Patho- Module 4: Cardiac (EXAM 2) KNACK PROOFED

what are congenital heart defects?

-conditions/structural defects of the heart that are present at birth

-the most common type of birth

what are the manifestations of congenital heart defects?

-heart murmurs

-dyspnea

-tachypnea

-cyanosis

-fatigue

-chest pain/discomfort

-difficulty gaining weight

-fall asleep during meals for children/babies

*can cause heart failure!

what is pericarditis? (decreased cardiac output)

-inflammation of the sac around the heart which is called the pericardium by viral infection

what can cause pericarditis?

-viral infection!

-chest trauma

-MI (myocardial infarction)

-cancer

-TB

-autoimmune conditions

what can pericarditis lead to?

-pericardial effusion which is when fluid accumulates in the space between the

pericardial sac and heart

-swollen tissue creates friction (swollen pericardial tissue rubbing against heart tissue)

what is cardiac tamponade?

-life-threatening cardiac compression from fluid accumulation

-caused by pleural effusion

-so much fluid that the heart is compressed and it cannot pump effectively

-prevents stretching and filling during diastole leading to decreased cardiac output

-arterial pressure decreases because of decreased cardiac output

-venous pressure rises because of accumulation of blood

what are the manifestations of cardiac tamponade?

-falling arterial pressures

-rising venous pressures

-narrowing pulse pressure

-muffled heart sounds! (they are drowned out by all the fluid)

-becks triad!!! (hypotension, JVD, muffled heart sounds)

what is constrictive pericarditis?

-long-term or chronic inflammation of pericardium

-loss of elasticity from chronic inflammation

-can result in a thickened pericardium

-becomes thick and fibrous and sticky and gets stuck on the heart

-decreased cardiac output

what are the manifestations of constrictive pericarditis?

-pericardial friction rub (grating sound)

-sharp and sudden severe chest pain that

increases with deep inspiration and decreases when sitting up/leaning forward

-dyspnea

-tachycardia

-palpitations

-edema

-flulike symptoms

what is infective endocarditis?

-inflammation and infection of the endocardium

-commonly caused by a bacteria such as streptococcus and staphylococcus!!

-thrombi form that travel (emboli) causing blockages

what are the manifestations of infective endocarditis?

-roth spots (retinal hemorrhages with pale/white centers)

-petichae

-osler nodes (painful, tender, red or purple nodules)

-new onset heart murmur

-janeway lesions (painless, flat, erythematous macules)

-anemia

-splinter nail-bed hemorrhages

-emboli

what are the risk factors associated with infective endocarditis?

-IV drug use!

-valvular disorder!

-prosthetic heart valves/implanted devices!

-rheumatic heart disease

-aortic coarctation

-congenital heart defect!

-Marfan Syndrome

what are the life-threatening complications associated with infective endocarditis?

-myocardial infarction

-stroke

-pulmonary embolism

*this is because of the emboli that infective endocarditis cause!

what is infective myocarditis?

-uncommon and poorly understood inflammation of myocardium

-causes the heart muscle to become thick and swollen

-penetration of an organism into the myocardium which causes muscle fiber disfunction

-organisms, blood cells, toxins, and immune substances damage the muscle

-associated with autoimmune disorders such as lupus

what are the complications associated with infective myocarditis?

-heart failure

-cardiomyopathy

-dysrhythmia

-thrombus formation

what are the manifestations of infective myocarditis?

-decreased urine output

-palpitations (heart beat not in regular rhythm!)

-leg swelling or fluid staying in the legs

what are valvular disorders?

-conditions where one or more of the heart valves (aortic, mitral, tricuspid, pulmonary) do not function properly, disrupting normal blood flow through the heart

what is valve stenosis?

-NARROWING of a heart valve, restricting forward blood flow

-less blood is flowing through the valve

-decreases cardiac output and increases workload which causes hypertrophy

-atresia: failure to open valve, which may

accompany stenosis

what is valve regurgitation?

-incomplete closure of a valve, allowing blood to leak backward

-bidirectional blood flow

-decreases cardiac output and increases workload on the heart which causes hypertrophy

-causes dilation of the ventricles

what causes valvular disorders?

-congenital defect

-infective endocarditis

-rheumatic fever

-myocardial infarction

-cardiomyopathy (big and sick heart/big because of hypertrophy)

-heart failure

what are the manifestations of valvular disorders?

