Ch 10 Circulatory System

Front 1

Coronary Artery Disease (CAD)

Back 1

Arteries become narrowed by atherosclerotic deposits over time cause cardiac ischemia and eventually a MI

Front 2

Coronary Artery Disease (CAD) Signs and Symptoms

Back 2

Pain of angina pectoris. Burning, squeezing, crushing, and radiating to the arm, neck, or jaw due to diminished blood flow and low O2 saturation. Nausea, vomiting, and weakness can be experienced. May be asymptomatic up until MI.

Front 3

Coronary Artery Disease (CAD) Etiology

Back 3

Plaque in lumen of coronary artery result in atherosclerosis and narrowing of lumen of arteries, not enough blood is received by heart. Cells gradually weaken and die. Scar tissue forms interfering with hearts ability to pump.

Front 4

Coronary Artery Disease (CAD) People at Risk

Back 4

Genetic predisposition, older than 40, men over women, Caucasian. Smoking history, hypertension, diabetes, obesity, elevated serum cholesterol or reduced HDL. Lack of exercise, stress.

Front 5

Coronary Artery Disease (CAD) Treatment

Back 5

Restore adequate blood flow to myocardium. Vasodilators prescribed. Angioplasty attempted. Coronary bypass for severe cases

Front 6

Angina Pectoris

Back 6

Chest pain due to ischemia during or shortly after exertion. Reduced oxygen to myocardium.

Front 7

Angina Pectoris Signs and Symptoms

Back 7

Sudden onset of left side chest pain. Pain radiates to left arm or back. May experience dyspnea. Blood pressure may increase arrhythmia may occur.

Front 8

Angina Pectoris Etiology

Back 8

Atherosclerosis causes narrowing of coronary arteries compromising blood flow. Exertion requires increased blood flow to supply more O2, but vessels unable to supply. Severe prolonged tachycardia, anemias, and respiratory disease can cause cardiac ischemia.

Front 9

Angina Pectoris Treatment

Back 9

Cessation of strenuous activity and placing nitroglycerin tablets under tongue. Immediate medical attention required if persists after 20 minutes.

Front 10

Myocardial Infarction

Back 10

Death of myocardial tissue caused by ischemia.

Front 11

Myocardial Infarction Signs and Symptoms

Back 11

Sudden severe substernal or left sided chest pain. Pain may be crushing, feeling of massive constriction of chest, may be burning or vague discomfort. Pain may radiate to left or right arm, back, or jaw. Irregular heart beat, dyspnea, diaphoresis often accompany pain. May be silent especially if diabetic.

Front 12

Myocardial Infarction Etiology

Back 12

Insufficient O2 supply. Pain caused by ischemia, if not reversed within 6 hrs cardiac muscle dies. Coronary thrombus most common cause.

Front 13

Myocardial Infarction Treatment

Back 13

O2 administered and morphine for pain. Aspirin given to reduce damage. Vasodilation attempted by nitroglycerin drip. Angioplasty most effective to decrease damage.

Front 14

Cardiac Arrest

Back 14

Sudden unexpected cessation of cardiac activity.

Front 15

Cardiac Arrest Signs and Symptoms

Back 15

Patient unresponsive, no respiratory effort, no palpable pulse.

Front 16

Cardiac Arrest Etiology

Back 16

Results from anoxia or interruption of electrical stimuli to heart. Can be from respiratory arrest, arrhythmia or MI. Electrocution, drowning, severe trauma, massive hemorrhage or drug OD can also cause.

Front 17

Cardiac Arrest Treatment

Back 17

CPR within 4-6 minutes, AED or defibrillators, epinephrine and isoprotenrol to stimulate heart. Lidocaine or amiodarone (anti arrhythmias) may also be used.

Front 18

Cardiac Arrest Prognosis

Back 18

Within 1-2 minutes of cessation of cardiac activity, respiratory efforts cease. 4-6 minutes brain cells begin to die, 10 minutes brain dies, death inevitable.

Front 19

Essential Hypertension

Back 19

Abnormally high BP.

Front 20

Essential Hypertension Signs and Symptoms

Back 20

Headaches, epistaxis, lightheaded, syncope. Usually no symptoms. Generally detected when BP is taken during screening.

Front 21

Essential Hypertension Etiology

Back 21

Unknown. Stress major factor. Age hereditary, smoking, obesity, sedentary lifestyle, poor diet, type A personality.

Front 22

Essential Hypertension Diagnosis

Back 22

Systolic greater than 140 mm Hg, diastolic greater than 90. 120-140 indicates borderline hypertension.

Front 23

Essential Hypertension Treatment

Back 23

Diuretics to reduce circulating blood volume, ACE Inhibitor for vasodilation, CBCs to slow heartbeat, ARBs to dilate vessels.

Front 24

Malignant Hypertension

Back 24

Severe form of hypertension.

Front 25

Malignant Hypertension Signs and Symptoms

Back 25

Severe headache, blurred vision, dyspnea

Front 26

Malignant Hypertension Etiology

Back 26

Unknown. Extreme stress may cause

Front 27

Malignant Hypertension Diagnosis

Back 27

Systolic greater than 200 diastolic greater than 120.

