PTE 741: exam 1

cardiovascular system

what is the function of the cardiovascular system?

circulate oxygenated blood, fluids, and nutrients via the arterial system to meet metabolic demands and to collect deoxygenated blood and metabolic waste products which need removal.

what are the four components of the cardiovascular system?

1. heart: generates force and pressure gradient

2. blood: volume made up of cells and plasma

3. blood vessels: contain blood

4. neurohormonal system: ANS sympathetic and parasympathetic systems that control the system

______ _______ is the number one cause of death in the United States.

heart disease

list the non-modifiable CV risk factors.

• age

• gender

• race

• family history or prior CV diagnosis

what are some examples of modifiable CV risk factors?

hypertension, hyperlipidemia, tobacco & alcohol use, diabetes, obesity, sedentary lifestyle, and women over 35 years old taking oral contraceptive pills

around the age of _____, there is an inflection point (increase in) risk of CVD.

60-65 years old

• females: 65 and males: 55

________ is the highest risk factor for developing heart disease.

atherosclerosis

a patient presents to the ER complaining of chest and shoulder pain. during the initial encounter, he admits to recently feeling super fatigued, dizzy upon standing, and labored breathing while walking within his house. what diagnosis is most likely determined?

CVD

a patient presents to the ER complaining of frequent urinating with little urine output along with feeling nauseous. upon observation, a nurse notices the patient has cyanosis, BLE edema, and no leg hair. should the nurse order an ECG?

yes; these are signs and symptoms of CVD

which nerve roots innervated the heart?

C3-T4

what are palpitations?

abnormal heart beats that are experienced by an individual

palpitations that are more than __ /min, are prolonged, and are accompanied by shortness of breath, chest discomfort, and/or syncope are cause for concern.

6

list some conditions that may cause dyspnea due to an increased demand on the body.

• fever/infection

• tachycardia

• deconditioning

• anxiety

• some medications (stimulants)

list some conditions that may cause dyspnea due to decreased delivery ability.

• CVD/CHF

• hypotension

• bradycardia

• obesity

• anemia

dyspnea on exertion

occurs with mild-moderate activity

paroxysmal nocturnal dyspnea (PND)

sudden episodes of shortness of breath while sleeping

orthopnea

recumbent dyspnea relieved by upright positioning

at what point should a patient with dyspnea be referred to a cardiologist?

• unable to climb a single flight of stairs without feeling mod-severe SOB

• nocturnal awakening due to SOB

• orthopnea

• progressive worsening of symptoms

• dyspnea accompanied by chest discomfort or syncope

complaints of fatigue is non-specific and a symptom for many issues, so how does one know its related to CVD?

if the patient has one or more CVD risk factors along with fatigue, exhibits abnormal vital signs with exercise, or prior heart issues

T or F: a CVD associated cough may represent pulmonary vascular congestion.

T

what causes BLE edema?

R heart failure

arterial end net filtration pressure =

10 mmHg

venous end net filtration pressure =

-7 mmHg

what is claudication?

pain or cramping in the muscles of the LE that occurs with activity and is relieved by rest

what are the differences noted between diseases of the heart muscle vs. heart valves?

heart muscle disease: less force contraction available → less flow

heart valve disease: 1) shrinking valves → less flow 2) valve incompetence → normal flow but in wrong direction

what are the three factors of cardiopulmonary pathologies?

1. obstruction/restriction

2. inflammation

3. dilation/distention

obstructive/restriction

restriction impairs flow; obstruction prevents flow

inflammation

myocardial or vascular inflammation are related to infection or auto-inflammatory diseases, impair muscle activity, and/or enhances clotting factor activity

dilation/distention

excessive dilation impairs myocardial contractility; excessive distention places excessive stress on vessel walls

what is hyperlipidemia?

elevated serum lipids that increases risk for atherosclerosis and coronary artery disease

list some types of serum lipids that may be elevated in the case of hyperlipidemia.

• total serum cholesterol

• low-density lipoproteins (LDL)

• triglycerides

• apolipoprotein-B (ApoB)

what are the desirable values for cholesterol, triglycerides, LDL, and HDL?

cholesterol: <200 mg/dl

triglycerides: <150 mg/dl

LDL: <130 mg/dl

HDL: >45 mg/dl

________ are the most common lipid lowering drugs in the world.

statins

how do statins decrease cholesterol levels?

statin MOA inhibits HMG-CoA within liver cells

• HMG-CoA is an enzyme used to produce mevalonic acid which is a precursor to cholesterol

list the muscular and non-muscular side effects of statins.

muscular: myopathy, myositis, and weakness

non-muscular: nausea/vomiting, fever, liver impairment, new-onset diabetes

T or F: in general, at least 25% of pateints taking statins will develop myopathy.

