Patho Exam 2 Part 2

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What are the disorders of the pericardium?

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1

What are the disorders of the pericardium?

Pericarditis, Pericardial effusion, and Tamponade​

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5

What are the coronary artery diseases?

Acute Coronary Syndrome and Chronic ischemic heart disease

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6

What are the infectious disorders of cardiac function?

Infective endocarditis and Rheumatic heart disease​

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7

What are the valvular heart disease types?

mitral and aortic valve disorders

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8

What is pericarditis?

inflammation of the pericardium sac

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9

Heart is covered with the _____.

pericardial sac

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10

Injury to the heart can result in _____.

pericarditis

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11

What are the causes of acute pericarditis?

Idiopathic, Viral, or MI (trauma or injury)

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12

Uncomplicated cases of acute pericarditis resolves in…

2 weeks with NSAIDS

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13

Complicated cases of acute pericarditis may result in…

ericardial effusion or persistent, and recurrent inflammation

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14

What are the manifestations of acute pericarditis?

fever, chest pain, malaise, tachycardia, leukocytosis, friction rub​

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15

What is chronic pericarditis?

healed stage of acute pericarditis

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16

In chronic pericarditis, _____ develops.

scar tissue (makes it harder to beat)

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17

What are the manifestations of chronic pericarditis?

exercise intolerance, weakness, fatigue, systemic venous congestion​

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18

What is pericardial effusion?

accumulation of fluid in pericardial sac​

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19

What are the types of fluids that can accumulate in the pericardial sac?

-serous, serosanguineous, chylous (lymph)​

-blood​

-infectious or noninfectious

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20

What does the range of symptoms of pericardial effusion depend on?

degree of fluid accumulation​

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21

Large effusions can lead to _____.

cardiac tamponade

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22

What is cardiac tamponade?

restricts the heart from beating and can lead to the heart stopping

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23

What does cardiac tamponade include?

external compression of the heart chambers which impairs filling of the heart​

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24

What are the manifestations of cardiac tamponade?

decreased stroke volume, increased HR (compensatory), venous congestion, pulsus paradoxus, muffled heart sounds, decreased ECG amplitude​

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25

What is a pulsus paradoxus?

waxing and waning of the blood pressure with the heart rate​

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26

Effusion means _____.

fluid

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27

_____ is responsible for approximately 1/3 of US deaths.

CVD

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28

What does CVD include?

coronary artery/heart disease (CHD, CAD), stroke, HTN, and heart failure (HF)​

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29

What is CAD (coronary artery disease) also called?

Heart Disease and ischemic heart disease​

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30

What is CAD?

-Insufficient delivery of oxygenated blood to myocardium  r/t atherosclerosis

-Impaired coronary blood flow to the coronary arteries leading to Progressive narrowing (generally from atherosclerosis)​

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31

What happens when CAD is severe and prolonged?

irreversible myocardial cell damage​

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32

What does CAD include?

angina pectoris and myocardial infarction (MI)​

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33

What is sequelae of HD?

sudden cardiac death, heart failure, dysrhythmias​

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34

_____ arteries surround the heart and feed the heart​.

coronary

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35

In _____, arteries are getting clogged up and causes the heart muscles to become ischemic and painful (chest pain).

CAD

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36

What is angina pectoris?

chest pain when the heart muscle demands oxygen (when they stop; pain goes away)​

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37

What are the risk factors for CAD?

-Age, Family history​

-Abnormal lipid levels (high LDL, high cholesterol, HDL/LDL ratio profile low)​

-Smoking​

-HTN​

-Diabetes and metabolic syndrome​

-Obesity​

-Chronic inflammatory conditions​

-Males develop earlier; males and females succumb to heart disease equally. ​(After menopause, women’s risk increases​)

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38

_____ decreases what flows through the coronary arteries and decreases blood flow leading to ischemia that after a long time can lead to necrosis.

atherosclerosis

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39

_____ arise from coronary sinus just above the aortic valve.

coronary arteries

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40

Coronary arteries fill during _____.

relaxation

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41

_____ of the oxygen in the blood that passes through the myocardium is extracted.

75%

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42

What does the right coronary artery?

Feeds posterior heart, septum, SA and AV nodes, R ventricle​ and atrium

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43

What is the left coronary article?

-Left anterior descending and circumflex​

-Feeds anterior heart, septum, L ventricle

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44

What is the main pumping chamber of the heart?

left ventricle (largest and stronger)

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45

_____ is the most common cause of CAD.

atherosclerosis

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46

What is the process of atherosclerosis and CAD like?

it is slow and progressive and disrupts flow through the coronary artery

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47

How is plaque formation initiated for CAD?

-By injury to the coronary artery endothelium​

-Uncertain how this injury begins​

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48

What happens once there is an injury to the coronary artery endothelium?

-More permeable to recruit leukocytes​

-LDL leak through endothelium, become oxidized and attract macrophages​

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49

Plaques with large lipid cores tend to be more _____.

unstable

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50

What is stable plaque?

