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113 Cards in this Set

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  • Back

What is difference between Arteriosclerosis and Atherosclerosis?

Frequently the terms are used interchangeably, although atherosclerosis is the most common form of arteriosclerosis.

What is Arteriosclerosis?

group of diseases characterized by thickening /decreased elasticity of arterial wall.

What is Atherosclerosis?

MC type of arteriosclerosis, esp cardiac, carotid, cerebral, legs, kidney. Thickening of the arterial wall through atheroma formation - fibrous plaques within intima due to thickening of arterial wall by accumulation of lipids, macrophages, T-cells,ECM

What is the etiology of atherosclerosis?

Old age. Arterial lesions develop long before symptoms.

What are the five steps of lesion formation?

(1)Hypertension -- endothelial cell injury -- deposition of platelets and lipoproteins, (2)Proliferation of smooth mm cells, (3)Macrophages & sm. mm cells accumulate -- foam cells -- further damage, (4)of lipids in the vessel wall, (5)Hardening of arteries

What is atheromas?

Basic lesion of atherosclerosis. Characterized by excessive accumulation of lipids in the wall of aorta and major arteries. Central part – soft, lipids, cellular debris (porridge like). Surrounded by fibrous tissue (easily ruptured)

How does a rupture affect a thrombus?

initiates formation of blood clot -- thrombus

What happens when a big artery ruptures?

Big arteries (aorta) – not an immediate concern -- ultimately form into fibrous scars

What happens when a small artery ruptures?

Small arteries (coronary, cerebral) – complete occlusion of lumen -- infarction

What are 11 risk factors for atherosclerosis?

(1)Age, (2)Sex – more males than females until after menopause, (3)Heredity, (4)Lipid metabolism – elevated serum levels of cholesterol, lipoproteins and triglycerides, (5)Hyperlipidemia, (6)Familial – modify by diet (decrease unsaturated fatty acids), (7)Secondary – obesity, (8)Hypertension, (9)Clotting factors, (1)Cigarette smoking – not fully understood mechanism, (11)Behaviour – stress, activity level

What are four major localized forms of atherosclerosis?

(1)Atherosclerosis of the Aorta, (2)Peripheral Vascular Disease, (3)Coronary Heart Disease, (4)Cerebrovascular Disease

What are the eight steps of progression of atherosclerosis of the aorta?

(1)Mild – fatty streaks – small, raised fibrotic plaques, (2)Numerous atheromas form and occupy large surface areas, (3)Rupture of atheroma, (4)Formation of thrombi -- narrows lumen, (5)Calcification reduces aortic elasticity, (6)Rigid, calcified tube – internally covered with thrombi, (7)Hypertension develops – aorta can’t expand and narrow lumen, (8)Aneurysms form (Major danger = rupture)

How common is atherosclerosis of the aorta?

Almost everyone over 50 yrs old have some degree – especially men

What is an aneurysm?

abnormal stretching (dilation) in an artery wall (most common) or a vein or the actual heart with a diameter that is at least 50% greater than normal.

What are the two most common sites for an aneurysm?

(1)aortaforming a thoracic aneurysm, (2)abdominal aneurysm

What four factors increase the risk of aneurysm?

(1)Incidence increases with age (over 50), (2)Family members of anyone with an aneurysm have a four-fold increased risk of aneurysm, (3)More in men than in women, (4)½ of affected persons are hypertensive.

What is the pathogenesis of an aneurysm?

plaque formation -- weakened arterial wall & increased internal pressure -- bulging -- dissection or rupture

What are nine risk factors for an aneurysm?

(1)Atherosclerosis, (2)Trauma, (3)congenital or hereditary abnormalities of connective tissue (eg.Marfan’s synd - Congenital defect of the arterial wall), (4)inflammatory disease, (5)Infection, (6)Smoking, (7)Genetics, (8)Hypertension, (9)high cholesterol

What are three symptoms of an aneurysm?

