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79 Cards in this Set

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occurs when heart is no longer able to eject the blood delivered to it
CHF
most common cause of right sided
left ventricular failure
PF?
pulmonary fibrosis
PPH?
primary pulmonary hypertension
PE?
pulmonary embolism
CHF is most often due to inability of ...?
the heart to provide blood to the tissues
the most common cause of right sided HF
left ventricular failure
causes of CHF without left sided failure
lung disease
cor pulmonale
pulmonic or aortic valve disease
most common causes of left sided failure
systemic HTN
mitral valve disease
aortic valve disease
ischemic heart disease
primary myocardial disease
MVP
What's the disease?
Acute bacterial endocarditis
What is this?
Low output CHF
Heart can't pump enough for tissues
High output CHF
Tissues require more heart output than normal
common cause of acute cor pulmonale
pulmonary embolism
common cause of chronic cor pulmonale
COPD
PF
PPH
PPH
primary pulmonary hypertension
PF
pulmonary fibrosis
Adaptive responses to HF
increased catecholeamine stim, positive inotropism, incr. heart rate
eccentric hypertrophy
concentric hypertrophy
Cause of concentric hypertrophy
pressure overload
Cause of eccentric hypertrophy
volume overload
concentric hypertrophy definition
incr. thickness of wall w/o incr. chamber size
conditions causing volume overload
valvular regurgitation and abnormal shunts
conditions causing pressure overload
hypertension and valvular stenosis
the major cause of death in pts with untreated HTN
CHF
the leading discharge diagnosis in hospitalized pts over 65
CHF
Compensated HF
Frank-Starling still works and CO is still okay
Decompensated HF
Frank-Starling doesn't work and CO drops
In CHF, the kidneys get confused and think that they need to reabsorb what?
water
The RAS system increases what hormone?
Aldosterone
CHF causes ________ hyperaldosteronemia.
secondary
What are" heart failure cells"?
macrophages full of hemosiderin
What is the brown induration or hepatization characteristic of chronic venous congestion?
Hemosiderin and fibrin
Most common manifestation of left ventricular failure (LVF)
dyspnea
Types of LVF-caused dyspnea
exertional dyspnea,
orthopnea,
paroxysmal nocturnal dyspnea
Extra heart sound heard in CHF
S3
BNP is released from where in response to excessive stretching of ventricles
ventricles
If BNP is high, what is probable diagnosis?
CHF (79% PPV)
renal insufficiency
If BNP is low, what is probable diagnosis?
not CHF (89% NPV)
BNP effects
downregulates RAAS
decr. symp. in heart and kidneys
incr. renal blool flow
incr. Na+ excretion
the best time to order BNP measurement
Pt in ED with SOB
to rule out CHF
lung auscultation of CHF finds what?
rales
type of CHF pt with normal ANF level
chronic and stable
define MI diagnosis
increased blood CTni, CTnc, CK-MB
drug assoc. with vasospasm
cocaine
CT?
cardiac troponin
term used to refer to pts with S/Sx assoc with possible AMI (eg: burping and indigestion)
ACS (acute coronary syndrome)
part of cornary vessel that responds to injury
intima
3 levels of coronary vessel
intima, media, adventitia
The 2 coronary artery conditions of ACS
1)mural thrombus with variable obstruction
2)occlusive thrombus
Conditions assoc with occlusive thrombus
acute transmural MI or
sudden death
Conditions assoc with mural thrombus w/ variable obstruction
unstable angina or
acute subendocardial MI or
sudden death
Leading cause of mortality in the Western world
CAD
unstable angina aka
crescendo angina
preinfarction angina
character of unstable angina
increased frequency of angina pain
3 acute coronary syndromes
unstable angina
non-STEMI
STEMI
the leading cause of death in US and industrialized nations
IHD
IHD risk factors
AGE, gender (male), smoking, HTN, DM, hypercholesterolemia, lack of regular exercise, personality
2 types of MI
transmural
subendocardial
more common MI
transmural
more serious MI
transmural
define subendocardial infarct
up to 1/2 of inner (subendocardial) thickness of the wall
location of transmural injury
least perfused subendocardium
3 common narrowed coronary arteries
LAD - left anterior descending
LCx - left circumflex
RCA - right coronary artery
Common location of TI
left ventricle (septum and free wall)
Cause of posterolateral infarct
LCA occlusion
Cause of anterior infarct
LAD occlusion
cause of posterior infarct
RCx occlusion
Time for MI to "heal".
7 weeks
Microscopic appearance of myocytes 12-18 hours after TI
loss of nuclei and striations
Microscopic appearance of myocytes 24 hours after TI
neutrophil infiltrate
time frame of reversible infarct
0-1 hr
Ruputure of Transmural occurs in 4-15% of cases during what time frame
2-10 days post MI
90% of Transmural MIs involve the free wall and lead to massive cardiac _______.
tamponade
10% of transmural MIs involve the IV septum with left to right ____.
shunt
Pericarditis, ventricular aneurysm or rupture are rare with _____________ infarcts
subendocardial
symptoms of AMI
1) sudden severe pain, may radiate
2) pain accompanied by nausea, sweating, vomiting
3) 20% asymptomatic recognized by EKG or enzymes or both
percent of sudden death from ventricular arrhythmia
25%
10% of pts die during hospitalization from MI and an additional ____% will die during the first year
10%
CABG
coronary artery bypass graft