Front 28

Malignant Hypertension Treatment

Back 28

IV vasodilators and sodium nitroprusside (Nipride). BP monitored on regular basis drugs continued for life.

Front 29

Malignant Hypertension Prognosis

Back 29

Depends on patients response. At risk for CVA, stroke, irreversible renal damage. If drugs unsuccessful likely to succumb after CVA.

Front 30

Congestive Heart Failure (CHF)

Back 30

Acute or chronic inability of the heart to pump enough blood throughout the whole body to meet homeostasis.

Front 31

Cor Pulmonale Treatment

Back 31

Receiving causative factors and reducing hypoxemia. Bronchodilators administered, supplemental oxygen. Bed rest, diuretics if edema present. Anticoagulant to avoid thromboembolism. Low salt diet encouraged.

Front 32

Pulmonary Edema

Back 32

Fluid shift into the extra vascular spaces of the lungs.

Front 33

Pulmonary Edema Signs and Symptoms

Back 33

Dyspnea, coughing, orthopnea (breathe easier in upright position), increased cardiac and respiratory rates, bloody frothy sputum. BP falls, skin cold and clammy. Symptoms often at night when lying down.

Front 34

Pulmonary Edema Etiology

Back 34

Caused by left sided heart failure, mitral valve disease, pulmonary embolus, systemic hypertension, arrhythmias, renal failure. Head trauma, drug OD, exposure to high altitudes. Excessive fluid accumulates in pulmonary tissue and air spaces of lungs, pulmonary circulation is overloaded with excessive volume of blood

Front 35

Pulmonary Edema Treatment

Back 35

Placed in Fowler position (sitting), oxygen therapy administered. Diuretics improve excretion, IV vasodilators induce venous dilation, beta adrenergic drugs dilate bronchioles to control bronchial spasms. Mechanical ventilation if severe.

Front 36

Congestive Heart Failure (CHF) Signs and Symptoms

Back 36

Insidious onset. Gradually increasing dyspnea. Cardiac and respiratory rates become anxious. As progresses neck veins distend and edema notes on ankles. If right side fails liver and spleen enlarge and peripheral edema more prominent. Left side causes increased pulmonary congestion and respiratory difficulties.

Front 37

Congestive Heart Failure (CHF) Etiology

Back 37

MI is common cause of acute CHF. For chronic could be hypertension, CAD, chronic obstructive pulmonary disease, cardiac valve damage, arrhythmias, cardiomyopathy.

Front 38

Congestive Heart Failure (CHF) Diagnosis

Back 38

Breath sounds diminished, fluid in lungs.

Front 39

Congestive Heart Failure (CHF) Treatment

Back 39

Reduce workload of heart and increase efficiency. ACE inhibitors and ARBs used to increase blood flow. Diuretics decrease volume of fluids reducing vascular pressure. May require pacemaker, Defibrillator, or if severe heart transplant.

Front 40

Congestive Heart Failure (CHF) Prognosis

Back 40

Varies. Chronic CHF is vulnerable to major organ impairment and resulting complications.

Front 41

Cor Pulmonale

Back 41

Right sided heart disease. Enlargement of right ventricle due to primary lung disease.

Front 42

Cor Pulmonale Signs and Symptoms

Back 42

Dyspnea, distended neck veins, edema of extremities. Liver is enlarged and tender.

Front 43

Cor Pulmonale Etiology

Back 43

Outcome of acute or chronic pulmonary disease and pulmonary hypertension. Diseased pulmonary blood vessels impair flow of blood to pulmonary tissue, increased pulmonary BP increases workload of right side of heart causing right ventricle to hypertrophy becoming less effective at pumping blood to lungs. Can be caused by emphysema, fibrotic pulmonary lesions, and pulmonary emboli.

Front 44

Cor Pulmonale Diagnosis

Back 44

Based on history of pulmonary disease and hypoxia.

Front 45

Cardiomyopathy

Back 45

Non inflammatory disease of cardiac muscle resulting in enlargement of myocardium and ventricular dysfunction.

Front 46

Cardiomyopathy Signs and Symptoms

Back 46

Experience symptoms of CHF, including dyspnea, fatigue, tachycardia, palpitations and occasional chest pain. Peripheral edema and hepatic congestion present. Syncope and cardiac murmurs. Symptoms vary with type and cause.

Front 47

Cardiomyopathy Etiology

Back 47

Unknown. 3 groups: dilated, hypertrophic, restrictive.

Front 48

Cardiomyopathy Dilated Etiology

Back 48

Dilated may be from chronic alcoholism, autoimmune, viral infections. Results in diffuse degeneration of myocardial fibers followed by decrease in contractile effort.

Front 49

Cardiomyopathy Hypertrophic Etiology

Back 49

Genetic, idiopathic. Left ventricular wall hypertrophies, as does interventricular septum resulting in small elongated left ventricle and possible obstruction of aortic valve.

Front 50

Cardiomyopathy Restrictive Etiology

Back 50

Rare occurs when any infiltrative process of the heart causes fibrosis and thickening day the myocardium, walls of ventricles become thickened. Muscle does not relax normally resulting in chamber not filling properly with blood. Inability of heart to pump blood properly may lead to heart failure.

Front 51

Cardiomyopathy Treatment

Back 51

Determined by type.

