Pathopsyiology Musculo,cardio

Front 1

Arteriosclerosis

Back 1

 Abnormal thickening and hardening of arterial walls
 Narrowed lumen

Front 2

 Atherosclerosis

Back 2

 Most common form of arteriosclerosis
 Fat & fibrin on vessel walls
 → CAD, cerebrovascular disease
 Causes: inflammation*, smoking, HTN, DM, ↑ lipids, ↑ homocystine, autoimmune, infection (chlamydia, herpes viruses)

Front 3

 Ischemic events

Back 3

 Coronary heart disease, myocardial infarction, stroke
 Rx: treat ischemia, exercise, smoking cessation, control hypertension and DM, reducing LDL cholesterol
 Cholesterol <200, LDL <100, HDL >40
 Drugs to ↓ lipidemia

Front 4

Aneurysm

Back 4

 Local dilation or outpouching of a vessel wall or cardiac chamber
 Aorta very susceptible ¾ are abdominal
 Causes:
 Atherosclerosis, plaque erodes vessel wall

Front 5

types of aneurysms

Back 5

 True aneurysm involve all three layers
 Fusiform – saccular
 False aneurysm
 Only intima (inner) layer as in leak between vascular graft and artery
 Dissecting
 Wall of an artery dissects longitudinally
 Surgical emergency

Front 6

Aortic aneurysms

Back 6

 Often asymptomatic until rupture
 Risks: Age, atherosclerosis, HTN, tobacco, white race, family, males, Marfan’s syndrome, trauma
 Treatment
 Surgical – graft for greater than 5 cm
 Endovascular surgery

Front 7

Venous thromboembolism (Deep vein thrombosis)

Back 7

 Triad of Virchow
• Venous stasis, endothelial injury, hypercoagulability (Factor V Leiden, antithrombin III, Protein C or Protein S deficiencies)
 Risk factors: surgery (esp. hips & knees), immobility, cancer, pregnancy, postpartum, oral contraceptive, HRT
 S/S, Dx: unilateral leg swelling, pain,
 Dx: US, venous duplex
 Rx: anticoagulation, bedrest

Front 8

Thrombus

Back 8

 Blood clot that remains fixed to a vessel wall
 Detached thrombus = thromboembolus
 Tend to form at areas of inflammation
• Surgery, trauma, infection, plaque
 Veins – thrombophlebitis
 Valvular thrombi – endocarditis & RHD
 Rx: anticoagulants

Front 9

Embolus

Back 9

 Bolus of matter: thrombus, air, amniotic fluid, fat, bacteria, cancer cells
 Pulmonary embolus
 From venous circulation to lungs
 Systemic (arterial) embolus originates in L ♥ from MI, ♥ failure, endocarditis, dysrhythmias
 Causes ischemia, infarction, sepsis, stroke

Front 10

Varicose Veins

Back 10

Varicose Veins
 Blood pooling " distended, tortuous, palpable veins
• Trauma to saphenous vein / valvular damage
• Prolonged standing
Gravity and i muscle pump

Front 11

Raynaud disease

Back 11

characterized by attacks of vasospasm in the small arteries & arterioles of the fingers and less commonly in te toes, primary artery disease
 Raynaud’s (primary)
 Unknown origin
 Vasospastic attacks 2° to cold, emotions
 Raynaud’s (secondary)
 2° to systemic diseases
• Collagen vascular (scleroderma), lupus, and rheumatoid arthritis
 Vasospasm – mostly fingers
 Pallor, cyanosis, numbness, cold sensation followed by rubor, throbbing, paresthesias
 Rx: SSRI, vasodilators, reserpine, Ca++ channel blockers

Front 12

Superior vena cava syndrome

Back 12

 Compression of the SVC causing venous distention of the head and upper extremities
 Bronchogenic cancer (75%), lymphoma, metastases, pacemaker insertion, long-term CV catheter
 R mainstem bronchus abuts the SVC which is easily compressed by tumor, lymph node growth
 S/S: edema, fullness, tightness of collars, rings, HA, visual disturbances, respiratory distress, purple skin coloration
 Rx: diuretics, steroids, anticoagulants prn, stent placement

