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Patho Test 2 - Cardiovascular
Powerpoint study
103
Anatomy
Graduate
06/17/2016

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Cards

Term
Heart Disease
Definition
What is the leading cause of death in the US?
Term
BP = CO x PVR
Definition
Hydraulic Equation
Term
Heart rate
Contractility
Filling pressure (tone & volume)
Definition
Three components of Cardiac Output (CO)
Term
Arterial diameter
Arterial length
Elasticity
Definition
Three Components of Peripheral Resistance (PVR)
Term
Increase HR
Increase contractility
Increase Venous return
Definition
How can you increase cardiac output?
Term
Vasodilation which can be achieved by:

Direct action on the vessels

Central control (CNS) action
Definition
How can you reduce PVR?
Term
Alpha 1 vascular receptors
Beta 1 cardiac receptors
Definition
Two Sympathetic nervous system inputs
Term
Angiotensin II
Definition
Causes vasoconstriction
Triggers aldosterone production & release
Term
Aldosterone
Definition
Most potent natural mineralocorticoid
Helps with sodium & fluid retention
Is also a cardiac growth factor
Term
Sympathetic receptor blocker

Renin-Angiotensin-Aldosterone inhibitors

Reduce blood volume via diuretics
Definition
Hypertension Treatment Targets
Term
Atherosclerosis
Definition
The main cause of cardiovascular disease

Refers to vascular narrowing due to fatty (lipid) deposits within arteries and arterioles
Term
lipid metabolism
Definition
What is arherosclerosis related closely to?
Term
Exogenous
Dietary consumption & absorption

Endogenous
Production of cholesterol in the liver
Definition
Two Sources of Cholesterol:
Term
Lipoproteins
Definition
macromolecule consisting of lipid and specialized protein
Term
Low-Density-Lipoproteins (LDL)
Definition
Transporter of endogenous cholesterol
Term
High-Density-Lipoproteins (HDL)
Definition
Reverse cholesterol transport”
Removes LDL-cholesterol and triglycerides
Term
Lowering LDL and raising HDL
Definition
What are the best goals for lipids?
Term
Yes
No (for some strange reason "HDL paradox)
Definition
Do drugs that lower LDL reduce risk of arthroscelrosis?
What about drugs that raise HDL?
Term
Fatty Streak
Definition
LDL-cholesterol accumulated under endothelium
Term
Foam Cells
Definition
Monocytes become macrophages which ingest oxidized LDL
Term
Women have higher levels of HDL

Estrogen is known to raise HDL
Definition
Why is there a gender age difference in arthroscelrosis risk?
Term
Coronary
Angina pectoris
Congestive heart failure

Peripheral vascular disease
Renal artery stenosis
Femoral or popliteal stenosis
Aorta aneurysm formation
Definition
What are the Chronic Effects of Atherosclerosis?
Term
*plaque rupture
Definition
Most myocardial infarctions and strokes are caused by what?
Term
Lifestyle changes

Treat hyperlipidemia

Treat hypertension

Treat diabetes
Definition
Atherosclerosis Treatment
Term
Niacin (nicotinic acid)

 Bile acid-binding agents
Cholestyramine, Colestipol)

*** HMG-CoA reductase inhibitors
“Statins”(lovastatin, pravistatin et al)
 
Fibric acid derivatives
“Fibrates” (gemfibrozil, fenofibrate)

 Inhibitors of sterol absorption
Definition
Lipid Lowering Agents
Term
Reduce endogenous cholesterol synthesis

Lowers LDL levels
Reduces risk of heart disease in proportion to decrease in LDL
Definition
What do statins do?
Term
Liver damage
Monitor hepatic enzymes during treatment

Muscle damage (Myopathy & Rhabdomyolysis)

 Contraindicated:
Pregnancy
Children/Teens
Definition
What are the Adverse Effects of The Statins?
Term
SYSTOLIC reading:
Definition
Pressure at which flow first resumes in an occluded artery
Term
DIASTOLIC reading:
Definition
Pressure at which flow returns to normal in an occluded artery
Term
Hypertension
Definition
Persistent elevation of blood pressure to 140/90 or above
Term
Pre-hypertension
Definition
Systolic of >130
Diastolic of >80
Term
Pheochromocytoma
Definition
Rare tumor of adrenal medulla or sympathetic ganglia
Secretes high levels of norepinephrine
Term
Periodically***
Definition
Main symptoms of Pheochromocytoma occur how?
Term
Severe headaches
Severe diaphoresis
Palpitations
Tremor
Anxiety
Definition
What are the main symptoms of Pheochromocytoma?
Term
No
"Silent killer"
Definition
Are there usually symptoms of hypertension?
Term
Reduce cardiac output
Reduce peripheral vascular resistance
Definition
HTN Treatment Strategies
Term
Diuretics
Definition
Drug groups that Lower blood volume
Term
Sympathoplegic/adrenergic blocking agents
Definition
Drug groups that Block alpha 1 and beta 1 action
Term
Direct vasodilators
Definition
Drug groups that Reduce peripheral vascular resistance
Term
Inhibitors of renin-angiotensin-aldosterone system
Definition
Drug groups that Reduce volume and peripheral resistance
Term
Toxicity & side effects from drugs