Dilated: control CHF, anti arrhythmic agents, digitalis, anticoagulants prescribed. Activities limited, bed rest.

Hypertrophic: reduce workload of heart. Beta adrenergic blockers (Inderal), reduce myocardial contractility, heart rate, and conductivity, thus preventing arrhythmias. CBCs for BP, ACE inhibitors to relax blood vessels.

Restrictive: reduce workload. Changes in cardiac muscle caused by infiltrates are irreversible, poor prognosis.

Front 52

Cardiomyopathy Prognosis

Back 52

Meds improve survival rate. Some fatal, heart transplant only hope.

Front 53

Pericarditis

Back 53

Acute or chronic inflammation of pericardium (serosa), sac enclosing and protecting the heart.

Front 54

Pericarditis Signs and Symptoms

Back 54

Fever, malaise, chest pain that fluctuates with inspiration or heartbeat, dyspnea and chills. Feel anxious “heart pounding”. Detectable friction rub, or grating sound. Tachycardia.

Front 55

Pericarditis Etiology

Back 55

Idiopathic or consequence of inflammation or infection elsewhere in the body. May occur secondary to MI

Front 56

Endocarditis Etiology

Back 56

Bacteremia, infectious agents in bloodstream. Staph, strep, E. coli. Drug users high risk, rheumatic disease prone to it.

Front 57

Endocarditis Treatment

Back 57

IV antibiotics. Antipyretic, anticoagulants, bed rest, surgical repair if valves damaged.

Front 58

Endocarditis Prognosis

Back 58

Complete recovery of early diagnosis and treatment. Poor if untreated.

Front 59

Pericarditis Treatment

Back 59

Management of underlying disease and reducing inflammation and pain. Antibiotics or possible drainage or aspiration. Bed rest, anti inflammatory, NSAIDS, corticosteroids.

Front 60

Pericarditis Prognosis

Back 60

Acute resolves w complete recovery. If chronic may need resection.

Front 61

Myocarditis

Back 61

Inflammation of muscular walls of heart.

Front 62

Myocarditis Signs and Symptoms

Back 62

Damage caused by pathogenic invasion or toxic insult. May be acute if chronic. Any age. Palpitations, fatigue, dyspnea, fever, arrhythmia, tenderness of chest.

Front 63

Myocarditis Etiology

Back 63

Viral, bacterial, fungal, or Protozoal infection. Occasionally idiopathic. Secondary to MI. Exposure to toxic agents, lithium, cocaine, alcoholism, radiation, chemical poisoning. Collagen disease.

Front 64

Myocarditis Treatment

Back 64

If infection is cause proper antiinfective agents given. Rest and reduce heart workload.

Front 65

Myocarditis Prognosis

Back 65

Complete recovery favorable unless chronic and damage to muscle occurs.

Front 66

Endocarditis

Back 66

Inflammation of lining and valves of heart.

Front 67

Endocarditis Signs and Symptoms

Back 67

Secondary to infection, or preexisting heart disease, or immune rxn. Vague to pronounced symptoms of infection: fever, chills, night sweats, weakness, anorexia, fatigue. Vegetative growths on cardiac valves released into bloodstream inform of emboli. Cause ischemia.

Front 68

Rheumatic Fever

Back 68

Systemic inflammatory and autoimmune disease involving the joints and cardiac tissue

Front 69

Mitral Stenosis Signs and Symptoms

Back 69

Exertional dyspnea and fatigue. Cough and palpitations followed by hemoptysis. If severe become cyanotic.

Front 70

Mitral Stenosis Etiology

Back 70

Rheumatic heart disease is cause of most cases. Antibodies often attack the body tissue in autoimmune response.

Front 71

Mitral Stenosis Treatment

Back 71

Limit sodium intake, diuretics, to reduce workload of heart. Anticoagulant to prevent thrombi. If atrial fibrillation results digoxin given to slow rapid heart rate. Surgery (commissurotomy) to free up valve or non surgically with balloon valvuloplasty. Valve replacement final option.

Front 72

Mitral Insufficiency

Back 72

Mitral valve fails to close completely allows blood from left ventricle to flow back into left atrium.

Front 73

Mitral Insufficiency Signs and Symptoms

Back 73

Dyspnea and fatigue. Heart murmur can be heard as blood leaks back.

Front 74

Mitral Insufficiency Etiology

Back 74

Scar tissue from inflammation and vegetations ( consequence of endocarditis), rheumatic fever, mitral valve prolapse, CAD, MI, cardiac dilation.

Front 75

Mitral Insufficiency Treatment

Back 75

Bed rest, oxygen therapy, antibiotics for infectious process. Surgical repair or replacement of valve if severe. Can lead to CHF.

Front 76

Mitral Valve Prolapse (MVP)

Back 76

Usually benign, when one or more cusps of mitral valve protrude back into left atrium during ventricular contraction.

Front 77

Mitral Valve Prolapse (MVP) Signs and Symptoms

Back 77

Most asymptomatic. Usually discovered during routine check. If have Symptoms include chest pain, dyspnea, dizziness, fatigue, syncope (unconsciousness). Severe anxiety. Affects all ages.

Front 78

Mitral Valve Prolapse (MVP) Etiology

Back 78

Abnormally long or short chordae ten finale may be cause. Malfunctioning papillary muscles increase severity of condition.

