Pathology Test 3 Lecture 2

Front 1

S and S of __:
Cardinal symptoms: chest, neck or arm pain, palpitations, dyspnea, syncope, fatigue, cough & cyanosis.
Edema & claudication—most common symptoms of patho conditions.
Chest Pain may arise from ischemia, MI, pericarditis, endocarditis, Mitral Valve Prolapse (bicuspid), or aortic dissection w/w/o aneurysm. May also see:
Nausea, vomiting, diaphoresis, dyspnea, fatigue, pallor or syncope.

Back 1

CV DZ

Front 2

Studies for CVD were done on __ in the past

Back 2

males

Front 3

Angina pattern distribution is in the __ nerve

Back 3

Ulnar

Front 4

with CVD women tend have pain to the _ or _ region

Back 4

jaw or scapular

Front 5

S and S of _:
_— irregular, fast or extra heartbeat. May be caused by MVP, caffeine, anxiety, exercise, athlete’s heart, or a severe condition such as CAD, cardiomyopathy, complete heart block, ventricular aneurysm, AV valve dz, mitral or aortic stenosis.
_—(shortness of breath)— caused by pulmonary patho, trauma, fever, certain meds. DOE (difficulty on exertion) may be due to impaired L ventricle
_- prop up in order to breath
_- not breathing at night

Back 5

CVD
Palpitations
Dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea

Front 6

s and s of _:
_ —cardiac origin—conditions of dysrrhythmias, orthostatic hypotension, Vertebral Basilar Insufficiency, aortic dissection, CAD, & hypoglycemia (low blood sugar). Predictors include:
Low BMI, ETOH, DM or increased glucose levels
Noncardiac contributors: stress, migraine HA, anxiety, seizures or psych conditions
_—parasympathetic increase causing vasodilation throughout the body
Prolonged sitting or standing
_ response—passes out—regains consciousness after recumbency

Back 6

CVD
Syncope
Vasovagal syncope
Vagal

Front 7

S and S _:
_ —may be pulmonary or CV issue such as MVP w/exercise, stress or positional
_—visible cyanosis most often accompanies CV or pulmonary problems but may be due to hematologic or CNS disorders.
_—hallmark of right side ventricular failure. Usually bilateral & dependent, may be accompanied by Jugular Venous Distention (fig.12-13), cyanosis & abdominal distention from ascites
_—Peripheral Vascular Dz along w/CAD. What do we do w/these patients?_. How do we know it is vascular vs spinal stenosis? Put them on an ex routine and find out when they _

Back 7

CVD
Cough
Cyanosis
Peripheral edema
Claudication
Get them up and moving
get their symptoms

Front 8

pathway of blood

Back 8

RA, RV, PA, Lungs, PV, LA, LV, arteries, arteriols, capillaries, venuouls, Veins, RA

Front 9

Layers of the heart:
From inside to out

Back 9

Endocardium
myocardium
epicardium
visceral layer of serous pericardium
pericardial space
parietal layer of serous pericardium
fibrous pericardium

Front 10

_- is where we have fluid

Back 10

Pericardial cavity

Front 11

Congestive Heart failure- _ layer is affected

Back 11

outer most

Front 12

_- fire at one spot spreads throughout
Past 65 _ node deteriorates and fired at a slower rate, then the_ node takes over and it fires at a higher rate then the _- therefore the HR will go up and stay that way (why they may put a pace maker in)

Back 12

Functional synsichium
SA
AV
SA

Front 13

_- where there is no rhythm
_- the ventricles
_-should return to the isoelectric line
Below isoelectric=_
Above isoelectric= having a _ or did have a _

Back 13

Isoelectric line
QRS
ST
ischemia
heart attack heart attack

Front 14

_ (_)

1. Ventricular Septic Defect
2. Atrial Septal Defect
3. Patent Ductus Arteriosus
4. Tetralogy of Fallot
5. Pulmonic Stenosis
6. Coarctation of the Aorta
7. Transposition of the Great Vessels

Back 14

congenital heart DV (peds)

Front 15

_: Most common defect
Hole between L & R ventricles due to lower pressure on the R side so less oxygenated blood to the system.
Not as much oxygenated blood but not deoxygenated blood so no cyanosis.

Back 15

Ventricular septal defect

Front 16

In most kids, the foramen ovale closes. If _ continues, the R side of the heart becomes thicker, pressure changes & blood can shift from R to L.
These patients will have chest pain w/exertion

Back 16

ventricular septal defect

Front 17

_ Hole between L & R atrium.
Normally, when the 1st breath is taken the fossa ovale closes. If it does not, then blood from the pulmonary vein enters the L atrium & some blood crosses the _into the R atrium & ventricle.

