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Pathophysiology: Cardio 1
Cardio Unit 1, pages 428-453
80
Anatomy
Undergraduate 2
04/10/2010

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Cards

Term
Risk Factors For CAD
Definition

- Age                                 - Obesity

- Family History

- Abnormal lipids

- Cigarette smoking

- Hypertension

- Diabetes

Term
CHD is also known as
Definition
IHD and CAD
Term

 

 

Tx and Prevention of

Atherosclerosis

Definition

 

 

Lipid Lowering Therapy

Term

 

 

Precursor Lesions

Definition

 

 

Begin as fatty streaks and progress to small regions of medial wall thickening with scattered macrophages at a young age.  They are not symptomatic.

Term

 

 

Advanced Lesions

Definition
As plaques acquire more free lipid within arterial wall, they are more vulnerable to ruputure, thrombus formation, and progressive plaque growth.  Carry risk of disrupting blood flow.  Associated with stable angina/exercise enduced
Term

 

2 Factors Important For

Cardiac O2 Demands

Definition

 

 

1.  Rate of coronary perfusion

2.  Myocardial Workload

Term

 

5 Ways Coronary Perfusion

Impaired

Definition

1.  large, stable atherosclerotic plaque

2.  acute platelet aggregation/thrombosis

3.  vasospasm

4.  failure of autoregulation by microcirculation

5.  poor perfusion pressure

Term

 

Collateral Circulation

Definition

 

Occurs when major vessels are slowly blocked over time.  May help preserve blood flow despite total arterial occlusion.

Term


Angina Pectoris is associated with...

Definition



....myocardial ischemia

Term

 

 

Anginal Pain Described As...

Definition

 

 

...burning, crushing, squeezing, choking, elephant on chest, may be mistaken for indegestion or dental pain

Term

 

Atypical Symptoms of Angina

Definition

 

...back pain, fatigue, weakness

Term

 

 

Stable Angina

Definition

 

classic/typical

 

Characterized by stenotic atherosclerotic coronary vessels that reduce blood flow, onset predictable.

Term

 

TX for Stable Angina

Definition

 

 

Rest and Nitroglycerin

Term

 

 

Nitroglycerine Therapeutic

Effects

 

Definition

 

causes coronary ad peripheral vasodilation, reduced preload, and therefore myocardial workload

Term

 

Variant Angina

aka...

Definition

 

 

Prinzmetal Variant Angina

Term

 

Variant Angina

S/S

Definition

 

onset unrelated to physical/emotional exertion, HR, or anything else that would inc. myocardial O2 demand.  DUE TO VASOSPASM!!!

Term

 

TX of Variant Angina

Definition

 

CCB's

Term

 

CCB's therapeutic effects

 

Definition

 

 

Inhibit vascular smooth muscle contraction.  Used for variant angina.

Term

 

TX Chest pain, evidence of acute ischemia, and STEMI

Definition

 

Reperfusion strategies

Term

 

Treatment of unstable angina and

NSTEMI

Definition

 

Antiplatelet's are cornerstone of therapy

Term

 

What is thought to be the initiatingevent in most MI's?

Definition

 

Development of a thrombus on top of an ulcerated or cracked atherosclerotic plaque.  Platelet plug occurs, clotting cascate, resulting in thrombus.

Term

 

 

What happens to myocardial cells within 1-2 minutes of ischemia?

Definition

 

They have impaired ability to contract

Term

 

What happens within 10 minutes of MI?

Definition

 

ATP levels fall to half of normal

Term

 

What happens within 30-40 minutes of complete occlusion in MI?

Definition

 

Irreversible cell injury

Term

 

Nearly all infarcts are located where?

Definition

 

L. Ventricular Walls

Term

 

When can morphological changes be detected in the heart after MI?

Definition

 

6-12 hours after infarct

Term

 

What does area of infarct look like at 18-24 hours after MI?

Definition

 

paler than surrounding tissues

Term
What does area of infarct look like after 24 hours of MI?
Definition

 

turns yellowish and becomes soft with a rim of red vascular connective tissue

Term

 

What does area of infarction look like 1-2 weeks after MI?

Definition

 

necrotic tissue progressively degraded and cleared away.  Great risk for rupture.

Term

 

DX Criteria for MI

Definition

- S/S: severe crushing, chest pain radiating from arm, shoulder, jaw or back

 

- Electrocardiographic changes:  ST segment elevation, Q wave

 

- Elevated CKMB, Troponins I and T

Term

 

How is ongoing injury and ischemia seen on an ECG?  What efforts should be taken to

reduce injury/ischemia?