Front 79

Rheumatic Fever Signs and Symptoms

Back 79

Follows a sore throat caused by hemolytic strep. Usually child, experiences fever and polyarthritis, edema, redness, limited ROM. Also experience carditis, cardiac murmurs, cardiomegaly, CHF. Weakness, malaise, anorexia, weight loss, rash on trunk, abdominal pain. Occurs 1-5 weeks after upper respiratory infection

Front 80

Mitral Valve Prolapse (MVP) Treatment

Back 80

Generally not required if asymptomatic. If have Symptoms use beta blockers, avoid caffeine, smoking, large and heavy meals. Good prognosis.

Front 81

Arrhythmias

Back 81

Any deviation from normal heart beat.

Front 82

Arrhythmias Signs and Symptoms

Back 82

Occur when interference with the conduction system of the heart resulting in abnormal heart beat. Palpitations, tachycardia, skipped heart beats, bradycardia, syncope, fatigue.

Front 83

Sinus Tachycardia (Arrhythmias)

Back 83

S&S: Over 100 bpm, regular, P wave uniform. Etiology: rapid impulse originates in SA node, conduction normal. Diagnosis: rapid rate. Treatment: beta blockers, CCBs, candidate for ICD.

Front 84

Sinus Bradycardia (Arrhythmias)

Back 84

S&S: <60 bpm, regular, p wave uniform. Etiology: slow impulse originate in SA node, conduction normal. Diagnosis: slow rate. Treatment: atropine.

Front 85

Premature Atrial Contraction (Arrhythmias)

Back 85

S&S: rate depends on underlying rhythm, usually normal P wave, diff morphology from other p waves. Etiology: irritable atrium, single ectopic beat arises prematurely, conduction through ventricle normal. Diagnosis: ECG Treatment: unnecessary or anti arrhythmic drugs.

Front 86

Atrial tachycardia (Arrhythmias)

Back 86

S&S: 150-250 bpm. Rhythm normal, sudden onset. Etiology: irritable atrium firing at rapid rates, normal conduction. Diagnosis: atrial and ventricular rates identical. ECG. Treatment: reflex vagal stimulation, calcium channel blockers, cardio version, candidate for ICD or ablation

Front 87

Atrial Fibrillation (Arrhythmias)

Back 87

S&S:Atrial rate >350 bpm. Ventricle <100 bpm (controlled) or > 100 (rapid ventricular response) Etiology: Atrial ectopic foci discharging too rapid for muscles to respond and contract, quivering atrium, AV node blocks some ventricle responds irregularly. Diagnosis: no p wave irregular ventricle rate. Treatment: IV verapamil, procainamide, cardioversion, ICD or ablation.

Front 88

First degree Heart Block (Arrhythmias)

Back 88

S&S: rate depends on underlying rhythm, P-R interval >.20 sec. Etiology: delayed AV node impulse eventually conducted. Diagnosis: ECG shows P-R > .20 s. Treatment: atropine, pacemaker if unsuccessful.

Front 89

Second degree Heart Block Wenckebach Heart Block (Arrhythmias)

Back 89

S&S: intermittent block w progressively longer delay in conduction until one beat is blocked. Atrial rate normal, ventricular slower, rhythm irregular. Etiology: SA node initiates impulse, conduction through AV node blocked intermittently. Diagnosis: normal P wave, some not followed by QRS. P-R progressively longer followed by block of impulse. Treatment: if severe pacemaker.

Front 90

Rheumatic Fever Etiology

Back 90

After sore throat beta hemolytic strep antibodies develop and cross react with normal tissue. Antibodies attack own cells, migrate to endocardium, mitral valves, aortic valve where vegetation form. Carditis follows.

Front 91

Classic second degree Heart Block (Arrhythmias)

Back 91

S&S: ventricle rate 1/2 or 1/4 slower, QRS dropped every 2nd, 3rd or 4th beat. Etiology: SA node initiates conductionthrogh AV blocked. Diagnosis: QRS blocked every 2,3,4th impulse. Treatment: pacemaker inserted

Front 92

Third degree Heart Block (Arrhythmias)

Back 92

Atrial rate normal, ventricular rate 20-40 or 40-60 bpm no relationship bt P wave and QRS complex. Etiology: SA node initiates but completely blocked causing atria and ventricles to beat independently. Diagnosis: rhythms are regular but independent of each other. Treatment: pacemaker

Front 93

Premature Ventricular Contraction (Single Focus) (Arrhythmias)

Back 93

Single ectopic beat arising from ventricle follows by compensatory pause. Etiology: ectopic beat originates in irritable ventricle. Diagnosis: buzzard QRS > .12s followed by pause. Treatment: none of <6/min. If multi focal p wave absent before ectopic beat.

Front 94

Ventricular Tachycardia (Arrhythmias)

Back 94

S&S: 150-250 bpm regular rhythm, experience palpitations, dyspnea, anxiety, chest pain. Etiology: 4 or more PVCs at rapid rate. Diagnosis: P wave hidden in QRS complex. Treatment: immediate intervention, IV lidocaine, cardioversion, ICD or ablation.

