Patho - ch. 12 - cardiovascular and lymphatic

What is Coronary Artery disease?

CAD

the single leading cause of deaths 

thickening and loss of elasticity of artery

narrowing of coronary artery to an extent that there is inadequate blood supply

coronary artery becomes damaged or blocked due to buildup of plaque 

Etiology of CAD

predominant age of CAD 50-60years for men and 60-70years for women

leading cause is atherosclerosis (lumen of coronary artery is narrowed)

hereditary, obesity, age, high cholesterol diet, smoking, hypertension

S/S of CAD

immediate result of inadequate blood supply to myocardium is burning, squeezing, tightness in chest and radiates to neck

women experience abdominal and back pain

nausea, vomiting, sweating, SOB, feeling of panic

diagnostics of CAD

medical history

EKG - cardiac catheter to determine damage

dye injection into coronary arteries to see blockage on x-ray

treatment/therapy for CAD

lessen angina

Coronary Artery Bypass Graft (CABG)

lifestyle change (exercise and weight loss)

medication - nitroglycerin, cholesterol reducing, calcium channel blockers

surgery: laser angioplasty, bypass surgery

vitamin D supplements

Prognosis/prevention of CAD

guardedly favorable → greatly depends on amount of arterial blockage, extent of muscle damage, and success of lifestyle changes

complications: myocardial infarction, V-fib, congested heart failure, angina pectoris, sudden cardiac death

• minimize controllable risk factors 

What is essential hypertension?

persistant elevated blood pressure that develops without apparent cause

it progresses over a number of years 

affects everyone

• stage 1: more than 140/90 BP

• stage 2: more than 160/100 BP

Etiology of essential hypertension

onset in clients midlife and increase with age

idiopathic but some are higher risk (chronic stress, obese etc)

genetics but no pattern

insulin resistant drugs

sedentary lifestyle, smokers, women with oral contraceptives 

S/S of essential hypertension

may remain asymptomatic for months/years until vascular change in heart, brain, or kidneys

light headache, tinnitus, nocturia, tendency to tire easily, palpitations

headaches in occipital area

blurry vision

diagnostic for essential hypertension

medical exam

BP readings on 2 separate occasions after rest < 130/80

bruits (abnormal sound)

EKG and chest x-ray

treatment/therapy for essential hypertension

focus on nutritional diet in low fats and high fruits/veggies

weight loss

biofeedback, relaxations, liver oil calcium

low diet in salt and fat and high potassium

regular exercise 

prognosis/prevention of essential hypertension

good if detected early

control is key

could result to kidney failure and myocardial infarction

• minimize controllable risk factors: diet, stress, obesity, sedentary lifestyles

What is Mitral insufficiency/stenosis?

blood from the left ventricle flows back into the left atrium

left side heart failure, mitral valve prolapse or failing of valve tissue may occur

• blood is obstructed from left atrium to left ventricle

• enlarged left atrium

etiology of mitral insufficiency

secondary to myocardial infarction (MI) or infected endocarditis - vegetation on valves

rarely from childhood rheumatic fever

untreated streptococcal infection

S/S of mitral insufficiency

orthopnea, dyspnea, fatigue, palpitations, edema, A-fib, abnormal heart sounds

• can be those without symptoms

Diagnostics of mitral insufficiency

transthoracic echocardiography

EKG

chest x-ray

cardiac catheterization: severity of pulmonary hypertension

treatment/therapy of mitral insufficiency

depends on severity

balloon valvulopasty: surgical procedure to open narrowed heart valve

• serious can treat with artificial valve

practice oral care

limit caffeine, salt, alcohol intake

Prognosis/prevention of mitral insufficiency

good and usually doesn’t progress and some live without surgery

but can lead to right ventricle hypertrophy and failure

What is pernicious anemia?

failure of the gastric mucosa to secrete adequate intrinsic factor, resulting in malabsorption of Vitamin B12

