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coronary circ pt 2
patho exam 2
| Question | Answer |
|---|---|
| Specific Acute Coronary Syndromes (ACS) | Acute form of CAD |
| Specific Acute Coronary Syndrome types | NSTE-ACS, NSTEMI, STEMI |
| NSTE-ACS | non-st-segment elevation acute coronary syndrome |
| NSTEMI | non-st-segment elevation myocardial infarction |
| STEMI | st-segment elevation myocardial infarction |
| Risk factors of acute coronary syndrome | CAD, other triggers still being explored |
| Shared pathophysiology of acute coronary syndrome | CAD most commonly progresses to its acute form, atherosclerotic plaque ruptures, prompts thrombogenesis and blood flow obstruction |
| Pathogenesis of Acute coronary syndrome | sudden imbalance of myocardial oxygen consumption and myocardial demand |
| stable fixed atherosclerotic plaque is seen in what? | stable angina |
| plaque disruption and platelet aggregation is seen in what? | unstable angina |
| complete occlusion of vessel is seen in what? | STEMI |
| Non-ST-segment elevation acute coronary syndrome | NSTEMI and unstable angina |
| Differences between unstable angina and NSTEMI | degree of ischemia that results, whether damage causes release myocardial necrosis biomarkers |
| myocardial necrosis biomarkers | troponin, creatine, kinase-MB, myoglobin |
| troponin | protein on top of myocardium |
| myoglobin | protein that carries O2 located only on inside of muscle |
| Non-ST-segment elevation acute coronary syndrome pathogenesis | atherosclerotic plaque rupture, coronary artery vasoconstriction, myocardial oxygen demand and supply imbalance |
| Non-ST-segment elevation acute coronary syndrome risk factors | cigarette smokin (vasospastic angina) |
| Non-ST-segment elevation acute coronary syndrome clinical manifestations | presentation of unstable angina and NSTEMI similar, severe chest pain lasting more than 20 minutes (even after you sit patient) |
| Non-ST-segment elevation acute coronary syndrome- emergency medical services needed incase of: | chest pain (lasting after patient is sitting), severe dyspnea (patient is sweating), syncope or pre syncope episode, palpitations |
| Non-ST-segment elevation acute coronary syndrome diagnosis | ECG, serial cardiac troponins |
| Non-ST-segment elevation acute coronary syndrome treatment | supplemental oxygen, short acting sublingual nitroglycerin, intravenous nitroglycerin, morphine sulfate, oral beta blockers, high-intensity statin therapy, anti platelet therapy and anticoagulation therapy, invasive strategies |
| What does nitroglycerin induce? | vasodilation, increasing blood flow to the heart |
| ST-segment elevation myocardial infarction | more precise definition of a heart attack, complete blockage of vessel |
| "STE" meaning in STEMI | ECG tracing of ST-segment elevation |
| "MI" meaning in STEMI | myocardial infarction |
| ST-segment elevation myocardial infarction prevention of death requires rapid: | recognition, reperfusion treatment, management (avoid stress or severe exercise) |
| ST-segment elevation myocardial infarction pathogenesis | disruption of atherosclerotic plaque leads to thrombosis and disrupts blood flow, imbalance of myocardial oxygen supply and demand results |
| ST-segment elevation myocardial infarction causes | non-obstructive CAD, coronary artery vasospasm, contusions related to trauma, cocaine abuse, hematologic problems |
| non obstructive CAD | thrombus that was not obstructive but becomes obstructive |
| coronary artery vasospasms | vessels constrict |
| contusions related to trauma | lose a lot of blood, not enough blood to supply heart |
| cocaine abuse | restarts system and blood flow, increases blood flow to brain which is why people can complete more tasks, reduces blood flow to heart |
| hematologic problems | changes in RBC (ex. sickle cell) |
| ST-segment elevation myocardial infarction 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) |
| prinzmetal angina | type of variant, no formation of thrombus, but smooth muscle spasms reducing blood flow |
| ST-segment elevation myocardial infarction clinical manifestations | classic chest pain and dyspnea, malaise and fatigue, radiating pain, diaphoresis, dizziness, weakness, palpitations, altered mental status, feeling of doom, tachycardia, bradycardia |
| ST-segment elevation myocardial infarction diagnosis | ECG, cardiac troponins |
| ST-segment elevation myocardial infarction treatment | very invasive, PCI, CABG, anitplatelet therapies, anticoagulation agents, morphine for pain |