***Orthostatic hypotension
Definition
What are the Risks of Going Too Low with BP?
Term
200/140
Definition
At what blood pressure is hospitalization required?
Term
Ischemia
Definition
Reduced/absent blood flow
Term
Hypotension



Chronic anemia


Increased Metabolism
Definition
Insufficient Oxygen Transport can be caused by what?
Term
plaque rupture***
Definition
Initial event is usually what in an acute myocardial infarction?
Term
Acute Myocardial Infarction
Definition
Myocardial tissue death due to abrupt reduction in coronary blood flow
Term
Chest pain, but up to 30 percent may have no pain ***
Definition
Most patients complain of what in an Acute Myocardial Infarction?
Term
Blood pressure is at the diurnal peak
Increased viscosity due to overnight fast
Cortisol at secretion peak
Definition
Why is there an increased risk of Acute Myocardial Infarction in the early morning hours?
Term
ST-segment elevation myocardial infarction
Definition
What is a STEMI?
Term
transmural ischemia***
Involves the full thickness of the cardiac wall
Definition
What does a STEMI usually mean?
Term
Non-ST-elevation myocardial infarction
Definition
What is a NSTEMI?
Term
Ischemia is usually subendocardial rather than transmural
Definition
What does a NSTEMI usually mean?
Term
Supportive measures
Rest
Oxygen
Sedation & analgesia
Control arrhythmias

Anticoagulation
Heparin
Antiplatelet agents
Definition
NSTEMI Treatment
Term
Most important: Reperfusion! ***
Percutaneous coronary intervention (PCI)
Thrombolytic therapy

Additional measures:
Aspirin: 325mg ASAP
Oxygen per nasal cannula
Reduce myocardial oxygen demand
Control arrhythmias
Definition
STEMI Treatment
Term
PCI rather than thrombolytic
Early intervention ***
Definition
What is preferred in STEMI treatment? What is Key in STEMI treatment?
Term
Cardiac arrhythmia
Ventricular fibrillation

Massive infarction
Cardiogenic shock
Definition
Main Causes of MI Mortality
Term
Stable angina
Unstable angina
Variant (Prinzmetal’s)
Definition
What are the 3 Faces of Angina Pectoris
Term
Stable angina
Definition
Type of angina characterized by Recurring episodes of chest pain
Brought on by exertion or stress
Relieved by rest
Term
Unstable angina
Definition
Type of angina characterized by occurring with minimal activity or at rest
Term
Variant angina
Definition
Type of angina characterized by atypical characteristics
Extreme fatigue with minimal exertion
Term
coronary atherosclerosis
Definition
What is stable angina caused by?
Term
Congestive Heart Failure (CHF)
Definition
Cardiac function insufficient to meet metabolic and blood flow requirements
The ventricular ejection fraction is reduced***
Term
Rising
Definition
What is the incidence doing in CHF?
Term
Chronic ischemia damages myocardium

Remodeling*** occurs which results in progressive cardiac enlargement (cardiomegaly)

Overstretching of the myocardium reduces ventricular function which leads to…
Fluid overload, increased BP
More Ischemia
Definition
The CHF Vicious Cycle
Term
Dyspnea
Definition
air hunger; shortness of breath
Term
Orthopnea
Definition
Inability to sleep supine without dyspnea
Term
Idiopathic Cardiomyopathy
Definition
Usually seen in young & healthy adults

Usually follows a precipitating event
Viral infection
Pregnancy and delivery

Spontaneous remission is common but…

Severe cases may require cardiac transplantation
Term
Congenital Heart Disease
Definition
Valvular defects can lead to myocardial stress, damage and ultimate CHF