(1)Persistent but vague substernal, back, neck, or jaw pain may occur as enlargement of the aneurysm impinges adjacent structures, (2)compression of adjacent tissues --pain, (3)Common sites: aortic arch, abdominal aorta (AAA),femoral a, popliteal a, cerebral

What is peripheral vascular disease?

Atherosclerosis of arteries that supply blood to the extremities and major abdominal organs. Affects: elderly, diabetics, hyperlipidemia, hypertension.

Which visceral arteries commonly have peripheral vascular disease with atherosclerosis of aorta?

Renal arteries

Describe peripheral vascular disease of the renal arteries.

Reduced renal function. Release of renin -- hypertension. Reduced excretion of urine agg. HTN -- damage of kidneys. Can lead to KD failure.

Describe peripheral vascular disease of the intestinal arteries.

Ischemia in small and large intestines. Progressive GI problems – constipation, poor digestion, intolerances, malabsorption.Acute occlusion --massive intestinal infarction (high mortality)

T/F: Peripheral vascular disease primarily affects the arms.

False, peripheral vascular disease primarily affects the legs.

Describe peripheral vascular disease in the extremities.

Chronic ischemia – due to progressive narrowing of the femoral or popliteal arteries. Inadequate blood supply at rest. Intermittent claudication – long distance walking/run -- cramping. Acute occlusion – smaller arteries - Gangrene

Describe a coronary heart disease.

Atherosclerosis of the coronary arteries. Leads to myocardial ischemia.

What are five factors that can influence the clinical features of coronary heart disease?

(1)Extent of occlusion, (2)How fast ischemia develops, (3)Extent of atherosclerosis in other coronary arteries, (4)Anatomical location of occlusion, (5)Presence of other issues –hypertension

What are two types of myocardial ischemia?

(1)Chronic progressive, (2)Sudden occlusion

Describe chronic progressive myocardial ischemia.

Not enough blood reaches the myocardium. Slowly causing pump failure. Asymptomatic or angina pectoris. Eventually leads to congestive heart failure

Describe sudden occlusion myocardial ischemia.

MI in anatomically defined area. Most common – anterior descending branch of the left coronary artery.

What are three clinical presentations of myocardial ischemia?

(1)angina pectoris, (2)myocardial infarction, (3)congestive heart failure - progressive ischemia

What is angina pectoris?

Episodic/temporary chest pain (or discomfort) which occurs when the cardiac workload exceeds the oxygen supply to the heart and ischemia occurs. The symptomatic expression of cardiac ischemia.

What are five symptoms of angina pectoris?

(1)transient pain or discomfort in the chest & possibly left arm, (2)usually described as mild to moderate in degree, (3)generally lasts 1-3 minutes, but can persist for up to 20min, (4)most types relieved by rest or nitroglycerin (vasodilator), (5)symptoms can have abnormal presentation in women

What are the three types of angina pectoris?

(1)Chronic Stable A. (aka Classic A.), (2)Unstable A. (aka Preinfarction A.), (3)Prinzmetal’s A. (aka vasospastic or variant a.)

Describe Chronic Stable A. angina pectoris.

Exertion pain, relieved by rest or nitro; Most Common type.

Describe Unstable A. (aka Preinfarction A.) angina pectoris.

Prolonged, recurrent pain at rest; = worsening ischemia. VERY CONCERNING

What is the etiology for angina pectoris?

Increased O2 heart demands; increased CO; decreased blood flow to the

What are two risk factors for angina pectoris?

(1)CAD accounts for 90% of angina, (2)Early mornings, strong emotions, physical exertion

What is a myocardial infarct?

Heart attack

What causes a myocardial infarction?

Caused by rapid, sudden occlusion of a coronary artery. Sudden death in 25% of all cases. Cardiac arrest = asystole

What are three potential results of a patient surviving a myocardial infarction?

(1)Signs of heart failure, (2)Cardiogenic shock, (3)Systemic major organ failure, a)Cerebral ischemia – longer than a few minutes causes irreversible damage b(Kidney’s most commonly damaged -- monitor urine output for KD failure

What is the pathogenesis of a myocardial infarction?

