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