Definition

 

ST-segment elevation

 

Improve perfusion or reduce O2 demand

Term

 

What does the Q wave represent on ECG?

Definition

 

usually persistent findings, specific for MI, diagnostic for MI.  Q waves may appear abnormally deep or wide.  May have inverted T wave.

Term

 

What is better NSTEMI or STEMI MI?

Why?

Definition

 

NSTEMI, because infarct size is usually smaller

Term

 

NSTEMI or STEMI

Definition

 

present with ACS

No ST elevation

ST may be depressed or T wave changes

+ serum markers = NSTEMI

- serum markers = STEMI

Term

 

What serum markers are used for dx MI?  Which one is most useful?  When are they useful?

Definition

Serum Markers:  CK-MB, Troponin I and T

 

Markers of Choice = Troponin I and T because they remain elevated for a longer time than do CKMB

 

All serum markers are diagnostically useful only during acute periods of MI

 

Term

 

What is the clinical course for MI?

Definition

 

Signs:  cardiac inflammation including fever, leukocytosis, inc. ESR.

 

Symptoms:  circulatory inadequacy including fatigue, restlessness, anxiety, weakness

Term

 

 

Potential Complications Following

MI

Definition

 

cardiac dysrhythmias, heart failure, cardiogenic shock, ventricular rupture, pericarditis, thromboembolism

Term

 

Sudden Cardiac Death

Definition

- unexpected death within 1 hour of onset of symptoms

 

- Coronary Heart Disease root of vast majority of cases

 

- Ventricular fibrillation usually the cause

 

- Ischemia from fibrosis, atrophy, scarring of old MI tissue, electrolyte imbalances,

Term

 

Chronic Ischemic Cardiomyopathy

Definition

 

 

Heart failure as a consequence of slow, progressive apoptotic death of myocytes from chronic ischemia.  Usually found in elderly.

Term

 

 

Stenosis

 

 

Definition

 

 

Failure of a valve to open completely

Term

 

Regurgitation

Definition

 

inability of a valve to close completely, thereby allowing blood to flow backward across the valve when no flow should be occuring

Term

 

 

Murmurs

Definition

 

abnormal turbulence of blood flow often associated with valvular disorders

Term

 

Mitral Stenosis

Definition
Flow of blood from L. Atrium to L. Ventricle is impaired and characterized by abnormal L. Atrial / L. Ventricle pressure gradient during DIASTOLE
Term

 

How does the heart remodel to compensate for Mitral Stenosis?

Definition

 

Atrial pressure remains higher than ventricular pressure throughout DIASTOLE.  Increased pressure work of Atrium leads to ATRIAL chamber enlargement and hypertrophy.

Term

 

If uncorrected, what does Mitral Stenosis lead to?

Definition

 

chronic pulmonary hypertension, R. ventricular hypertrophy, and R. sided HF

Term

 

What are S/S of mitral stenosis due to?

Definition

 

Due to congestion of blood volume and increase pressure in L. atrium and pulmonary circulation as well as decreased stroke volume b/c L. Ventricle not filling up all the way.

Term

 

What are S/S of mitral stenosis?

Definition

 

orthopnea, cough, dyspnea on exertion, paroxysmal nocturnal dyspnea, abnormal breath sounds, pooer arterial oxygenation, fatige, poor activity tolerance, weakness, EXERTIONAL DYSPNEA MOST COMMON COMPLAINT

Term

 

What does mitral valve stenosis sound like?

 

Definition

 

low pitched, rumbling diastolic murmur at heart apex.  An opening snap may be heard in some patients.

Term

 

Mitral Valve Prolapse

Definition

 

the mitral valve balloons up into L. atrium during ventricular systole.  usually asymptomatic, associated with other connective tissue disorders

Term

 

How is mitral valve prolapse heard?

Definition

 

midsystolic click or systolic murmur.  If symptomatic patients may experience palpitations, rhythms abnormalities, dizziness, fatigue, dyspnea, ches pain, depression, anxiety

Term

 

Aortic Stenosis

Cause?

Definition

 

In the past most commonly due to rheumatic fever.  Now, mainly due to age related calcification.

Term

 

What compensatory heart mechanisms take place with aortic stenosis?

Definition
L. ventricle produces high stystolic pressure to overcome resistance of stenotic aorta resulting in hypertrophy of L. ventricle.  Predisposes heart to ischemia and attacks of anginal pain.
Term

 

What kind of heart failure can aortic stenosis produce?

Definition

 

L. sided heart falure

Term


Symptoms of aortic stenosis

Definition


Due to diminished CO:  syncope, fatige, low systolic BP, faint pulses, angina, crescendo-decrescendo heart murmur, prominent S4. 

