Concepts of Patho Exam 2

What tests/methods can be used to diagnose and investigate cardiovascular abnormalities

blood pressure measurement using sphygmamometer, electrocardiography, echocardiography, cardiac stress testing, measuring biomarkers of the heart, coronary angiography

hypertension grade 1

130-139,

hypertension grade 2

greater than or equal to 140, greater than or equal to 90

S1 sound caused by

closure of the atrioventricular valves

S2 sound caused by

closure of the aortic and pulmonary valves

S3 extra sounds indicative of

heart failure or volume overload

S4 extra sounds indicative of

failing or hypertrophic left ventricle, aortic stenosis

what are murmurs and what causes them

produced as a result of turbulent blood flow, usually heard as whooshing sound; could indicate stenosis or regurgitation

what is a EKG

electrodiagnostic test that records the electrical impulses that stimulate the heart to contract

EKG is used to evaluate what

arrhythmia (most common use), MI, conduction defects, hypertrophy, pericardial disease, electrolyte abornmalities and pulmonary disease

T or F: EKG may be normal even in the presence of heart disease

T: if the disorder does not affect the electrical activity of the heart

12-lead EKG provides comprehensive view of what

the flow of the heart's electrical currents

what is an elevated ST segment diagnostic of

MI

What is echocardiography used to evaluate

heart wall motion and abnormalities (infection, cardiomyopathy, and aneurysm) Valvular disease (stenosis, regurgitation, mitral valve prolapse) & the identity and quantity of pericardial fluid

what is cardiac stress testing

non-invasive test that provides information about the patient's cardiac function; EKG heart rate and blood pressure are monitored; goal is to increase heart rate to 80-90% maximum level; maximum rate is 220 minus patient age

when is a stress test used

to evaluate chest pain in a patient with suspected but not apparent coronary disease

what methods are used to stress the heart

exercise (most common) ie: treadmill, bicycle; chemical (safer and more accurate) ie: adenosine (vasodilator), dipyridamole (vasodilator), dobutamine (stimulates heart muscle) pacing used in patients with permanent pacemaker

what is the principle of stress testing

stress testing is based on the principle that occluded arteries will be unable to meet the heart's increased demand for blood during the testing

in association with stress testing, how else can the stressed heart be evaluated

cardiac nuclear scanning

what are the cardiac biomarkers

troponin, creatine kinase MB (CK-MB), myoglobin, and lactate dehydrogenase (LDH)

what are troponins

troponin T and I have a high specificity for myocardial cell injury; not useful in evaluating reinfarction bc levels could be elevated from the 1st event

what is creatine kinase (CK) test used for

test is used to support the diagnosis of MI, and can also indicate neurologic skeletal muscle disease; CK-MB is specific for myocardial cells

what does high CK-MB levels suggest

suggestion that significant infarction has already occurred

what is myoglobin

oxygen binding protein found in cardiac and skeletal muscles; more sensitive but not as specific as CK-MB

what is lactate dehydrogenase (LDH)

LDH-1 comes from the heart, elevated levels may indicate myocardial injury

when is cardiac catheterization (coronary angiography) used

is most often used to evaluate chest pain; it is used to visualize the heart chambers, arteries and great vessels; used to locate coronary occlusion, severity of valvular or septal defects; visualization is achieved with injected radioactive dye

what does CT angiography of the heart provide information about

provides information about the latency (openness) of heart vessels in patients with chest pain; it is non-invasive and can evaluate chest pain

what is an Agatson calcium score and what instrument is used to obtain it

a multidetector CT (MDCT) which produces fast and accurate images of the heart and coronary vessels can detect the extent of calcification in correlation with the progression of plaque

what does an Agatson score \>400 indicate

increased occurrence of coronary procedures (bypass, stent placement, angioplasty)

what blood tests are used to assess the risk for coronary vascular disease

total cholesterol, HDL, LDL, triglycerides, and Apolipoprotein B, Fibrinogen and C reactive protein (marker of systemic inflammation)

HDL

good cholesterol, it is an independent inverse risk factor for CAD

LDL

bad cholesterol, is associated with increased risk of atherosclerotic heart and peripeheral vascular disease

how many subclasses of LDL are there

7 difference subclasses based on size; chemical kits are available for accurate quantification of lipoproteins

what is normal range of total cholesterol

less than 200

what is normal HDL in male and female

male greater than 45 female greater than 55

what is normal LDL

less than 130

normal VLDL

7-32

normal triglycerides in male and female

40-160 in male, 35-135 in female

what is VLDL

is it the main carrier of triglycerides, associated with increased risk of CAD bc it can be converted to LDL in the muscle

what is thrombosis

formation of a blood clot inside a blood vessel; can occur in veins and arteries

what are the causes of thrombosis

vessel wall injury, stasis and hypercoagulabiloty; thrombosis is the main cause of heart attacks and strokes

what is involved in coagulation

plasma coagulation factors (proteins) and blood platelets result in the formation of fibrin clot at the site of injury;

what is fibrinolysis

fibrin is degraded after stemming blood loss

describe normal hemostasis

a balance between coagulation and fibrinolysis

describe a hypo coagulable state

it is pro-hemorrhagic: there is more coagulation than fibrinolysis

describe a hyper coagulable state

it is a prothrombotic state: there is more fibrinolysis compares to coagulation

what is thrombophilia

hyper coagulability; abnormality of blood coagulation that increases the risk of thrombosis; can be congenital or acquired