| PCI | precutaneous coronary intervention, catheter is placed in the artery to compress the plaque and widen the artery, in most cases a stent is then placed to keep the artery widened |
| CABG | coronary artery bypass grafting, uses vein or artery from another part of the body as a graft providing a new pathway for blood to reach the heart |
| What usually comes after MI? | chronic heart failure |
| Chronic heart failure treatment | palliative care, complete organ transplant, mechanical assist device |
| palliative care | patient rests and monitor heart, cardiac rehabilitation- patient observed while exercising |
| What happens in chronic heart failure? | stroke volume decreases because left ventricular contraction fraction decreases, sometimes can reduce oxygen to other tissues depending on extent of damage to heart |
| Complications of acute coronary syndrome | inflammatory complications, embolic events, mechanical complications |
| Inflammatory complications of acute coronary syndrome | pericarditis, dressler syndrome |
| embolic events caused by acute coronary syndrome | thromboembolism |
| mechanical complications of acute coronary syndrome | mitral regurgitation, ventricular aneurysm and rupture, heart failure, cardiogenic shock |
| Main complication that causes sudden cardiac death | cardiac arrest |
| cardiac arrest | abrupt loss of cardiac function- due to electrical issue SA node can stop functioning stopping electrical impulse generation |
| dysryhthmias and sudden cardiac death- Cardiac arrest causes | acute MI when plaque ruptures, thrombosis completely occludes coronary artery, dysfunction of autonomic nervous system |
| dysfunction of autonomic nervous system that can cause cardiac arrest | development of dysrhythmias, automaticity, absolute refractory period, electrolytes |
| dysryhthmias and sudden cardiac death- Cardiac arrest clinical manifestations prodromal symptoms | angina, dyspnea, weakness , fatigue, palpitations related to dysrhythmias, syncope |
| dysryhthmias and sudden cardiac death- cardiac arrest clinical manifestations specific to heart disease that occur within hours or minutes of cardiac arrest | related to dysrhythmias, ischemia, heart failure, heart skips a beat or is beating hard and fast |
| main difference in clinical manifestations of cardiac arrest and CAD | manifestations of cardiac arrest occur a lot faster |
| dysryhthmias and sudden cardiac death- Cardiac arrest diagnosis | ECG, continual heart monitoring, exercise and stress testing, long-term ECG recording, invasive electrophysiologic studies |
| long term ECG recording for diagnosis of dysrhythmias and sudden cardiac death | most frequently used, holter monitor (most often used), event recorders, implantable loop recorders |
| dysryhthmias and sudden cardiac death treatment | antiarrythmics, anticoagulants, integrated approach using nurse-based, physician supervised care, pacemakers and implantable cardioverter-defibrillators (ICDs), acute situation- assessment and basic life support |
| pacemakers and implantable cardioverter-defibrillators | avoid cardiac arrest, any problems with SA nose and electrical aspects of heart can be resolved with pacemaker |
| Myocardial rupture related to ischemia of acute MI | includes rupture of free walls of left or right ventricle, ventricular septum, left ventricle papillary muscle (includes mitral valve) |
| ventricular septum | very common with newborns, problems with oxygenation |
| other causes of ventricular rupture | blunt or penetrating trauma, abscesses related to infective endocarditis |
| ventricular aneurysm and rupture complications | acute mitral regurgitation, cardiac tamponade |
| cardiac tamponade | increase in fluid in the pericardium cavities |
| ventricular aneurysm occurs from a defect where? | in left or right ventricle wall |
| ventricular aneurysm | due to defect in ventricle wall, it bulges outward during both systole and diastole |
| what is ventricular aneurysm a result of? | MI |
| Ventricular aneurysm diagnosis | systolic murmur, ECG is characterized by ST elevation |
| ventricular aneurysm treatment | aneurysmectomy, management of complications |
| ventricular septal rupture | abnormal opening between left and right ventricles, left-to-right shunting |
| What does ventricular septal rupture result from? | complete coronary artery occlusion with little collateral circulation |
| What does any problem with the septum result in? | mixture of oxygenated and deoxygenated blood |