T

T or F: patients who are taking statins and are vigorously exercising are at a lower risk of musculoskeletal side effects.

F; they are at highest risk

what is ischemia in terms of coronary artery disease?

ischemia is insufficient oxygen delivery to the heart

• insufficient blood supply means insufficient O2 and nutrients to meet heart’s metabolic. demands

describe the difference between relative ischemia vs. absolute ischemia.

relative: reversible by rest or increased delivery (via NTG); aka angina

absolute: not reversible without interventions and leads to cell death; aka myocardial infarction

what is the difference between atherosclerosis and arteriosclerosis?

atherosclerosis: plaque build up inside arteries

arteriosclerosis: the hardening of the arteries → thick and less flexible

T or F: atherosclerosis is i a progressive disease and is usually asymptomatic until a major event.

T

what is thrombosis?

the formation of a blood clot inside a blood vessel, blocking blood flow, and can happen in veins or arteries

describe the progression of plaque build up.

1. penetration of lipoproteins into the smooth muscle cells of the blood vessels

2. coronary lesion begins to form

3. coronary lesion grows outward at first in a compensatory manner to maintain an open vessel until it cannot maintain it anymore

4. plaque begins to build up within lesion, gradually pressing into the blood vessel

5. obstructs blood flow and possibly ruptures

plaque formation and maturation are _____ events whereas a plaque rupture is an _____ event.

chronic; acute

plaque _______ flow, and thrombosis ______ flow.

restricts; obstructs

ischemia is an inflammatory event that can lead to pain. how does this occur?

ischemic pain occurs when demand is greater than supply, leading to lactate accumulation (→ pain)

angina chart

a patient reports chest pain after warming up on the Nu-step for 8 mins. he describes this pain as squeezing with a deep ache, but reports this feeling with activity is normal. after resting for 5 mins, his chest pain is gone. what type of angina did he experience?

chronic stable angina

a patient presents to the ER with severe chest pain that rose her from a deep sleep. she describes the chest pain as heartburn and reports feeling extra fatigued recently. she stated that her chest pain diminished while she was eating breakfast at her kitchen table, but still wanted to check it out. what type of angina did she experience?

nocturnal

what’s the difference between unstable angina vs atypical angina?

unstable: medical emergence; unpredictable, long-lasting symptoms due to plaque rupture with platelet aggregation that are not relieved with rest or NTG

atypical: myocardial ischemia with non-classic symptoms like jaw pain, epigastric discomfort, nausea, or dyspnea that can be relieved

what are the steps a therapist must follow if a patient is having chest angina who has a known history of CAD?

1. rest 5 mins

2. take NGT

3. rest 5 mins again

4. refer to EMS

what are the steps a therapist must follow if a patient is having new onset chest angina?

1. rest 5 mins then either:

   1. pain resolved and low risk → contact PCP

   2. no pain resolution and high risk → refer EMS

what coronary artery is known as the widow maker and has a very high mortality rate if an MI where to occur there?

left main coronary artery (LCA)

list some examples of classic clinical signs and symptoms of a myocardial infarction.

• sudden death

• pain radiating down arms, neck, throat, jaw, back, and/or shoulders

• nausea/indigestion

• dimness or loss of vision

• pallor

• diaphoresis

• SOB/dyspnea

• weakness, numbness, feeling of faintness

• impending doom

list some examples of clinical signs and symptoms of a myocardial infarction in women.

• confusion

• dyspnea

• weakness and lethargy

• indigestion, heartburn, epigastric pain

• anxiety and depression

• sleep disturbance

• sensation in chest of inhaling cold air

• isolated mid-thoracic or inter-scapular back pain

• aching, heaviness, weakness in arms

what is pericarditis?

inflammation and irritation of parietal pericardium that induces friction between the layers and weeping of fluid into the inter-membrane cavity (aka pericardial effusion)

a patient with a history of heart issues complains of chest pain and dyspnea during a therapy session. he describes the pain as a sharp, stabbing pain with movement so the therapist stops and takes the patient’s vitals. the therapist discovers tachycardia and a fever. the therapist suspects pericarditis and suggests the patient sits in what position while on his way to the ER.

upright and leaning forward to avoid the heart beating against the pericardium

what is pericardial effusion?

the buildup of excess fluid in the pericardium, the thin, two-layered sac surrounding the heart, which puts pressure on the heart, preventing it from pumping effectively

what is pericardial tamponade?

