PATHO2 STUDY GUIDE

Cardiac output

• amount of blood heart pumps per min

• DETERMINED BY: CO=SV x HR (stroke V x heart rate)

• dependent on venous return and contractility

• ventricles relax and fill w blood

• abv valves open

• “DUB”

what happens during diastole?

• ventricles contract

• ABV valves close

• “LUB”

what happens during systolic?

cardiac cycle

the sequence of events that occur in the heart between the start of one heartbeat and the next

SYS: heart contracts to pump blood out

DIA: heart relaxes taking filling w blood

stable angina

• Associated w a fixed coronary obstruction that produces a disparity btn coronary blood flow and metabolic demands of the myocardium

• Angina is due to poor blood flow through the blood vessels in the heart called the coronary arteries.

• S/S:

  • chest pain relieved by rest

• TX:

  • Aspirin

  • nitroglycerin meds

  • ca channel blockers

  • no smoking

  • less stress

  • lifestyle changes

  • limit cholesterol & saturated fats

  • avoid cold & vasoconstriction

unstable angina

a condition in which your heart doesn't get enough blood flow and oxygen

Angina is due to poor blood flow through the blood vessels in the heart called the coronary arteries.

• TX

  • aspirin

  • Nitroglycerin: Can be taken intravenously, sublingually, transdermally, or orally to improve blood flow and reduce the heart's workload

  • Beta-blockers: Reduce the heart rate and force of the heartbeat, and lower blood pressure

  • Statins: Lower cholesterol levels

  • no smoking

    less stress

    lifestyle changes

    limit cholesterol & saturated fats

    avoid cold & vasoconstriction

• S/S: chest pain unrelieved by rest

• High blood pressure:

• High cholesterol:

• Diabetes:

• Smoking:

• Family history:

• Obesity:

• Lack of physical activity:

• Older age:

• Inflammatory diseases:

• Chronic kidney disease

risk factors for atherosclerosis

stop smoking, change in diet, physical activity

What patient education is needed regarding modifiable risk factors for atherosclerosis?

• age

• gender

• race

• history

• genes

• diet

• tobacco

• alcohol

• obesity

risk factors for hypertension

dash diet, lifestyle changes, no smoking, sleep, weightloss

What patient education is needed regarding modifiable risk factors for hypertension?

• Smoking,

• obesity

• sedentary lifestyle

• high Blood pressure:

• Cholesterol: High levels of non-HDL cholesterol and low levels of HDL cholesterol are risk factors for MI.

• Diabetes:

• Age: The risk of MI increases with age, with the average age of first MI being 65 for men and 72 for women.

• Alcohol:

• Stress:

• Family history:

risk factor for myocardial infarction?

• weightloss

• eating a diet low in saturated fat and sodium

• regular physical activity,

• smoking cessation,

• managing blood pressure and cholesterol levels,

• controlling diabetes

• limiting alcohol intake

What patient education is needed regarding modifiable risk factors for MI?

• Upper airway infections:

  • Viral croup

  • Spasmodic croup

  • Epiglottis

• Lower airway infections:

  • Acute bronchiolitis

types of childhood respiratory problems

viral croup

• Viral infection that causes inflammation of the windpipe and vocal cords, resulting in a distinctive cough and difficulty breathing in larynx, trachea, and bronchi

• If progress nasal flares; cyanosis

• Common ages 3 months to 5 years

• S/S: barking, seal-like cough, stridor, runny nose, common cold, hoarseness, and low-grade fever.

• TX: cool, moist air, steroids, epinephrine

• Causes include:

  • Most common parainfluenza viruses, adenoviruses, rhinovirus, RSV and influenza A and B viruses

NU: humidifier, hydrate, o2, rest

spasmodic croup

a type of croup that occurs suddenly and often at night in children; thought to be caused by an allergy or by reflux from the stomach.

S/S: Hoarseness, a barky cough, stridor (a high-pitched breathing noise), and labored breathing.

TX: allergy or reflux medicines, steroids, breathing treatment

NU: humidifier, hydrate, o2, rest

epiglottitis

• bacterial infection of epiglottis that cx it to become inflamed

• Occurs suddenly causing airway obstruction and asphyxia

• COMMON IN CHILDREN; children sit up right with head and neck extended fwd

• S/S:

  • a severe sore throat.

