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104 Cards in this Set
- Front
- Back
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arteriosclerosis
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thickening and hardening of arterial walls resulting in a loss of elasticity
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atherosclerosis
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similar to arteriosclerosis, but also includes the buildup of fat and fibrin plaques along the intima that over time narrow the lumen of the arteries
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pathophysiology of athersclerosis
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inflammatory disease (inflammation plays a fundamental role in all of the steps in the intiation and progression of atherogenesis)
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artherosclerosis begins with what?
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injury to the endothelium of vessels
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injury to endothelium of vessels may be caused by what? (atherosclerosis)
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-hypertension
-smoking -diabetes -dyslipidemia -autoimmune -vessel wall stress -microorganisms (cytomegalovirus, chlamydia, helicobacterpylori, herpes) |
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detailed pathophysiology of atherosclerosis
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1.inflammation of endothelial cells
2.inflamed epithelial cells canot make antithrombotic and vasodilating cytokines and express adhesion molecules that bind macrophages 3.bound macrophages adhere to endothelium and release toxic enzymes and free radicals that further injure the epithelium and result in oxygenation of LDL 4.oxidized LDLs engulfed by macrophages are called foam cells and penetrate the intima of vessels 5.accumulation of foam cells result in formation of fatty streaks 6.fatty streaks produce more oxygen radicals 7.cause more inflammatory and immune changes *more damage to vessel wall* 8.smooth muscle cells proliferate 9.collagen produced 10.overgrow of fatty streaks results in formation of fibrous plaques 11.narrowing of vessel lumen 12.rupture of the plaque causes platelet adherence 13.results in complicated lesion |
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progressive occlusion of a vessel is usually asymptomatic until there is what % of occlusion?
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60%
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partial blockage of artery
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transient S/S with stress
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large/complete blockage of artery
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ischemia/tissue infarction
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atherosclerosis can precipitate a number of conditions including
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1.Coronary Artery Disease
2.Cerebrovascular Disease 3.Peripheral vascular disease |
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what is Coronary Artery Disease (CAD)?
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inability of the coronary vessels to supply blood to the heart muscle due to narrowing/occlusion of the coronary arteries
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what causes 1/3 of all deaths in the US?
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CAD
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at risk populations of CAD (non-modifiable)
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-age
-african american -male -genetic predisposition |
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at risk populations of CAD (modifiable)
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-hyperlipidemia
-hypertension -cigarette smoking -DM -physical inactivity -obesity -excessive ETOH abuse -diet -high homocysteine levels |
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primary pathophysiology of CAD
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*atherosclerosis*
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4 factors that determine myocardial O2 demand
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1. HR
2. contractile force 3. myocardial mass 4. ventricular wall tension |
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ischemia begins within how long of coronary occlusion?
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10 minutes
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tissue death occurs within how long of coronary occlusion?
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20 minutes
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clinical manifestations of CAD
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angina pectoris (stable angina)
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describe angina pectoris
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-chest pain brought on by brief, reversible periods of myocardial ischemia
-3 to 5 mins duration -crushing, radiating, clenched fist chest pain -pallor -diaphoresis -dyspnea |
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angina pectoris is relieved by what?
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rest & NTG
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prinzmetal angina is what?
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-coronary spasms
-unpreditable -when pt is at rest |
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silent ischemia is what? & can be associated with what?
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ischemia without pain; can be associated with stress
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unstable angina is what?
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sudden coronary occlusion due to thrombus formation
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unstable angina is a warning of what?
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impending infarct
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unstable angina is reversible if recognized and treated promptly. true or false.
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TRUE :)
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S/S of unstable angina
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-dyspnea
-chest pain -diaphoresis -anxiety -tachycardia |
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what is myocardia infarction?
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lack of O2 to myocardium
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anaerobic metabolism in a MI leads to production of what?
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lactic acid
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what do you see with an MI?
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-loss of contractile function
-adnormal wall motion -decreased stroke volume -decreased ejection fraction -increased ventricular diastolic pressure and volumes -dysrhythmias |
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clinical manifestations with MI
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-chest pain with NO RELIEF
-pain radiating to left arm, jaw, back -N&V -diaphoresis -cool clammy skin -sense of impending doom -"elephant sitting on my chest" -temp |
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what would the Vital Signs look like with MI
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-BP: low then high
-tachycardia -extra heart sounds -pericardial rub |
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with MI, you will see a pronounced what on the EKG?
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pronounced Q
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P wave
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deplorization of atria
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QRS complex
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depolorization of ventricles
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T wave
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repolarization of ventricles
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normal cardiac conduction pathway
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1. SA node
2. AV node 3. Bundle of His 4. Right bundle branch 5. Left bundle branch 6. Perkinje system |
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dilated cardiomyopathy is hallmarked by what?
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ventricular dilation
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dilated cardiomyopathy causes what?
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1. decreased systolic function
2. contractility |
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hypertrophic cardiomyopathy is what?
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increased thickening of interventricular septum
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restrictive cardiomyopathy is hallmarked by what?
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rigid non-compliant myocardium (impedes ventricular filling)
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restrictive cardiomyopathy is usually caused by what?
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an infiltrative disease (amyloidosis)
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ischemia cardiomyopathy is caused by what?
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CAD
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ischemia cardomyopathy is usally accompanied by what?
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heart failure due to systolic dysfunction
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acquired valvular disorders are usually caused by what?
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-inflammation
-ischemia -trauma -infection |
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what is a common cause of valvular disorders?
