Pathophysiology Exam 2!!

What is pericarditis?

Inflammation of the pericardium.

What are the manifestations of pericarditis?

Pericardial friction rub, flu-like symptoms (fever, chills, myalgia), sharp chest pain, dyspnea, and tachycardia.

How does pericarditis chest pain change with position and breathing?

Worsens with deep breathing and lying down; improves when sitting up and leaning forward.

What is cardiac tamponade?

A life-threatening complication of pericarditis in which excessive fluid accumulation compresses the heart.

What are the manifestations of cardiac tamponade?

Muffled heart sounds, falling arterial pressure, and rising venous pressure.

What is infective endocarditis?

Infection of the endocardium that causes vegetations on internal heart structures and valves.

What organisms commonly cause infective endocarditis?

Staphylococcus and Streptococcus.

What are the risk factors for infective endocarditis?

IV drug use and congenital heart defects.

What are the manifestations of infective endocarditis?

New or worsening heart murmur, flu-like symptoms, Osler's nodes, Janeway lesions, and splinter hemorrhages in nail beds.

What is valve stenosis?

Narrowing or hardening of a valve that decreases blood flow through it.

What is valve regurgitation?

Incomplete valve closure that allows blood to flow backward.

How do valve disorders affect the heart?

Cause heart murmurs, decreased cardiac output, increased cardiac workload, and cardiac muscle hypertrophy.

What is cardiomyopathy?

Conditions that weaken and enlarge the myocardium.

What is dilated cardiomyopathy?

The most common type; primarily affects systolic heart function.

What causes dilated cardiomyopathy, and what are its manifestations?

Often idiopathic; may cause emboli and left-sided heart failure.

What is hypertrophic cardiomyopathy?

Usually congenital; affects both systolic and diastolic heart function.

What are the manifestations and major danger of hypertrophic cardiomyopathy?

Left- and right-sided heart failure and sudden cardiac death; an important cause of sudden death in young athletes.

What is restrictive cardiomyopathy?

The least common type; primarily affects diastolic heart function.

What causes restrictive cardiomyopathy, and what are its manifestations?

Often idiopathic or related to chest radiation; may cause emboli and right-sided heart failure.

What is heart failure?

Inadequate pumping by the heart to meet the body's needs.

How does heart failure affect cardiac function?

Decreases cardiac output, contractility, and stroke volume while increasing preload and afterload.

What causes left-sided heart failure?

Left ventricular infarction, aortic valve stenosis, hypertension, and hyperthyroidism.

Where does blood back up in left-sided heart failure?

Into the pulmonary circulation (lungs).

What are the manifestations of left-sided heart failure?

Activity intolerance, pulmonary congestion, orthopnea, cough, shortness of breath, paroxysmal nocturnal dyspnea (PND), hemoptysis, and rales.

What is orthopnea?

Shortness of breath when lying flat that improves when sitting upright.

What is paroxysmal nocturnal dyspnea (PND)?

Sudden nighttime breathlessness that awakens a person from sleep.

What causes right-sided heart failure?

Right ventricular infarction, pulmonary valve stenosis, and pulmonary disease.

Where does blood back up in right-sided heart failure?

Into the systemic circulation.

What are the manifestations of right-sided heart failure?

Dependent edema, weight gain, ascites, distended neck veins, headache, flushed face, hepatomegaly, and splenomegaly.

What is peripheral arterial disease (PAD)?

Impaired blood flow through arteries carrying blood away from the heart.

What are the manifestations of PAD?

Intermittent claudication, shiny skin with hair loss, cool extremities, numbness, tingling of the toes, and poor pulses.

What is intermittent claudication?

Pain during activity caused by inadequate arterial blood flow.

What is peripheral venous disease?

A condition that interferes with the return of venous blood from the legs.

What are the manifestations of peripheral venous disease?

Edema, stasis dermatitis, and stasis ulcers, especially around the ankles.

How do arterial and venous circulation problems differ?

Arterial: cool extremities and weak pulses. Venous: edema, warmth, and stasis skin changes.

What is Raynaud's disease?

Vasospasm of arteries in the extremities, usually the hands.

What contributes to Raynaud's disease?

Autoimmune factors or sympathetic nervous system overreaction; it is more common in women.

What are the manifestations of Raynaud's disease?

Cold, pale, painful extremities with color changes from white to blue to red.

What is atherosclerosis?

A chronic inflammatory disease involving thickening and hardening of arterial walls.

What are the risk factors for atherosclerosis?

Dyslipidemia, diabetes mellitus, hypertension, stress, and tobacco use.

What complications can result from atherosclerosis?

Peripheral vascular disease, coronary artery disease, thrombus formation, and stroke.

Why can atherosclerosis be difficult to detect?

It is often asymptomatic until complications develop.

What is coronary artery disease (CAD)?

Atherosclerotic changes in coronary arteries that impair myocardial perfusion and oxygen delivery.

What can cause CAD?

Atherosclerosis, vasospasms, thrombus formation, and cardiomyopathy.

What are the manifestations of CAD?

Angina, indigestion-like discomfort, nausea, vomiting, cool clammy extremities, and diaphoresis.

