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patho exam 2
coronary circulation disorders
| Question | Answer |
|---|---|
| anastamosis | junction of vessels |
| left and right coronary arteries are | the main arteries in the heart |
| anterior interventricular artery | widow maker, supplies blood to the left ventricle |
| the major coronary arteries | work with very high pressure |
| coronary artery disease is | reduced supplies of oxygen and nutrients to the cells of the heart |
| coronary heart disease is interchangeable with the term | coronary artery disease |
| coronary heart disease types | atherosclerosis, angina pectoris, acute coronary syndrome (ACS), silent myocardial ischemia, myocardial infarction (MI) |
| acute coronary syndrome | group of complications |
| silent myocardial ischemia | complication with reduction of O2 supply, asymptomatic so needs specific tests for Dx |
| cardiovascular disease (CVD) | pathological process causing disease of heart and coronary and systemic cirvulation |
| cardiovascular disease induces | stroke, transient ischemic attack (TIA), claudication, limb ischemia, delayed O2 to brain |
| ischemia | temporary deficiency of blood flow to tissue |
| myocardial ischemia | heart muscle does not receive enough blood flow, leading to a lack of oxygen and nutrients |
| myocardial infarction | necrosis in myocardium due to obstructed blood flow |
| coronary artery disease epidemiology | more than 1 in 3 adults in the US have 1 or more types of CVDs |
| coronary artery disease risk factors | modifiable (diet, exercise), nonmodifiable (age, race, fam Hx), inflammation (infection), other medical conditions (iatrogenic from Tx, chemo to treat cancer could induce cardiotoxicity) |
| when is most blood flow delivered to myocardium? | most blood flow to myocardium delivered during ventricular diastole |
| coronary artery disease pathophsyiology | coronary collateral circulation (like an anastamosis) problems with endothelial cells, smooth muscle cells, blood vessel walls |
| coronary collateral circulation is | triggered by insufficient blood supply and is formed when there is an occlusion of any artery in circulation |
| what does coronary collateral circulation increase | angiogenesis |
| coronary artery disease pathophsyiology: endothelial cells | thrombus is formed by a process linked to atherosclerosis cells that line the arteries become damaged, lead to an imbalance between factors that causes arteries to dilate and constrict |
| coronary artery disease pathophsyiology: smooth muscle cells | vasospasms happen if smooth muscle contracts due to a lack of O2 |
| coronary artery disease pathophsyiology: blood vessel wall | atherosclerosis affects the whole vascular system! can cause aneurysms, carotid artery disease and peripheral artery disease |
| steps of atherosclerosis | damage to endothelium, cholesterol and lipids accumulate, continuation of accumulation causes plaque build up, plaque becomes unstable and ruptures releasing contents into blood stream and can cause thrombus |
| foam cell job in atherosclerosis | accumulate cholesterol and contribute to plaque growth, inflammation, and instability |
| injury to endothelium induces | arachidonic acid and histamines which causes more cells to come and die which further contributes to formation of thrombus |
| what is atherosclerosis induced by | lipidemia, high LDLs and triglyceride free fatty acids |
| atherosclerosis activates | macrophages which increase LDLs, now macrophages are no longer functional and leave peripheral arteries to be a foam cell |
| atherosclerosis leads to | narrowing of arteries and increased resistance which increases BP and decreases blood flow to certain areas |
| diagnosis of CAD | presence of a dysrhythmia (arrythmia) stress test EKG blood tests |
| presence of a dysrhythmia (arrythmia) | may not be detected in one beat faster/slower cardiac cycle than normal |
| stress test | make the heart work which increases heart activity and then observe for abnormalities |
| diagnosis of CAD: blood tests | lipid panel, C-Reactive protein (CRP), lipoprotein (a), homocysteine |
| lipid panel includes | LDL, HDL, total cholesterol and triglycerides |
