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Heep Cardio 3

Cardiovascular System 3, Heep, Survey of Western Clinical Sciences, Bastyr

Describe Coronary Heart Disease: Heart diseases caused by impaired coronary blood flow.
What are types of CHD: cardiac angina, MI, cardiac arrhythmias, heart failure and sudden death. Risk factors for CHD:
Describe CHD: Affects the left coronary artery in most 75% of the vessel lumen needs to be occluded before patient has symptoms Effects of CHD range from: ischemia and pain to MI.
What Tests for evaluation of coronary circulation: ECG, Stress test, nuclear imaging and cardiac catheterization.
Two basic types of CHD: Ischemic heart diseases. Cardiac angina Myocardial infarction
Define Ischemia: suppress or withhold blood flow. In heart it happens when the coronary arteries do not supply adequate blood to meet the demands of the heart, especially during activity/exercise.
What leads to Ischemia: can be due to: atherosclerosis, vasospasm, thrombosis.
What are Sx of Cardiac Ischemia: Cardiac ischemia can be symptomatic (angina pectoris) or silent (more risk for MI and sudden death).
Define Angina: means “to choke”
Describe Angina: Chest pain or pressure on chest due to myocardial ischemia.
What are the qualities of Pain of Angina: The PAIN is constrictive, squeezing and suffocating. It is steady, located in precordial area. Pain can radiate to jaw, shoulder, arm, abdominal area. Pain is brief, less than 5 minutes.
Does Angina Pain radiate? can radiate to jaw, shoulder, arm, abdominal area.
Is Angina pain Chronic? Pain is brief, less than 5 minutes.
What are the 3 types of angina: Classic Unstable Variant Describe Classic Angina:
Describe Unstable Angina: pre-infarction angina, usually significant CHD present, risk for MI and heart failure is high. Pain with any position/level of exertion
Describe Variant (Prinzmetal angina): vasospasm, in rest or nocturnal, has a pattern.
Contributing factors for Angina: cold, smoke, emotional stress especially before bed time, high autonomic activity (high anxiety)
Meds for Angina: Nitroglycerin* (vasodilator) and Ca channel blockers ariant/Prinzmetal
What are the Medication groups for Angina: Nitroglycerin: Sublingual or dermal β blockers (antagonists) – selective to β1 β1 primarily in heart muscle  ↑ HR and contractility β2 primarily in bronchial system and peripheral vascular system  vasoconstriction and bronchoconstriction Calcium cha
Describe β blockers: (antagonists) – selective to β1 β1 primarily in heart muscle  ↑ HR and contractility β2 primarily in bronchial system and peripheral vascular system  vasoconstriction and bronchoconstriction
Which β blocker works on heart muscle: β1, ↑ HR and contractility
Which β blocker works on Bronchial Systemand peripheral vascular system: β2 causes vasoconstriction and bronchoconstriction
Define Myocardial Infarction: “Heart attack” – ischemic death of myocardial tissues associated with atherosclerotic disease of coronary arteries.
How common is MI: 1.5 million new or recurrent cases per year. 1/3 of them die within the first hour.
Primary cause of MI: 90% are from a thrombus obstructing a coronary artery.
Are you most likely to get an MI in the Morning or Evening? 3 times more common in early morning to noon.
Describe Pain Manifestation of MI: PAIN – abrupt, severe and crushing – “something sitting on my chest”. Pain lasts longer than angina, not relieved by rest or nitroglycerin. Pain can refer to jaw, arm, shoulder, stomach.
Describe Other Sx of MI: restless, anxiety, tachycardia, sweating, nausea and vomiting, extreme fatigue. Skin pale cool and moist
If someone has persistent pain do they have an MI or Angina? MI Pain lasts longer than angina,
Describe Heart damage over time after an MI: 20-40 minutes to resuscitate – during which cells reversibly injured. >40 minutes cell death and necrosis. In 2-3 days scar tissue forms. In a week softening of the tissue and risk for rupture In 7 weeks the regeneration and scar formation complete.
How do you Dx MI: Dx: need ECG, Lab tests ECG: ST elevation, ST depression, T inversion, Q wave formation Labs: CK-MB and LDH increase. Cardiac troponin and myoglobin levels go up in blood.
Describe GOLDEN TIME: 1 hour after the attack of MI, after that hour cell death is irreversible.
