Test 3 - Cardiovascular System

Cardio-thoracic ratio

widest part of the heart should not exceed 50% of the diameter of the thoracic cage

congestive heart failure

inability of the heart to pump enough blood to meet the body’s metabolic needs

Heart Failure Occurs due to:

impaired pumping ability or increased workload

Congestive heart failure refers to heart failure accompanied by…

congestion of body tissues

What happens if the heart cannot keep pace with the venous return?

blood damming back into the venous system or lungs

Left heart failure

decreased cardiac output leading kidneys to release renin that increases BP leading to pulmonary edema

Right heart failure

backup of blood in systemic circulation increasing pressure in venous circuit

left heart failure eventually leads to _____________

right heart failure

Symptoms of pulmonary edema

dyspnea and fatigue as it interferes with the movement of O2 from the lungs

manifestations of left sided heart failure

decreased cardiac output, fatigue/exertional dyspnea, tachypnea/increased RR, orthopnea, cyanosis, chronic dry cough/wheezingv, paroxysmal nocturnal dyspnea, blood-tinged sputum

pulmonary edema

fluid accumulation int he interstitial spaces and alveoli of the lungs

Rad Appearance of Left Sided Heart Failure

diffuse peri-hilar alveolar densities - bat wing or butterfly sign

Interstitial pulmonary edema rad appearance

Kerly B lines indicating fluid in interloper septa, loss of sharp definition of lungs, costophrenic angle blunting if severe

Manifestations of right heart failure

fatigue, dependent edema, distention of jugular veins, liver engorgement, ascites, anorexia/GI distress, cyanosis, increased peripheral venous pressure

Rad Appearance of right heart failure

globular cardiomegaly (>50% cardio-thoracic ratio), right ventricular enlargement, no retrosternal air or retro cardiac space

Treatment of Congestive Heart failure

low sodium diet, diuretics, digoxin and correct underlying problem (angioplasty, stinting, coronary artery bypass surgery)

Monitoring of CHF

Swan-ganz catheter to assess pulmonary venous pressure

Cardiac Arteries of the Left side

circumflex and anterior interventricular/anterior descending

The Circumflex artery supplies…

left side and back of ventricle and left atrium

The LAD/anterior inter ventricular artery supplies…

front and bottom left ventricle and front of septum

Cardiac Arteries of the Right side

right coronary, marginal and posterior interventricular/descending

posterior interventricular/descending artery supplies…

both ventricles

marginal artery supplies…

right ventricle

right coronary artery supplies…

right atrium

Coronary artery disease

branching term for cardiac disease resulting from insufficient coronary blood flow

Coronary artery disease refers to which 3 diseases?

atherosclerosis, angina pectoris and myocardial infarction

Arteriosclerosis

group of disorders resulting in thickening and inelasticity of arterial walls (hardening of arteries)

atherosclerosis

plaque build up affecting large and medium sized arteries

Atherosclerosis progression is _____

slow

Significant aspect of atherosclerosis

location

Widowmaker heart attack common age

30-40

Atheroma Development

fatty streaks/lipids deposited in vessel intimate beginning in childhood stimulating an immune response that produces fibrous encapsulation creating fibrous plaques that elevate the vessel lining, roughening surface and narrowing lumen

Plaque commonly elevates the lining at what locations?

bends or junctions where turbulence is greatest

Consequence of Atherosclerosis

imbalance between myocardial oxygen supply and demand threats the myocardium beyond the lesion

Non-modifiable risk factors of CAD

age, sex heredity

modifiable risk factors of CAD

blood cholesterol, BP, smoking, physical inactivity, diabetes, obesity, stress, personality

angina pectoris

chest pain due to deficit of oxygen for heart muscle from heart working harder than usual or impaired blood supply to the myocardium

angina pectoris symptoms

substernal pain radiating down medial aspect of left arm, mimic indigestion

Angina pectoris is brought on by…

activities that increase O2 demand

Treatment of Angina Pectoris

vasodilator drug - nitroglycerine

myocardial infarction

ischemic death fo myocardial tissue

Prolonged ischemia over _______ minutes causes ________

30-35; irreversible cellular damage and muscle death

Infarcted area from myocardial infarction is surrounded by a _______

zone of ischemia

S&S of Myocardial Infarction

severe prolonged crushing chest pain, sweating, nausea, vomiting, increased serum levels of cardiac enzymes released by necrotic myocardial cells, changes in ECG waves

