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128 Cards in this Set

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Diseases Causing Left Heart Failure
-ischemic heart disease
-mitral/aortic valve disease
-hypertension
-non-ischemic myocardial disease
Ischemic Heart Disease Definition
disease resulting from insufficient blood supply to the myocardium
AKA: coronary artery disease,
coronary heart disease
Causes of Myocardial Ischemia
-reduced/obstructed coronary artery blood flow*
-hypertrophy
-shock
-hypoxemia from resp. problem
-extreme rapid heart rate
Consequences of Myocardial Ischemia
-reduced nutrient supply
-dec. removal of metabolites
-dec. oxygen supply
-dec. ATP production
Causes of Coronary Obstruction
-Mainly atherosclerosis, then other changes in plaque such as:
-cracking, hemorrhaging, embolism, platelet aggregation, thrombosis, vasospasm
Structural Damage Resulting from IHD
Myocardial Necrosis in ventricles
(myocardial infarction)
Myocardial Infarction Determinants of Damage
-location (site of occlusion, CA anatomy) affects subendocardial region 1st b/c poor perfusion
-size
-progression of necrosis; begins in 20-30 min, max at 3-6 hrs
Clinical Manifestations of IHD
-angina pectoris
-acute MI
-sudden cardiac death
-chronic ischemic heart disease w/ CHF
Typical Angina Pectoris
-reversible
-stress induced, relieved by rest or nitroglycerine
-chest crush feeling, radiating px down left arm
Variant Angina
-at rest or awakens pt asleep
-coronary artery spasm near atherosclerotic plaque
-relieved by nitroglycerine
Unstable Angina
-inc anginal pain
-more intense, longer than stable
-harbinger of serious IHD
-"pre-infarction angina"
Infarction Angina
-irreversible
-chest crush, radiating px to neck, jaw, epigastrium, shldr or left arm
-long lasting pain not relieved by rest or vasodilators
Myocardial Infarction
-critical stenosis (75%)
-15% pts asymptomatic
-usually left ventricle, LCA
-causes inflammatory response
MI Symptoms
-chest crush sensation w/ referred pain for 30 min to hrs
-may show: pallor, weak rapid pulse, diaphoresis, dyspnea
MI Diagnostic Test
EKG: change to Q wave, ST segment and T inversion, shows arrhythmias
Blood Tests: CK-MB, lactate dehydrogenase, troponin I and T all increase
MI Complications
-contractile dysfxn
-arrhythmias
-myocardial rupture
-pericarditis
-thromboembolism
Myocarditis
Myocyte damage from inflamm by:
-coxsackieviruses A & B
-parasites (chaga's disease)
-bact infection (lyme disease)
-bact toxin (diptheria)
-allograft rejection
-drug allergy
Dilated Cardiomyopathy
-90% of cardiomyopathy
-may be caused by viral infection, poorly controlled diabetes or thyroid disease
-most common cause is CAD
Hypertrophic Cardiomyopathy
-abnormal diastolic filling reducing ventricular space and dec SV
-outflow obstruction by excessive contraction
-extremely rapid contraction causing dec SV
Restrictive Cardiomyopathy
-ventricular expansion prevented by endomyocardial fibrosis, dec SV
-less common
Hypertensive Heart Disease
hypertension causes inc afterload, causing inc demand of myocardium, resulting in hypertrophy
=>hypertrophy results in myocardial ischemic injury
Hypertenion Mechanism of Myocardial Ischemic Injury
regurgitation of blood into pulmonary circulation->inc hydrostatic pressure->inc edema->inc resp membrane thickness->dec oxygen perfusion
Valve Stenosis vs. Insuffieiency
stenosis- failure to open completely impeding fwd flow
insuffiencey- failure to close completely allowing reverse blood flow
Causes of Valve Disease
-mitral stenosis
-aortic stenosis
-mitral regurgitation
-aortic regurgitation
Mitral Stenosis
-postinflammatory scarring resulting from rheumatic fever induced by GROUP A STREPTOCOCCI
Aortic Stenosis
-senile calcific aortic stenosis
-post inflamm scarring
-degeneration caused by calcification
-results in pressure overload and consequent left vent hypertrophy
-angina and syncope symptoms
Mitral Regurgitation
