UCF nur3125 pathophysiology - exam 2

cardiac, acid base, and pulmonary

pericarditis (manifestations)

inflammation of the pericardium
Manifestations:
- pericardial friction rub, flu like symptoms, sudden sharp chest pain (worsens on deep breath and when lying down; lessens when sitting up and leaning forward), dyspnea, tachycardia

cardiac tamponade (manifestations)

acute and life-threatening complication of pericarditis. cardiac compression from excessive fluid accumulation
manifestations:

• muffled heart sounds - caused by excess fluid

• falling arterial pressures and rising venous pressures - caused by inhibited blood flow due to excess pressure

infective endocarditis (cause, manifestations, risk factors)

infection of endocardium causing vegetation on internal structures and valves (caused by staphylococcus and streptococcus)

Risk factors:

• IV drug use

• congenital heart defects

Manifestations:

• new or worsening heart murmur - caused by vegetation of heart valves

• flu-like symptoms - caused by infection

• osler’s nodes - tender and painful red spots on fingertips and toes

• janeway leasions - painless spots on palms and soles

• splinter hemorrhages in nail beds

janeway lesions vs osler nodes

janeway lesions

• painless

• palms and soles

osler nodes

• tender and painful

• fingertips and toes

valve disorders (two types, manifestations)

stenosis and regurgitation

manifestations

• heart murmurs

• lead to:

  • decreased cardiac output

  • increased cardiac workload

  • hypertrophy of heart muscle

cardiomyopathy (3 types)

conditions that weaken and enlarge the myocardium

3 types

• dilated

• hypertrophic

• restrictive

cardiomyopathy - dilated (cause, manifestation)

most common type; affects systolic heart function

cause:

• idiopathic

manifestations:

• emboli

• left-sided heart failure (think systemic circulation affects systolic heart function)

cardiomyopathy - hypertrophic (cause, manifestation)

affects systolic and diastolic heart function

cause:

• congenital

manifestations:

• left and right sided heart failure - think of how it affects systolic and diastolic

• sudden death

  • most common cause of sudden death in young people, primarily athletes

cardiomyopathy - restrictive (cause, manifestations)

least common; affects diastolic heart function

cause:

• idiopathic

• radiation to chest

manifestations:

• emboli

• right-sided heart failure - remember that right sided = diastolic

Left Sided Heart Failure (causes, manifestations)

heart failure: inadequate pumping to meet body’s needs; leads to decreased cardiac output, increased preload and afterload, decreased contractility and stroke volume

Left Sided:

• Blood backs up into pulmonary circulation due to ineffectiveness of left ventricle

• Causes:

  • infarction of left ventricle - increases inadequacy of left ventricle

  • aortic valve stenosis - reduces adequacy of heart pumping

  • hypertension - overworks left ventricle

  • hyperthyroidism - overactivity

• manifestations:

  • activity intolerance - due to pulmonary issues

  • pulmonary congestion

  • orthopnea (shortness of breath when lying flat)

  • cough - due to fluid

  • shortness of breath

  • paroxysmal nocturnal dyspnea

    • sudden shortness of breath and coughing that awakens person from sleep

  • hemoptysis - bloody sputum (due to blood in lungs that is able to be coughed up)

  • rales - due to fluid

Right Sided Heart Failure (causes, manifestations)

heart failure: inadequate pumping to meet body’s needs; leads to decreased cardiac output, increased preload and afterload, decreased contractility and stroke volume

Right Sided:

• causes:

  • infarction of right ventricle - reduces right ventricle ability to push blood into pulmonary circulation

  • pulmonary valve stenosis - inhibits entry into lungs

  • pulmonary disease - inhibits entry into lungs

• manifestations

  • dependent edema in feet (dependent edema = edema that is pulled down by gravity to lowest point)

  • weight gain

  • ascites

  • JVD

  • headache

  • flushed face

  • hepatomegaly - portal system connection

  • splenomegaly - portal system connection

peripheral arterial disease (manifestations)

impaired blood flow in arteries

manifestations:

• intermittent claudication (charlie horse)

• skin of extremities shiny with hair loss (no blood supplying the outer tissues)

• cool extremities (poor blood flow)

• numbness and tingling of toes

• poor pulses

peripheral venous disease (manifestations)

interferes with adequate return of venous blood flow from legs

manifestations:

• edema

• stasis dermatitis (bruise-like discoloration of the skin)