Term

 

TX of Aortic Stenosis

Definition

 

Surgery only

Term

 

Aortic Regurgitation what cardiac compensatory mechanisms take place?

Definition

 

L. Ventricly hypertrophies and dilates

Term

 

S/S or aortic regurgitation?

Definition

 

bounding pulse, head bobbing, high pitched blowing murmur during ventricular diastole

Term

 

Major complication and TX for aortic regurgitation?

Definition

L. sided heart failure due to increased work load.

 

Well tolerated for years and valve replacement surgery can be delayed.

Term

 

Rheumatic Heart Disease

Definition

 

due to an immune attack on individual's own tissues, inflammation of heart usually includes all layers.  Skin, joint and brain tissue may undergo inflammation

Term

 

 

Infective Endocarditis

Definition

 

- Vegetations

-IV drug abusers particularly susceptible

- risk of embolization or perforation of valve leavlet

- Subacute:  low grade fever, fatigue, weight loss, flu like symptoms

- acute:  heart murmur, fever, chills

Term

 

Myocarditis

Definition

 

inflammation, leukocyte infltration and necrosis of cardiac muscle cells.  Causes in microbial, immune diseases, physical agents.  CHAGAS DISEASE, T. CRUZI, PENICILLIN

Term

 

Acute myocarditis characterized by

 

Definition

 

general dilation of all four heart chambers

flabby ventricular myocardium with lesions

heart muscle inflamed/edematous

white blood cells in heart muscle

endocardial structures normal

Term

 

S/S of myocarditis

Definition

 

fatigue, dyspnea on exertion, dysrhythmia with associated palpitations

Term

 

Dilated Cardiomyopathy

Definition

 

cardiac failure associated with dilation of one or both ventricular chambers.  Factors include ETOH toxicity, genetic abnormality, pregnancy, postviral myocarditis

Term

 

Dilated Cardiomyopathy TX

Definition

 

Characterized by slowly progressing biventricular HF with low EF.  50% mortality rate in 2 years.  Cardiac transplant usually only treatment.

Term

 

Hypertrophic Cardiomyopathy

Definition

 

Characterized by thickened, hyperkinetic ventricular muscle mass.  Hypertrophy not uniform.  L. ventricle usually more involved than R.  IDIOPATHIC HYPERTROPHIC SUBAORTIC STENOSIS.

Term

 

Hypertrophic Cardiomyopathy

S/S

Definition
May be asymptomatic.  Symptos associated with ventricular outflow obstruction or impaired diastolic filling.  Strenous activity may precipitate obstruction, low/no stroke volume, sudden death.
Term

 

Hypertrophic Cardiomyopathy
TX

Definition

 

Beta blockers/CCB's may be used to dampen hypercontractility.  DO NOT USE drugs that INC MYOCARDIAL CONTRACTILITY OR HR as it may worsen symptoms.

Term

 

Restrictive Cardiomyopathy

Definition

 

Rare.  Characterized by stiff fibrotic ventricle with impaired diastolic filling, abnormal deposition of amyloid protein in tissues.  Results in low stroke volume and HF.  Difficult to manage - no therapy available for most types.

Term

 

Pericardial Effusion

Definition

 

accumulation of noninflammatory fluid in pericardial sac (serous/serosanguineous/

chylous/blood)

Term
Cardiac Tamponade
Definition

External compression of heart chambers that impairs filling and usually due to accumulation of pericardial fluid. 

 

S/S: distended neck veins, waxing/waning of BP w/breathing (pulsus paradoxus).

 

TX:  aspirate fluid

Term

 

Pericarditis

Definition

Acute:  usually idiopathic, NSAIDS used, anginal pain, friction rub, fever, leukocytosis, malaise, tachycardia, ST segment elevation

 

Chronic:  healing of an acute form of pericarditis - adhesive mediastinopericarditis and constrictive pericarditis.

Term

 

Shunt

Definition

 

abnormal path of blood flow through heart or great vessels

Term

 

R. to L. Shunt

Definition

 

cyanotic

Term

 

L. to R. shunt

Definition

 

acyanotic

Term

 

Infant Deformations of Heart

Acyanotic

Definition

 

Atrial Septal Defect

Ventricular Septal Defect

Patent Ductus Arteriosus

Coarction of Aorta

Pulmonary Stenosis or Atresia

Term

 

Infant Deformations of Heart

Cyanotic

Definition

 

Tetralogy of Fallot

Transposition of Great Arteries

Truncus Arteriosus

Tricuspid Atresia

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