-shortness of breath

-fatigue especially with with increase in physical activity

-chest tightness and difficulty breathing

-unable to lie down or having to get up to breath at night

-fainting

-palpitations

-swollen eyes, legs, or flatulence (the accumulation of gas in the gastrointestinal tract that is released through the rectum)

-heart failure or pulmonary embolism

what is cardiomyopathy?

-acquired or inherited conditions that weaken and enlarge myocardium

-disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body

-can cause heart failure or arrhythmias

-this is an umbrella term

what is dilated cardiomyopathy?

-most common type

-heart chambers are enlarged and weakened causing poor systolic function and decreased cardiac output and blood stagnation

-when ventricles become enlarged, baggy, and weak. they are overstretched!

-typically starts in the left ventricle and then reaches the right ventricle

who is more as risk for developing dilated cardiomyopathy?

-african american men

-people of advancing age

what causes dilated cardiomyopathy?

-chemotherapy

-alcoholism

-cocaine abuse

-pregnancy, infection

-thyrotoxicosis

-diabetes mellitus,

-neuromuscular disease

-hypertension

-coronary artery disease

-med hypersensitivity

what are the manifestations of dilated cardiomyopathy?

-breathing changes and nonproductive

cough

-dysrhythmia(s), cardiac pain and

abnormalities

-abnormal lung sounds

-peripheral edema

-Ascites (the abnormal accumulation of fluid in the peritoneal (abdominal) cavity) and hepatomegaly

-weak pedal pulse

-cool/pale extremities

-poor capillary refill

-jugular vein distension

*sympathetic nervous system and the kidneys compensate

*kidneys and heart are closely related

what is hypertrophic cardiomyopathy?

-thickening of the heart muscle (often the intraventricular septum) that makes filling difficult and is a leading cause of sudden cardiac death

-the ventricle wall becomes stiff and unable to relax

-hence hypertrophy! an increase in the size of the heart!

-heart becomes scarred!

what are the risk factors associated with hypertrophic cardiomyopathy?

-hypertension

-obstructive valvular disease

-thyroid disease

-dominant genes

what are the manifestations associated with hypertrophic cardiomyopathy?

-dyspnea/intolerance on exertion (exercise should be avoided)

-syncope (a temporary loss of consciousness ("fainting") due to reduced blood flow and oxygen to the brain)

-orthopnea (difficulty breathing when lying flat)

-angina (chest pain or discomfort caused by reduced blood flow)

-dysrhythmia

-left ventricular failure

-myocardial infarction

what is restrictive cardiomyopathy?

-the ventricles are stiff and rigid and CANNOT relax

-note this is difference from hypertrophic cardiomyopathy because the walls are not thickened here!

-affects diastolic function

-poor prognosis

what are the causes of restrictive cardiomyopathy?

-amyloidosis

-hemochromatosis

-radiation

-connective tissue diseases

-myocardial infarction

-sarcoidosis

-cardiac neoplasms

what are the manifestations of restrictive cardiomyopathy?

-fatigue

-breathing and lung changes

-angina

-hepatomegaly

-jugular vein distension

-ascites

-murmurs

-peripheral cyanosis

-pallor

what are dysrhythmias?

-abnormal or irregular heartbeat (rate and

rhythm)

what is preload?

-volume of blood in ventricles at end of diastole

-ventricles are relaxed and about to contract

-the blood pressure in the left ventricle at the end of diastole right before the ventricles contract

in what situations is preload increased?

-hypervolemia

-regurgitation of cardiac valves

-heart failure

what is afterload?

-resistance LEFT ventricle must overcome to push blood out into circulation

increased after load=increased cardiac workload

in what situations is afterload increased?

-hypertension

-vasoconstriction (harder to pump)

what is heart failure?

-the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients!

-AKA congestive heart failure (CHF)

-leads to decreased cardiac output (CO) and increased preload/afterload!

what causes heart failure?

-congenital defect!

-myocardial infarction!

-valvular disease!

-dysrhythmia!

-thyroid disease

what are the compensatory mechanisms associated with heart failure?

-sympathetic nervous system

-renin-angiotensin-aldosterone system (ultimately causes fluid retention)

-hypertrophy

*these will help at first but eventually will lead to heart failure!

what is the systolic disfunction associated with heart failure?

-decreased contractility not allowing the ventricles to pump hard enough during systole

what is the diastolic disfunction associated with heart failure?