Ischemia -- necrosis (in the ‘zone of infarction’) -- fibrous scar tissue formation from fibroblasts [overall: approx. 6 weeks]. The remaining myocardial cells enlarge to compensate.

What are three longterm outcomes for survivors?

(1)Arrhythmias, (2)Congestive Heart Failure, (3)Recurrent infarcts

What are three symptoms of myocardial infarction in men.

(1)Prolonged crushing chest pain, (2)possibly w/ radiation (throat, neck, back, jaw, shoulder, arm), (3)Pain is constant lasting 30 min to several hours; m/b with pallor, s.o.b., sweating but cold

What are three symptoms of myocardial infarction in women.

(1)SOB in middle of night, (2)chronic unexplained fatigue, (3)also m/b continuous pain in mid t-spine, neck, or shoulders; heartburn

What is coronary heart disease?

Congestive heart failure. Hypoxia to muscle -- heart is unable to pump sufficient blood -- back pressure impedes venous blood to return to heart. Can be both sides of the heart, or predominantly right-sided or left-sided. CHF not itself a disease – more of a collection of symptoms caused by inadequate pump action.

What are seven risk factors for congestive heart failure?

(1)Stress, (2)Inactivity, (3)Obesity, (4)DM, (5)Nutritional deficiency (thiamine, vitamin c), (6)Pre-existing pulmonary dz, (7)Some medications (steroids, NSAIDS)

What is the etiology of right-sided congestive heart failure?

Left sided heart failure. Pulmonary disease (Cor pulmonale) – ex. Pulmonary embolism. Cor Pulmonale (hypertrophy of the right ventricle caused by a disorder of the lungs or of the pulmonary blood vessels). Causes congestion of the peripheral organs and extremities

What are two symptoms of right-sided congestive heart failure?

(1)Swollen legs (especially towards the end of the day, liver enlargement (with pain), (2)Also jugular venous distension

What is the etiology of left-sided congestive heart failure?

Failure of the Left Ventricle. HTN (in younger women). CAD (older pop’ns). MI. valvular disease. Congenital. Endocarditis. Causes Pulmonary Edema.

What are three symptoms of right-sided congestive heart failure?

(1)Dyspnea, (2)Spasmodic cough, (3)Fatigue w/ muscle weakness

What is the pathogenesis of congestive heart failure?

Structural changes in the heart muscle lead to weakening contractions, and inefficient pumping. Neurohormonal cascade of events that ultimately result in impaired heart function and circulatory congestion. Over long period of time – symptoms often very gradual because of this.

Compare right and left CHF.

Left: Respiratory, Fatigue, Weakness, Irritability/confusion/sleep problems

Right: Peripheral edema, Jugular vein distension, Abdominal distension/ascites, URQ pain (liver congestion); possible jaundice

What is cerebrovascular disease?

Caused by atherosclerosis of the arteries supplying the brain

What are two potential conditions that cerebrovascular disease can lead to?

(1)Transient Ischemic Attack (TIA), (2)Cerebrovascular Accident (Stroke)

What is a transient ischemic attack (TIA)?

Short term ischemia. No acute infarction (death) of tissues. Similar symptoms as stroke. Usually resolves within a few minutes to 24 hours.

What is a cerebrovascular accident (stroke)?

Rapid loss of brain function due to ischemia. Weakness of loss of function in one side of body.

What is hypertension?

Persistent elevation of systolic (>140mmHg), diastolic(>90mmHg) or both measured on at least 2 separate occasions at least 2 weeks apart.

What is blood pressure?

The force exerted against the walls of arteries and arterioles.

Systolic: pressure when the heart contracts

Diastolic: pressure when the heart is relaxed

What is the pathogenesis of hypertension?

BP is regulated by cardiac output (C.O.) and total peripheral resistance (TPR). Most common cause of increased BP is the narrowing of arterioles.

What two mechanisms control blood pressure?