Back 17

atrial septic defect
atrial septal defect

Front 18

_ In utero, the aorta & pulmonary artery are connected, w/1st breath, it closes.
If it does not, some of the blood from the aorta crosses the _ & flows into the pulmonary artery

Back 18

patent ducts arteriosus
ductus arteriosus

Front 19

_ #1 cause of blue babies.
1. transposition of aorta
2. pulmonic stenosis (hardening)
3. Ventral Suptal Defect
4. R ventricular hypertrophy—due to pulmonary artery hardening
This defect leads to deoxygenated blood being pumped into the systemic circulation.

Back 19

tetralogy of fallot

Front 20

_ Hardening of the pulmonary artery leads to the shunt not working properly

Back 20

pulmonic stenosis

Front 21

_ In this defect, the aorta is narrowed or no shunt is present. What condition occurs depends on where the narrowing occurs. May lead to severe obstruction of blood flow in the descending thoracic aorta.

Back 21

coarctation of the aorta

Front 22

_ Systemic venous blood returns to the R atrium & then goes to the R ventricle & on to the aorta instead of going to the lung via the pulmonary artery.
The infant needs to have surgery immediately.

Back 22

transposition of the great vessels

Front 23

_ or _
etiology- artherosclerosis of coronary arteries
Incidence- 1.5 million MI, 400000 fatal
Manifestation: angina-reversible. myocardial infarction- death of tissue. Sudden death-lethal arrhythmia.
Angina pectoris= myocardial ischemia

Back 23

ischemic heart dz or CAD

Front 24

_ that doesn't go away with rest- is bad and may be having a heart attack if it doesn't get better with meds

Back 24

irreversible angina

Front 25

ischemia or CAD:
_syndrome occurs when the coronary arteries close up (vasospasm) causing SEVERE pain from ischemia.

Back 25

Prinz metals

Front 26

ischemia or CAD:
Vulnerable areas of the coronary arteries—occurs because _accumulates at areas of _.

Back 26

cholesterol
turbulence

Front 27

s and s of _:
Gripping vicelike feeling of pain or pressure behind the breast bone
Pain may radiate to the neck, jaw, back, shoulder, or arms
Toothache
Burning indigestion
Dyspnea
Nausea
Belching
ST segment depression

Back 27

Angina

Front 28

RX of _:
1. Dietary
2. Exercise—routine decreases CAD by 25%
3. Medications
4. Angioplasty—buys days, maybe years
5. CABG

Back 28

angina

Front 29

_ In the majority of cases, sudden formation of a thrombus on a narrowed coronary artery that blocks blood flow getting to tissue.
30% do not know they had a _

Back 29

MI
MI

Front 30

s and s _

Severe substernal chest pain or squeezing pressure
Pain radiating down arms
Feeling of indigestion
Angina lasting for 30 minutes or >
Angina unrelieved by rest
Nausea
Pallor
Pain of infarct unrelieved by positional change
Diaphoresis
SOB
Weakness & feeling of faintness
ST segment elevation
T wave inversion
Q waves

Back 30

MI

Front 31

types of MI:
_—most vulnerable area of the heart because it is the last place to get blood (deepest)
_—wall to wall infarction. Example—outside of heart, epicardium to inside or endocardium (through all the layers)

Back 31

Subendocardial or semi
Transmural

Front 32

Dx of MI:
_—_segment elevation is the hallmark for a transmural MI
_ (CPK-MB)—24 hours post infarct (looking for specific markers)
_
_

Back 32

EKG
ST
Serum enzymes
History
Angiography

Front 33

Complications of MI:
_
_ —knock out 40% of ventricular muscle fiber
_ —transmural MI leads to rupture through ventricular wall->cardiac tamponade possible or papillary muscle ruptures
_- like berry or AAA
_ —inflammatory response pulls platelets into area forming a thrombus in the ventricle—can break & go to the brain
_ —inflammation of the pericardium—can lead to cardiac tamponade which limits venous return

Back 33

Dysrhythmias
Cardiogenic shock
Rupture
Aneurysms
Mural thrombosis & embolus
Pericarditis

Front 34

__ 2-3 million, more common in males
Causes:
Ischemic heart dz
Rheumatic heart dz
Congenital heart dz
HTN heart dz
Cardiomyopathy
Inflammatory heart dz
Nutritional
Endocrine
metabolic