Front 95

Ventricular fibrillation (lethal Arrhythmias)

Back 95

S&S: lose consciousness immediately, no peripheral pulse, no heart sound, no BP. Etiology: ventricular fibers twitch rather than contract. Unknown reason. Diagnosis: pulseless, unconscious. ECG rapid chaotic waves originate in ventricle. Treatment: precordial shock (defibrillation) ICD or ablation.

Front 96

Shock

Back 96

Collapse of cardiovascular system. Inefficient cardiac output.

Front 97

Shock Signs and Symptoms

Back 97

Inadequate perfusion of organs and tissues. Cold pale, clammy skin, rapid, weak, and thready pulses. Rapid breathing altered level of consciousness. BP drops, anxious, irritable, restless, impeding doom, dizziness, profuse sweating, thirst, pupils dilate, shaking/trembling.

Front 98

Shock Etiology

Back 98

Life threatening emergency. Blood circulating is reduced. Failure of heart to pump adequately. Insufficient oxygen can generate shock.

Front 99

Shock Treatment

Back 99

Patients placed in supine position, feet legs elevated. Kept warm but not overheated check compressions, airways, breathing (CABs). Viral signs monitored. O2 administered and IV fluids.

Front 100

Rheumatic Fever Treatment

Back 100

Complete course of antibiotics. Penicillin. Antipyretic for fever, anti inflammatory for arthritic symptoms. Bed rest.

Front 101

Rheumatic Heart Disease

Back 101

Cardiac manifestations that follow rheumatic fever.

Front 102

Rheumatic Heart Disease Signs and Symptoms

Back 102

Acute endocarditis, leads to chronic cardiac involvement, valvular damage, bc vegetation cause stenosis (narrowing) of the valves. Cause dyspnea, tachycardia, edema, non productive cough, cardiac murmur.

Front 103

Rheumatic Heart Disease Etiology

Back 103

After rheumatic fever vegetation’s enlarge, or valves scar, cause stenosis of the openings. Frequency is decreasing due to medications.

Front 104

Rheumatic Heart Disease Treatment

Back 104

Aimed at reducing stenosis of valves and preventing further damage. Surgery to relieve stenosis or replace valve may be necessary. Good dental hygiene needed to prevent gingival infection causing further blood borne infection and damage to valve. Prophylactic antibiotics given before dental procedure

Front 105

Rheumatic Heart Disease Prognosis

Back 105

Varies depending of damage to valve. Recurrence likely. Valve replacement give better outlook.

Front 106

Mitral Stenosis

Back 106

Hardening of the cusps of mitral valve that prevent a complete and normal opening for the passage of blood from left atrium to left ventricle

Front 107

Cardiogenic Shock

Back 107

Inadequate output of blood by the heart.

Front 108

Emboli Etiology

Back 108

Usually blood clots, can be air bubbles, fat globules, bacterial clumps, pieces of tissue, placenta. Most common is venous thrombosis (DVT).

Front 109

Emboli Treatment

Back 109

Depends on area. Pulmonary embolism, MI, CVA is aggressive and immediate also if arterial embolus in extremities to prevent death of tissue and gangrene. Blood flow reestablished by lowering limb, wrapping to keep warm and treating constricted vessel. Heparin used to deter further clot and antispasmodic for vascular spasms. Surgical intervention may be needed.

Front 110

Arteriosclerosis

Back 110

Hardening of arteries. 3 forms: Monckbergs (tunica media calcific sclerosis), atherosclerosis (fatty deposits tunica intima), arteriosclerosis (walls of arterioles thicken)

Front 111

Atherosclerosis

Back 111

Thickening and hardening of arteries. Plaques of cholesterol and lipids form in tunica intima

Front 112

Atherosclerosis Signs and Symptoms

Back 112

Responsible for most MI and cerebral infarction. Often asymptomatic. Can have angina pectoris, dizziness, elevated BP, shortness of breath.

Front 113

Atherosclerosis Etiology

Back 113

Hereditary, sedentary lifestyle, diet rich in lipids and cholesterol, cigarettes, diabetes, hypertension, obesity.

Front 114

Atherosclerosis Treatment

Back 114

Dietary changes, stop smoking, hypertension and diabetes controlled, hyperlipidemic (lovastatin) prescribed to inhibit cholesterol absorption

Front 115

Aneurysms

Back 115

Weakening and resulting dilation of walls of an artery

Front 116

Aneurysms Signs and Symptoms

Back 116

Abdominal aortic most common. Discovered when palpitating during routine check. As enlarges experience abdominal or back pain, pulsating mass observed from abdomen. If rupture experience hemorrhage shock. Rupture of cerebral aneurysm mimic CVA.

Front 117

Aneurysms Etiology

Back 117

Buildup of atherosclerotic plaque is common cause, can be from trauma, infection, inflammation, congenital tendencies.

Front 118

Cardiogenic Shock Signs and Symptoms

Back 118

Myocardium fails to pump effectively. Same symptoms as shock preceded by MI or severe heart failure, certain arrhythmias, or acute valve failure.

Front 119

Aneurysms Diagnosis

Back 119

Pulsation observed. Bruit heard on auscultation. Cerebral discovered when rupture.

Front 120

Aneurysms Treatment

Back 120

Surgical repair. Stents and grafts now option to prevent surgery.