-mitral valve prolapse (loose)
-most common in industrial world
-postinflamm scarring
-infective endocarditis
-results in dec SV = dec CO
-asymptomatic, auscultation reveals MIDSYSTOLIC CLICK
Aortic Regurgitation
-post inflamm scarring from rheumatic disease
-infective endocarditis
-Marfan Syndrome loss of fibrillin
Causes of Right Heart Failure
-left heart failure
-valve disease
-Cor Pulmonale
Cor Pulmonale
right heart disease caused by pulmonary hypertension result of lung or pulmonary vascular disease
Acute Cor Pulmonale
-caused by pulmonary embolism: >50% vascular bed obstructed-> inc burden-> r vent dilation and failure
Chronic Cor Pulmonale
-chronic obstructive lung disease: pulm hypertension -> r heart hypertrophy -> dilation and failure
Cor Pulmonale Clinical Manifestation
venous congestion leading to: -soft tissue edema
-distended neck veins
-tender liver
-DVT
Congenital Heart Disease Facts
-8:1000 births
-most common cause of child heart disease in world
-unknown cause, likely genetic and environmental factors
=> L to R shunts, R to L shunts, obstruction of blood flow
L to R Shunt Congenital Defects
-atrial septal defect
-ventricular septal defect
-persistent ductus arteriosus
R to L Shunt Congenital Defects
CYANOSIS
-tetralogy of Fallot: VSD, ASD, great artery transposition
-isolated artery transposition
Congenital Blood Flow Obstruction
abnormal narrowing of the aorta
Red Blood Cell Disorders
Anemia: dec RBC concentration 2* to hemorrhage, inc destruction or dec production
Polycythemia: inc RBC concentration
Conditions Inducing Increased RBC Destruction
-hereditary spherocytosis
-sickle cell
-thalassemia
-G6PDH deficiency
-mechanical trauma to RBC
-malaria
-narrowing of vessels
Conditions Causing Decreased RBC Production
-nutritional deficiency (megaloblastic anemia)
-multipotent stem cell suppression (aplastic anemia)
-marrow replacement via tumor (myelophistic anemia)
-chronic disease
Blood Loss Anemia
result of hemorrhage, can occur acutely from trauma (volume loss, then shock and death) or chronic if rate of loss exceeds rate of production
Mechanical Trauma to RBC
-RBC membrane shredding in circulation, destroyed locally
-result of TURBULENT FLOW as in valve prosthesis or vascular graft or MICROCIRCULATION DMG
Hereditary Spherocytosis
-hereditary RBC membrane defects result in sphere shape, and dec deformation
-weak spectrin, ankyrin, band 4.2 and band 3
-result SPLENIC HEMOLYSIS
Thalassemia
-alpha and beta forms
-result in altered Hb formation reducing oxygen carrying capacity
-altered RBC structure causing lysis
Sickle Cell Anemia
-amino acid GAG alteration to GTG coding for Valine resulting in sickle Hb
-O2 binds to RBC, then de-O2-> RBC shape change occurs and cells cause clotting->hypoxia->necrosis, especially in large jts
Immune Hemolytic Disorders
-increase in RBC destruction because of antibodies directed at antigens on RBC surface
-can occur with transfusion reactions or newborn disease as in erythroblastosus fetalis
Impaired RBC Production
-nutritional deficiency
-dec erythropoietin (kidney disease)
-stem cell suppression
-tumor replacing marrow
Nutritional Deficiency Anemia
-iron
-folate
-vitamin B12 and intrinsic factor (related to gastric bypass or stapling)
Suppression of Multipotent Stem Cell
-stem cell injury resulting from chemotherapy and radiation
-aplastic anemia which alters production of RBC and WBC
Marrow Replacement by Tumor
metastatic cancer deposited in marrow or granulomatous disease alters production; immature precursors may be released into blood
Symptoms of Anemia
-weakness
-malaise
-fatigue
-dyspnea w/ mild exertion
-headache
-dim vision
-feel faint
Signs of Anemia
-splenomegaly
-jaundice due to inc bilirubin
-tacchycardia
-tacchypnea
-angina w/ preexisting heart probs
Anemia Complications
-marrow expansion in skull
-inc iron absorption
-tissue anoxia changes
-liver, heart, kidney fatty change
Coagulation Disorders
result in excess bleeding