(acute) fluid rapidly builds up in the pericardium creating immense pressure that stops the heart from filling with blood and pumping effectively, leading to a severe drop in blood pressure and shock

• chronic= pericardial thickening

why do patients with pericardial tamponade experience a drop in cardiac output?

the outside compression force exceeds the incoming pressure of blood during diastole, so there is a drop in preload (stroke volume) and cardiac output despite body trying to maintain it via increasing the heart rate

• hypotension with compensatory tachycardia

T or F: pericardial tamponade is a restrictive heart disease.

T

define heart failure.

impaired cardiac pumping or filling that leads to insufficient cardiac output and fluid congestion, resulting in symptoms of poor perfusion and volume overload

T or F: at the root of congestive heart failure is inadequate blood flow (failure to deliver) which results in inadequate perfusion and fluid backup (congestion).

T

what’s the difference between stroke volume and ejection fraciton?

stroke volume: the volume of blood pumped out of the heart's left ventricle with each heartbeat (normal 60-100 ml/min)

ejection fraction: the percentage of blood pumped out of the heart's main pumping chamber (left ventricle) with each beat (normal 50-70%)

the most common reason for diminished stroke volume is…

poor myocardial function due to CAD

what is mean arterial pressure (MAP)?

the average blood pressure in the arteries throughout one complete heartbeat cycle providing an indicator of blood flow to vital organs like the brain and kidneys

the left heart is a high-pressure system that supplies the body, so what anticipatory symptoms of left heart failure- that include those of poor perfusion- can therapists observe to these organs: brain, lungs, muscle, skin, and kidneys?

brain: fatigue, confusion, restlessness, memory loss

lungs: shortness of breath, cough, tachypnea/orthopnea

muscle: fatigue, exercise intolerance, weakness

skin: pallor, cyanosis, clammy diaphoresis

kidneys: renal failure, decreased urine output

_____ is the number one cause of left heart failure.

CAD

to compensate for left heart failure, the body increases ___ and ___ to move blood and improve ventilation and respiration.

HR and RR

with left heart failure, congestion is observed in the lungs, whereas with right heart failure, congestion is observed in the _____.

body (venous system)

what are some common examples of right heart failure symptoms?

fatigue, increase peripheral venous pressure, ascites, enlarged liver and spleen, abdominal pain, dependent edema, anorexia, and distended jugular veins

_____ is the number one cause of right heart failure.

LHF (left heart failure)

LHF vs. RHF chart

what is systolic heart failure?

HF due to inability for myocardium to generate pressure leading to poor cardiac output and poor contraction

systolic heart failure =

heart failure with reduced ejection fraction (HFrEF)

what is diastolic heart failure?

HF due to inability of heart to relax leading to poor output and poor filling

diastolic heart failure =

heart failure with preserved ejection fraction (HFpEF)

ejection fraction values

normal ejection/beat = 70 ml

normal = 55-70%

reduced </= 40%

what is an aneurysm?

abnormal dilation of all layers of a blood vessel due to weakness from trauma, infections, atherosclerosis, or congenital diseases

aortic and popliteal aneurysms are usually ________ shaped and cerebral aneurysms are usually _______ shaped and located at/near bifurcations.

fusiform; saccular

what are the three stages of aortic dissection/rupture?

1. stage 1: rupture of intima

2. stage 2: dissection of media

3. stage 3: rupture of vessel

list the four risk factors associated with abdominal and thoracic aortic aneurysms.

1. males

2. hypertension

3. ages 40-70

4. tobacco use

what is rheumatic fever?

a rare inflammatory illness that can develop after an untreated strep throat or scarlet fever infection, where the immune system mistakenly attacks the body's own tissues, causing inflammation in the heart, joints, brain, and skin

• usually seen in 5-15 year olds

what is endocarditis?

a serious inflammation or infection of the heart's endocardium, chambers, and valves, typically caused by bacteria or fungi entering the bloodstream from another part of the body, attaching to heart tissue, and forming growths (vegetations) that can damage the heart

what are some complications with/following endocarditis?

myocarditis, valvular damage, and bacterial embolism

a patient presents to the ER with chest, joint, and low back pains. he reports having a fever, chills/cold, and difficulty breathing when walking around his house. the ER nurse notices petechiae on the patient’s back and begins to think he is experiencing ________.

endocarditis

what is mitral valve prolapse?

inversion (ballooning) of mitral valve during ventricular systole associated with tissue weakness, autoimmune diseases, aortic stenosis, hypertrophic cardiomyopathy, and other heart defects

T or F: mitral valve prolapse affects more males than females.

F; affects females more

what are is the triad of mitral valve prolapse symptoms?

1. fatigue

2. palpitations

3. dyspnea