Back 34

CHF

Front 35

_ Causes: MI causing back up into the lungs

Back 35

L side heart failure

Front 36

_ s and s
Fatigue & dyspnea after mild exercise
Persistent spasmodic cough especially lying down (cough will continue, and goes away when propped up)
Paroxysmal noctural dyspnea
Orthopnea
Tachycardia
Muscle weakness
Edema & weight pain
Irritability/restlessness
Decreased renal fx or frequent urination @ PM
S3 heart sounds—classic sign (S1 and S2 are normal)

Back 36

L side heart failure

Front 37

_ Cause L sided heart failure

Back 37

right sided heart failure

Front 38

s and s _
Increased fatigue
Dependent edema
Pitting edema (#5-10#)
Edema in sacral area or back of thighs
S3 heart sound

Back 38

Right sided heart failure

Front 39

_ If not treated, L ventricle mass gets thicker but gets weaker.
Vascular supply does not improve, making them more prone to MI or ischemia.

Back 39

HTN

Front 40

_:
Lung pathology that leads to pulmonary HTN, leading to Right sided heart failure.
Examples: Both are paired together
1. _—hypoventilation due to mucus in the bronchi. Not much air in or out. Reflex vasoconstriction—increases resistance to bloodflow thereby increasing Right sided pressure
2. _—loss of lung parenchyma—loss of lung capillaries—increases resistance to blood flow—increasing Right sided pressure. At end stage _—go into _.

Back 40

cor pulmonale
Bronchitis
Emphysema
emphysema
cor pulmonale

Front 41

_ Group A streptococci activate antibodies & T cells cross react with markers on cardiac cells & heart valvular glycoproteins causing inflammation of the heart valves.
This leads to the valves not working correctly & causing a variety of symptoms and signs.

Over time will destroy all the heart valves, will need to replace then

Back 41

rheumatic heart dz

Front 42

_ S and S
Migratory joint pain
Subcutaneous nodules on the exterior surface of joints
Fever secondary to streptococcal infection
Skin lesions characterized by a flat, painless rash of short duration

Back 42

rheumatic fever

Front 43

_ s and s
Nonanginal chest pain
Palpitations
Fatigue
Dyspnea

Back 43

rheumatic Heart dz

Front 44

_ Damage to the endothelial lining of the heart & heart valves
Causes—infective agent is usually the cause. Example is IV drug abusers

Back 44

endocarditis

Front 45

_ s and s
Fever
Night sweats
Petechiae- broken blood vessels
Splinter hemorrhages in the nail beds
Recurrent flus
HA
Myalgias, arthralgias, back pain

Back 45

endocarditis

Front 46

_ Abnormal heart sounds!
Systolic—aortic stenosis (AV valve hardening) or AV valve incompetence (not working)
Diastolic—aortic valve incompetence (not working)
Continuous— stenosis in 1 place, incompetence in another place or patent ductus arteriosus (aorta/p. Artery connection)

Back 46

murmurs

Front 47

_ s and s]Easy fatigue
Dyspnea
Palpitations
Chest pain
Pitting edema
Orthopnea or paroxysmal dyspnea
Dizziness & syncope (fainting)

Back 47

CVD

Front 48

Inflammation of the myocardium
Etiology—viral infection to myocardium->inflammation
If severe—heart transplant, if mild—meds.

Back 48

myocarditis

Front 49

_ Inflammation of the pericardium

Back 49

pericarditis

Front 50

_ s and s

Substernal pain that may radiate to neck, upper back, upper traps, left supraclavicular area
Difficulty in swallowing
Relieved by leaning forward or by sitting upright***
Aggravated by movement associated w/deep breathing (laughing, coughing, deep inspiration)
Aggravated by trunk movements (SB or rotation)
Hx of fever, chills, weakness, or heart dz. A recent MI along with these symptoms should alert you!

Back 50

pericarditis

Front 51

If inflammation around the heart, this limits venous return and causes __.

Back 51

cardiac tamponde

Front 52

_ s and s
Narrowing of pulse pressure, S/D. Squeezing the blood vessels to raise the total peripheral resistance

Back 52

cardiac tamponde

Front 53

_Heart muscle cells damaged by unknown causes
1._—dilated—leads to large dilated heart. Caused by viral infection—end result is _.
2. _—really thick myocardium so chamber in ventricle becomes smaller thus limiting venous return
3. _—unknown cause & prognosis varies with amount of restriction.

Back 53

cardiomyopathies
Congestive
congestive dilated cardiomyopathy
Hypertrophic
Restrictive