| Ventricular septal rupture diagnosis | echocardiography with doppler imaging, cardiac catheterization |
| ventricular septal rupture treatment | surgery- closing septum |
| pericarditis and Dressler syndrome | swelling and inflammation of pericarditis |
| What does pericarditis and dressler syndrome result from? | injury |
| another name for Dressler syndrome | post-MI syndrome |
| dressler syndrome | late pericarditis, after an MI there can be a leak of fluid into pericardial cavity that can induce infection |
| When can dressler syndrome occur? | occurs after 2-3 weeks after MI with unknown pathogenesis; autoimmune |
| pericarditis and dressler syndrome clinical manifestations | pleuritic chest pain, pain worse with deep inspiration, coughing, swallowing, or lying in supine position |
| pleuritic chest pain | occurs when the pleura become inflamed |
| pericarditis | swelling and inflammation of the pericardium |
| pericarditis and dressler syndrome diagnosis | ST-segment elevation in all or most of leads with upright or inverted T waves, pericardial effusion on echocardiography or CT scan |
| Pericarditis and Dressler syndrome treatment | hospitalization for management and observation of possible cardiac tamponade, aspirin |
| cardiac tamponade | increased pericardial pressure- blood or fluid buildup between myocardium and pericardium, life threatening |
| cardiac tamponade causes | pericardial effusion related to MI, trauma, infection, cancer, medication side effects, heart failure, radiation, pericarditis, inflammatory disease, PCI, recent cardiac surgery |
| What does cardiac tamponade affect? | diastolis of the heart due to increasing pressure |
| Cardiac tamponade clinical manifestations | systemic and pulmonary hypoperfusion, rapid accumulation of pericardial fluid, slow accumulation of pericardial fluid, pulsus paradoxus |
| cardiac tamponade clinical manifestations- systemic and pulmonary hyoperfusion | dyspnea, edema, oliguria, jugular venous distention, tachypnea, tachycardia |
| oliguria | decrease in amount of urine because patient is losing fluid due to accumulation of fluid in pericardial cavity |
| What does rapid accumulation of pericardial fluid cause? | hypotension- systolic pressure drops, systolic and diastolic pressure will be very close |
| What does slow accumulation of pericardial fluid cause? | edema |
| cardiac tamponade diagnosis | history (chemo/radiotherapy can induce damage), imaging such as echocardiography, CT scan, or MRI |
| pulsus paradoxus | systolic blood pressure drops significantly during inspiration |
| cardiac tamponade treatment | pericardiocentesis, surgical pericardiostomy |
| pericardiocentesis | procedure where they drain the fluid from pericardial cavity and pressure around pericardium decreases so heart can function normally |
| surgical pericardiostomy | stop the leakage into pericardial cavity |
| what do valvular disorders disrupt? | blood flow through atria and ventricles |
| valvular disorders | stenosis, regurgitation, prolapse |
| stenosis | valves can not open properly |
| regurgitation | valve can not close properly, backflow of blood either from ventricular to atrial or coronary artery |
| prolapse | valves become enlarged and do not close properly, increase in backflow of blood |
| valvular disorders causes | CAD and ACS, rheumatic fever |
| mitral regurgitation as a complication of MI | common complication of acute MI, abnormalities of any part of mitral valve apparatus |
| valvular disorders-mitral regurgitation risk factors | older age, female sex, large infarct size, heart failure, history of ACS and/or CAD |
| valvular disorders-mitral regurgitation clinical manifestations mild to moderate | no apparent symptoms |
| valvular disorders-mitral regurgitation clinical manifestations acute severe | shortness of breath, fatigue, new holosystolic murmur, flash pulmonary edema, shock |
| valvular disorders-mitral regurgitation treatment | diuretics, vasodilators, surgical intervention- valve replacement |
| hardest valve to replace | mitral |
| valvular disorders- mitral regurgitation diagnosis | x-ray, auscultation (listen for valve closing), TTE, TEE |
| TTE | transthoracis echocardiogram- ultrasound that creates detailed images of the heart |
| TEE | transesophogeal echocardigram- ultrasound probe inserted into esophagus to create images of the heart |
| valvular disorders-mitral regurgitation treatment | surgical intervention, treatment of coexisting diseases |
Created by:
camrynfoster