What is angina?

Intermittent chest pain caused by myocardial ischemia and reduced oxygen supply to the heart muscle.

What is stable angina?

Chest pain that resolves when cardiac oxygen demand decreases.

What is unstable angina?

Chest pain that increases in intensity or frequency, may occur at rest, and does not resolve with demand reduction.

What is Prinzmetal (variant) angina?

Angina caused by coronary artery vasospasm.

What is a thrombus?

A stationary blood clot, such as one associated with deep vein thrombosis (DVT).

What is an embolus?

A traveling clot or other material that can obstruct a blood vessel; a traveling clot can cause a pulmonary embolism (PE).

What is Virchow's triad?

Endothelial injury, sluggish blood flow, and increased coagulability.

What is the result of thromboembolism?

Vessel occlusion that reduces or blocks blood flow.

What are the manifestations of arterial occlusion?

Weak or absent pulse, cool cyanotic extremity, and usually no edema.

What are the manifestations of venous occlusion?

Pulse usually present, red and warm extremity, and edema.

What is a myocardial infarction (MI)?

Irreversible death of myocardial tissue caused by inadequate coronary blood flow and oxygen.

What can cause an MI?

Coronary atherosclerosis, thrombus formation, or vasospasm.

What is a silent MI, and who is at risk?

An MI without typical symptoms; it may go unnoticed in people with diabetes or neuropathy.

What are the manifestations of an MI?

Chest discomfort, nausea, vomiting, shortness of breath, diaphoresis, indigestion, ST elevation, and elevated CK-MB and troponin.

What is the treatment goal for an MI?

Restore blood flow to the heart muscle through reperfusion as quickly as appropriate.

What is hypertension?

Prolonged elevation of blood pressure that increases afterload and cardiac workload.

What is primary hypertension?

The most common type; develops gradually without an identifiable cause.

What is secondary hypertension?

Hypertension caused by an identifiable underlying condition; may develop suddenly and severely.

Why is hypertension called the silent killer?

It often has no symptoms despite causing ongoing damage.

What symptoms can occur with hypertension?

Fatigue, headache, malaise, and dizziness.

What are the complications of hypertension?

Atherosclerosis, aneurysms, heart failure, stroke, renal damage, vision loss, and hypertensive crisis.

What is shock?

Inadequate tissue and organ perfusion caused by reduced blood volume or circulatory dysfunction.

What happens during the compensatory stage of shock?

The sympathetic nervous system and renin-angiotensin-aldosterone system activate to maintain perfusion.

What happens during the progressive stage of shock?

Compensation fails; tissue hypoxia causes anaerobic metabolism, lactic acid buildup, and metabolic acidosis.

What happens during the irreversible stage of shock?

Severe cellular injury and organ damage occur.

What is distributive shock?

Massive vasodilation causes blood to be distributed poorly, reducing effective tissue perfusion.

What are the three types of distributive shock?

Neurogenic (spinal cord injury), septic (severe infection), and anaphylactic (severe allergic reaction).

What is cardiogenic shock?

The heart's pump fails to maintain adequate cardiac output, often after an MI.

What is hypovolemic shock?

Reduced venous return caused by loss of circulating blood volume, such as hemorrhage or dehydration.

What are the common manifestations of shock?

Restlessness, irritability, hypotension, tachypnea, cool pale skin, cyanosis, and decreased urine output.

What are early manifestations of hypovolemic shock?

Thirst and tachycardia.

What is afterload?

The resistance the ventricles must overcome to eject blood.

What is cardiac output?

The volume of blood pumped by one ventricle per minute; heart rate × stroke volume.

What is diastole?

The phase when the heart relaxes and its chambers fill with blood.

What is heart rate?

The number of heartbeats per minute.

What is peripheral vascular resistance?

Resistance to blood flow through systemic blood vessels, mainly the arterioles.

What is preload?

Ventricular stretch at the end of diastole, related to the amount of blood filling the ventricles.

What is stroke volume?

The volume of blood ejected by one ventricle with each heartbeat.

What is systole?

The phase when the ventricles contract and eject blood.

What type of IV solution is 0.45% saline?

Hypotonic.

What type of IV solution is 0.9% saline (normal saline)?

Isotonic.

What type of IV solution is 5% dextrose in 0.9% saline (D5NS)?

Hypertonic.

What type of IV solution is lactated Ringer's (LR)?

Isotonic.

What type of IV solution is 5% dextrose in lactated Ringer's (D5LR)?

Hypertonic.

What are the four mechanisms that maintain fluid balance?

Thirst mechanism, antidiuretic hormone (ADH), aldosterone, and natriuretic peptides.

What do FVD and FVE stand for?

FVD = fluid volume deficit; FVE = fluid volume excess.

Which condition causes tachycardia and tachypnea?

Both FVD and FVE.

Which condition causes low urine specific gravity (less than 1.005)?

FVE.

Which condition causes poor skin turgor?

FVD.

Which condition causes jugular venous distention (JVD)?

FVE.

Which condition causes a bounding pulse?

FVE.

Which condition causes thirst?

FVD.

Which condition causes urine specific gravity greater than 1.030?

FVD.