congenital or acquired
dec production
ineffective production
inc destruction (antibodies or sequestration in spleen)
THROMBOCYTOPENIA
Coagulation Factor Deficiencies
Inherited= von Willebrand disease, hemophilia A and B
Acquired= vitamin K deficiency, liver disease, DIC
Upper Respiratory Tract Acute Infections
-common cold; rhinovirus 60%
-acute pharyngitis
-acute bacterial epiglottis
-acute laryngitis
4 Major Diffuse Obstructive Lung Disorders
Emphysema (indirect)
chronic bronchitis
bronchiectasis
asthma
Obstructive Lung Disease General Mechanism and Clinical Determination
-occurs two ways: airway narrowing and loss of elastic recoil
TEST: FEV1
COPD Diseases and Commonalities
-emphysema
-chronic bronchitis
-chronic asthma
-bronchiectasis
=>all show DYSPNEA and CHRONIC AIRFLOW LIMITATION
Allergic Asthma
-most common, childhood, commonly hereditary
-triggered by allergens
-attacks preceded by rhinitis, urticaria, eczema
Nonreaginic Asthma
-not hereditary, no assoc. allergies, usually triggered by resp. tract infection such as viruses
-hyperirritability of the bronchial tree, viral inflammation, air pollutants
Drug Induced Asthma
-aspirin sensitive to small doses
-cyclooxygenase pathway inhibited, unaffected leukotrienes cause vasoconstriction
Occupational Asthma
-minute quantities of fumes trigger attack occurring after repeated exposure
-type I hypersensitivity, bronchoconstrictor liberation, uknown hypersensitivity
Asthma Structural Changes
-hyperplastic mucus glands
-hypertrophied bronchiole smooth muscle
-inflammatory infiltrate (thick mucus plugs bronchioles)
Asthma Manifestations
-severe dyspnea
-coughing
-wheezing
-bronchospasm
=>dec FEV1
Chronic Bronchitis Definition
chronic inflammation of the large bronchi, productive cough for 3 mos 2 consecutive years
Chronic Bronchitis Causes
-SMOKING, pollutants, grain, cotton, silicon dust
-bacterial and viral infections trigger attack
Chronic Bronchitis Structural Changes
-hypertrophy of submucosal glands in trachea and bronchi
-large airway hypersecretion of mucus
Chronic Bronchitis Pathogenesis
-neutrophil proteases (elastase & cathepsin) and matrix metalloproteinases stimulate mucus hypersecretion
-persistence leads to small airway goblet cell inc producing more mucus
Cigarette Smoke Influences on Infection
-impairs ciliary action
-may cause direct epithelial dmg
-inhibits bacterial clearing by leukocytes
Chronic Bronchitis Functional Deficit
DECREASED AIRFLOW
-inc mucus->thick sputum + lrg # of mucus secreting cells in bronchial epithelium->airway obstruction
Chronic Bronchitis Symptoms
CHRONIC COUGH AND SPUTUM
-worse in morning/night
-may exist without evolving to obstructive lung disease
Obstructive Lung Disease Common Symptoms
-shortness of breath
-prolonged expiration
-fever/malaise w/ infection
-wheezing
-hypoxemia & mild cyanosis
-dec exercise tolerance
-hypercapnia (inc blood CO2)
Chronic Bronchitis Tests
-FEV1
-Blood CO2 inc and O2 levels dec
-hypoxemia leads to polycythemia
Emphysema Definition
Abnormal permanent enlargement of airspace distal to terminal bronchiole, airspace wall distruction without obvious fibrosis
-DOES NOT APPEAR UNTIL 1/3 OF LUNG TISSUE INCAPACITATED
Emphysema Pathogenesis
SMOKING IRRITATES LUNGS CAUSING INFLAMMATION
-leukocytes release elastase damaging alveolar wall reducing elasticity
-hereditary deficiency of AAT + free radical inhibition of AAT leads to dec control of elastase = MORE TISSUE DMG
Emphysema Structural Deficit
enlargement of distal airspaces and decrease in gas exchange surface area
Emphysema Functional Deficit
-dec gas exchange capability
-loss of elasticity causes dec recoil of lungs and impaired expiration
Emphysema Symptoms
-1ST IS INSIDIOUS ONSET DYSPNEA
-cough/wheezing
Emphysema Signs
-OBVIOUS PROLONGED EXPIRATION
-weight loss (careful of tumor)
-barrel chest
-pt sits hunched
-breathes w/ pursed lips
-overventilation=> inc O2 "pink puffers"
Emphysema Tests
FEV1!!