Etiology of pernicious anemia

caused by failure of certain of certain cells in mucosa to secrete adequate lvls of protein

can damage brain, heart, and other organs

S/S of pernicious anemia 

fatigue, dyspnea, palpitations, tingling of extremities, sore/bright red tongue, impaired coordinations

diagnostics of pernicious anemia

medical history

complete blood count (CBC)

reveal lvl of hemoglobin, folic acid, and vitamin B12

bone marrow aspiration and gastric analysis

treatment/therapy of pernicious anemia

Vit B12 injections daily/weekly

nasal gel/spray

may improve within days after starting treatment

prognosis/prevention of pernicious anemia

can recover, feel well live a normal life if treatment is prompt

can cause permanent damage to nerves/other organs if delayed treatment - gastric cancer

encouraged to eat high Vit B12 diet

What is aplastic anemia?

absence of regeneration of RBC, WBC, and platelets

bone marrow stops producing

unable to fight infection

Etiology of aplastic anemia

results from injury or destruction of blood forming tissue in bone marrow

idiopathic but could be from chemotherapy or drug therapy, HIV, autoimmune disorders, infection

uncommon

S/S of aplastic anemia

onset is slower

fatigue, pallor, SOB, irregular heart rate, dizziness, uncontrolled bleeding from minor cuts, skin rash 

diagnostics of aplastic anemia

blood tests: see low RBC, WBC, reticulocytes

bone marrow study

liver function

medical history 

Treatment/therapy for aplastic anemia

• without treatment its fatal

bone marrow stem cell transplant

immunosuppressive therapy

exposure to toxins must be avoided

prognosis/prevention of aplastic anemia

poor - death result is 80%

transfusions for years

complications: infection, hemorrhage 

bone marrow transplant: 75-80% survival

What is Iron deficiency anemia?

inadequate supply of iron resulting in smaller blood cells

acute: rapid blood loss

chronic: poor diet slow blood loss

Etiology of iron deficiency anemia

excessive blood loss from GI bleed or pregnancy

can be a chronic intestinal diseases

low dietary intake

overuse of NSAIDS causing a GI bleed 

S/S of iron deficiency anemia

extreme fatigue, pallor, inability to concentrate, headache, weakness, cold hands/feet, irritability,

• symptoms can become more severe

tachycardia, increase infection, brittle nails

Diagnostics of iron deficiency anemia

detailed health history

blood tests: low hemoglobin and hematocrit valves (% of RBC in total volume)

endoscopy - GI bleed, colonoscopy - tumors/colon cancer, ultrasound -  reasons for excessive menstrual flow

extreme: bone marrow aspiration 

treatment/therapy for iron deficiency anemia

• depends on severity or cause

liquid iron - dietary supplements

high in iron food (poultry, eggs, seafood, green veggies, oats)

prescribes Vit C and calcium

limit sugar, alcohol, caffeine

prognosis/prevention of iron deficiency anemia

good if underlying cause is detected and treated

• untreated: heart irregularities, growth difficulty in children, premature/low weight births

screen for anemia when pregnant

What is folic acid deficiency anemia?

inadequate intake of folic acid, a nitrogenous acid found in some foods

large abnormal RBCs

Etiology of folic acid anemia

insufficient folic acid (B complex vitamin)

arise from increase utilization of folic acid (pregnancy, infancy, blood disorders)

impaired absorption - drug related imbalance

poor diet or consequence to alcoholism

S/S of folic acid deficiency anemia

fatigue - gray hair - mouth sores - swollen tongue - forgetfulness - depression - trouble concentration - anorexia - loss

Diagnostic of folic acid deficiency anemia

physical exam - blood tests (CBC) and find decreased B12

bone marrow for secondary cause

Treatment/therapy for folic acid deficiency

oral supplements

vitamin B12 supplements

diet high folic acid - seafood, beef, green veggies, beans, eggs

prognosis/prevention of folic acid deficiency anemia

supplements before and after pregnancy

high folic aid diet

good prognosis

What is lymphedema?