| C-Reactive protein (CRP) is a | marker of inflammation in the body |
| lipoprotein (a) is type of | cholesterol that can build up in the arteries |
| homocysteine is an | amino acid that can damage blood vessels due to a breakdown of proteins because of damage in walls |
| detection of heart attack | cardiac troponin test I and T |
| diagnosis of CAD: scans and imaging | echocardiography, nuclear stress test (SPECT), coronary angiogram (coronary angiography or arteriography) |
| echocardiography | can use contrast, allows you to see walls and chambers of the heart, if there is any reduction then heart is dysfunctional |
| coronary angiogram (coronary angiography or arteriography) | invasive! allows you to see if there is any occlusion and see if there is any narrowing |
| treatment of CAD | lifestyle changes, HTN management (to lower BP), lipid-lowering therapy (statins), anxiety management - counseling and support which is a therapeutic approach |
| statins | reduces the liver's production of cholesterol |
| myocardial ischemia and infarction is a result of | atherosclerosis, disruption of coronary blood flow, reduced contractility or ischemic myocardial fibers, disruption in cardiac conduction system, ischemic cascade, coronary microvascular disease |
| atherosclerosis | narrowed coronary arteries which decreases blood flow, fracture in fibrous cap, superficial erosion of intima |
| disruption of coronary blood flow | imbalance among oxygen supply, demand coronaand consumption |
| coronary artery occlusion is only reversible if lasts for | 20 minutes or less |
| ischemic cascade | occlusion initiates steps, electrolyte balance, anaerobic metabolism, systolic and diastolic dysfunction, ECG abnormalities |
| ST segment depends on | hearts electrical activity and is affected by electrolyte imbalances, medications and other underlying conditions |
| stable angina is | chest pain due to decreased oxygen in heart muscles due to narrowed coronary arteries |
| stable angina is a chronic form of | ischemic heart disease |
| ischemic heart disease (IHD) | arteries that supply blood to the heart become narrowed or blocked and this creates an O2 deficit in the heart |
| stable angina happens when | there is an increase in oxygen demand but a decrease in blood flow during exertion or emotional stress |
| main cause of stable angina is | atherosclerosis |
| clinical manifestations of stable angina | related to exertion, resolved with rest or short acting nitroglycerin |
| diagnosis of stable angina | resting ECG, stress test, CT angiography |
| resting ECG | measure electrical activity while at rest |
| stress test | make the heart work, monitor BP, HR and O2 levels |
| CT angiography | uses Xrays and contrast to create 3D images of vessels |
| treatment of stable angina | risk factor modification to decrease chances anti platelet medication to prevent clots that cause MI antihypertensives that help decrease risk of high BP |
| silent ischemia is thought to be related to | defective anginal warning system - NO WARNING CHEST PAIN |
| silent ischemia is | often asymptomatic |
| silent ischemia CMs | chest pain (NOT always present) ST segment changes - either elevated or depressed |
| diagnosis of silent ischemia | ambulatory ECG - checks ST segment, tracks daily activities SPECT - scan performed during rest and stress to compare |
| treatment of silent ischemia | same medical therapies as for symptomatic ischemia coronary angiography (identify blockages) and revascularization (restore blood flow) |
| coronary microvascular disease | damage to walls and of small coronary arteries that supply O2 and nutrients to the heart |
| cause of coronary microvascular disease | not clearly understood, idiopathic |
| CMs of coronary microvascular disease | angina (chest pain) in absence of myocardial ischemia also SOB, fatigue, and dizziness |
| diagnosis of coronary microvascular disease | transthoracic doppler echocardiography - measures coronary flow velocity reserve SPECT CMR myocardial perfusion imaging - evaluates how a hearts blood flow responds to stress |
| specific acute coronary syndromes (ACS) are caused by | a sudden decrease in blood flow to the heart muscle |