-tends to be fixed

-obstructs or reduces blood flow​

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51

Stable plaque includes _____ angina.

stable

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52

What is unstable plaque?

tends to rupture, bleed, and cause platelet adhesion and thrombus formation​

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53

What does unstable plaque include?

unstable angina, MI, and sudden death​

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54

Large lipid cores tend to be more _____.

unstable

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55

Thin fibrous caps on plaques make those plaques more _____.

vulnerable to rupture (cardia cath. Can tell)​

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56

What are the causes of plaque rupture?

can be spontaneous, related to increased HR, surge of sympathetic activity, increased BP, and increased force of cardiac contractions​

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57

What is ischemia?

insufficient blood flow/oxygen supply to meet metabolic demands (reversable)​

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58

What is infarction?

total lack of blood flow leading to cell and distal tissue will necrosis (irreversible) ​

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59

Ischemia is ____ while infarction is ___.

reversible; not reversable

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60

What are the causes of reduced coronary artery blood flow?

-Large stable plaque​

-Acute platelet aggregation/thrombosis (plaque breaks)​

-Vasospasm (hard to control, unpredictable)​

-Microcirculation, endothelial cell impairment​

-Poor perfusion pressure (drop in BP)​

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61

There are lots of signs when _____ happens.

infarction

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62

Fibrous plaque produces _____ when 70% of the lumen is occluded.

intermittent ischemia

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63

What is collateral circulation?

-a compensatory mechanism

-opportunity to build alternate vessels to perfuse the area

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64

What is stable angina pectoris (chronic ischemic heart disease)?

-When onset of ischemia is predictable (activities cause, rest relieves)​

-Pain when exercising but goes away when stopped​

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65

What is acute coronary syndrome sudden (ACS)?

obstruction of blood flow and thrombus formation

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66

What does ACS include?

-unstable angina

-non ST elevated myocardial infarction

-ST elevated myocardial infarction

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67

What is unstable angina?

-pain does not go away with rest

-plaque disruption with subtotal vessel occlusion​

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68

What is the symptom of ischemia?

pain (no dead cells)

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69

What is non ST elevated myocardial infarction (non STEMI)?

-plaque disruption with subtotal vessel occlusion

-has not gone through entire wall thickness​

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70

What is ST elevated myocardial infarction (STEMI)?

plaque disruption with total vessel occlusion​

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71

What does ST elevation indicate?

-ongoing cardiac ischemia that is transmural (affecting the entire wall thickness)​

-more serious event/issue​

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72

ST is seen on an _____.

EKG

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73

_____ are released in response to tissue injury and damage.

biomarkers

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74

What do biomarkers help identify?

-where the patient is in the clinical course​

-if the patient is having Unstable Angina or if they have had an MI (NSTEMI or STEMI)​

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75

_____ send out enzymes/biomarkers.

dead tissues

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76

What happens when creatinine kinase MB (CK-MB) is released?

-indicates injury to the myocardial cells​

-remains elevated for 48-72 hours​

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77

What does troponins indicate?

-myocardial necrosis​

-more specific, remain elevated for a longer period of time​

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78

What does CRP indicate?

tissue inflammation

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79

What do we know if CL-MB and troponins are both elevated?

infarction has occurred​

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80

What does STEMI indicate?

ischemia and biomarkers

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81

NSTEMI has _____.

biomarkers

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82

_____ has no ST elevation and no biomarkers (no dead tissue) and no damage but still there.

unstable angina

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83

What is transmural?

indicates necrosis through full thickness of heart muscle

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84

What is bundle branch block (BBB)?

Abnormal and deep QRS which indicates necrotic injury to ventricle

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85

Majority of infarcts of ACS occur on the _____ ventricular wall.

left

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86

What are the manifestations of ACS?

-chest pain more severe and lasts longer

-nausea, vomiting, diaphoresis, SOB, feeling of epigastric indigestion

-ECG changes (ST elevation)

-presence of biomarkers

-plaque rupture with thrombosis development

-MI can be silent and asymptomatic only to be found later

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When there is an ST elevation,…

-biomarkers are present

-STEMI

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89

When there is no ST elevation and no biomarkers,…

unstable angina

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90

When there is no ST elevation and has biomarkers,…

NSTEMI

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91

What is the clinical course of ACS?

-cardiac inflammation from tissue necrosis

-dead cardiac cells become electrically silent (dysrhythmias)

-drop in stroke volume, HR increases, decreased perfusion to kidney

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92

Poor cardiac output causes…

poor perfusion to body

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93

What is the treatment for ACS?

-decrease myocardial oxygen demand and increase oxygen supply (administer oxygen)

-reduce myocardial workload (decrease preload/after load, decrease HR)

-pain relief

-high incidence of electrical disturbances

-antiplatelet and/or anticoagulant therapy

-stenting or opening the artery

-coronary artery bypass grafing

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94

What are the cardiac rehabilitation programs?

-focus on lifestyle changes

-exercise

-nutrition

-smoking cessation

-stress reduction

-medication management

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95

What is myocardial ischemia?

not enough blood flow/oxygen delivery to meet metabolic needs

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96

What are the types of chronic ischemic CAD?

-Stable angina​

-Vasospasm angina (Printzmetal angina)​

-Silent myocardial infarction​

-Ischemic cardiomyopathy​

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97

Why may stable angina not develop until CAD advances?

-Sedentary lifestyle​

-Inability to perceive the pain​

-Development of collateral circulation​

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98

_____ is precipitated by increased demands of the heart (physical exertion, emotional distress).

angina pectoris/stable angina

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99

What is the pain of stable angina described as?

-Constricting, squeezing, suffocating​

-Increases in intensity​

-Located precordial, substernal area and radiates to back, jaw, shoulder, arm​

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100

What is prinzmetal angina also called?

variant, vasospastic angina​

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