Emphysema Complications
-COPD death result of resp acidosis and coma
-right heart failure
Bronchiectasis Definition
permanent dilation of bronchi and bronchioles caused by destruction of muscle and elastic tissue due to chronic necrotizing infections
Bronchiectasis Causes
-develops with other obstructive and infectious diseases
-uncommon due to antibiotic rx
Bronchiectasis Symptoms
-severe productive cough with foul smelling purulent sputum
-fever
-finger clubbing
-dyspnea/orthopnea if severe
General Conditions Leading to Restrictive Lung Defect
-Extrapulmonary disorders (chest wall probs: polio, obesity, pleural disease)
-Acute or chronic interstitial infiltrative disease
RESULT IN DEC TLC AND FVC
Acute Interstitial Infiltrative Disease Definition
ARDS = FIBROSIS and diffuse alveolar capillary damage resulting in respiratory insufficiency
HISTOLOGY = diffuse alveolar dmg
ARDS Predisposing Conditions
hospitalization from:
-infection
-injury
-inhaled irritants
-hematologic conditions
-pancreatitis
-hypersensitivity rxns
ARDS Structural Deficit
CAPILLARY AND ALVEOLAR ENDOTHELIUM DAMAGE:
-inc vascular permeability and alveolar flooding
-loss of diffusion ability
-type II pneumocyte dmg result in surfactant abnormality
ARDS Functional Loss
-non-homogenous lung stiffness and dec in FVC
-physiogical shunt resulting in hypoxemia
ARDS Clinical Manifestation
-DYSPNEA AND TACHYPNEA
-respiratory insufficiency, cyanosis, arterial hypoxemia, and respiratory failure
ARDS Diagnostics
-chest x ray later shows diffuse infiltrates bilaterally
-dec FVC and TLC
Chronic Restrictive Lung Disease Definition
-chronic inflammation of the interstitium of alveolar walls resulting from particulate accumulation (pneumoconiosis)
-interstitial fibrosis of unknown origin
CRLD Susceptible Populations
-coal miners
-farmers
-asbestos workers
-sandblasters
ALL PRONE TO PARTICULATE INHALATION
CRLD Pathogenesis
ALVEOLITIS RESULTING IN LEUKOCYTE ACCUMULATION
->distortion of alveolar structures
->mediator release dmgs lung cells
->results in end-stage fibrotic lung
CRLD Clinical Manifestation
-dyspnea, tachypnea
-END-INSPIRATORY CRACKLES
-cyanosis w/out wheezing or other evidence of airway obstruction
CRLD Tests
-FVC decreased
-FEV1/FVC ratio not reduced
-chest xray shows diffuse infiltrates (small nodules, irregular lines or glass shadows)
CRLD Complications
-pulmonary hypertension
-physiological shunt closes unused blood vessels, increasing right heart workload, cor pulmonale results
Atelectasis Definition
ALVEOLAR COLLAPSE
Compression Atelectasis
-fluid accumulation in lung collapses alveoli
Resorption Atelectasis
-bronchi obstruction collapses alveoli
Microatelectasis
-surfactant loss collapses alveoli
Contraction Atelectasis
-increased elastic recoil results in alveolar collapse
Atelectasis Functional Loss
INADEQUATE AIRSPACE EXPANSION
= loss of lung volume
results in phys. shunt, ventilation-perfusion imbalance and hypoxemia
Pleural Effusion and Pleuritis
"Hydrothorax"
-exudate or transudate accumulation in pleural space
-exudate via microbe/virus, cancer or pulmonary infarction, results in pleural adhesions
-transudate common from CHF, usually reabsorbed w/out effect
Pneumothorax
Air accumulation in pleural space most common w/ EMPHYSEMA OR FX RIB, can occur spontaneously in healthy adult
Hemothorax