| specific acute coronary syndromes (ACS) are acute form of | CAD |
| types of specific acute coronary syndromes (ACS) | non ST segment elevation acute coronary syndrome (NSTE-ACS) non ST segment elevation myocardial infarction (NSTEMI) ST segment elevation myocardial infarction (STEMI) |
| risk factors of acute coronary syndrome | CAD, other triggers are still being explored |
| shared pathophysiology of acute coronary syndrome | CAD most commonly progresses to its acute form atherosclerotic plaque ruptures (sudden) prompts thrombogenesis and blood flow obstruction (sudden) |
| ACS can be a result of | sudden imbalance of myocardial oxygen consumption and myocardial demand |
| progression of plaque | starts with endothelial damage that allows LDL cholesterol to enter and form a fatty streak |
| stable angina plaque type | stable fixed atherosclerotic plaque |
| unstable angina plaque type | plaque disruption and platelet aggregation and unstable plaque |
| NSTE-ACS and STEMI plaque type | plaque disruption and platelet aggregation and unstable plaque with thrombus |
| non ST segment elevation acute coronary syndrome (NSTE-ACS) types | NSTEMI and unstable angina |
| differences between unstable angina and NSTEMI | degree of ischemia the results and whether damage causes release of myocardial necrosis biomarkers |
| are NSTEMIs or unstable angina more severe | NSTEMIs |
| non ST segment elevation acute coronary syndrome (NSTE-ACS) pathogenesis | atherosclerotic plaque rupture, coronary artery vasoconstriction, myocardial oxygen demand and supply imbalance |
| non ST segment elevation acute coronary syndrome (NSTE-ACS) risk factors | CIGARETTE SMOKING!!! (vasospastic angina) |
| CMs of non ST segment elevation acute coronary syndrome (NSTE-ACS) | presentations of unstable angina and NSTEMI similar, severe chest pain lasting more than 20 minutes |
| non ST segment elevation acute coronary syndrome (NSTE-ACS) emergency medical services needed in cases of: | chest pain, severe dyspnea, syncope or presyncope episode, palpitations |
| syncope | a brief loss of consciousness caused by a temporary decrease in blood flow to the brain |
| presyncope | a feeling of impending loss of consciousness, with symptoms like lightheadedness, dizziness, weakness, and nausea |
| diagnosis of non ST segment elevation acute coronary syndrome (NSTE-ACS) | ECG and serial cardiac troponins |
| treatment of non ST segment elevation acute coronary syndrome (NSTE-ACS) | supplemental oxygen, short acting sublingual nitroglycerin, IV nitroglycerin, morphine sulfate, oral beta blockers, high intensity statin therapy, anti platelet therapy and anticoagulation therapy, invasive strategies |
| ST-segment elevation myocardial infarction (STEMI) | more precise definition of heart attack "STE" refers to ECG tracing of ST-segment elevation "MI" refers to myocardial infarction |
| prevention of death by ST-segment elevation myocardial infarction (STEMI) requires rapid: | recognition, reperfusion treatment, management |
| pathogenesis of ST-segment elevation myocardial infarction (STEMI) | disruption of atherosclerotic plaque leads to thrombosis and disrupts blood flow, imbalance of myocardial oxygen supply and demand results |
| causes of ST-segment elevation myocardial infarction (STEMI) | nonobstructive CAD, coronary artery vasospasms, contusions related to trauma, cocaine abuse, hematologic problems |
| ST-segment elevation myocardial infarction (STEMI) risk factors | same as for CAD, air pollution, prinzmetal angina, contusions related to trauma to coronary arteries, cocaine abuse, aortic insufficiencies, hematologic problems, atrial fibrillation (embolus) |
| CMs of ST-segment elevation myocardial infarction (STEMI) | classic chest pain and dyspnea, malaise and fatigue, radiating pain, diaphoresis, dizziness, weakness, palpitations, altered mental status, feeling of doom, tachy or bradycardia |
| diagnosis of ST-segment elevation myocardial infarction (STEMI) | ECG and cardiac troponins |
| treatment of ST-segment elevation myocardial infarction (STEMI) | PCI - Percutaneous Coronary Intervention which is a medical procedure to open blocked heart arteries CABG - coronary artery bypass grafting, surgical procedure to treat CAD |