  • difficulty and pain when swallowing.

  • difficulty breathing,

  • (stridor)

  • a high temperature.

  • irritability and restlessness.

  • muffled or hoarse voice.

  • drooling

• CXs:

  • Streptococcus pyogenes

  • S. Pneumoniae

  • S. Aureus

• NU:

  • monitor breathing and o2 levels

  • avoid agitation

  • antibiotics

bronchiolitis

• inflammation and swelling of the bronchioles

• easy to inhale o2, hard exhale

• S/S:

  • loss of appetite, wheezing, edema, retractions, fever, SOB, irritability

• TX:

  • steroids

• NU:

  • admin o2

  • hydrate

  • infection control

  • suctioning/breathing

  • nasal saline

  • antipyretics

  • cool-mist humidifier

aneurysm

• Abnormal localized dilation of a blood vessel.

• Can occur in veins or arteries

• Types: saccular (1side), ruptured, fusiform(center), false, dissection

• EMERGENT ISSUE!

• S/S:

Abdominal aortic aneurysm

• ID by pulsation in abdomen, mass, or extended beyond normal width of aorta

• Ruptured or leaking

• S/S: hypotension, abdominal pain, pulse in ab

DISSECTING aneurysm

• Loosing blood in/on ripped vessel

• Acute, life-threatening

• Can occur anywhere along the length of the aorta

• Most common site-ascending aorta

• Most common in 40-60 year old males

• Hypertension is a predisposing risk factor

• Diagnosis is made by vascular imaging: CT or MRI

• Treatment: medical management if chronic, surgery if acute

• S/S: abrupt presence of excruciating pain, described as tearing or ripping

DVT

• Presence of a thrombus and the accompanying inflammatory response in the vein wall

• If untreated, risk for pulmonary emboli (PE) which can be life-threatening

• CX: smoking, hormone replacement, immobile

• Signs and symptoms:

  • Fever, malaise

  • Redness and swelling at site

  • Tenderness at site

  • Elevated WBC count and ESR

• Treatment: Anticoagulation therapy

STEMI

• life-threatening type of heart attack that occurs when a SIGNIFICANT artery to the heart is completely blocked.

• most severe type of heart attack and requires immediate emergency care

• DX:

  • ECG, test serum cardiac enzymes *troponin

  • ST segment: Persistent elevation on ECG

• pain:

  • Abrupt onset

  • Severe & crushing pain

  • Substernal, radiating to L arm, neck, jaw

  • GI (nausea & vomit)

  • Fatigue & weak

  • Tachycardia, anxiety, restlessness, feeling of doom

  • Cool, pale, moist skin

• TX: PCI to remove block

• MEN & WOMEN symptoms differently*

NSTEMI

a type of heart attack that occurs when a SMALL coronary artery is partially blocked, reducing blood flow to the heart muscle

• DX:

  • ECG used to differentiate

  • ST segment: May not present with significant elevation

• TX:

  • PCI within 24hr

  • anticoagulant

  • antiplatelets

  • beta blocker

  • statins

  • ace inhibitors

  • ARB meds

ASTHMA

• a chronic inflammatory disease of the lungs that causes the airways to narrow and become inflamed, making it difficult to breathe

• CXs:

  • allergens

  • smoking

  • infections

  • air pollution

  • meds (aspirin, nsaids)

• TX:

  • bronchodilators

  • anti inflammatories

  • steroids

cardiac conduction system

• A network of specialized muscle cells is found in the heart's walls. These muscle cells send signals to the rest of the heart muscle causing a contraction.

• Controls rate & direction of electrical impulse conduction in <3

• Impulse starts in SA NODE

• Certain areas the myocardial cells have specific phase to make conduction system cells

• *Maintains pumping efficiency of ❤

Ventricular fibrillation

an arrhythmia that starts in your ventricle. This occurs when the electrical signals that tell your heart muscle to pump cause your ventricles to quiver (fibrillate) instead.

