Patho ch 26 - Cyanotic Heart Disease

Pathophysiology Ch. 26 - Cyanotic Heart Disease and Alterations in Cardiological Function

consistent elevation of systemic arterial blood pressure

hypertension

hypertension is a disease of the _____

arteries

hypertension is a sustained systolic and diastolic blood pressure of (values) =

systolic > 130 mmHg, diastolic > 80 mmHg

BP values of systolic = 130-139 mmHg, diastolic = 80-89 mmHg - indicate what type of hypertension?

hypertension stage 1

hypertension stage 1 values =

systolic = 130-139 mmHg, diastolic = 80-89 mmHg

BP values of systolic equal to or higher than 140 mmHg, diastolic equal to or higher than 90 mmHg - indicate what type of hypertension?

hypertension stage 2

hypertension stage 2 values =

systolic = 140 mmHg or higher, diastolic = 90 mmHg or higher

BP values of systolic = higher than 180 mmHg, diastolic = higher than 120 - indicate which type of BP/hypertension stage?

hypertensive crisis

hypertensive crisis values =

systolic = higher than 180 mmHg, diastolic = higher than 120 mmHg

primary (aka essential) hypertension is a result of =

a fault in the blood vessels organ system

the exact cause for primary (aka essential) hypertension is considered =

idiopathic, no known cause

a fault in the blood vessels organ system causes which type of hypertension

primary (aka essential)

secondary hypertension is a result of =

a fault in an organ system other than the blood vessels, a result of an underlying primary disease

a fault in an organ system other than the blood vessels or as a result of an underlying primary disease or drugs - causes which type of hypertension?

secondary

which type of hypertension is the most common and what percent of cases does it account for?

primary (aka essential), 95%

what percent of cases does secondary hypertension account for?

~5%

normal systolic and diastolic blood pressure values =

systolic = 100-120 mmHg, diastolic = 60-80 mmHg

BP values of systolic = 100-120 mmHg, diastolic = 60-80 mmHg - indicate what type of BP?

normal

hypertension is a common disorder affecting what percent of the population?

25%

hypertension is a risk factor for causing which diseases?

atherosclerosis, congestive heart failure, renal failure

pre-hypertension (aka elevated bp) values =

systolic = 120-129, diastolic less than 80

values of systolic = 120-129, diastolic less than 80 - indicate which type of BP?

elevated or pre-hypertension

the common factor across hypertension cases is that =

sodium retention, or a decrease in renal excretion

pathophysiology of hypertension =

increased arteriolar vasoconstriction → increased total peripheral resistance → elevated BP

RAAS stands for

renin-angiotensin-aldosterone-system

what system regulates your BP under normal conditions?

RAAS

overactivity of the parasympathetic nervous system and RAAS, alterations in natriuretic peptides, inflammation, endothelial dysfunction, insulin resistance and damage to arterial walls are all examples of =

pathophysiology of hypertension

hypertension can cause an increased risk of _____. This is because hypertension makes it harder for _____ to bind to its receptors, which causes ______

diabetes, insulin, elevated blood sugar

diabetes can increase the risk for _____ because a high blood glucose level causes _____, which causes _____, which leads to a higher blood pressure

hypertension, endothelial damage, vasospasm

hypertension and diabetes usually do what

occur together or cause one another

diagnosis of hypertension is usually ____

incidental

diagnosis of hypertension requires =

3 different readings on 3 different days, 5 min of rest, no smoking or caffeine intake in past 30 min

family history, advancing age, sex, and race are all examples of _____ risk factors of hypertension

non-modifiable

sodium intake, glucose intolerance, insulin resistance, obesity, heavy alcohol use, cigarettes, inflammation, and dyslipidemia (high LDL low HDL) are all examples of _____ risk factors of hypertension

modifiable

which sex is at a higher risk of developing hypertension? why?

males, testosterone

which sex is at a lower risk of developing hypertension? why?

females, protected by estrogen

at what age does the risk of developing hypertension become equal for both sexes?

65+

which race is at the highest risk for developing hypertension?

black/african american

ex: someone transitioning from a female to male is taking testosterone - what happens to their risk of developing hypertension?

same risk as a genetic male

CBC, kidney panel (BUN & creatinine), urinalysis, lipid profile, EKG, and echocardiogram are all types of what?

hypertension diagnostic tools

the stairway effect increases the risk for a patient being _____

non-compliant

adding more drugs to a patients treatment regimen as the years go on

stairway effect

low sodium diet, DASH diet, exercise, weight reduction, decrease stress, alcohol moderation, and education are all things a person can do to achieve what

decreased risk of hypertension

diuretics, angiotensin-converting-enzyme inhibitors (ACE- inhibitors), angiotensin-II receptor blockers (ARB), calcium channel blockers, aldosterone antagonists, and beta blockers are all examples of what

medications that treat hypertension

a patient with long-term or poorly controlled hypertension is at a higher risk for developing what types of conditions?

neuropathy, nephropathy, retinopathy

malignant hypertension is aka

hypertensive crisis or resistant hypertension

resistant hypertension or hypertensive crisis is aka

malignant hypertension

type of hypertension that is life-threatening and has end-organ damage as a result

hypertensive crisis

when assessing a patient with hypertension, we must rule out a secondary cause. This is because if the cause of hypertension is secondary, treating the underlying primary condition will result in =