| chronic heart failure from ST-segment elevation myocardial infarction (STEMI) | palliative care, complete organ transplant, mechanical assist device |
| complications of ACS | inflammatory complications, embolic events, mechanical complications |
| inflammatory complications | pericarditis and dressler syndrome |
| embolic events | thromboembolism |
| mechanical complications | mitral regurgitation, ventricular aneurysm and rupture, heart failure, cardiogenic shock |
| dysrhythmias and sudden cardiac death | cardiac arrest |
| cardiac arrest | abrupt loss of cardiac function |
| causes of cardiac arrest | acute MI when plaque ruptures, thrombosis completely occludes coronary artery, dysfunction of ANS |
| coronary artery supplies | SA node blood, when coronary artery is occluded then sudden death occurs |
| dysfunction of ANS when in cardiac arrest | development of dysrhythmias, automaticity (ability to perform a task without conscious effort), more absolute refractory periods and an imbalance of electrolytes |
| CMs of cardiac arrest are | same as CAD but a lot faster!! |
| CMs of cardiac arrest: prodromal symptoms of sudden cardiac death | angina (not felt for long), dyspnea, weakness, fatigue palpitations related to dysrhythmias, syncope |
| CMs of cardiac arrest: specific to heart disease that occur within hours or minutes of cardiac arrest | QUICK!! related to dysrhythmias, ischemia, heart failure, heart skips a beat or is beating hard and fast |
| diagnosis of dysrhythmias and sudden cardiac death | ECG, continual heart monitoring, exercise and stress testing, long-term ECG recording, invasive electrophysiologic studies |
| long-term ECG recording types | holter monitor event recorders implantable loop recorders |
| treatment for dysrhythmias and sudden cardiac death | antiarrhythmics, anticoagulants, integrated approach using nurse-based, physician supervised care, pacemakers and implantable cardioverter-defibrillators (ICDs) which deal woth the electrical problems |
| treatment for dysrhythmias and sudden cardiac death in an acute situation | assessment and basic life support |
| ventricular aneurysm and rupture | myocardial rupture that can induce ischemia of acute MI |
| myocardial rupture that can induce ischemia of acute MI | free walls of left or right ventricle, ventricular septum - problem with oxygenation, left ventricle papillary muscle - most common because responsible for mitral valve |
| other causes of myocardial rupture | blunt or penetrating trauma and abscesses related to infective endocarditis |
| complications, aka what induces ruptures | acute mitral regurgitation, cardiac tamponade which is an increase in fluid in between the pericardial cavity |
| ventricular aneurysm | defect in left or right ventricle wall, bulges outward during both systole and diastole (blood moves outside of chambers) a localized bulge or dilation in the wall of a blood vessel |
| ventricular aneurysm is a result of | MI |
| diagnosis of ventricular aneurysm | systolic murmur, ECG is characterized by ST elevation |
| treatment of ventricular aneurysm | aneurysmectomy - removal of ventricle aneurysm management of complicatoins |
| ventricular septal rupture | abnormal opening between left and right ventricles (septum) has left to right shunting |
| left to right shunting | a condition where blood flows from the left side of the heart to the right side, instead of following the normal path of circulation |
| what does ventricular septal rupture result from | complete coronary artery occlusion with little collateral circulation |
| coronary artery occlusion induces | higher levels of collateral circulation which will cross septum |
| diagnosis of ventricular septal rupture | echocardiography with doppler imaging, cardiac catheterization |
| treatment of ventricular septal rupture | surgery to close the septum! |
| pericarditis and dressler syndrome | swelling and inflammation of the pericardium (the membrane on top of the heart) |
| pericarditis and dressler syndrome results from | injury |
| dressler syndrome aka | post MI syndrome |