The quivering means that your heart is not pumping blood out to the rest of your body.

concerns: DEATH, brain damage, liver and kidney

Atrial fibrillation

• type of arrhythmia that affects the heart's conduction system, causing irregular electrical signals in the upper chambers of the heart

• The short circuits are conducted down into the pumping chambers via the AV Node and drive these chambers very rapidly and irregularly.

• Concerns: heart failure, stroke, cardiac arrest, blood clots

Tb

• transmitted person to person via droplets from throat lungs w active resp disease

• Infect practically any organ of the body, the lungs are most frequently involved

• POSITIVE TEST:

  • Implies that a person has been infected with M. tuberculosis and has mounted a cell-mediated immune response

  • Does not mean the person has active tuberculosis

• DX:

  • skin test, chest x-ray

• TX:

  • 679Bacillus Calmette-Guerin (BCG) vaccine

  • 6m antibiotics

• S/S:

  • sob, fever, night sweats, persistent cough, bloody phlegum, chest pain, dipsia, orthopnea, anemia

Bovine tuberculosis

Acquired by drinking milk from infected cows; initially affects the gastrointestinal tract

Has been virtually eradicated in North America and other developed countries

M. tuberculosis hominis (human tuberculosis)

Airborne infection spread by minute droplet nuclei harbored in the respiratory secretions of persons with active tuberculosis

Living under crowded and confined conditions increases the risk for spread of the disease

respiratory distress syndrome

• deficient surfactant in lining of alveoli (premes)

• surfactant gradually increases until 33-36wks; after SURGE of surfactant

• type 2 pneumocytes that produce the fluid inside alveoli to keep open and expand ; helps w surfactant tension

  • if alveoli/ airway collapse no gas exchange

• ^ risk: diabetics, babies deliver c section

• decrease risk: prolonged rupture of membrane, prenatally administered steroids

• S/S: tachypnea, nasal flaring, expiratory grunting, retractions

• TX: mechanical ventilation, exogenous surfactant

Pneumonia

• Respiratory disorders involving inflammation of the lung structures (alveoli and bronchioles)

• Causes

  • Infectious agents: such as bacteria and viruses

  • Noninfectious agents: such as gastric secretions aspirated into the lungs

• S/S:

  • high fever, chills, cough w sputum color indicator, SOB, pleuritic chest pain, fatigue, aches, headache, high heart rate, nausea, vomit, pain, low bp, mood swings, anorexia

• TX:

  • antibiotics-bacterial

    • antiviral

    • antifungal

pneumothorax

• a condition that occurs when air leaks from the lung and fills the space between the lung and chest wall (pleural cavity)

• S/S:

  • chest pain

  • dipsia

  • ^ respiration

  • asymmetry of chest

  • decrease breath sound

  • compression & atelectasis of unaffected lung

  • decrease cardiac output

• TX: inserting a needle or chest tube between the ribs to remove the excess air

spontaneous pneumothorax

occurs when air filled blister on the lung ruptures

common in tall, slinder boys

traumatic pneumothorax

caused by penetrating or nonpenetrating injury

Tension Pneumothorax

Occurs when the intrapleural pressure exceeds atmospheric pressure

Most life-threatening and can impair cardiac and respiratory functions

Atelectasis

• The incomplete expansion of a lung or portion of a lung

• Causes

  • Airway obstruction

  • Lung compression such as that occurs in pneumothorax or pleural effusion

  • Increased recoil of the lung due to loss of pulmonary surfactant

• S/S:

  • Trouble breathing/shortness of breath (dyspnea).

  • Coughing.

  • Chest pain.

