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145 Cards in this Set
- Front
- Back
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Spinal cord segment supplying the heart
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C5-C6; reason for pain in the shoulder during MI
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Atrial fibrillation
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Arrhythmia common in elderly
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Ventricular tachycardia
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Arrhythmia where contractions occur too fast, can lead to V-fib
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Ventricular fibrillation
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Life threatening arrhythmia (sudden death); no effective cardiac output; need AED
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Dyspnea
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Shortness of breath; if it is “unusual onset” suspect cardiac disease; if it’s insidious suspect pulmonary disease
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Syncope
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Lightheadedness and fainting due to inadequate cardiac output (valve dysfunction, arrhythmias, heart failure)
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Heart failure and Cough
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Sign of left-sided heart failure; due to pulmonary congestion (fluid “backs up” into lungs)
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Cyanosis
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Blue discoloration of the skin due to poor oxygen saturation
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Hypoxia
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Oxygen deficiency; leads to cyanosis of mucous membranes
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Peripheral Edema
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Tissue swelling due to CHF; fluid retention/”back up”
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Claudication
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Cramping leg pain due to atherosclerosis/PVD; insufficiency of blood flow to gastrocs/soleus
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Result of Aging on CV system
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Reduced # of myocytes; fibrosis; reduced Ca transport; reduced capillary density; decline of sympathetic NS; impaired autonomic control of HR
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Implications of cardiac fibrosis
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Reduced compliance; poor filling
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Implications of reduced Ca transport
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May impair cardiac contraction
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Implication of reduced capillary density
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Means less blood supply per area of heart muscle
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Reduced responsiveness to beta-adrenergic stimulation
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Age related change of CV system; explains why older people have lower HRmax; affects sympathetic NS
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Implications of impaired autonomic reflex control
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Means it takes longer for HR to come down after exercise; necessitates warm-up and cool-down
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Functional Changes to CV system with age
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Decreased HRmax, cardiac output, and VO2max; increased incidence of arrhythmias (atrial fib)
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Mitral Valve Prolapse
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Valve between left atrium and ventrical allows retrograde flow of blood; more common in women; benign; imitates ischemic discomfort
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Estrogen and CAD
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Cardio protective: increases HDL, reduces clotting, dialates blood vessels (lowers BP, improves blood flow); reason risk of CAD increases with menopause
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Response to injury and atherosclerosis
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Irritants damage endothelial lining; platelets adhere and release PDGF; smooth muscle moves to inner layer of vessel; plaque forms; LDLs deposit in plaque
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Non-modifiable CAD risk factors
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Age (65+); gender (males); genetics
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Modifiable CAD risk factors
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BP; cholesterol; smoking; inactivity; obesity; diabetes; stress (type A)
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Hypertension values
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SBP>140; DBP>90
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Risky cholesterol level
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>200mg/dl
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BMI for obesity
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>30kg/m2
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Fasting Glucose level suggesting diabetes
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>126mg/dl
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Rate pressure product
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Indicates myocardial work; HR * SBP
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Classifications of angina
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Stable, unstable, prinzmetal, silent
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Depressed ST segment or T-wave inversion
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Signs of ischemia on EKG
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Treatment options for MI
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Rest, oxygen, medication, CABG/PTCA, lifestyle changes, cardiac rehab
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Angiography
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Dye is injected into coronary arteries via femoral catheter; shows reduced flow
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Angioplasty
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Widening the coronary arteries (balloon)
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Transmural MI
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Full thickness damage to myocardial tissue due to ischemia
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Subendocardial MI
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Partial thickness damage to myocardial tissue due to ischemia
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Diagnosis of MI
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Symptoms, EKG abnormalities, serum markers
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Tamponade
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Blood in the pericardial sac as result of ventricular aneurysm/hemorrhage/rupture
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CHF-Congestive Heart Failure