Front 121

Phlebitis

Back 121

Inflammation of vein. Often lower leg.

Front 122

Phlebitis Signs and Symptoms

Back 122

Pain and tenderness. Swelling, redness, warmth noted followed by cordlike mass under skin.

Front 123

Phlebitis Etiology

Back 123

Uncertain. Could be obesity, blood disorder, injury, surgery.

Front 124

Phlebitis Treatment

Back 124

Analgesic given for pain.

Front 125

Thrombophlebitis

Back 125

Inflammation of vein with formation of thrombus on vessel wall.

Front 126

Thrombophlebitis Signs and Symptoms

Back 126

Interference of blood flow and resulting edema. Pain, swelling, heaviness, warmth in affected area, along with fever and chills. Tender to palpitations.

Front 127

Thrombophlebitis Etiology

Back 127

Venous stasis, blood disorders that cause hyper coagulated state, injury. Diagnosed by gross edema in one leg.

Front 128

Thrombophlebitis Treatment

Back 128

Affected part immobilized to prevent thrombus from spreading and dislodging becoming an embolus. Heparin administered to keep from enlarging, antibiotics to prevent infection.

Front 129

Cardiogenic Shock Etiology

Back 129

MI, severe heart failure, certain arrhythmias, valve failure.

Front 130

Varicose Veins

Back 130

Swollen, tortuous knotted veins. Usually lower leg.

Front 131

Varicose Veins Signs and Symptoms

Back 131

Develop gradually, feeling fatigue in legs, full ache, leg cramps at night, ankles swell. Veins thicken feel hard to touch. Pain worsens can have dull or stabbing quality.

Front 132

Varicose Veins Etiology

Back 132

No clear cause. Prolonged sitting or standing cause pressure on valves of superficial veins

Front 133

Varicose Veins Treatment

Back 133

Rest periods, lie down with feet higher than heart, engage in exercise, submerging legs in warm water, support stockings. Surgical intervention (vein ligation) to atrophy vein

Front 134

Thromboangiitis Obliterans (Buerger Disease)

Back 134

Inflammation of peripheral arteries and veins of extremities with clot formation

Front 135

Thromboangiitis Obliterans (Buerger Disease) Signs and Symptoms

Back 135

Pain in affected area. Usually leg or instep of foot aggravated by exercise, relieved by rest. If condition not resolved and circulation not restored area atrophy, ulcers, and gangrene can develop.

Front 136

Thromboangiitis Obliterans (Buerger Disease) Etiology

Back 136

Long term smoking. Inflammation and clot formation advance till vessel is obliterated and circulation compromised. Ischemic tissue dies, gangrene follows. Mostly males Jewish descent.

Front 137

Thromboangiitis Obliterans (Buerger Disease) Treatment

Back 137

Stop smoking. Reduce inflammation restore partial circulation. Exercise helps. Surgery to establish detours may be necessary. Amputation I’d gangrene. No cure for condition but stop smoking.

Front 138

Raynaud Disease

Back 138

Vasopatic condition of fingers, hands or feet. Cause pain, numbness, discoloration of areas.

Front 139

Raynaud Disease Signs and Symptoms

Back 139

Bilateral condition precipitated by cold causes blanching discoloration followed by blue as venous blood remains finally red or purple when circulation restored. Can be triggered by stress. More common in women. Is secondary to another disease called Raynaud Phenomenon. If severe digits may ulcerate becoming very painful. Prognosis usually good.

Front 140

Cardiogenic Shock Treatment

Back 140

Increase efficiency of myocardium and blood vessels. Improve blood supply to vital organs o2 demands of myocardial tissue reduced. Intraaortic balloon pump may be inserted. Prognosis varies but often favorable

Front 141

Raynaud Disease Etiology

Back 141

Small peripheral arteries and arterioles spasm and constrict compromising circulation. Spasms follow exposure to cold or stress. Resolve after application of warmth. Worsen by smoking.

Front 142

Raynaud Disease Treatment

Back 142

Application of warmth, stop smoking avoid cold and stress. Drug therapy to dilate vessels and increase circulation

Front 143

Cardiac Tamponade

Back 143

Compression of heart muscle and restriction of heart movement caused by blood or fluid trapped in pericardial sac. Aka cardiac compression

Front 144

Cardiac Tamponade Signs and Symptoms

Back 144

Coronary, epicardial, or pericardial vessels break and blood is trapped in pericardial sac. Severe dyspnea, rapidly falling BP, weak rapid pulse. Cyanotic above nipple line. Consciousness falls.

Front 145

Cardiac Tamponade Etiology

Back 145

Insult to integrity of a vessel in pericardium. Pressure of blood causes heart to beat inappropriately leading to cardiac arrest. Can be in certain cancer patients, hyperthyroidism, kidney failure, lupus.

Front 146

Cardiac Tamponade Treatment

Back 146

Insert needle into pericardial space withdrawing blood. Surgery needed to repair leak. Surgery has pos prognosis.

Front 147

Emboli

Back 147

Clots of aggregated material lodged in blood vessel and inhibit blood flow.