  • Rapid breathing (tachypnea).

pleural effusion

An abnormal collection of fluid in the pleural cavity

• Types of fluid

  • Transudate

  • Exudate

  • Purulent drainage (empyema)

  • Chyle

  • Blood

• S/S:

  • Chest pain, especially when coughing or breathing deeply

  • Coughing

  • Fever and chills

  • Hiccups

  • Rapid breathing

  • Shortness of breath

• TX:

  • Thoracentesis

  • Injection of a sclerosing agent into the pleural cavity

  • Open surgical drainage

hypertension in pregnancy

high blood pressure resulting in protein

• types:

  • Preeclampsia—eclampsia

  • Chronic hypertension

  • Chronic hypertension with superimposed preeclampsia

  • Gestational hypertension

• DX: bp over 140/90

• TX: deliver baby

STATINs

• lipid lowering agents indicated for pts w CAD

• treatment for hyperlipidemia

• CHD Prevention

• decrease LDL, VLDL, ^ HDL

• absorbed in GI, metabolized in liver

• Side effects muscle toxicity, liver enzyme elevation

common cold

• Viral infection of the upper respiratory tract

• common pathogens associated with: *rhinovirus, parafluvirus, resp syncytial, corona, adenovirus

• S/S: Cough, sneeze, headache, sore throat, nasal congestion, runny nose, malaise, fever chills

• Transmitted: fingers; Nasal and eye surface common portal w direct contact

• Management: 7 days; isolate 2days

• TX: rest, antipyretics

dysphagia

difficulty swallowing

left side heart failure

• *blood backs in lungs; IMPACTS LUNGS

• weakened, making it harder to pump blood into the body.

• most common type of heart failure and is usually caused by coronary artery disease, a heart attack, or long-term high blood pressure.

• S/S:

  • Decreases cardiac output

  • Elevated pulmonary venous px

  • Cyanosis

  • Pulmonary edema

  • Orthopnea

  • Lung crackles

right side heart failure

• makes it harder to pump blood to the lungs; IMPACTS BODY

• S/S:

  • Edema

  • Weight gain

  • Congestion of viscera

  • JVD

  • GI Distress

  • Impaired liver function

• Blood backs into the body*

heart failure

• Complex disorder that results from any structural or functional disorder of ❤ that results in or ^risk of low cardiac output

• Includes pulmonary or systemic and congestion

• Any condition reducing ❤ pumping

• TX: find/fix cause, vent ❤ pumps, vent assist devices, transplant, lifestyle changes

• CX: CAD, hypertension, cardiomyopathy

cardiac tamponade

• slow or rapid compression of heart due to accumulation of fluid, pus or blood in pericardial sac

• limits ventricular filling and ^ intracellular px and decreases cardiac output

S/S: JVD, decrease bp, muffled heart sound, decreases LOC, ^ HR, edema, circulatory shock

TX: iv fluids, o2, emergency pericardiocentesis

pericardial effusion

Accumulation of fluid in the pericardial cavity

CX: neoplasms, cardiac surgery, trauma, cardiac rupture due to MI & dissecting aortic aneurysm

TX: NSAIDS, corticosteroids, pericardiocentesis (drain)

hypercholesterolemia

• a lipid disorder in which your low-density lipoprotein (LDL), or bad cholesterol, is too high.

• Serum cholesterol levels: 240 mg/dL or greater

  • Levels that could contribute to a heart attack, stroke, or other cardiovascular event associated with atherosclerosis

• primary

  • describes elevated cholesterol levels that develop independent of other health problems or lifestyle behaviors.

• secondary

  • associated with other health problems and behaviors.

acute arterial occlusion

• Sudden event causing obstruction of blood flow to the affected tissue or organ.

• Most common cause: embolus or thrombus

• EMERGENT ISSUE

• 7Ps assessment: pistol shot (sudden onset), pallor, pain, polar, pulselessness, paresthesia, paralysis

Peripheral Artery Disease (PAD)

• AKA atherosclerotic occlusive disease

• caused by atherosclerosis, a condition where plaque builds up in the arteries, narrowing and stiffening them

• Common in the lower extremities

• Gradual onset of vessel occlusion

• Hallmark S/S: intermittent claudication( pain in legs walking)

  • pale or bluish skin color, weak or absence of pulse in legs, shiny, hairless legs, sores/wounds on L extremity

*Lack of perfusion, NO o2 to blood

collateral circulation

alternate or “backup” blood vessels in your body that can take over when another artery or vein becomes blocked or damaged. Provides alternative routes for blood flow

cardiogenic shock

cardiac shock, happens when your heart cannot pump enough blood and oxygen to the brain and other vital organs

arises from primary cardiac dysfunction

hypovolemic shock

an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body.