abnormal accumulation of lymph, usually in extremities, due to abnormality in lymphatic drainage

primary: occurs alone

secondary: occurs from something else

etiology of lymphedema

when lymph vessels are unable to adequately drain lymph fluid from extremities

primary: rare - inherited

secondary: result of surgery, trauma, burns, radiation, infection

mostly in women

S/S of lymphedema

affected limb: swollen/hypertrophied - thick fibrotic skin

usually painless - lympharyngitis (inflammation of lymph vessels) - cellulitis (inflammation of connective tissue)

chronic dull heavy sensation

edema (pitting/nonpitting)

Diagnostics of lymphedema

rule out reasons for swelling - client history

not obvious so an MRI, CT, or dopplar ultrasound is done

lymphoscintigraphy with radioactive dyes move through lymph vessels

treatment/therapy for lymphedema

lessen swelling

gentle exercise, massage, pneumatic compression, compression garments

no medication is successful - but could be anti-inflammatory

prognosis/prevention for lymphedema

depends on cause and infection may worsen

responds well with proper care

• no known condition

What is Congestive Heart Failure?

CHF

pumping ability of heart is progressively impaired to a point that it no longer meets its bodily needs

blood flow slows = blood returning to heart backing up and congesting inn tissue → peripheral edema in legs

may occur in pulmonary circulation = life threatening edema

limits kidneys ability to dispose sodium and water

Etiology of CHF

• left side: fluid back up in lungs

• right side: fluid collects in ABD, legs, and feet

• systolic heart failure: L ventricle  can’t contract, vigorously pumping problem

• Diastolic heart failure: L ventricle cannot relax or fully fill - fill problem

may be cause of other cardiac/pulmonary disease=hypertension, CAD, MI

S/S of CHF

• Left ventricle: dyspnea, fatigue, pulmonary symptoms, SOB

• Right ventricle: distended neck veins, hepatomegaly, systemic symptoms

tachycardia, palpitations, edema, lack of appetite, weight gain (unexplained), wheezing, nocturia, cyanosis

Diagnostics of CHF

complete physical exam

EKG, chest X-ray, elevated central venous pressure

blood tests (CBC, electrolyte, glucose, bilirubin, blood urea nitrogen (BUN)

echocardiography - cardiac CT - MRI - cardiac catheterization

Treatment/therapy of CHF

goal: improve heart pumping function, relieve symptoms, improve quality of life

diuretics: reduce circulatory congestion by reducing total blood volume

bedrest, weight loss, salt intake is restricted

Prognosis/prevention of CHF

good although it depends on cause

acute: responds quickly to therapeutic measures

chronic: bleak

after symptoms - 5 year mortality rate is 50%

avoid predisposing factors

reduce stress and control hypertension

What is Atrial fibrillation?

most common heart arrhythmia

both atrials in the heart beat irregularly, often rapidly and out of rhythm with lower ventricle

as high as 175 bpm

blood can stagnate and clot → brain → stroke

etiology for A-fib

injuries to heart or abnormalities

hypertension, congenital birth defect, hyperthyroidism, previous heart problems

greater if theres family history of Afib and binge drinking

S/S of Afib

can be sporadic or chronic because heart isn’t beating efficiently

racing heart/tachycardia

palpitations, confusion, chest pain, weakness, SOB

Diagnostics of Afib

seek underlying cause

EKG - Holter monitor (1-2 days

chest X-ray

blood tests

stress testing

photoplethysmography: detect Afib in seconds 

Treatment/therapy of Afib

occasional: correct through coughing

attempt to slow heart beat with beta/calcium channel blockers

procedure: electrically or medications - cardioversion

cryoablation: remove tissue with extreme cold 

modify diet, reduce weight, no alcohol

Prognosis/prevention of Afib

can increase likelyhood of CVA or MI

long term is monitored

good if cause is found

complications: stroke, peripheral atrial embolization, bleeding 

Prevention: no alcohol, over counter meds are avoided

What are the most common signs of cardiac/lymphatic diseases/disorders?