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rheumatic heart disease
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most common valves affected by valvular diroders
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aortic & mitral
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stenosis
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valve is stiff and opening is narrowed
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regurgitation
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valves are incapable of closing completely allowing blood flow to regurgitate backwards
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mitral regurgitation
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backflow of blood from L ventricle into the L atrium during systole
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mitral regurgitation usually leads to what?
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left atrium hypertrophy.....CHF
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S/S of mitral regurgitation (acute)
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-SOB
-fatigue -weakness -cough |
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what is mitral stenosis?
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obstruction of blood flow from L atrium to L ventricle
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who is more likely to develop mitral stenosis?
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women
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mitral stenosis usually leads to what?
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L atrium hypertrophy
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S/S of mitral stenosis
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-DOE
-fatigue -cough -frequent respiratory infections -dysrhythmias |
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what is aortic regurgitation?
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back flow of blood into L ventricle from aorta during diastole
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aortic regurgitation eventually leads to what?
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L ventricle hypertrophy and L ventricle failure
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what is aortic stenosis?
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narrowing of the orifice between the L ventricle and the aorta
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aortic stenosis eventually leads to what?
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L ventricle hypertrophy
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congestive heart failure is what?
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syndrome associated with myocardial dysfunction that results in decreased systemic tissue perfusion
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5 conditions upon which heart function is dependent upon:
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1. preload
2. afterload 3. myocardial contractility 4. heart rate and rhythem 5. metabolic state |
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preload equals what?
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end diastolic volume
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afterload is what?
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resistance to the L ventricular ejection....amt of tension required to open the aortic valve
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prolonged increased demands on the heart leads to what?
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1. dilation
2. hypertrophy 3. tachycardia |
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left ventricle heart failure AKA....?
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congestive heart failure
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systolic heart failure
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decreased CO prevents adequate tissue perfusion --> leads to ventricular remodeling
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diastolic heart failure
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decreased compliance of the Left ventricle and abnormal diastolic relaxation --> increased left ventricle end-diastolic pressure
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clinical manifestations of CHF
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-dyspnea
-cough with frothy sputum -fatigue -decreased urine output -edema -cyanosis -rales/crackles -BP changes |
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hypertension is defined as measures in systolic and diastolic as what?
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systolic >140mmHg
diastolic >90mmHg |
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preHTN
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systolic:120-139
diastolic: 80-89 |
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stage 1 HTN
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systolic: 140-159
diastolic: 90-99 |
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stage 2 HTN
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systolic: >160
diastolic: >100 |
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risk factors for hypertension
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-males <55
-females >55 -black |
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theories for pathogenesis of HTN
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-overactivity of SNS system
-overactivity of RAA system |
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shock is caused by what?
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disruption of normal heart function, blood volume, blood pressure
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what happens with shock?
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the cardiovascular system fails to perfuse the tissues adequately --> impairment of cellular metabolism
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what happens with impairment of cellular metabolism?
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-impairment of oxygen use
-impairment of glucose use |
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cardiogenic shock
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decreased CO and tissue hypoxia with adequte intravascular volume
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s/s of cardiogenic shock
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-impaired mental status
-increased preload -systemic and pulmonary edema -dusky skin tone -hypotension -oliguria |
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hypovolemic shock
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caused by loss of whole blood, plasma, or interstitial fluid in large quantities
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hypovolemic shock begins to develop when intravascular volume has decreased by how much?
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15%
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s/s of hypovolemic shock
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-poor skin turgor
-thirst -oliguria (low urine) -decreased preload -tachycardia -thready pulse -decreased mental status |
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neurogenic shock is caused by what?
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massive, widespread vasodilation that results from parasympathetic overstimulation and sympathetic understimulation
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causes of neurogenic shock
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-trauma to spinal cord
-interruption in oxygen supply or glucose supply to medulla -depressive drugs -anesthetic agents -severe emotional stress |
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anaphylactic shock
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-vasodiation
-peripheral pooling -decreased tissue perfusion |
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anaphylactic shock begins as what?
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an allergic response to an allergen
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septic shock cause
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caused by an infection that enters the bloodstream
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most common bacteria of septic shock
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gram positive (staph, MRSA)
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septic shock can lead to what?
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multiple organ dysfunction syndrome
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S/S of shock
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-weakness
-cold/hot -nausea -vertigo -dyspnea -pallor -hypotension -decreased CO and UO -increased RR -respiratory alkalosis -increased HR |
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defects with increased pulmonary blood flow
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ventricular septal defect & atrial septal defect
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ventricular septal defect
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opening in the septal wall between the ventricles
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atrial septal defect
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opening in septal walls between the atria
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patent ductus arteriosus
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fetal structure that should begin closing with the first breath and should complete by 3 months
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pulmonic stenosis
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narrowing of the pulmonary valve or artery causing the right ventricle to hypertrophy
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pulmonic stenosis causes.....
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mild right sided heart failure
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aortic stenosis
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stenosis of aortic valve prevents blood from passing from left ventricle into the aorta
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aortic stenosis leads to what?
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L ventricle hypertrophy
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coarctation of the aorta
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narrowing of the lumen of the aorta
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defects with decreased pulmonary blood flow
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-tricuspid atresia
-tetralogy of fallot |
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tricuspid atresia
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tricuspid valve is closed, blood flows through the patent foramen ovale into left atrium, by passes the lungs, shunted back through the patent ductus arterosus into the lungs
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teralogy of fallot
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-pulmonary stenosis
-ventricular septal defect -overriding aorta -hypertrophy of right ventricle |
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S/S of tetralogy of fallot
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-cyanosis
-polycythemia -dyspnea -clubbing |
