Pathophysiology - Cardiac Unit (27,29)

What do we monitor for after an invasive CV diagnostic test (catheterization/angiography)?

bleeding and hematoma at the infection site

What are risk factors for CV disease?

- hyperlipidemia

- hypertension

-excess weight

- no exercise

- smoking

- psychological stress

- diabetes

- family hx

What 2 valves closing produce the S1 sounds?

tricuspid and mitral

What 2 valves closing produce the S2 sounds?

aortic and pulmonic

how we find cardiac output?

HR x Stroke volume

what labs do we use to diagnose cardiac conditions?

- serum cardiac enzymes (Troponin T and I)

- serum lipids (cholesterols, HDL, LDL)

- albumin, arterial blood gas

The patient presents with chest pain, dysrhythmias, bleeding, hematoma, and a drastic change in peripheral pulse in the right leg after angiography. What do you do?

- RAPID RESPONSE!

- 12 Lead ECG

- if bleeding, control it with pressure

- stroke intervention

What is the normal range for cholesterol?

<200 mg/dL

normal range for triglycerides in females?

35-136 mg/dL

normal range for triglycerides in males?

40-160 mg/dL

normal range for HDL?

>45 mg/dL

normal range for LDls?

< 130 mg/dL

normal range for troponin T?

<0.1 ng/mL

normal range for troponin I?

<0.03 ng/mL

rheumatic carditis

why do we have to monitor for dehydration in HF pts?

because edema can occur with HF, meaning that these pts will be on diuretics, making them pee and lose more fluid.

= dehydration risk

Why do patients who have prosthetic valves have to be on anticoagulation therapy?

to prevent thrombus formation

what are 2 key features of LHF?

- decreased cardiac output

- pulmonary congestion

= impaired gas exchange

What is the key feature of RHF?

congestion of peripheral tissues

= dependent edema, ascites, GI tract congestion, liver congestion

What is ascites?

fluid in the peritoneal cavity

what can GI tract congestion result in?

anorexia, GI distress, weight loss

what can pulmonary edema from LHF result in?

- cough with frothy sputum

- orthopneaa

- nocturnal dyspnea

what kind of HF is caused by:

- hypertension

- coronary artery disease

- valvular disease

left

What kind of HF is caused by:

- left ventricular failure

- right ventricular MI

- pulmonary hypertension

RIght

Function of angiotensin 2?

vasoconstriction

What does the secretion of bouncer aldosterone lead to?

sodium and water retention

LHF - what are the symptoms of "DO CHAP?"

D - dyspnea

O- orthopnea

C-cough

H- hemoptysis

A- adventitious lung sounds

P - pulmonary congestion

Arm weakness is a symptom of which HF? Right or left?

Left

Pt arrives to the ER with extremely distended neck veins, a wide abdomen, and dependent edema. Scans show an enlarged liver and auscultation presents with ascites. What does the pt have?

RHF

What is mitral stenosis?

narrowing of the mitral valve (=obstructed blood flow)

What is rheumatic fever?

it is an inflammatory disease that may develop after an infection with streptococcus bacteria (such as strep throat or scarlet fever)

what is mitral stenosis usually caused by?

rheumatic fever

What is mitral valve prolapse (MVP)?

when the enlarged mitral valve doesn't close right during systole

what is aortic stenosis?

disease of wear and tear on the aortic valve

what is infective endocarditis? what pt population is most vulnerable?

- microbial infection of endocardium, IV drugs

3 key features of infective endocarditis?

- Osler nodes (lil purple blumps on palms, soles)

- Janeway lesions (red macules on hands & feet)

- Roth spots (round/oval hemorrhages on retina)

where does pericardial chest pain radiate?

- from the left side of the neck, shoulder, or back

- worsens w inspiration, coughing, swallowing

- bad w supine position

how do we treat pericarditis?

- antiinflammatory meds

- reposition pt to sit up or lean forward

- auscultate

what meds should you NEVER give to pt with pericarditis?

Aspirin & NSAIDS bc it could increase risk of tamponade

What is a cardiac tamponade?

compression of the heart by an accumulation of fluid in the pericardial sac

What are the key features of a cardiac tamponade?

- jugular vein distension with clear lungs, muffled heart sounds, and decreased cardiac output

Emergency treatment for cardiac tamponade?

pericardiocentesis - 8 in needle injected to drain fluid

pt presents to er with inflammatory lesions, cardiomegaly, and aschoff bodies. what is the dx?

rheumatic carditis