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Dilated heart that cannot pump enough blood to meet body’s demands
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Causes of CHF
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Decreased myocardial capacity (MI or muscle disease) or Increased pressure/volume load (HTN or valvular)
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Hypertensive Cardiovascular Disease
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Increased resistance to blood flow caused by vessel narrowing and/or fluid retention; requires increased driving pressure; chronic high BP
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Rheumatic Heart Disease
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An acquired valvular disease that occurs in childhood, caused by Strep (A); antigen-antibody complexes lead to vegetations on the valves causing infective endocarditis; end result is calcification and scarring
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S&S of Mitral Valve Prolapse
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Murmur, palpitations, tachycardia, SOB
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Depressed Starling Curve
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Result of congestion; EDV increases without corresponding increase in SV
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Driving Pressure
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Flow * Resistance; the pressure the heart has to overcome to drive blood through the body
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Stenosis
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A valve that has stiffened/narrowed; makes it harder for heart to pump blood through
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Insufficiency
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A valve that won’t close or stay shut; allows retrograde flow (MVP); incompetent/regurgitation
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Dilated Cardiomyopathy
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impaired contraction of heart fibers due to dilation of ventricle; most common in black men 40-60yoa
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Myocarditis
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Chronic myocardial inflammation due to virus or bacteria (leads to CHF)
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Myocardial Ischemia
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Lack of oxygen to heart muscle (often caused by atherosclerotic disease and leads to CHF)
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Law of LaPlace
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Wall tension = Distending Pressure * Radius of Ventricle; explains why dilation reduces pump function; increase in pressure or radius increases the force needed to push blood out
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Causes of Left Sided Heart Failure
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Causes: MI, HTN, mitral or aortal valve disease, Narrow aorta (coarctation)
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Effect of Left HF on Lungs
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Passive congestion (backwards), pulmonary edema, orthopnea, paroxysmal nocturnal dyspnea
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Orhopnea
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SOB when lying down flat
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Effect of Left HF on kidneys
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Decreased renal perfusion (not pushing through) and Na/water retention
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Characteristics of Left HF
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Weight gain due to edema, pitting edema in the feet, facial edema, vasoconstriction, hypertension, strong/weak pulse, fever/pallor, cachexia, third heart sound
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Pulsus Alterans
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alternating strong and weak pulse beats; sign of left sided heart failure
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Anasarca
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generalized massive edema; common in right sided heart failure
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ACE-inhibitor
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Drug used to inhibit vasoconstriction
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Causes of Right HF
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MI, COPD/pulmonary HTN, pulmonic or tricuspid valve disease, pulmonary artery stenosis
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Average cardiac output
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5L
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Effect of Right HF on lungs
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Increased pulmonary vascular resistance (forward; no congestion or edema)
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Effect of Right HF on Spleen/Liver
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Passive congestion (back-up), enlarged spleen and liver, ascites
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Ascites
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fluid accumulation in the gut
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Effects of Right HF on Kidneys
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Decreased perfusion (back-up); anasarca; pedal pitting edema; facial edema; distended jugular due to congestion; visible veins on shoulder
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Orthostatic Hypotension
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going from lying to standing up causes drop in BP (SBP 20mmHg; DBP 10mmHg) and increase in HR (10-20%)
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Causes of orthostatic hypotension
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autonomic, decreased volume, venous pooling, immobility, medication, malnutrition
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Implications for PT with orthostatic hypotension
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avoid prolonged standing and whirlpool; use cool-down; caution in sit to stand; use elastic stockings
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Pericarditis
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Inflammation of the sac surrounding the heart; can lead to tamponade and CHF
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Aneurysm
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Stretching a vessel wall to 50% larger than normal diameter; risks include age and atherosclerosis
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PVD (peripheral vascular disease)
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pathologic condition of blood vessels supplying the extremities and major abdominal organs (lower extremity more common); caused by atherosclerosis; results in claudication
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Cystic Medial Necrosis (monckeburg’s arteriosclerosis)
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form of arteriosclerosis; involves the middle layer of arteries (tunica media); common in those with Marfan’s syndrome
