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