Front 13

Pericardial tamponade

Back 13

 Fluid in the pericardium creates enough pressure to cause cardiac compression
 S/S: * pulsus paradoxus – BP during expiration > BP during inspiration by >10mm Hg, muffled ♥ sounds, DOE, dull CP
 Causes: uremia with LV failure, ♥ surgery, radiation to chest
 Rx: pericardiocentesis

Front 14

Acute pericarditis

Back 14

 inflammation of the two layers of the thin, sac-like membrane that surrounds the heart
 Commonly caused by infection, uremia, neoplasm, surgery, trauma
 S/S: severe chest pain that worsens with respiratory movements or lying down
 Low grade fever, tachycardia, friction rub (sandpaper)
 Rx: treat cause

Front 15

Endocarditis

Back 15

 Heart valve vegetation which h risk of embolus
 Must have invasion of blood stream
 Staph aureus*, strep viridans
 Portal of entry
 Low host resistance, high virulence
 Risks: overt infection, IV drug abuse, surgical or dental procedure, mechanical heart valves, long term catheters, valvular disease, ♥ surgery
 “classic” findings: fever, murmur, petechiae
 Rx: IV to oral abx for 4 – 6 wks

Front 16

 Valvular stenosis

Back 16

 Blood can not flow forward, chamber “in front of” the valve has h workload

Front 17

 Valvular regurgitation (insufficiency)

Back 17

 Cusps fail to close completely, some blood leaks back
 Eventually " heart failure

Front 18

Anaphylactic shock

Back 18

 Widespread hypersensitivity
 Penicillin, latex & food allergies, venoms, pollens
 Alteration same as neurogenic, ↓ tissue perfusion
 Extensive immune & inflammatory response
 Bronchoconstriction, urticaria (hives), edema, hypotension
 Remove stimulus, epinephrine, steroids, volume

Front 19

Cardiogenic shock

Back 19

 ↓ CO & tissue hypoxia with adequate intravascular volume
 Dyspnea, tachycardia, hypotension, ↑ SVR, ↓ EF & tissue perfusion
 Heart failure – any kind
 Occurs with MI, ischemia, infection, drug toxicity
 Mortality of 70%

Front 20

Hypovolemic shock

Back 20

 Loss of blood/ fluid
 Hemorrhage, burns, diaphoresis, DM, DI, emesis, diuresis in large amounts
 S/S: ↓ BP, ↑ HR & SVR (compensatory), oliguria, poor skin turgor, thready pulse,
 ↓ mental status
 peripheral vasoconstriction
 R-A-A, ADH activation
 Rx: Fluid replacement

Front 21

Neurogenic shock

Back 21

 Vasogenic shock
 Vasodilation, ↑ parasympathetic or ↓ sympathetic stimulation
 * ↓ SVR, hypotension, bradycardia
 Loss of vascular tone, blood volume the same
 Causes: injury to spinal cord or medulla, depressive drugs, anesthesia

Front 22

Septic shock

Back 22

 Component of systemic inflammatory response syndrome (SIRS)
 Infection →bacteremia →sepsis →septic shock →multiple organ dysfunction (MODS)
 Endotoxins act as triggers for a cascade
 Vasopressors to support hypotension
 Acidosis, oliguria, change in mental status
 Low BP, low SVR, systemic edema, GI abnormality, ARDS
 Common in ICU, 40% mortality

Front 23

Multiple organ dysfunction syndrome (MODS)

Back 23

 50-90% mortality
 Sepsis, septic shock most common causes
 Dysfunction of two or more organ systems
 Risks: age > 65, organ dysfunction, bowel infarction, steroids, multiple blood transfusion, chronic disease, delayed resuscitation, severe tissue injury (more, p. 698)
 First organ to be affected: Lung – adult respiratory distress syndrome (ARDS)
 Renal, liver, GI, hematologic, cardiac, CNS

Front 24

Myocardial infarction: define, what causes the cardiac dysfunction? Which lab tests and diagnostics are performed..how is diagnosis made?