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Marfan’s syndrome
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Genetic connective tissue disorder; fibrillin deficiency; elastin not maintained; tall, thin, and lanky; often develop CVD/aortic aneurysm
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Thromboangiitis obliterans (buerger’s disease)
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Form of arteriosclerosis caused by inflammatory reaction that causes fibroelastic tissue to replace the inner lining of vessels; narrows lumen and encourages thrombi in hands and feet; more common in men and smokers
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Raynaud’s Disease
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vasospastic disorder characterized by spasm of small arteries in the digits caused by cold or stress; common in females and smokers
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Ways blood returns to the heart
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respiratory pump, muscular pump, one way valves
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Thrombophlebitis
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Inflammation of a vein due to a blood clot
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DVT deep vein thrombosis
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a clot in one of the deep veins; positive homan’s sign; swelling, heat, pain, redness; caused by venous insufficiency or increased coagulation
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Patients with venous insufficiency (stasis)
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Post-surgical immobilization of limb, spinal cord patients with immobility, obese patients, patients with right-sided heart failure
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Causes of increased coagulation
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Blood dyscrasias/hypercoagulation, varicose veins, oral contraceptives, tamoxifen treatment
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Phlebitis
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Irritation to a vein due to IVs and IV drug use
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Stasis Ulcer
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associated with poor venous circulation (chronic venous insufficiency); skin breakdown just above medial ankle; common in diabetics
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Saddle Embolus
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DVT breaks off and travels to heart, lodges in small pulmonary vessel; plugs up both right and left pulmonary arteries; cuts off blood flow to lungs
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Microemboli
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DVT breaks off as shower of small clots that settle in pulmonary vessels; causes dyspnea
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Lymphedema
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swelling of tissues due to accumulation of protein-rich fluid in extracellular spaces (stasis of lymph flow); skin becomes firm and orange
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Primary lymphedema
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idiopathic lymphedema; more common in females; connatal (birth); praecox (adolescence); tarda (over 35)
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Secondary Lymphedema
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lymphedema caused by disease or surgical procedure; elephantiasis; post mastectomy
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Stages of lymphedema
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1 pitting, reversible; 2 irreversible, non-pitting, skin changes; 3 elephantiasis, severe non-pitting, atrophic skin changes
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Elephantiasis
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caused by parasite Wuchereria Bancrofti; common in tropical climate; carried by mosquitos
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Treatment for lymphedema
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exercise and compression
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Lymphadenitis
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lymph nodes are inflamed due to infection somewhere in body
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Lymphangitis
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acute inflammation of subcutaneous lymph channels as result of hemolytic strep or staph infection (blood poisoning)
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Lipedema
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symmetrical swelling of lower extremities due to adipose deposits; more common in women; hormonal imbalance
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Aging and Blood
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decrease in iron, iron-binding, iron and B12 absorption, hemoglobin, hematocrit, lymph nodes, and cellular immunity; increased RBC fragility and platelet adhesiveness
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Plasma
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55% of blood volume (90% water, 10% electrolytes and proteins)
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Hypovolemic shock
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too much fluid lost
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Cardiogenic shock
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shock associated with CHF
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Obstructive shock
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shock caused by occlusion, MI, ischemia
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Septic shock
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shock caused by blood infection
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Neurogenic shock
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shock caused by head trauma; affects CNS (ANS); sympathetic system shuts down, vessels dilate, and BP drops
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Hemochomatosis
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blood disorder more common in older men where too much iron is absorbed and accumulates in organs/tissues; can cause rusty colored skin
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CBC
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RBC, WBC, Platelets, Hemoglobin, Hematocrit
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Normal Hematocrit
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45% (or three times the hemoglobin)
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Reticulocyte
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immature RBC
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Granulocytes
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Neutrophils, eosinophils, and basophils
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Agranulocytes
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monocytes and lymphocytes
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Mean corpuscular volume (MCV)
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size/volume of RBC
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Mean corpuscular hemoglobin concentration (MCHC)