BP normalizes, hypertension goes away

diseases of these body systems = renal (ex. tumor, ulcerative kidney disease), endocrine (cushing’s, hyper/hypothyroidism, acromegaly), cardiovascular, neurologic (increased stress, sleep apnea) can all cause =

secondary hypertension

type of arteriosclerosis in which plaque build up causes the vessel to thin

atherosclerosis

atherosclerosis is the most common cause of what condition

coronary artery disease

coronary artery disease is most commonly caused by what

atherosclerosis

atherosclerosis can also lead to what condition (besides coronary artery disease)

cerebro-vascular disease leading to stroke (CVA)

high BP causes endothelial damage → this activates inflam processes → inflam processes cause plaque buildup, hardening of smooth muscle → blocks vessel flow → can cause embolism

atherosclerosis pathophysiology

obstruction of an artery, typically by a clot of blood, fat/plaque, or an air bubble

embolism

a blood clot, air bubble, piece of fatty deposit, or other object which has been carried in the bloodstream and lodged in a vessel, causing an embolism

embolus

the action of listening to sounds from the heart, lungs, or other organs, typically with a stethoscope

auscultation

a stationary blood clot is termed

thrombus

diagnostic tool that shows only the electrical activity of a heart

EKG (electrocardiogram)

auscultation of the heart shows us what about a patients condition?

severity or abnormality

diagnostic tool that shows the physical structure and activity of the heart as it is pumping

echocardiogram

diagnostic tool that shows a patients cardiovascular function - patients do physical activity

exercise stress test

the line on a chest x ray where the apex of the heart should end/not go further than. if the apex passes this line, it indicates acromegaly. you can use the left nipple as a reference point

midclavicular line

diagnostic tool that is used to measure pressure and assess valve and heart function - a tube is inserted into the heart/arteries

cardiac catheterizaiton

a diagnostic tool that is used to visualize the blood flow in the coronary arteries - dye is injected into the bloodstream

angiography

a diagnostic tool that is used to assess blood flow in peripheral arteries and record sounds of blood flow/identify obstructions - uses sound waves

doppler study

coronary artery disease is also known as

ischemic heart disease

any vascular disorder that narrows or occludes he coronary arteries leading to myocardial ischemia and possibly myocardial infarct - is termed =

coronary artery disease

any vascular disorder that narrows or occludes arteries OTHER than the coronary arteries

peripheral artery disease

chest pain is medically termed

angina pectoris

the types of angina pectoris are =

blockage (stable and unstable) and spasms(prinzmetal)

difference between stable and unstable angina: pain on exertion, relief of pain upon rest or when treated with nitroglycerin, short duration of pain (1-5 min) = which type?

stable

difference between stable and unstable angina: pain on rest, no relief with rest, nitroglycerin not effective, 5-10 min pain duration = which type?

unstable

when a patient with stable angina is assessed, the physical exam is often _____ because the process is _____

normal, reversible

nitrate (nitroglycerin), beta blockers, calcium channel blockers, statins, and ranolazine are examples of medications for the treatment of

stable angina

the medication of choice for stable angina is =

nitroglycerin SL

sudden coronary obstruction resulting from a thrombosis or embolus is termed

acute coronary syndrome

unstable angina is typically foreshadowing or a warning sign for what

myocardial infarction

the size of the myocardial infarct as well as the vessel involved is going to determine the _____ for a heart attack patient

prognosis

what factors affect a heart attack patients prognosis?

size and vessel involved

the types of myocardial infarction (heart attack) =

STEMI and non-STEMI

a myocardial infarction occurs when =

a coronary artery is completely obstructed

_____ is the most common cause of a myocardial infarction

atherosclerosis

atherosclerosis is the most common cause of what medical emergency?

myocardial infarction

levine sign, feelings of squeezing, aching or burning, “elephant on chest”, epigastric pain, feeing of indigestion, nausea/vomiting, sweating (diaphoresis), symptoms occurring in the early morning - all clinical representations or signs and symptoms of what

myocardial infarction

a patient clenches their fist and places it over their heart, exclaiming their heart hurts - this is known as _____ which is an indicator of a heart attack. (myocardial infarction)

the levin sign

in a myocardial infarction, the pain is ____ in the directions of the _____ and _____

radiating, left neck, left arm

regardless of age, sex, or ethnicity, a patient presenting with pain in the epigastric region is typically an indicator of _____ problems rather than GI.

heart

GI problems will not cause pain in the _____ region, but heart problems will - this is why you think heart before you think GI when a patient is presenting with pain in this area.

epigastric

MI typically happens in the morning because =

most stressful time of day on the body (physically and hormonally)

12-lead EKG, cardiac biomarkers test (troponin or a CK-MB), CBC, Comprehensive metabolic panel, lipid profile are all examples of diagnostic tools for what

myocardial infarction

the cardiac biomarker test of choice between a troponin test and a CK-MB test is =

troponin

_____ is a thrombolytic agent used to treat acute myocardial infarction (MI) by dissolving blood clots, restoring blood flow to the heart

tissue plasminogen activator (tPA)

the TPA treatment timeframe for a heart attack patient is =

4 hours

aspirin, oxygen canula, nitroglycerin, TPA, analgesic (such as morphine), IV anti-hypertensive drugs, statins, reperfusion treatment - all examples of treatment for what

myocardial infarction

_____ is a life-threatening MI complication where the heart's lower chambers (ventricles) quiver erratically instead of pumping blood effectively

ventricular fibrillation (v-fib)

sudden death, cardiac tamponade, cardiogenic shock, congestive heart failure, and stroke are all examples of what?

risks or complications of a heart attack

percutaneous coronary intervention (balloon angioplasty), coronary artery bypass graft (CABG), external counter-pulsation (ECP) are all surgical interventions for what

myocardial infarction

prinzmetal angina is also known as

variant/vasospastic angina