-decreased filling which leads to not enough blood filling the ventricles during diastole

what is left side heart failure?

-left ventricle is unable to pump which results in blood backed up in lungs which causes pulmonary congestion

-causes dyspnea and activity intolerance

-associate with pulmonary circulation!!

*usually experience pulmonary dysfunction as a manifestation

what causes left sided heart failure?

-left ventricular infarction

-hypertension

-aortic or mitral valve stenosis

what is right sided heart failure?

-failure of the right ventricle to pump efficiently causing blood to be backed up

-blocks the peripheral circulation!!

what causes right sided heart failure?

-pulmonary disease (if it is not caused by left sided failure it is caused by this!)

-left-sided failure!

-pulmonic or tricuspid valve stenosis

what are the manifestations of left side heart failure?

-pulmonary congestion

-cough

-crackles

-pink-tinged sputum

-tachypnea

-tachycardia

-fatigue

-cyanosis

-exertional dyspnea

*notice how these all have to do with respiratory distress

what are the manifestations of right side heart failure?

-peripheral edema

-ascites

-enlarged spleen and liver

-JVD

-weight gain

-increased peripheral venous pressure

what are aneurysms? (a result of ineffective tissue perfusion)

-bulging blood vessels that can burst

-caused by a weakening of an artery

-commonly aortic and abdominal

* a true aneurysm affects all three vessel layers

what is a possible consequence/complication to aneurysms?

-exsanguination which is severe loss of blood to the point of extreme weakness or death

what is a sacular aneurysm?

bulge on the side which is asymmetrical

what is fusiform aneurysm?

-involves complete circumference of artery

-symmetrical

what is a dissecting aneurysm?

-not a true aneurysm because it occurs in the inner layers

what is a right sided valvular disorder?

what is a left sided valvular disorder

what is the difference between ischemia and infarction?

-ischemia can lead to death which is death

-ischemia is lack of oxygen leading to hypoxia and/or pain

what are the manifestations of aneurysms?

-depend on location and size

-may be asymptomatic

-may include: pulsating mass!

-pain

-respiratory difficulty

-neurologic decline

what is dyslipidemia?

high levels of lipids in the blood which increases risk for chronic disease

What are LDLs (low density lipoproteins)?

-"bad cholesterol"

-absorbed by cells in need of cholesterol for membrane repair or steroid synthesis

-most invasive in nature

What are HDLs (high density lipoproteins)?

-"good cholesterol"

-helps remove LDL choles

what is atherosclerosis?

-chronic inflammatory disease that is initiated by a vessel wall injury!

-leads to thickening/hardening of the arterial wall!!

-leads to platelet aggregation and vasoconstriction

what are risk factors associated with atherosclerosis?

-diabetes

-obesity

-smoking

-hypertension

-immobile/sedentary life-style

-family history

-dyslipidemia

what are the manifestations of atherosclerosis?

-asymptomatic until complications develop

-the blockage will usually be above 70% by the time symptoms manifest

what is peripheral vascular disease?

-narrowing of the peripheral vessels (arteries and/or veins)

what is trombonists obliterans (AKA buerger disease)?

-chronic inflammatory condition of the arteries

-can lead to thrombosis

-idiopathic

-20-40 men who smoke are more susceptible!

what is raynaud's phenomenon?

-attacks of vasospasm in the small arteries and arterioles of fingers and sometimes toes

-self-resolving

-ultimately can cause ischemia

-more common in females and associated with autoimmune diseases!

what is coronary artery disease (CAD)?

-narrowing or blocking of the arteries supplies the myocardium

-the most common type of heart disease in the U.S.

-leading cause of MI/death in the world in both men and women

what is obstructive CAD?

-when plaque accumulates in the large arteries causing narrowing and decreased blood supply to the myocardium

-blood flow can be completely occluded

what is non-obstructive CAD?

-large arteries are occluded by less than 50%

-also caused by damage or injury to the lining of the coronary arteries that impact the ability to vasodilate in response to increased myocardial

what is coronary microvascular disease?

-affects smallest vessels in the myocardium

-can be a normal part of aging

what is stable angina?

-angina=chest pain

-chest pain caused by ischemia that is initiated by increased oxygen demand and relieved with decreased demand (at rest)

-exertion induced!!

what is unstable angina?