Front 148

Emboli Signs and Symptoms

Back 148

Depends on location of occluded vessel and magnitude of area of tissue severed by vessel. Severe pain, pale, numb, cold to touch, arterial pulse absent below occlusion if arterial. If large artery can have nausea, vomiting, fainting, eventually shock.

Front 149

Agranulocytosis (Neutropenia)

Back 149

Blood dyscrasia, leukocyte levels become extremely low.

Front 150

Acute Lymphocytic Leukemia (ALL) Signs and Symptoms

Back 150

Appear pale may report bone pain, weight loss, sore throat, fatigue, fever, night sweats, weakness. Increased bruising and bleeding. Leukemic cells infiltrate spleen, liver, lymph nodes, nervous system and interfere with their functioning. Can cause lymphadenopathy and splenomegaly. If CNS affected cause headache, blurred vision, nausea, vomiting, cranial nerve palsies. Mediastinal mass found in T cell ALL.

Front 151

Acute Lymphocytic Leukemia (ALL) Etiology

Back 151

20% of all leukemia’s. Most common for childhood leukemia. Cause unknown. Can be prolonged exposure to radiation, chemicals, drugs, smoking, viruses, genetic factors (chromosomal abnormalities)

Front 152

Acute Lymphocytic Leukemia (ALL) Treatment

Back 152

Chemo for 2-3 years in 3 phases: induction, consolidation, maintenance. Hematopoietic stem cell transplant is relapse. Better prognosis for children

Front 153

Chronic Lymphocytic Leukemia (CLL)

Back 153

Neoplasm that involves lymphocytes. Slow progressing. Accumulation of mature appearing but hypofunctional lymphocytes.

Front 154

Chronic Lymphocytic Leukemia (CLL) Signs and Symptoms

Back 154

Weight loss, fever, night sweats, extreme fatigue, splenomegaly, hepatomegaly, painless swelling of cervical, supraclavicular, or axillary lymph nodes. Susceptible to frequent viral and fungal infections.

Front 155

Chronic Lymphocytic Leukemia (CLL) Etiology

Back 155

Most common for adults. Often males. 1st degree relative with CLL increased chances.

Front 156

Chronic Lymphocytic Leukemia (CLL) Treatment

Back 156

Treatment withheld till patient is symptomatic. Chemo is typical treatment. Can use radiation therapy.

Front 157

Acute Myelogenous Leukemia (AML)

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Rapid progressive neoplasm of cells committed to the myeloid line of development. Leukemic cells accumulate in bone marrow, peripheral blood and other tissues.

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Acute Myelogenous Leukemia (AML) Signs and Symptoms

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Rapid accumulation of myeloblasts lead to pancytopenia result in symptoms of anemias, easy bleeding, bruising and increased risk of infection. Weight loss, fatigue, pallor common.

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Acute Myelogenous Leukemia (AML) Etiology

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Pos family history or previous aggressive chemo. Smoking, common in Japanese survivors of atomic bomb.

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Agranulocytosis (Neutropenia) Signs and Symptoms

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Rapid onset. Severe fatigue and weakness followed by sore throat, ulcerations on oral mucosa, dysphagia, elevated body temp, weak and rapid pulse and chills.

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Acute Myelogenous Leukemia (AML) Treatment

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Chemo

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Chronic Myelogenous Leukemia (CML)

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Slow progression. Excess of mature appearing but hypofunctional neutrophils.

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Chronic Myelogenous Leukemia (CML) Signs and Symptoms

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Triphasic course: chronic, accelerated, blast crisis. Most diagnosed in chronic phase with abnormal proliferation of WBCs. In accelerated phase neutrophil differentiation becomes impaired. Have bone pain, night sweats, fever. In blast crisis chromosomal abnormalities acquired if reach this stage 3 month avg survival.

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Chronic Myelogenous Leukemia (CML) Etiology

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Associated with abnormal chromosome 22, Philadelphia chromosome.

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Chronic Myelogenous Leukemia (CML) Treatment

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Only curable via hematopoietic stem cell transplant but only viable option for about 25% of patients. Can use TKI tyrosine kinase inhibitors to control disease but not cure. Complete remission defined as ablation of chromosome 22. 35% 5 year survival rate.

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Lymphedema

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Abnormal collection of lymph usually in extremities.

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Lymphedema Signs and Symptoms

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Swelling of extremity. No pain unless severe then pin and limited movement. Extremity becomes swollen and grossly distended.

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Ly

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Obstruction of lymph vessel may be inflammatory or mechanical. If untreated connective tissues lose elasticity and edema becomes permanent. Can be from infections, neoplasm, or thrombus. Tight clothing can cause temporary lymphedema. Mastectomy can cause.

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Lymphedema Treatment

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Aimed to reduce swelling. Limb elevated above heart to encourage drainage. Elastic bands or stockings applied to compress. Diuretics to reduce fluid. Surgical intervention if mechanical obstruction. Antibiotics if infection present.

Front 170

Lymphangitis

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Inflammation of lymph vessel.

Front 171

Agranulocytosis (Neutropenia) Etiology

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Caused by drug toxicity or hypersensitivity. Chemo, benzene can cause. Acute insult to immune system reduces body’s response to bacterial infections. Occurs more in females.

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Lymphangitis Signs and Symptoms

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Red streak at site of entry of infective organism. Redness extends to lymph node which is swollen and tender. Cellulitis can develop. Fever chills and malaise present.