blood in pleural cavity, clot presence, usually result of intrathoracic aortic aneurysm
Chylothorax
milky lymphatic fluid accumulation in pleural space implying lymph duct obstruction by intrathoracic cancer
Pulmonary Embolism Susceptibility
-cardiac disease or cancer
-immobilization s/p hip fx
-hypercoagulability from factor V, obesity, recent surgery, oral contraceptives or pregnancy
=DVT PRIMARY SOURCE
Physiological Consequences of Pulmonary Emboli
-respiratory compromise from poorly perfused blood
-obstruction leads to pulmonary hypertension and R heart failure
Pulmonary Emboli Diagnostics
-chest xray may show infarct 12-36 hrs after as wedge shaped infiltrate
-pulmonary angiography most definitive but risky
Pulmonary Embolism Prevention
-early ambulation s/p surgery
-elastic/compression stockings
-preventative anticoagulation drugs
Causes of Pneumonia
-poor resistance to infection from chronic disease, immune dysfxn, leukopenia
-impaired clearing mechanism
Factors Interfering With Lung Clearing Mechanism
-loss of cough from coma, anesthesia, NM disorders
-injury to ciliary apparatus
-impaired alveolar macrophages from alcohol, tobacco, anoxia
-pulmonary edema/congestion
Community Acquired Acute Pneumonia
pneumococcus infection causes inflammatory exudate to fill alveoli and solidifying pulmonary tissue
Anatomic Distribution:
Bronchopneumonia
-patchy consolidation
-chest xray shows focal opacities
Anatomic Distribution:
Lobar Pneumonia
-consolidation of a lrg portion or entire lobe
-chest xray radioopaque well defined lobe
Nosocomial Pneumonia
-acquired during hospital stay
-pts with severe disease, immune suppression, on prolonged antibiotic therapy or mechanical ventilation susceptible
-STAPH AUREUS AND GRAM NEGATIVE RODS MAIN INFECTIONS NOT PNEUMOCOCCI
Most Common S/S of Pulmonary Disease
-cough 3 types
-dyspnea
-abnormal sputum
-chest px
-hemoptysis
-cyanosis
-altered breathing pattern
-digital clubbing
Exocrine Pancreas Disorders
-acute pancreatitis
-cystic fibrosis
-pancreatic carcinoma
Acute Pancreatitis
-inflamm with acinar cell injury
causes:
-ALCOHOLISM OR GALL STONES (CHOLELITHIASIS)
-also blunt trauma, surgery, medication
Acute Pancreatitis Pathogenesis
AUTODIGESTION
-acinar cell injury leads to activation of trypsinogen, trypsin and proteolytic enzyme activate other enzymes causing autodigestion of pancreas
Acute Pancreatitis Pathogenesis
Indirect
-duct obstruction from alcoholism or gall stone
-metabolic injury causing impaired intra-acinar proenzyme transport
Acute Pancreatitis Pathogenesis
Direct
-alcohol, drugs, trauma and virus cause direct release of enzymes and hydrolases that digest pancreatic cells
Acute Pancreatitis Manifestation
-variable severity of sx
-increasing ab px radiating to upper back or T-L jxn made worse by supine or walking
-nausea, fever, tacchycardia, weakness
PX CAUSED BY EDEMA, IRRITATION FROM ENZYMES, OBSTRUCTED BILIARY TRACT
Acute Pancreatitis Complications
-peripheral vascular collapse and shock
-ARDS
-renal failure
-hypocalcemia
-pancreatic pseudocyst
-peritonitis
Acute Pancreatitis Tests
-blood test reveals inc serum amylase in 24 hrs, lipase 72-96 hrs
-urine shows inc amylase
-xray shows pancreatic enlargement
Cystic Fibrosis
-chromosome 7 abnormality causing defect in Cl- transport affecting all exocrine glands