| dressler syndrome is | late pericarditis (specific) and a leak of blood into pericardial cavity which causes infection |
| when does dressler syndrome occur | 2-3 weeks after MI with unknown pathogenesis; induced by autoimmune disorder |
| CMs of pericarditis and dressler syndrome | pleuritic chest pain (a sharp, stabbing pain that occurs when the pleura become inflamed) pain becomes worse with deep inspiration, coughing, swallowing or lying in supine position |
| why does pain worsen with deep inspiration | deep breathing expands the lungs which decreases the pericardial cavity |
| diagnosis of pericarditis and dressler syndrome | ST segment elevation in all or most of leads with upright or inverted T waves, pericardial effusion on echocardiography or CT scan |
| treatment of pericarditis and dressler syndrome | hospitalization for management and observation of possible cardiac tamponade, aspirin |
| cardiac tamponade is | increased pericardial pressure, blood or fluid between myocardium and pericardium which means the heart cannot relax |
| cardiac tamponade is extremely | life-threatening |
| causes of cardiac tamponade | pericardial effusion related to MI - a consequence of pericarditis trauma, infection, cancer meds side effects heart failure, radiation, pericarditis inflammatory disease, PCI and recent cardiac surgery (at risk for leak of blood in pericardial cavity) |
| cardiac tamponade means the heart | won't fill correctly due to increase pressure because of the wall thickness |
| CMs of cardiac tamponade | systemic and pulmonary hypoperfusion, rapid accumulation of pericardial fluid, slow accumulation of pericardial fluid, pulsus paradoxus |
| systemic and pulmonary hypoperfusion | dyspnea, edema, oliguria (low urine output) JVD, tachypnea, tachycardia |
| rapid accumulation of pericardial fluid | hypotension, systolic BP will drop so diastolic and systolic will be very close |
| slow accumulation of pericardial fluid | edema |
| diagnosis of cardiac tamponade | history - past chemo or radiation increases heart damage imaging such as echocardiography, CT scan or MRI |
| treatment of cardiac tamponade | pericardiocentesis and surgical pericardiostomy |
| pericardiocentesis | drains the fluids from the pericardial cavity which decreases pressure around the heart and will help the heart go back to normal function |
| surgical pericardiostomy | create a small opening in the pericardium, the sac around the heart, to drain excess fluid |
| valvular disorders | disrupt blood flow through atria and ventricles |
| valvular disorders types | stenosis, regurgitation and prolapse |
| valvular disorders causes | stroke volume to decrease |
| stenosis | valves cannot open properly, wrinkly when opened |
| regurgitation | valves cannot close properly, still opened when supposed to be closed |
| prolapse | problem where the valve can't close, it's flat and increases backflow of blood |
| causes of valvular disorders | CAD and ACS rheumatic fever |
| mitral regurgitation as a complication of MI | common complication of acute MI abnormalities of any part of mitral valve |
| risk factors for mitral regurgitation as a complication of MI | older age, female sex, large infarct size, heart failure, history of ACS and/or CAD |
| mitral regurgitation as a complication of MI CMs | mild to moderate: no apparent symptoms acute severe: shortness of breath, fatigue, new holosystolic murmur, flash pulmonary edema, shock |
| pulmonary edema | accumulation of fluid in lungs since blood flows through the lungs |
| treatment for mitral regurgitation as a complication of MI | diuretics, vasodilators, surgical intervention (valve replacement) |
| mitral regurgitation as a complication of MI diagnosis | Xray, auscultation (listen to the heart and sounds of the valves closing), TTE, TEE |
| Transthoracic Echocardiogram (TTE) | a type of ultrasound of the heart that uses sound waves to create moving images of the heart |
| Transesophageal Echocardiogram (TEE) | type of ultrasound which is passed down the esophagus, to get detailed images of the heart |
| treatment of mitral regurgitation as a complication of MI | surgical intervention and treatment of coexisting diseases |
Created by:
leh195