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Lymphangitis Etiology

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Bacterial invasion into lymph vessel.

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Lymphangitis Treatment

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Systemic antibiotics. Affected area elevated and rested. Warm wet compress applied. Surgical drainage of purulent material indicated.

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Hodgkin Lymphoma

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Cancer of body’s lymphatic system. Tumors arise in tissues of lymph nodes and spread to other nodes, spleen, liver, bone marrow.

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Hodgkin Lymphoma Signs and Symptoms

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Painless enlargement of lymph nodes in neck or mediastinum, fatigue, pruritus. As progresses fever, night sweats, weight loss. Different from other lymphomas bc presence of Reed Sternberg cell (large cell w 2 or more mirror image nuclei)

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Hodgkin Lymphoma Etiology

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2 peaks: in 20s or over 50. History of previous malignancy, prior chemo or radiation, family history, immunosuppression, exposure to Epstein Barr virus.

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Hodgkin Lymphoma Treatment

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Chemoradiotherapy for stages 1-3. Chemo for stage 4. ABVD. HSCT if multiple relapse. One of the most treatable forms of cancer. 90% survival rate.

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Non-Hodgkin Lymphoma

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Describes a number of heterogeneous neoplasm of lymphoid cells.

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Non-Hodgkin Lymphoma Signs and Symptoms

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Painless lymphadenopathy, fatigue, pruritus, bone pain, GI symptoms. Tonsils and adenoids can be enlarged. Fever night sweats and weight loss.

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Non-Hodgkin Lymphoma Etiology

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Previous radiation treatment, family history, immunotherapy, chemo, HIV, HTLV, Epstein Barr virus, hepatitis C.

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Agranulocytosis (Neutropenia) Treatment

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Halt exposure to toxic drug or chemical. Can be fatal w/in a week if left untreated.

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Non-Hodgkin Lymphoma Treatment

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Chemo. Typically not curable.

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Transfusion Incompatibility Reaction

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Blood or blood product transfused has antibodies to recipients RBCs or recipient has antibodies to donors RBCs.

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Transfusion Incompatibility Reaction Signs and Symptoms

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Hemolysis or agglutination. Chills, fever, tachycardia, back pain, vomiting, diarrhea, hives, rash, dyspnea. Hypotensive, circulatory collapse. Renal failure.

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Transfusion Incompatibility Reaction Etiology

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ABO- and RH- incompatible blood produce hemolysis or agglutination.

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Transfusion Incompatibility Reaction Treatment

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Monitored closely first 15 minutes. First indication of symptoms transfusion stopped immediately. Mild rxns treated with antihistamine. anaphylaxis treated aggressively.

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Classic Hemophilia

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Hereditary bleeding disorders, deficiency of clotting factors.

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Classic Hemophilia Signs and Symptoms

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Prolonged bleeding, easy bruising, hemotomas, excessive nose bleeds. Males only. First sign may be ecchymosis at birth or bleeding at circumcision. Joint swelling and pain.

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Classic Hemophilia Etiology

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X linked genetic disorder. Factor 8 inactive.

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Classic Hemophilia Treatment

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No cure. Concentrated factor VIII administered. Life long blood transfusions. Can leave patient at higher risk for other diseases.

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Disseminated Intravascular Coagulation

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Simultaneous hemorrhage and thrombosis. Occurs secondary to other disease.

Front 193

Polycythemia

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Abnormal increase in hemoglobin, the RBC count, or hematocrit causing increase in RBC mass.

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Disseminated Intravascular Coagulation Signs and Symptoms

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Oozing of blood from needle puncture, mucous membranes, bleeding from purpura, wound hematomas, hematuria, bloody stools. Patient weak, headaches, air hunger, tachycardia. Follows trauma, burns, hypothermia, septicemia.

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Disseminated Intravascular Coagulation Etiology

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Thrombin activates fibrin causing clots where not needed. Thrombin causes platelet aggregation and further clotting. Fibrinolysis system activated due to presence of thrombin in plasma which cause additional bleeding.

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Disseminated Intravascular Coagulation Treatment

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IV heparin to inhibit formation of microthrombi and aggregation of platelets. Platelet replacement and plasma clotting factors administered. Often fatal.

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Polycythemia Signs and Symptoms

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Headache, dyspnea, irritability, mental sluggishness, dizziness, syncope, night sweats, weight loss. Circulatory stagnation, thrombus and increased blood viscosity may be noted. Splenomegaly and clubbing of fingers along with cyanosis.

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Polycythemia Etiology

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Unknown. Relative Polycythemia can result when plasma volume is reduced by dehydration, plasma loss, fluid and electrolyte imbalance, or burns. Reduced o2 cause increase in hemoglobin used often if live in high altitudes or have chronic pulmonary or cardiac disease.

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Polycythemia Treatment

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Periodic phlebotomy to reduce blood volume (lifelong). Myelosuppressive drugs and radiation improve blood count.

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Thrombocytopenia

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Idiopathic. Autoimmune. Reduced clotting capability.

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Acute Lymphocytic Leukemia (ALL)

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Overproduction of immature lymphoid cells in bone marrow and lymph nodes. 2types: B cell ALL or T cell ALL.