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Patho Exam 2 Part 2
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235 Terms
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1
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What are the disorders of the pericardium?
Pericarditis, Pericardial effusion, and Tamponade
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3
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4
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5
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What are the coronary artery diseases?
Acute Coronary Syndrome and Chronic ischemic heart disease
6
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What are the infectious disorders of cardiac function?
Infective endocarditis and Rheumatic heart disease
7
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What are the valvular heart disease types?
mitral and aortic valve disorders
8
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What is pericarditis?
inflammation of the pericardium sac
9
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Heart is covered with the _____.
pericardial sac
10
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Injury to the heart can result in _____.
pericarditis
11
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What are the causes of acute pericarditis?
Idiopathic, Viral, or MI (trauma or injury)
12
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Uncomplicated cases of acute pericarditis resolves in…
2 weeks with NSAIDS
13
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Complicated cases of acute pericarditis may result in…
ericardial effusion or persistent, and recurrent inflammation
14
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What are the manifestations of acute pericarditis?
fever, chest pain, malaise, tachycardia, leukocytosis, friction rub
15
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What is chronic pericarditis?
healed stage of acute pericarditis
16
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In chronic pericarditis, _____ develops.
scar tissue (makes it harder to beat)
17
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What are the manifestations of chronic pericarditis?
exercise intolerance, weakness, fatigue, systemic venous congestion
18
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What is pericardial effusion?
accumulation of fluid in pericardial sac
19
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What are the types of fluids that can accumulate in the pericardial sac?
\-serous, serosanguineous, chylous (lymph)
\-blood
\-infectious or noninfectious
20
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What does the range of symptoms of pericardial effusion depend on?
degree of fluid accumulation
21
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Large effusions can lead to _____.
cardiac tamponade
22
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What is cardiac tamponade?
restricts the heart from beating and can lead to the heart stopping
23
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What does cardiac tamponade include?
external compression of the heart chambers which impairs filling of the heart
24
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What are the manifestations of cardiac tamponade?
decreased stroke volume, increased HR (compensatory), venous congestion, pulsus paradoxus, muffled heart sounds, decreased ECG amplitude
25
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What is a pulsus paradoxus?
waxing and waning of the blood pressure with the heart rate
26
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Effusion means _____.
fluid
27
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_____ is responsible for approximately 1/3 of US deaths.
CVD
28
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What does CVD include?
coronary artery/heart disease (CHD, CAD), stroke, HTN, and heart failure (HF)
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What is CAD (coronary artery disease) also called?
Heart Disease and ischemic heart disease
30
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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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What happens when CAD is severe and prolonged?
irreversible myocardial cell damage
32
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What does CAD include?
angina pectoris and myocardial infarction (MI)
33
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What is sequelae of HD?
sudden cardiac death, heart failure, dysrhythmias
34
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_____ arteries surround the heart and feed the heart.
coronary
35
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In _____, arteries are getting clogged up and causes the heart muscles to become ischemic and painful (chest pain).
CAD
36
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What is angina pectoris?
chest pain when the heart muscle demands oxygen (when they stop; pain goes away)
37
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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)
38
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_____ decreases what flows through the coronary arteries and decreases blood flow leading to ischemia that after a long time can lead to necrosis.
atherosclerosis
39
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_____ arise from coronary sinus just above the aortic valve.
coronary arteries
40
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Coronary arteries fill during _____.
relaxation
41
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_____ of the oxygen in the blood that passes through the myocardium is extracted.
75%
42
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What does the right coronary artery?
Feeds posterior heart, septum, SA and AV nodes, R ventricle and atrium
43
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What is the left coronary article?
\-Left anterior descending and circumflex
\-Feeds anterior heart, septum, L ventricle
44
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What is the main pumping chamber of the heart?
left ventricle (largest and stronger)
45
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_____ is the most common cause of CAD.
atherosclerosis
46
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What is the process of atherosclerosis and CAD like?
it is slow and progressive and disrupts flow through the coronary artery
47
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How is plaque formation initiated for CAD?