Shunts can allow significant amounts of blood to bypass the lungs
Blood is under oxygenated
Results in cyanosis, stunting of growth and shortness of breath
Term
Coarctation of the aorta
Definition
Seen in kids, low blood pressure in LE, high blood pressure in UE
Term
Overriding Aorta
Pulmonic Stenosis
Ventricular septal defect
Right ventricular hypertrophy
Definition
Tetrology of Fallot
Term
Thrombosis
Definition
Formation of a blood clot in an intact vessel
Term
Embolism
Definition
Thrombus that dislodges and travels to a distant site where it occludes an arterial vessel
Term
Pulmonary embolism
Definition
Venous thrombus that embolizes to a pulmonary artery
Term
Venous stasis
Hypercoagulability
Vascular injury
Definition
Virchow’s Triad
Term
Aneurysm
Definition
Swelling or distention of an arterial segment
Term
Abdominal
Definition
What portion of the aorta is most susceptible to aneurym?
Term
Men 2:1
Definition
Ratio of m/f abdominal aneurysm?
Term
Back pain
Abdominal pulsating mass
Definition
What are the early symptoms of abdominal aneurysm?
Term
Surgical resection

Endovascular repair
Definition
What is the treatment of abdominal aneurysm?
Term
Disturbances in impulse formation

Disturbances in impulse conduction

Both of the above
Definition
What is the Immediate Cause of Arrthythmias?
Term
Correct causes of electrical impulse abnormalities

Ablate (destroy) areas where abnormal impulses originate

Use drugs that affect ion channels
Definition
Arrthythmia Treatment strategies
Term
Na+ Channel Blockers

Quinidine,Procainamide, Lidocaine
Definition
Class I Antiarrhythmic Agents
Term
Beta Blockers

Esmolol, Propanolol, Pindolol
Definition
Class II Antiarrhythmic Agents
Term
K+ Channel Blockers

Sotalol, Amiodarone, Bretylium
Definition
Class III Antiarrhythmic Agents
Term
Ca++ Channel Blockers

Diltiazem, Verapamil
Definition
Class IV Antiarrhythmic Agents
Term
Amiodarone (Corderone)
Definition
Useful in treatment of:
Ventricular tachycardia & fibrillation
Atrial fibrillation

Side effects numerous:
Pulmonary fibrosis (1% incidence)
Liver toxicity
Blocks T4 to T3 conversion
Photodermatitis (blue-gray skin)
Thyroid dysfunction
Term
No, they can also cause arrhythmias
Definition
Are anti-arrhythmic drugs useful as a preventative measure?
Term
Atrial Fibrillation ***
Definition
Most Common Chronic Arrhythmia
Term
Atrial Fibrillation
Definition
Loss of normal artial contraction causes 20-30% drop in left ventricular output

Ventricular rate becomes rapid and irregular
Pulse is “irregularly irregular”
Term
Mural thrombi ***
Definition
Clot development in enlarged left atria
Can cause embolic stroke
Term
Rate control
Beta blockers
Digoxin

Restore sinus rhythm
Cardioversion
Atrial ablation

Anticoagulation
Warfarin (Coumadin)
Dabigatrin (Pradaxa)
Apixaban (Eliquis)
Definition
Atrial fibrillation treatment
Term
Claudication
Definition
Pain with exercise (usually walking)
Relieved with rest
Term
Peripheral Occlusive Disease
Definition
Plaque buildup in a peripheral artery
Term
Medical treatment:
Lifestyle changes
Hypertension and lipid treatement
Evaluate for coronary disease ***

Surgical treatment:
Bypass grafts
Definition
Treatment for peripheral occlusive disease
Term
Narrowing, partial occlusion: “stenosis”

Leaking: “regurgitation”

Mitral valve prolapse

Valve infection: “endocarditis”
Definition
Four Main Valve Problems
Term
Mitral stenosis, mitral regurgitation

Tricuspid stenosis, tricuspid regurgitation

Aortic stenosis, aortic regurgitation

Pulmonic stenosis, pulmonic regurgitation
Definition
8 valve possibilities
Term
Exertional Dyspnea ***
Definition
What is often the first symptom of valvular disease?
Term
Aortic Stenosis
Definition
Most common form of valvular heart disease
Term
Symptoms:
None for mild stenosis
Syncope
Chest pain (angina)
Dyspnea
Definition
Symptoms for aortic stenosis
Term
If no symptoms: normal

If symptoms:
50% chance of death in 5 years
90% chance of death in 10 years
Definition
Aortic Stenosis Prognosis
Term
Rheumatic Fever
Definition
mmunologic complication of streptococcal infection
Peak age of incidence: 5 – 15
Damage to valves can begin 1 – 5 weeks after infection
Mitral valve most commonly affected ( 75%)
Term
Mitral valve (75%)
Aortic valve (20-30%)
Definition
What are the number one and number two most commonly affected valves by rheumatic carditis?
Term
“SBE”: subacute bacterial endocarditis
Definition
Life threatening infection of a heart valve
Organisms in blood stream (bacteremia) lodge on the valve
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