(1)Autonomic regulation (SNS), (2)Renin-angiotensin system (kidneys)

Is blood pressure increased or decreased with hypertension?

increased blood pressure

Is blood pressure increased or decreased with hypotension?

decreased blood pressure

What is primary hypertension?

a.k.a. essential or idiopathic. 90-95% of all HTN

What is the etiology of primary hypertension.

idiopathic, but assoc w smoking, obesity, cholesterol, stress, alcohol. Also highly genetic – familial and racial (i.e. Black men have very high incidence of HTN)

What are the risk factors for primary hypertension?

modifiable (smoking, stress, alcohol intake, weight) vs. non-modifiable risk factors (age, family history, gender, ethnicity)

What is secondary hypertension?

5-10% of all HTN. From an identifiable cause

What is the etiology of secondary hypertension.

renal dz (renal parenchema or renal art. stenosis) -- stimulation of renin-angiotensin system which causes BP to increase. Endocrine problems (1degree aldosteronism as in Cushing’s dz, acromegaly, pheochromocytoma, hyperthyroidism). Coarctation of aorta.

What are the risk factors for secondary hypertension?

modifiable (smoking, stress, alcohol intake, weight) ) vs. non-modifiable risk factors (age, family history, gender, ethnicity)

What are 11 symptoms of hypertension?

(1)Mostly Asymptomatic, (2)HA (occipital, worse waking in a.m., better activity), (3)Vertigo, (4)flushed face, (5)spontaneous epistaxis (nosebleed), (6)blurred vision, (7)Dyspnea, (8)Orthopnea (shortness of breath while recumbant), (9)chest pain, (10)edema in legs, (11)Nausea/vomiting

What is cardiomegaly?

Enlargement of the heart – especially left ventricle (1.2cm to 2.5cm). Enlarged cells need more blood (Often die of ischemia, Replaced by fibrous tissue)

How does the heart pump with cardiomegaly?

Left ventricle pumps inefficiently. Increases pulmonary artery pressure. .Hypertrophy of right ventricle and failure (Cor pumonale)

Describe benign and malignant hypertension.

Benign hypertension – chronic, long term

Malignant hypertension – sudden onset

What is hypertension encephalopathy?

Vascular changes in brain that cause acute or chronic cerebral ischemia. Hypertensive stroke (aka. Stroke) – sudden rupture of artery -- hemorrhage

What is hypertensive retinopathy?

May impair vision and eventually cause blindness. Retinal arteries are easily seen by ophthalmologists. Often first sign of hypertension.

What is rheumatic fever?

systemic disease related to streptococcal infections

What is rheumatic heart disease?

Rheumatic fever affecting theHT. 15 million cases each year.

What is the etiology of rheumatic heart disease?

RF typically occurs 2 wks after strep throat. Antibodies against streptococcal antigens find similar antigensin human heart, joints, skin, brain. Cell-mediated immune response and cytotoxic T-cells involved as well

What is the pathology of rheumatic heart disease?

Affects all parts of the heart (endocarditis, myocarditis, pericarditis)

Describe endocarditis.

Left Endocardium -- valve destruction -- Incompetent valves (mitral and aortic) or stenosis

Stenosis: Mitral – stagnation of blood in the left atrium -- Left atrial , pulmonary and right ventricular hypertension. Aortic – impedes blood flow from left ventricle to aorta -- Left ventricular hypertrophy

Describe myocarditis.

Inflammation of myocardium

Dx: Aschoff bodies – May cause arrhythmias

Describe pericarditis.

Only in severe cases

What type of bacterial infection can cause endocarditis?

Staphylococcus or Streptococcus

How does a bacterial infection affect the heart valves?

Causes inflammation -- destroys portions of the valves causing deformities. Infected valvular vegetations form -- may become emboli.

What are clinical features of endocarditis?

Many murmurs – blood flowing over deformed valves. Valvular insufficiency.

What are the risks of endocarditis?

Damaged valves d/t RF or surgery, congenital valvular defects

What causes myocarditis?

Caused by viruses. Invade cardiac muscle cells -- damage organelles -- cell death. Invasion of T-lymphocytes also kills cells.

What are clinical features of myocarditis?