\-By injury to the coronary artery endothelium
\-Uncertain how this injury begins
48
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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
49
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Plaques with large lipid cores tend to be more _____.
unstable
50
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What is stable plaque?
\-tends to be fixed
\-obstructs or reduces blood flow
51
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Stable plaque includes _____ angina.
stable
52
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What is unstable plaque?
tends to rupture, bleed, and cause platelet adhesion and thrombus formation
53
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What does unstable plaque include?
unstable angina, MI, and sudden death
54
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Large lipid cores tend to be more _____.
unstable
55
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Thin fibrous caps on plaques make those plaques more _____.
vulnerable to rupture (cardia cath. Can tell)
56
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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
57
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What is ischemia?
insufficient blood flow/oxygen supply to meet metabolic demands (reversable)
58
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What is infarction?
total lack of blood flow leading to cell and distal tissue will necrosis (irreversible)
59
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Ischemia is ____ __while infarction is__ ___.
reversible; not reversable
60
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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)
61
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There are lots of signs when _____ happens.
infarction
62
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Fibrous plaque produces _____ when 70% of the lumen is occluded.
intermittent ischemia
63
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What is collateral circulation?
\-a compensatory mechanism
\-opportunity to build alternate vessels to perfuse the area
64
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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
65
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What is acute coronary syndrome sudden (ACS)?
obstruction of blood flow and thrombus formation
66
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What does ACS include?
\-unstable angina
\-non ST elevated myocardial infarction
\-ST elevated myocardial infarction
67
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What is unstable angina?
\-pain does not go away with rest
\-plaque disruption with subtotal vessel occlusion
68
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What is the symptom of ischemia?
pain (no dead cells)
69
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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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What is ST elevated myocardial infarction (STEMI)?
plaque disruption with __total__ vessel occlusion
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What does ST elevation indicate?
\-ongoing cardiac ischemia that is transmural (affecting the entire wall thickness)
\-more serious event/issue
72
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ST is seen on an _____.
EKG
73
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_____ are released in response to tissue injury and damage.
biomarkers
74
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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)
75
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_____ send out enzymes/biomarkers.
dead tissues
76
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What happens when creatinine kinase MB (CK-MB) is released?
\-indicates injury to the myocardial cells
\-remains elevated for 48-72 hours
77
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What does troponins indicate?
\-myocardial necrosis
\-more specific, remain elevated for a longer period of time
78
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What does CRP indicate?
tissue inflammation
79
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What do we know if CL-MB and troponins are both elevated?
infarction has occurred
80
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What does STEMI indicate?
ischemia and biomarkers
81
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NSTEMI has _____.
biomarkers
82
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_____ has no ST elevation and no biomarkers (no dead tissue) and no damage but still there.
unstable angina
83
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What is transmural?
indicates necrosis through full thickness of heart muscle
84
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What is bundle branch block (BBB)?
Abnormal and deep QRS which indicates necrotic injury to ventricle
85
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Majority of infarcts of ACS occur on the _____ ventricular wall.
left
86
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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
87
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88
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When there is an ST elevation,…
\-biomarkers are present
\-STEMI
89
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When there is no ST elevation and no biomarkers,…
unstable angina
90
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When there is no ST elevation and has biomarkers,…
NSTEMI
91
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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
92
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Poor cardiac output causes…
poor perfusion to body
93
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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
94
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What are the cardiac rehabilitation programs?
\-focus on lifestyle changes
\-exercise
\-nutrition
\-smoking cessation
\-stress reduction
\-medication management
95
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What is myocardial ischemia?
not enough blood flow/oxygen delivery to meet metabolic needs
96
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What are the types of chronic ischemic CAD?
\-Stable angina
\-Vasospasm angina (Printzmetal angina)
\-Silent myocardial infarction
\-Ischemic cardiomyopathy
97
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Why may stable angina not develop until CAD advances?
\-Sedentary lifestyle
\-Inability to perceive the pain
\-Development of collateral circulation
98
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_____ is precipitated by increased demands of the heart (physical exertion, emotional distress).
angina pectoris/stable angina
99
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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
100
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What is prinzmetal angina also called?
variant, vasospastic angina
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