Pulmonary congestion Rad Appearance

interstitial/alveolar densities

pulmonary effusion rad appearance

blunted costophrenic angles

CAD Evaluation - Chest X-ray

not always helpful unless there are calcifications

CAD Evaluation - Selective coronary arteriography

demonstrates stenosis and occlusion of vessels and collateral circulation

CAD Evaluation - CT angiography

image coronary circulation and visualize lesions

CAD Evaluation - Nuc Med Stress test

identifies amount of residual damage to myocardium

CT Angiography typically performed on what patients?

patient with family history of CAD

Cardiac Catheterization rad appearance of CAD

narrowing of vessel

angiography

radiological study of vessels with use of contrast medium

arteriography

imaging of arteries with injection of radiopaque contrast medium

venography

imaging of veins with contrast medium

Injection of contrast into arterial system is usually via…

femoral or radial artery via a catheter inserted using fluoro guidance

Venography function

rule out thrombus formation or incompetence in the venous system

Venography Modern Use

visualize pelvic vessels and reflux in deep veins

angioplasty

procedures that increase or restore blood flow

Assessment of _________ must be done to determine best means of treatment

area/type of lesion

Methods of increasing blood flow

balloon angioplasty, stents, endarterectomy, thrombolysis, percutaneous mechanical thrombectomy

Stages of balloon angioplasty

vascular access, crossing the lesion, dilating the lesion and completed angiogram

Stage 1 of Balloon Angioplasty

seldinger technique for vascular access

seldinger technique

needle access for guide wire placement before catheter advancement

stage 2 of balloon angioplasty

guide wire advanced past stenosis and balloon catheter placed at area of stenosis

Stage 3 balloon angioplasty

duration of inflation carefully times to prevent damage to tissue distally due to ischemia

What happens to the plaque with balloon angioplasty?

controlled fracture with intimal lining and media stretched and cracks while outer adventitia stretched beyond recoil

Plaque is NOT _____,_______ or ________ by the balloon

remodelled, re-distributed, vaporized

Concentric lesion

equal plaque on both sides

eccentric lesion

plaque cracks to one side

Complications of balloon angioplasty

residual stenosis, dissection flaps, distal embolization

dissection flaps

stent may be required to hold flaps against vessel wall of eccentric lesions

Residual Stenosis in Balloon Angioplasty

less than 30% residual stenosis is the goal and a stent may be required if not achieved

Distal Embolic Protection Devices

distal occlusion and aspiration or filters

peripheral vascular disease

disease of blood vessels outside the heart and brain

aneurysm

localized donation caused by weakening in vessel wall or heart chamber

Vessel wall weakness may be due to:

atherosclerosis, infection, trauma, congenital disease, hypertension

Marfan’s syndrome

connective tissue disorder that can cause multiple small aneurysms along the aorta

consequences of aneurysms depends on _______ and _______

location; size

Consequences of Aneurysms

rupture, thrombus formation, pressure on adjacent structures

Diagnosis of Aneurysms

U/S or CT/MR angiography

Types of true aneurysms

fusiform and saccular

Fusiform aneurysm

involves entire circumference of vessel leading to gradual and progressive dilation of the vessel

Fusiform aneurysm location

thoracic/ascending aorta or large segment of abdominal aorta

saccular aneurysm

weak area on one side of vessel where blood can clot to form a thrombus

dissecting aneurysm

disruption of intima allowing blood to travel between layers of vessel wall

Dissecting aneurysm is a _______ aneurysm

false

Sign of dissecting aneurysm

excruciating chest pain

berry aneurysm

small spherical dilation of vessel at bifurcation

berry aneurysms usually occur in ______

circle of willis

Berry aneurysms lead to ______

subarachnoid hemorrhage

sign of berry aneurysm

excruciating headache

M/C location of berry aneurysm

anterior communicating artery (40%)

Aneurysm in chest rad appearance

widening of mediastinum

Magnetic resonance angiography for aneurysms

if contrast is contraindicated

U/S for Aneurysms

initial exam and serial tracking of abdominal aneurysm for size, dilation and thrombus

angiography for aneurysms

invasive, time consuming, used during interventional placement of prosthetic ends-luminal graft

CT angiography - aneurysm

definitive less invasive study

Stents

metal scaffolds used to support a vessel wall to treat stenosis and occlusive disease

stent graft

stent covered with graft material to treat aneurisms and arterial rupture