Vague. Fever, shortness of breath. Signs of heart failure: tachycardia, cyanosis, pulmonary edema

What is pericarditis?

Inflammation of pericardium and epicardium (aka. Visceral layer of pericardium). Often seen with open heart surgery. Associated with exudation of fluid into pericardial sac. Can lead to constrictive pericarditis which prevents diastolic dilation of the heart.

What causes pericarditis?

Bacteria or viruses

What are clinical features of pericarditis?

Sharp piercing chest pain, SOB, heart palpitations, fever, edema in legs

What is cardiomyopathy?

“ailment of the heart”. A group of diseases that affect the myocardium: Dilated, Hypertrophic, Restrictive. Incurable without heart transplant.

What is the cause of a dilated myocardium?

Caused by alcohol, viral myocarditis, chemo, or idiopathic

What is the cause of a hypertrophic myocardium?

Extensive thickening of left ventricular myocardium. Familial cause - autosomal dominant.

What is the cause of a restrictive myocardium?

Heart can not expand to fill. Amyloid infiltration.

What are the symptoms of cardiomyopathy?

Generally, the same symptoms as heart failure. Dilated: fatigue and weakness. Hypertrophic: asymptomatic - sudden death is usually first presentation (young, competitive athletes) – may be dyspnea. Restrictive: exercise intolerance, fatigue, SOB(manifestations of ’d CO)

What is a cardiac arrhythmia?

Disturbance of heart rate (SA-“pacemaker” node) or rhythm due to conduction problem. Normal heart rate: 60 – 100 bpm. Classified according to origin (atrial or ventricular), pattern (fibrillation or flutter), and speed (tachycardia (fast) or bradychardia (slow)).

What is the etiology of a cardiac arrhythmia?

Congenital. HTN w/ hypertrophy. MI. Valvular disease. Degeneration of conduction tissue (“sick sinus dz”). Often seen with CHF.

What are six risk factors for a cardia arrhythmia?

(1)Excessive alcohol intake/ binge drinking, (2)Obesity (high BMI), (3)Age, (4)Pre-existing heart dz, (5)Drugs – caffeine, decongestants, (6)hyperthyroid

What are six types of dysrhythmia?

(1)Ectopic beats, (2)Tachycardia, (3)Bradycardia, (4)Atrial fibrillation, (5)Ventricular fibrillation, (6)Heart block

What are ectopic beats?

Disturbance in cardiac rhythm in which beats arise from fibers outside the SA node. (Extra beat)

What is tachycardia?

Increased heart rate at rest (>100bpm)

What is bradycardia?

Decreased decreased HR at rest (<60bpm). Causes: beta-blockers, brain injury, tumour, vagal response.

What is atrial fibrillation?

Rapid, involuntary, irregular contractions of the atria

What is ventricular fibrillation?

Rapid, involuntary, irregular contractions of the ventricles – can be fatal

What is heart block?

SA node misfire or not transmitted through conduction system

What is a sinus arrhythmia?

Refers to a normal variation in the heart rhythm caused by respiration (inhale faster/exhale slower). Not a true arrythymia – actually a sign of a healthy well functioning heart.

What are three examples of heart valve mechanical disorders?

(1)Stenosis, (2)Insufficiency / regurgitation, (3)Prolapse

What is a stenosis?

narrowing /constriction of valve due to scars or leaflet deposits with increased load on previous chamber

What is valve insufficiency / regurgitation?

Valve fails to close properly, decreased cardiac output

What is a valve prolapse?

Mitral valve leaflets bulge back into atrium

How do these mechanical defects affect cardia workload.

These disorders increase cardiac workload -- initially asymptomatic tachycardia -- dyspnea -- cardiac failure. Can exacerbate other cardiac pathologies.

What are nine clinical features of heart valve disorders?

Symptoms will depend on the type of pathology and which valve is affected an include: (1)dyspnea with exercise, (2)fatigue, (3)right ventricular failure, (4)left ventricular hypertrophy, (5)murmur, (6)angina, (7)sudden death, (8)wide pulse pressure, (9)can also be asymptomatic