of the microcirculation to autoregulate blood flow correctly will lead to shock

Term
6 Features of Shock
Definition
  • Anaerobic Metabolism
  • Hydropic Swelling
  • Cell Damage
  • Inflammation
  • Widespread Vasodilation
  • Failure of Compensatory Mechanisms

 

Term
In anaerobic metabolism, increased _____ leads to acidosis

Definition
Lactate
Term

In glycolysis, lactate is created by _____ in the absence of _____

Definition

 

  • Pyruvate
  • O2

 

Term
Hydropic swelling is secondary to _____

Definition
Insufficient ATP
Term
Cell damage is caused by formation of _____

Definition
Oxygen Free Radicals
Term
Oxygen free radicals do what 4 things?
Definition
  • Are unstable
  • Attack cell membranes
  • Denature proteins
  • Damage DNA



Term
Name 4 oxygen free radicals
Definition

 

  • Superoxide (O2-)
  • Peroxide (H2O2)
  • Hydroxyl Radicals (OH-)
  • Singlet O
Term

Peroxide occurs from what two elements leaking in hydropic swelling?
Definition
  • Na
  • Ca
Term
Inflammatory cytokines ala macrophages lead to?

Definition
Inflammation
Term
Widespread vasodilation leads to?
Definition
  • Hypotension
  • Decr O2 consumption by tissues, impaired tissue perfusion

 

Term

Widespread vasodilation is caused by?

Definition
Incr activity of nitric oxide
Term
What happens when compensatory mechanisms fail?
Definition
Tissue damage activates clotting cascade
Term
2 Stages of Shock
Definition
  • Progressive
  • Compensatory

 

Term
Shock marked by hypotension and marked tissue hypoxia
Definition
Progressive

Term
Shock where homeostatic mechanisms temporarily maintain perfusion even though CO has fallen

Definition
Compensatory

Term
Cause of hypovolemic shock

Definition
Inadequate circulation blood volume precipitated by hemorrhage, burns, dehydration, or leakage of fluids into interstitial spaces

Term
Hypovolemic shock is caused by a loss of how much fluid?

Definition
1,000 mL or more
Term
What is the SNS response in hypovolemic shock?

Definition

 

  • Elevated HR
  • Vasoconstriction
  • Incr contractility

 

Term
Anaphylactic shock is caused by?
Definition
Excessive mast cell degranulation mediated by IgE Ab in response to Ag
Term
In anaphylactic shock, cross-linking of Ag/IgE leads to _____
Definition
Vasoactive Substance Release

Term
4 Vasoactive Substances Released in Anaphylactic Shock

Definition
  • PG
  • Histamine
  • LT
  • Bradykinin
Term

Does anaphylactic shock result in hyper- or hypotension?
Definition
Hypotension (due to vasodilatory mediators released by mast cells)
Term
Clinical Signs of Anaphylactic Shock
Definition
  • Urticaria
  • Bronchoconstriction
  • Stridor/Wheezing
  • Itching
  • Peripheral Vasodilation
  • Incr Capillary Permeability

 

Term

Enzyme released with cardiac muscle damage that allows a test for persons with chest pain to see if MI has occurred
Definition
Creatine Kinase MB (CK-MB)

Term
CK-MB is only elevated within what timeframe?

Definition

48-72 hours later
Term
Remain elevated longer than CK-MB and can be tested for MI
Definition
Troponin I/T
Term
Tests for these are less helpful with a new MI

Definition
Troponin I/T
Term
Where are troponins released from in cardiac cell injury?
Definition
Contractile Apparatus
Term
What does a lipid panel include?
Definition

 

  • Total Cholesterol
  • LDL
  • HDL
  • Triglycerides
  • VLDL (sometimes)
  • non-HDL (sometimes)

 

Term
Contractility of the heart

Definition
Inotropy

Term
Rate of the heart
Definition
Chronotropy
Term
Conduction velocity of the heart
Definition
Dromotropy

Term
The volume of blood in the chamber just prior to systole

Definition
Preload

Term
Initial stretching of the heart prior to contraction
Definition
Preload

Term
The impedance or resistance that must be overcome in order to eject blood from a cardiac chamber

Definition
Afterload

Term

What is the primary determinant of left ventricular afterload?

Definition
Systemic vascular resistance
Term

The tension or stress developed in the wall of the left ventricle during ejection
Definition
Afterload
Term
Generalized term for pathologic conditions resulting in decr distensibility of arteries
Definition
Arteriosclerosis
Term
Hardening of the arteries

Definition
Arteriosclerosis

Term

A type of arteriosclerosis characterized by proliferation of smooth muscle cells and lipid collection within the walls of arteries, resultings in narrowed lumina and impaired ability to dilate

Definition
Artherosclerosis

Term
ST segment elevation
Definition
STEMI
Term
No ST segment elevation, but + biomarkers

Definition

Non-STEMI
Term
Obstruction to blood flow through cardiac valves that open incompletely
Definition
Stenosis
Term
Retrograde blood flow through a cardiac valve when the valve is supposed to be closed
Definition
Regurgitation

Term
A collection of signs and symptoms that form together (but not a disease)
Definition
Syndrome

Term
What is responsible for infective endocarditis
Definition

Bacteria

 

usually strep or staph

Term
In pulsus paradoxus you would have ___________ stroke volume and __________ heart rate.
Definition

decreased stroke volume

increased heart rate

Term
What is the treatment for pulsus paradoxus?
Definition
pericardiocentesis
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