Back 24

 Necrosis following blood flow interruption. EKG changes with 30-60 sec of hypoxia
 Pain not relieved by nitrates, heavy, crushing, radiating
 “silent” in elderly and DM
 N/V, diaphoresis
 Dysrhythmias, heart failure

 Dx: EKG, serial enzymes, troponin
 “cardiac profile”
 Rx: thrombolytic therapy, heparin, percutaneous transluminal coronary intervention (PTCI)
 Sudden cardiac death related to
 Ischemia
 LV dysfunction

Front 25

Electrical instability

Back 25

 Myocardium has it’s own conduction system, concentrated at certain sites called nodes
 Heart can beat without nervous innervation (automaticity)
 SA node – pacemaker of the ♥ " AV node " Bundle of HIS" bundle branches " Purkinje fibers

Front 26

Rheumatic fever or heart disease

Back 26

 After upper respiratory infection with Group A beta-hemolytic streptococcus
 Untreated" RHD
 Also infects joints, skin, nervous system
 Children 5 – 15 yrs
 Genetic, *immune
 Destruction of MV & AV, atrial fibrillation
 High recurrence rate

Front 27

Acute Rheumatic fever
 Carditis

Back 27

 Valve dysfunction, murmur
 Pericardial effusion

Front 28

acute reumatic fever
 Polyarthritis

Back 28

 Acute, migratory, > than 1 joint

Front 29

acute rheumatic fever
 Chorea

Back 29

 St Vitus dance: aimless, involuntary movements

Front 30

acute rheumatic fever
 Erythema marginatum

Back 30

 Truncal rash, erythematous
 macules, transitory, h with heat

Front 31

Systolic, Primary, Secondary hypertension

Back 31

 Consistent elevation of BP often “silent”
 3rd leading cause of death
 Increases incidence MI, ♥ failure, stroke, kidney disease
 Risks include: genetics, nicotine, older age, obesity, heavy ETOH, gender (women>50), black race, h Na+, glucose intolerance
 From h in peripheral resistance, h blood volume or both
 Sustained pressure damages arterial walls, h inflammation

Front 32

 Primary (essential, idiopathic) HTN (92-95%)

Back 32

 Genetic, environmental factors
 Neural, hormonal i.e. sympathetic stim, R-A-A system, Na+ retention,
 Insulin resistance and endothelial dysfunction

Front 33

 Secondary HTN is caused by systemic diseases such as:

Back 33

 Renal disease
 Adrenal tumors
 Cortex – aldosterone
 Medulla – pheochromocytoma
 Drugs: BCP, steroids, antihistamines
 Can be reversed

Front 34

 Isolated systolic HTN

Back 34

 S >140, D < 90, * widening PP
 Rigidity of aorta, changes in A0 valve, age >65

Front 35

Congestive heart failure

Back 35

 Impaired ability of myocardial fibers to contract (systolic failure) or to relax (diastolic failure)
 Pressure reflected back into pulmonary circulation
 Rales, SOB
 Rx: diuretics, ACE inhibitors, β blockers, digoxin, daily weights

Front 36

Atrial fibrillation

Back 36

 No p waves, atrial rate 300 – 600 bpm
 Atria fibrillate or quiver
 Ventricular rate varies and is irregular– called ventricular response
 Rx: Cardioversion – timed electrical shock to the heart
 Drug therapy
 Digoxin, β blockers, CCB and others
 ANTICOAGULATION

 Causes
 Idiopathic  Thyroid disorders, valve disease, hypertension, sick sinus syndrome, pericarditis, lung disease, and congenital heart defects and others

Front 37

Cardiomyopathy

Back 37

 Affects the myocardium and leads to diminished cardiac performance
 Result of ischemic changes, HTN, infectious disease, toxins, connective tissue disease, nutritional deficiencies, metabolic disorders