This type of shock can cause many organs to stop working

caused by severe dehydration or blood loss

relates to the blood and fluids compartment

obstructive shock

a life-threatening emergency that occurs when blood flow is obstructed in the heart or great vessels, preventing the body from getting enough oxygen

arises from a blockage of the circulation.

distributive shock

vasodilatory shock is a medical emergency where your body can't get enough blood to your heart, brain and kidneys.

relates to the vascular system

Raynaud’s disease

• functional disorder caused by intense vasospasm(constrict) of the arteries, and arterioles in fingers and less often, the toes

• CX:

  • smoking,

  • stress,

  • cold

• TX:

  • control stress,

  • no smoking,

  • avoid cold

infective endocarditis

*Staphylococcus lead cause

• Damaged endocardial surface

• Portal of entry by which the organism gains access to the circulatory system

• Presence of valvular disease, prosthetic ❤ valves, oral, CHD, environment conducive to bacterial growth

Rheumatic fever

• an inflammatory condition that can affect the heart, joints, brain, and skin.

• can result to Rheumatic heart disease

• CX:

  • strep throat, scarlet fever, or impetigo aren't treated properly.

• S/S: fever and painful, tender joints.

• TX: focuses on managing inflammation and symptoms.

Kawasaki disease

• Skin, brain, eyes, joints, lymph nodes, ❤

• Vascuities in sm bc then progress to Lg arteries

• Acute feveral illness, age 4 and below

• Unknown cx

• ❤ disease

• Most common ❤ disease in young children

• If gets to arteries MI occur

• Hard to dx until all symptoms occur

cardiomyopathy

Any disorder that affects the heart muscle

Mi symptoms in women

• Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

• Shortness of breath with or without chest discomfort.

• breaking out in a cold sweat,

• nausea or lightheadedness.

MI Symptoms in men

• Chest pain that may feel like pressure, tightness, pain, squeezing or aching.

• Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly.

• Cold sweat.

• Fatigue.

• Heartburn or indigestion.

• Lightheadedness or sudden dizziness.

• Nausea.

• Shortness of breath.

ARDs Diagnosis on xray

by the presence of bilateral, diffuse, and patchy opacities that affect at least three quadrants of the lungs

influenza A

• Most common type; transmitted by inhalation of droplets

• Can infect multiple species

• Causes the most severe disease

• Further divided into subtypes based on two surface antigens: hemagglutinin (H) and neuraminidase (N)

• S/S:

  • fever and chills.

  • cough.

  • sore throat.

  • sneezing and stuffy or runny nose.

  • tiredness.

  • headache.

  • muscle aches and joint pains.

• TX: Antiviral drugs (-vir)

• Prevention:

  • Get the flu vaccine:

  • Wash your hands:

  • Cover your coughs and sneezes:

  • Avoid touching your face:

  • Clean surfaces:

  • Avoid crowds:

influenza b

• transmitted by inhalation of droplets

• Incubation period 1-4 days

• S/S:

  • Fever

  • Coughing

  • Headache

  • Body aches

  • Fatigue

  • Vomiting and diarrhea

• TX:

  • -vir meds

• Prevention:

  • Get the flu vaccine:

  • Wash your hands:

  • Cover your coughs and sneezes:

  • Avoid touching your face:

  • Clean surfaces:

  • Avoid crowds:

atherosclerosis

thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery.

Risk factors may include high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, physical activity, and eating saturated fats.

CAD

A buildup of plaque in the arteries that reduces blood flow to the heart

*ANGINA, cardiac arrhythmia, conduction defects, ❤ fail, sudden death

Chronic bronchitis vs. Emphysema

Types of chronic obstructive pulmonary disease

chronic bronchitis

Obstruction of small airways

Earliest feature is hypersecretion of mucus in the large airways

Marked increase in goblet cells and excess mucus plugging, inflammation, and fibrosis of small airways

emphysema

Characterized by enlargement of air spaces and destruction of alveolar walls and capillary beds

Leads to hyperinflation of the lungs and produces an increase in TLC

Types: centriacinar (upper lung, mostly associated with smoking) and panacinar (lower lung, mostly associated with AATD)