fatigue, weakness, palpitations, tachycardia, chest pain, night sweats, edema, headaches

What are some heart sounds?

frequency, intensity, duration, timing

frequency/pitch

high pitched or low pitched

intensity

loudness or softness

duration

very short heart sounds with longer silent periods

albumin

a group of simple plasma proteins in humans that act as a source for rapid replacement of tissue

phagocytosis

filter by destroying microorganisms and abnormal cells harmful to the body

What are some diseases of the heart muscle?

pericarditis, myocarditis, endocarditis

pericarditis

inflammation of the pericardium

*the sac like membrane that surrounds and protects the heart*

cardiac tamponade

is developed in a person who has pericarditis

• when fluid accumulates  in the pericardium sac compressing the heart and restricting ventricular filling

• leads to decrease output and circulatory collapse

myocarditis

inflammation of the cardiac muscle and conduction

can be viral/bacterial infection

• tachycardia, fever, fatigue

Endocarditis

“infective endocarditis”

vegetation forms as infected tissue is covered by a layer of platelets

inflammation of membrane lining valve and chamber

petechia

pinpoint hemorrhage spots on skin

What are some complications of the heart valves?

**opening of the heart is too large to close completely and blood leaks backwards

**opening is too narrow so it impedes flow of blood 

what is dilatation?

enlargement of the heart

what is stenosis?

increased ventricular pressure result of cardiac workload

left ventricle failure

What is angina pectoris?

chest pain

• squeezing, pressure, fullness, discomfort

stable angina

most common, during stress or exercise and is relieved by rest

unstable angina

unexpected, more frequent, emergency

variant angina

least common, occurs at rest

What is atrial flutter?

tachycardia that results in arrhythmia due to narrow QRS rhythm

lowered blood flow to the heart that results of a blood clot or coronary artery disease

“saw tooth” EKG

Myocardial infarction (MI)

heart attack

blood flow to sections of heart muscle becomes blocked (clot)

muscle damage can occur

Cardiac arrest

occurs when heart arrhythmia causes heart to suddenly stop beating 

Bradycardia

slowed heart rate

What is an aneurysm?

local dilation of blood vessel due to weakening of wall

• sacculated (sac like)

• fusiform (spindle/enlarged in middle)

• dissecting (in the layer of wall)

thrombus

blood clot

What is the most common aneurysm?

in the abdomine

(AAA) - abdominal aortic aneurysm

What is the most dangerous aneurysm?

Thoracic aortic aneurysm (TAA)

lead to hypotension and shock if ruptured

what is peripheral aortic aneurysm?

enlargement/weakened area of artery other than aorta

can cause limb numbness

What is the cause of aneurysms?

could be congenital or result from trauma, inflammation, infection, or degeneration

• hypertension, MI, heart failure, corotid artery occlusion

Treatment for aneurysms

wait-and-watch and beta blockers

surgery is treatment of choice when likely to rupture

prognosis/prevention of aneurysm

guarded for AAA and TAA

ruptured= very low survival rate

*make sure you lower BP and cholesterol

What is ARTERiosclerosis?

thickening of walls of small arteries

what is ATHERosclerosis?

type of arteriosclerosis

• accumulations of yellow plaque of cholesterol of large/medium arteries

Where is arteriosclerosis and atherosclerosis most common at?

the coronary and cerebral arteries 

• consequence: circulation impairment

S/S of arteriosclerosis/atherosclerosis

• depends on vessel and extent of obstruction

• often asymptomatic until artery is so narrow it cannot supply blood

claudication

pain in legs during walking

angioplasty surgery

laser surgery with stent placement

Thrombophilebitis

inflammation of vein when clot forms

abnormal mass of platelets on vascular wall

vein can partially or completely obstruct

often in legs 

• related to trauma, reduced/turbulent blood flow, stroke, pregnancy

superficial thrombophlebitis

blood clot just below surface of skin