what regulates thrombin generation

anti-thrombin, protein c & s

what is plasmin

breaks down fibrin into fragments (FDP) including D dimer

what is D dimer

fibrin degradation product, it remains stable in the blood, normal plasma does not have detectable amounts

what does elevated D dimer indicate

useful indicator for thrombosis like DVT and PE

what does a negative D dimer rule out

thromboembolism

what is factor V Leiden

congenital thrombophilia: causes resistance to activated protein C; this mutated FV does not respond to protein C anticoagulant system

what is prothrombin G20210A mutation

congenital thrombophilia: this mutation causes production of excess prothrombin

what are some causes of acquired thrombophilia

cancer, sickle cell anemia, heparin antibodies and antiphospolipid antibodies

risk factors for hyper coagulable state

familial history of blood clotting, abnormal blood clotting at age

what lab tests are used to test hypercoagulability

prothrombin time, activated partial thromboplastin time (APTT or PTT), fibrinogen level, CBC, molecular markers of blood coagulation activation, antithrombin activity, protein C activity, protein S activity

what genetic tests are used to determine hypercoagulability

factor V-Leiden, prothrombin G20210A

what is PT and PTT measuring

measuring how fast the body is clotting

what are the acquired autoimmune antibodies that cause clotting

anti-cardiolipin antibodies, anti-beta2 glycoprotein 1 antibodies, and lupus anticoagulant

how to diagnose thrombocytopenia

low platelet count (

how to diagnose hemophilia A and B

factor assay showing deficiency of coagulation factor; blood takes a longer time to clot bc absent clotting factor

what is vascular purpura

the vessel is too fragile, and they burst and tear which cause petechiae on the skin (small red dots) it is tested with a tourniquet

what is Von Willebrand disease

coagulation factor VIII normally circulates in the blood bound to Von Willebrand factor, it is necessary for normal adherence of platelets to damaged vessel wall

what are the 2 categories of respiratory disease origin

circulation and ventilation

what is the first step in making a diagnosis

a detailed clinical history

when are microbiological tests required

they are required for the diagnosis of infectious disease caused by bacteria, fungi or parasites

when are serological tests used

they are used to confirm particular infections by detecting the antibody of a certain organism

when are histological examinations done

they are done through biopsy, and are central for the diagnosis of many malignant and benign respiratory disease including infections; mainly done for cancer

what are cytological examinations done for respiratory system

examine sputum and bronchoalveolar lavage fluid

what is obstructive disease

manifested by increased resistance to airflow

what is restrictive disease

result from decreased lung expansion

Pulmonary function tests (PFTs) are used to determine

diagnosis, assessment of severity, and monitoring of treatment and ev; aluation of prognosis

what are the 3 categories of PFTs

spirometers (take maximum breath and blow into a device), measurement of airflow rates and calculating lung volumes and capacities; when requested gas diffusion and inhalation tests

what does an added time element to spirometry do

it can measure a rate

spirometry can distinguish between

restrictive and obstructive disease

if airflow rate from spirometer is less than

a re-test will be done with a bronchodilator because the problem can be obstructive, especially if the results improve after a bronchodilator

what is the normal result of a spirometer test

\>80%

FEV1/FVC

FVC \= forced vital capacity
FEV1 \= forced expiratory volume in 1 second
this ratio is less in obstructive disease

MMEF

maximal mid-expiratory air flow through the pulmonary tree during forced expiration
mmef is lower in obstructive but normal in restrictive

MVV

maximal volume ventilation, maximal rate of air a patient can breathe in and out during one minute; reduced in both restrictive and obstructive disease

PFT measures parameters that can be used to

calculate other parameter by using them in a calculation

gas exchange studies measure

the diffusing capacity of oxygen from the alveoli to the capillaries

when is gas exchange is abnormal

CHF, pneumonia, diseases that fill the alveoli with fluid or exudate, interstitial lung diseases (acute respiratory distress syndrome)

in interstitial lung disease

lung volumes and capacities are reduced

examples of interstitial lung diseases

pulmonary fibrosis, sarcoidosis, acute respiratory distress syndrome

asthma, emphysema, and chronic bronchitis PFR results display

reduced airflow rates

airway infection (acute bronchitis) PFR results display

abnormal airflow rates due to temporary obstruction

pneumonia PFR results display

reduced lung volumes but normal airflow rates

neuromuscular disease PFR results display

reduced lung volumes and capacities

inhalant pneumonitis PFR results display

reduced lung volumes and capacities, impaired diffusion capacity but normal airflow rates

normal oxygen tension or pressure is (PaO2)

80-100 mmHg

normal carbon dioxide pressure is (PaCO2)

35-45mmHg

hypoxemia

low oxygen IN THE BLOOD; hypoxia is low oxygen that could be anywhere

Arterial blood gas analysis (ABGs)

determine PaO2 and PaCO2

ABG measurement allows the diagnosis of

hypoxemia

PaO2 measure O2 content of blood, where is the O2 measured from

O2 dissolved in the plasma

PaO2 is decreased in patients who

venous blood mixes prematurely with arterial blood (congenital heart defects) and patients who are under ventilated (collapsed lung, atelectasis)

where is hormone measured

in the serum 99% time via immunoassay - chemiluminescent enzyme immunoassay

What does total T4 measure

it measures protein-bound T4 + free T4 hormone