"Cardio System 2"

What is coronary artery disease (CAD)?

Conditions that narrow or block the arteries of the heart

What occurs in subendocardial injury?

-ST depression

-Necrosis of the innermost part of the myocardium

What occurs in a Transmural (Epicardial) Injury?

-ST elevation

-Whole wall of myocardium is affected

What are risks factors for CAD?

-Dyslipidemia (accumulation of plaque)

-Hypertension (damage to endothelium)

-Smoking (vasospasms and vasoconstriction)

-Diabetes mellitus (glucose causes damage to cell wall)

-Obesity

-Sedentary lifestyle

How do you diagnose CAD?

-Ischemia along with dyspnea

-MI

-Resting EKG is abnormal

How do you treat CAD?

-Control/reduce risk factors

-Coronary artery bypass

-Catheterization (PTCA)

-Drugs

Can an angioplasty or bypass cure CAD?

No, it cannot be cured

What are statins?

They are drugs which lower the amount of 'bad' cholestrol in blood.

What is angina?

chest pain caused by reduced blood flow to the heart

What is Prinzmental's Angina?

Vasospasms of coronary vessles without underlying atherosclerosis

What is Stable Angina?

Excerise induced chest pain relieved by rest or nitroglycerin

What is nitroglycerin used for?

its a vasodilator that restores myocardial perfusion

What is Unstable Angina?

Chest pain that occurs at rest due to complicated plaque. Infarction may follow

What is a myocardial infarction?

heart attack, death of heart tissue (necrosis) in the myocardium due to prolonged ischemia

What are two types of MI's?

STEMI and non-STEMI

What is a STEMI?

ST elevation MI

What is a non-STEMI?

non ST elevated MI

What makes up a thrombus?

Platelets + Fibrin

What are stable plaques?

- thick fibrous caps that partially block vessels

- do NOT tend to form clots or emboli

What are unstable plaques?

- have thin fibrous caps that may completely block the artery

- plaque can rupture and cause a clot to form

- clot may end up in the heart or brain

What triggers acute coronary syndromes?

-rapid rise in BP

-increased workload on the heart

-activation of blood clotting mechanisms

What are some causes of acute coronary syndromes?

-Atherosclerosis occlusion

-Dysrhythmias

-Embolus

-Thrombosis

-Prolonged vasospasms

How long does ischemia have to be to cause cell death?

>20 minutes

Scar tissue:

replaces muscle, so it does not contract or conduct impulses

What are clinical manifestations of an MI?

-Sudden onset of pain

-Referred pain

-Tight, crushing feeling

-Lasting 15-20 minutes

-no relieved by NTG or rest

-tachycardia, tachypnea, dyspnea

-Sweat

-Anxiety-impending doom

-Nausea

Who presents atypical signs of an MI?

-elderly

-women

-diabetics

What does ischemia look like on an EKG?

inverted T wave and ST depression

What does an MI look like on an EKG?

ST elevation

What does a past silent MI look like on an EKG?

formation of Q waves

What are the 3 main cardiac biomarkers?

CK-MB

Troponin I

Troponin T

Why is myoglobin not the best indicator of an MI?

Because it could be elevated by other reasons such as exercise

How do you diagnose and MI?

-Cardiac biomarkers in the blood

-EKG

-Check potassium

-CBC to rule out infection or anemia

-CXR

-ECHO

-Stress test

What is the treatment for an MI?

-Oxygen FIRST

-Antianginals

-Antiplatelets

-Analgesics

-Thrombolytics

-Antiarrythmics

What are Antianginals?

nitrates that vasodilate coronary arteries to allow more O2 to get to the tissues

Aspirin is an:

Antiplatelet

The heart wall can have disorders in:

the Pericardium, Myocardium, and Endocardium

The pericardium:

surrounds the heart

THe myocardium:

muscular, middle layer of the heart

The endocardium:

inner lining of the heart

What occurs in acute pericarditis?

-pericardial membrane becomes inflamed and roughened

-90% are caused by viruses

What are symptoms of pericarditis?

-Sharp chest pain that worsens when breathing and lying down

-Referred back pain

-Dysphagia (pain when swallowing)

What are the clinical manifestations of acute pericarditis?

-low grade fever

-sinus tachycardia

-friction rub (sounds like grating)

What are complication signs of acute pericarditis?

-hypotension

-Pulsus paradoxus

What is pulsus paradoxus?

Abnormal drop in blood pressure when taking a deep breath.

>20 mmHg

What is a treatment for acute pericarditis?

NSAIDs

What is pericardial effusion?

accumulation of fluid in the pericardial cavity

-blood

-serous

-serosanguineous (part blood and serous)

What is cardiac tamponade?

compression of the heart by an accumulation of fluid in the pericardial sac

What are manifestations of cardiac tamponade?

-muffled heart sounds

-low arterial BP

-distended neck veins

(BECK's triad)

What is Beck's triad?

hypotension, muffled heart sounds, JVD

What are cardiomyopathies?

disorders of the myocardium

What causes cardiomyopathies?

-ischemic remodeling

-infection

-toxins

-nutrition deficiency

What is dilated cardiomyopathy?

virus attacking, causes big floppy heart that cannot pump properly; leads to impaired systolic function and reduced ejection

What is hypertrophic cardiomyopathy?

A congenital heart defect involving a thickening of the myocardium. Obstructs left ventricle outflow

What is restrictive cardiomyopathy?

The heart becomes stiff and can't pump properly, becomes rigid

What is stenosis?

Narrowing of valve opening, causing valve to not open all the way. Harder to force blood thorugh

What is regurgitation?

the valve does not close properly and blood backflows through the valve

What occurs in mitral valve stenosis?

Valve does not open all the way and LA does not empty properly

What occurs in mitral valve regurgitation?

backwards flow from LV into the LA

What occurs in aortic valve stenosis?

Blood will accumulate in the LV because the aortic valve cannot open

What occurs in aortic valve regurgitation?

Blood pumped into aorta will backflow into the LV

What is mitral valve prolapse?

Ballooning of mitral valve into left atrium during systole

Mitral valve prolapse is:

-common

-congenital

-occurs in young women

-asymptomatic

Symptomatic MVP can cause:

-palpitations

-tachycardia

-syncope

-light-headedess

-fatigue

What is infective endocarditis?

infection of the endocardium, usually secondary to bacterial or other infectious causes.

Who is at risk for infective endocarditis?

IV drug users (dirty needles)

Valvular heart disease patients

How is infective endocarditis treated?

antibiotics

rheumatic fever

inflammatory disease that involves the heart, joints, skin, and brain and damagaes the valves.

What rheumatic heart disease?

Occurs when rheumatic fever damages the heart valves.

What is rheumatic heart disease caused by?

group A streptococcal throat infection (IF LEFT UNTREATED)

Rheumatic Heart Disease Symptoms

• headache

• sore throat

• fever

• swollen lymph nodes

rheumatic heart disease treatment

antibiotics