• stasis ulcers on the ankles

atherosclerosis (risk factors, complications, manifestations)

chronic inflammatory disease characterized by thickening and hardening of arterial wall

risk factors:

• dyslipidemia (abnormally high lipids)

• DM

• HTN

• stress

• tobacco use

complications:

• PVD

• CAD

• thrombus

• stroke

Manifestations:

• asymptomatic until complications occur

Raynaud’s disease (causes, manifestations)

vasospasm of arteries of upper and lower extremities (usually hands)

causes:

• autoimmune, overreaction of SNS, more common in women

manifestations:

• cold

• pallor and pain in extremities

• skin color changes from WHITE to BLUE to RED

  • blood leaves skin (white), then goes without it for a while (blue), and then blood rushes back (red)

coronary artery disease (risk factors, causes, manifestations)

atherosclerotic changes of the coronary arteries impairing myocardial tissue perfusion (ischemia) and reducing oxygen to cardiac muscle

risk factors:

• same as atherosclerosis (dyslipidemia, DM, HTN, stress, tobacco)

causes:

• atherosclerosis

• vasospasms

• thrombus

• cardiomyopathy

manifestations:

• angina (chest pain)

• indigestion-like sensation

• N, V (nausea, vomiting)

• cool clammy extremities

• diaphoresis (excessive sweating)

angina (3 types)

intermittent chest pain caused by reduction in oxygen to the heart muscle which results from myocardial ischemia

• rather specific occurrence, not just chest pain

types:

• stable - goes away with demand reduction

• unstable - increased intensity or frequency, does not go away from demand reduction

• Prinzmetal’s/Variant - vasospastic

Thromboembolism (cause, manifestations)

Thrombus - stationary blood clot

Embolus - mobile blood clot (thrombus on the move)

Cause:

• Virchow’s triad - endothelial injury, sluggish blood flow, increased coagulopathy

  • all of these increase clotting factors

manifestations:

• arterial:

  • weak/absent pulse

  • cool cyanotic extremity

  • no edema present

• venous

  • pulse still present

  • red and warm (blood flow remains normal)

  • edema

Myocardial infarction (risk factors, manifestations, treatment)

coronary artery blood flow is blocked due to atherosclerosis, thrombus, or vasospasms, leads to ischemia, hypoxia, then death of myocardium; irreversible (“heart attack”)

risk factors:

• same as atherosclerosis (DM, HTN, stress, tobacco use, dyslipidemia)

silent MI

• DM:

  • Silent MI = seen in diabetes mellitus because of neuropathy

    • silent MI is MI with no manifestations

Manifestations:

• angina

• N/V

• shortness of breath

• diaphoresis

• indigestion

• ST elevation (ekg reading)

• CK-MB and troponin elevation (lab readings)

Treatment:

• goal is reperfusion of heart muscle

• varies depending on timing of treatment and cause

Hypertension (types, manifestations, complications)

prolonged BP elevation, excessive cardiac workload due to increased afterload and vasoconstriction

Types:

• primary HTN

  • most common

  • insidious onset

  • idiopathic

• secondary HTN

  • more sudden and severe

  • identifiable causes

manifestations:

• silent killer

  • often no symptoms

  • when symptomatic:

    • fatigue

    • headache

    • malaise

    • dizziness

complications:

• atherosclerosis

• aneurysms

• HF

• stroke

• renal damage

• vision loss

• hypertensive crisis

shock (stages, types, manifestations)

Stages:

• compensatory:

  • sympathetic nervous system and renin-angiotensin-aldosterone system are activated

• progressive:

  • compensatory mechanisms fail

  • tissues become hypoxic and cells switch to anaerobic metabolism

  • lactic acid builds up and metabolic acidosis develops

• irreversible:

  • organ damage occurs

types:

• distributive

• cardiogenic

• hypovolemic

manifestations: (vary depending on type)

• restlessness and irritability

• hypotension

• tachypnea progressing to Cheyne-Stokes respirations

• cool and pale skin

• cyanosis

• decreased urine output

• exclusive to hypovolemic:

  • initial thirst

  • tachycardia

shock (distributive)

massive vasodilation so blood isn’t getting to the heart

caused by:

• neurogenic shock - spinal cord injury

• septic shock - massive infection

• anaphylactic shock - severe allergic reaction

shock (cardiogenic)

left ventricle can’t maintain adequate cardiac output

• enough blood in the body but the pump isn’t working (post MI)

shock (hypovolemic)

venous return because of external blood volume losses

• heart is good but not enough blood in the body (hemorrhage or dehydration)