Exam 2- Heart- Abnormalities

When does angina pectoris occur?

Myocardial oxygen demand exceeds supply

Can be recurrent or present as initial incidents

Subjective data of agina pectoris

Substernal pain radiating to neck, jaw and arms, especially on left

Shortness of breath, fatigue, diaphoresis, faintness and syncope

Objective data of angina pectoris

No definitive examination findings

Ischemia with angina pectoris may lead to?

Presence of crackers due to pulmonary edema or reduction in the S1 intensity or an S4

(Crackle occurs when fluid in lungs)

What happens when a patient walks in with angina pectoris

Call 911 and get them in an ambulance to the hospital if haven't had previous episode

What is a bacterial infection of the endothelial layer of the heart and valves?

Bacterial endocarditis

Acute bacterial endocarditis

Fever, fatigue

Chronic bacterial endocarditis

Fatigue, murmur (from scarring of the valves)

If a patient walks in with bacterial endocarditis, what should you do?

Send to urgent care or family practitioner if they can get same day care

What starts as strep throat and ends up as heart infection?

Rheumatic fever

What is it when heart fails to propel blood forward, resulting in in congestion in the pulmonary circulation?

Congestive heart failure- left sided

Symptoms of congestive heart failure-left sided

Breathing difficulty, shortness of breath

Orthopedic (short of breath lying down)

Crackers (fluid in lungs)

Systolic CHF has narrow pulse pressure

Diastolic CHF has wide pulse pressure

Heart fails to propel blood forward with its usual force ,resulting in congestion in the system circulation?

Congestive heart failure- right sided

Symptoms of congestive heart failure-right sided?

Peripheral edema- especially at end of day or with prolonged sitting and standing

Pitting edema in lower extremities

Jugular venous distention

Ascites

Hepatomegaly

What is ascites?

Swelling of abdomen

What is hepatomegaly?

Swelling of the liver

What is jugular venous distention?

External jugular vein is visible when patient is reclined

What is inflammation of the pericardium

Pericarditis

Symptoms of pericarditis

Sharp and stabbing chest pain with each beat

Pain worse with coughing, swallowing, deep breathing lying flat or movement

The pain with pericarditis may be most severe when________ and relieved by ___________

Severe when supine

Relieved sitting up and leaning forward

Where is the pain with pericarditis

Back, neck, left shoulder

What are some other general symptoms of pericarditis

Difficulty breathing when lying down

Dry cough

Anxiety or fatigue

What is the big thing with pericarditis

Friction rub when auscultation

-have patient hold their breathe to see if its coming from the lungs or heart, if it doesn't stop then its from heart

What is excessive accumulation of effuse fluids or blood between the pericardium?

Cardiac tamponade

What is a common cause of cardiac tamponade

Penetrating trauma or have heart attack and muscle is weak so tears or from infection

What are some symptoms of cardiac tamponade

Anxiety, restlessness

Chest pain

Difficulty breathing

Discomfort relieve by sitting upright or leaning forwards

What do you notice with the skin with cardiac tamponade

Pale, gray or blue skin

Where may you get swelling with cardiac tamponade

Abdomen or arms or neck veins

What is the big thing with cardiac tamponade

Beck triad

What is beck triad?

Jugular venous distention

Hypotension

Muffled heart sounds

What is enlargement of the right ventricle secondary to chronic lung disease?

Cor pulmonale

What happens with cor pulmonale?

Gradual hypertrophy of the right ventricle progresses until ultimate heart failure

What causes cor pulmonale?

Chronic obstructive pulmonary disease (COPD) and pulmonary arterial hypertension

During the acute phase of cor pulmonale what happens

The right side of the heart is dilated and fails

What are the acute causes of cor pulmonale

Massive pulomary embolism and acute respiratory distress syndrome (ARDS)

What is a heart attack?

Myocardial infarction

What is ischemic myocardial necrosis caused by abrupt decrease in coronary blood flow to a segment of the myocardium?

myocardial infarction

Myocardial infarction most commonly affects?

Left ventricle

What is associated with myocardial infarction?

Atherosclerosis atherosclerotic plaques with clot formation

Where is pain with myocardial infarction?

Deep substernal pain radiating to jaw neck and left arm

What are common with myocardial infarctions?

Dysrhythmias

What is usually present with myocardial infarctions?

S4

What is seen on the ECG with a myocardial infarction?

ST elevation

Describe the pulse with myocardial infarction

Thready pulse (weak and rapid)

What happens with the blood pressure in a myocardial infarction

Blood pressure varies, usually hypertension in early phases

What is focal or diffuse inflammation of the myocardium?

Myocarditis

Initially the symptoms of myocarditis are?

Vague

What is the history of a patient with myocarditis?

Recent flue like syndrome of fevers, arthralgias and malaise or pharyngitis, tonsillitis, or upper respiratory tract infection

What comes along with myocarditis

Cardiac enlargement

Murmurs

Gallop rhythms (from S3 and S4)

Tachycardia

Dysrythmias

Pulsus alternans

What is the alternation of strong and weak arterial pulse due to alternate strong and weak ventricular contractions during myocarditis?

Pulsus alternans

Where do conduction disturbances occur in the heart?

Proximal to bundle of His or diffusely throughout the conduction system

What is sick sinus syndrome?

arrhythmias caused by malfunction of the sinus node

(Sinoatrial node doesn't work properly)

What is opening between the left and right ventricles in infants and children?

Ventricular septal defect

(Left to right shunt)

What is a sign of ventricular septal defect in infants and children?

Arterial pulse is small

A smaller ventricular septal defect causes a __________ murmur and ______________ felt thrill than a large one

Louder

More easily felt

What is the tetralogy of fallot?

1. Ventricular septal defect

2. Pulmonic stenosis

3. Dextroposition of aorta

4. Right ventricular hypertrophy

What are some symptoms of tetralogy of fallot?

Dyspnea with feeding

Poor growth

Exercise intolerance

What is some other symptoms of tetralogy of fallot?

Parasternal heave

Older children may develop clubbing of fingers and toes

What is failure of ductus arteriosus to close after birth?

patent ductus arteriosus

(Left to right shunt)

A small shunt in patent ductus ateriosus may be? While a larger one?

Asymptomatic

Larger one causes dyspnea on exertion

What are some symptoms of patent ductus arteriosus

Dilated and pulsatile neck vessels

Wide pulse pressure

Harsh loud continuous mucous heard at the first to third intercostal spaces and the lower sternal border with machine-like quality

What is a congenital defect in the septum dividing the left and right atria?

Atrial septal defect

(Left to right shunt)

Atrial septal defect can result in?

Ride sided enlargement and heart failure

What is the big thing with atrial septal defect?

S2 may be widely split

What is strep throat that spreads to the heart?

Acute rheumatic fever

-systemic connective tissue disease occurring after streptococcal pharyngitis or skin infection

What is the most common thing we see with hearts in older adults?

Atherosclerotic heart disease (coronary artery disease)

What causes atherosclerotic heart disease (coronary artery disease)?

Deposition of cholesterol and other lipids and is a inflammatory process

What is amyloid deposition in the heart?

Senile cardiac amyloidosis

What is amyloid?

Fibrillary protein produced by chronic inflammation or neoplastic disease

What is the result of senile cardiac amyloidosis?

Reduced contractility and heart failure