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percentage of the RBC that is hemoglobin
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Mean corpuscular hemoglobin
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amount of hemoglobin per RBC
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Porphyria
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accumulation of porphoryins (hemoglobin precursors); precipitate in tissues; cause mental illness and port-colored urine
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Normal lifespan of RBC
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120 days (4 months)
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Sickle cell anemia
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RBCs change shape, loose motility (especially in small vessels)
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Anemia
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reduction in oxygen-carrying capacity of blood; caused by blood loss, RBC destruction, or decreased production of RBCs
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Normal Hemoglobin
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<14 in males; <12 in females
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Stomatitis
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mouth ulcers associated with anemia
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Normocytic Anemia
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RBCs are of normal size/shape and have normal hemoglobin concentration; associated with excessive blood loss
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Destruction of RBCs (Anemia)
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Congenital or acquired: sickle cell, autoimmune hemolytic anemia, malaria
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Macrocytic, normochronic
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enlarged RBCs; B12 or folic acid deficiency
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Pernicious Anemia
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B12 deficiency; type of macrocytic normochronic anemia
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Folic acid anemia
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B9 deficiency; type of macrocytic normochronic anemia
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Plasmodium
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malaria parasite
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Microcytic hypochromatic anemia
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RBCs are smaller than normal; low hemoglobin concentration
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Iron deficiency anemia
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type of microcytic anemia associated with chronic blood loss/decreased production of RBCs
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Thalassemia
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mutation of hemoglobin; insufficient synthesis leads to loss of motility; can lead to clotting and ischemia
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Autoimmune hemolytic anemia
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form antibodies against own RBCs
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Aplastic Anemia
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Bone marrow is suppressed, decreases production of RBCs, WBCs, and platelets; prone to bleeding and infections
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Polycythemia
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a myeloproliferative disorder; too many RBCs; increased blood viscosity
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Primary polycythemia (vera)
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common in older men; causes rust colored skin and feeling of too much blood in the head; overactivity of bone marrow; can convert to AML
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Secondary polycythemia
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acquired due to drop in plasma volume or rise of RBC numbers (external bone marrow overstimulation)
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Neutrophilia
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“shift to the left” of PMNs during acute inflammation
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Leukokcytopenia
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decrease in WBCs
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Leukemia
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malignancy of red bone marrow; overproduction of immature WBCs
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Acute Myeloblastic Leukemia (AML)
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common in adults; Auer rods present
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Auer Rods
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aggregated lysosomes in cytoplasm
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Acute Lymphoblastic Leukemia (ALL)
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More common in children; lymph nodes are enlarged but not painful; joint pain and weight loss common
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Chronic myelogenous leukemia (CML)
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slow onset; middle age adults; translocation (Philadelphia chromosome)
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Chronic lymphocytic leukemia (CLL)
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older adults; proliferation of immature B-lymphocytes; decrease in antibody production; prone to bleeding and infection
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Coagulation
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vasoconstriction, platelet aggregation, activation of clotting factors, fibrin clot
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Plasmin
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breaks down and dissolves fibrin in clots
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Vasculitis
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hemostatic disorder in which small blood vessels are destroyed; purpura and petechia
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Hemophilia
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hereditary hemostatic disorder, usually in males; affects intrinsic pathway
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Von Willebrand’s disease
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hereditary hemostatic disorder where platelets won’t stick; tendency to bleed
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Idiopathic Thrombocytopenia
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autoimmune disorder of hemostasis; causes purpura and hemorrhage
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Primary thrombosis
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over production of platelets
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Secondary thrombosis
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caused by removal of spleen
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Disseminated Intravascular Coagulation
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hemostatic disorder characterized by widespread clotting and massive hemorrhage
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