-chest pain that become unpredictable

-occurs at rest or increases in frequency

and/or intensity

-considered a preinfarction (aka a warning sign!)

-unpredictable and it hurts!

what are the manifestations of angina's?

-angina that may radiate into the neck, jaw, arm, or back

-indigestion-like sensation

-nausea and vomiting

-extremely sweaty

-fatigue

-weakness

-dyspnea

which populations do not openly exhibit symptoms of anginas?

-women

-diabetics

what is a thrombus?

stationary blood clot that forms anywhere in the circulatory system

what are the three conditions that promote thrombus formation?

-endothelial injury

-sluggish blood flow

-hypercoagulability

which is the most common type of thrombi?

-venous thrombi more common that arterial due to lower pressure against gravity

what is an emboli?

-a traveling clot

-this is a portion of a thrombus that breaks loose

what is the relationship amongst emboli's and the right side of the heart origin?

-venous circulation that travels first to pulmonary circulation, creating a pulmonary embolism

what is the relationship amongst emboli's and the left side of the heart origin?

-arterial circulation and travel to other organs such as brain and heart, causing an infarction

what are the manifestations of pulmonary embolisms?

-sudden chest pain

-cough

-hemoptysis

what are the manifestations of a deep vein thrombosis?

-unilateral calf or groin pain

-swelling

-hot

-rednesss/erythema

what is a pulmonary embolism?

-when thrombus originates elsewhere

and disrupts blood flow in the pulmonary

artery or its branches

what are varicose veins?

-dilated, tortuous superficial veins

-improper venous formation

-most commonly in the legs

-increased venous pressure and blood pooling causes venous enlargement

what are the risk factors for varicose veins?

-pregnancy

-obesity

-prolonged sitting and/or standing

-alcohol use and liver disorders

what are the clinical manifestations of varicose veins?

-shiny hairless pigmented skin on the legs and feet

-venous stasis ulcers

-irregular purplish bulging veins

-pedal edema

what is lymph edema?

-unusual swelling in the extremities

what causes lymphedema?

-rare and caused by congenital absence or decrease in the number of lymphatics

-lymph accumulation in the extremities that causes swelling and usually due to an obstruction of a lymph node

what is a myocardial infarction?

-death of the myocardium from the sudden blockage of coronary blood flow

-aka a heart attack

-myocardial oxygen supply cannot meet body's oxygen's supply

-myocardial cells die

what are the risk factors associated with myocardial infarctions?

-dyslipidemia

-diabetes mellitus

-hypertension

-stress

-tobacco use

what are the manifestations of myocardial infarctions?

-diaphoresis

-elevation in cardiac biomarkers like triponin

-unstable angina that radiates

-indigestion sensation

-sleep disturbances

-dysrhythmias

what is hypertension?

-PROLONGED elevation in blood pressure creates excessive cardiac workload due to vasoconstriction increasing afterload

-decreased renal blood flow inappropriately activates renin- angiotensin-aldosterone system (RAAS)

what are the risk factors associated with hypertension?

-increased age

-african american

-fluid retention

-family history

-obesity

-high sodium intake

-high vitamin D intake

-stress

-smoking and alcohol

-inactivity

what is primary hypertension?

-most common

-develops gradually over time

-no identifiable cause

what is secondary hypertension?

-more sudden and severe

-caused by other factors such as renal disease, diabetes, adrenal gland tumors, certain medications can trigger hypertension

what is malignant hypertension (hypertensive crisis)?

-intense and non-responsive to interventions

-BP is at least 180/120 and the patient is

SYMPTOMATIC!

what are complications associated with hypertension

-cardiovascular disease (heart is working over time)

-stroke and brain complications

-kidney damage

-hypertrophy

-eye damage

-aneurysms and peripheral artery disease

what is orthostatic hypotension?

-orthostatic hypertension is a sustained increase in blood pressure (≥20 mmHg systolic or ≥10 mmHg diastolic) within 3 minutes of standing up from sitting or lying down

-lack of normal blood pressure compensation in response to gravitational changes on the circulation

what is virchow's triad?

1. circulatory stasis

2. hypercoagulability

3. vascular damage

*these are the 3 main risk factors for clot formation (thrombi/emboli)

*a clot will form when you have at least one (often more) of these factors according to virchow's triad

what is hypercoagulabilty in virchow's triad?

-when the blood is more likely to clot than normal

-causes like major trauma, cancer, or infection/sepsis