Complications of MI are: Fatal dysrhythmia specially ventricular tachycardia Heart failure, cardiogenic shock rupture of heart or other anatomical elements thrombo-emboli
Tx for a man over 35 y/o or woman over 40 y/o with pain from naval area up to jaw with no medical check up for to rule out heart problem: REFER TO MD for EKG to rule out heart problems. If Cold sweat, call 911
Tx for Pt w/chronic HT trouble has angina episode: If he has nitro available give it to him. If no response to 2 doses nitro. Call 911
What is a common mistake of cardiac pain? -Cardiac pain may be mistaken for acid reflux (& vice versa) -Cardiac pain may be mistaken for stomach pain (& vice versa)
Tx for Pt who has “chronic acid reflux” but TCM interview reveals palpitation & nausea: Okay to Tx this time but refer to MD for heart assessment/WM Dx before next TCM Tx.
Tx for Pt who reports “stomach pain that comes & goes”, not associated w/eating food. Usually morning onset, maybe sweating: DO NOT TREAT – Refer to MD for assessment.
Define Myocarditis: Inflammation of the heart muscle, post viral. Mostly self limited. Past Hx of “flu” or “cold”
Sx of Myocarditis: Fatigue, dyspnea, palpitation, fever
Define Cardiomyopathies: Disorders of the heart muscle. Ex: hypertrophic cardiomyopathy and peripartum cardiomyopathy.
What are common types of Cardiomyopathy? Hypertrophic cardiomyopathy Dilated cardiomyopathy Restrictive cardiomyopathy
Define Hypertrophic cardiomyopathy: Thickening of intraventricular septum and left ventricle.
Etiology of Hypertropic Cardiomyopathy: genetic, HTN, obstructive valvular disease, thyroid disease
What heart disease kills young athletic people? Hypertrophic cardiomyopathy is a major cause of death in young athletes who seem completely healthy but die during heavy exercise. However, certain normal changes in athletes' hearts can confuse the diagnosis.
Define Dilated cardiomyopathy: Muscle fibers are damaged, and can’t contract
Etiology of Dilated cardiomyopathy: infections, HTN, ischemic heart dz, drugs, EtOH, peripartum cardiomyopathy
Define Restrictive cardiomyopathy: Left ventricular hypertrophy and endocardial fibrosis
Define Infectious and immunologic disorders of the heart: The Endocardium and heart muscle are attacked by: Infectious agent especially in endocarditis Immunologic complex especially in rheumatic fever
Describe Infectious/bacterial Endocarditis: The bacteria enters blood stream directly Most common: Staph aureus, Strep pneumonia.
Sx of Infectious/bacterial Endocarditis: malaise, fatigue, fever low grade, petechia and splinter hemorrhages, arthritis and arthralgia, and sometimes diarrhea.
Complications of Infectious/bacterial Endocarditis: lungs, kidneys, spleen, CNS
Describe Immunologic disorders of the heart – rheumatic heart disease Rheumatic fever: acute inflammatory disease that follow a throat infection with group A β-hemolytic streptococci. Incidence mostly in age range 5-15 y.old.
Complications of Immunologic disorders of the heart: Causes valvular heart disease and permanent cardiac dysfunction.
Describe Rheumatic Fever: Inflammatory disease after strep throat
Primary Manifestation of Rheumatic fever Hx of sore throat present – sore throat is exudative and pus producing. Can see white coat back of the throat most of the times.
Other Sx of Rheumatic fever : migratory polyarthritis, fever, HA, abdominal pain, nausea and swollen lymph nodes.
Complications of Rheumatic Fever: chorea, erythema migrans, mitral valve prolapse, permanent cardiac dysfunctio
What would labs positive for Rheumatic Fever show: high ESR and CRP and leukocytosis.
Treatment for Rheumatic Fever: Antibiotic Steroids Rest
Define Kawasaki’s disease: – vasculitis of coronary arteries in children <5yo post-URI Sx: exhaustion, very high fever that is unresponsive to medications.
Define Valvular heart disease: Valvular opening decreases in size (stenosis) or valves don’t close properly.
Describe etiology of Dysfunctional heart valves: Congenital, trauma, IHD, degenerative changes, and inflammation. RF is a common cause for valvular problems. They produce blood flow turbulence Mostly chronic conditions
Define Stenosis: (stenotic valvular problems):Decrease of blood flow through a valve, resulting in impaired emptying and increased work demand on the heart chamber that empties blood across the diseased valve
Ex of Stenosis: mitral stenosis, aortic stenosis
Define Regurgitation of Valves: (regurgitant valvular defect): Permit the blood flow to continue when the valve is closed. Exp: tricuspid regurgitation, aortic regurgitation, mitral regurgitation with prolapse.
Describe Mitral valve prolapse (MVP): Bulging of MV into the left atrium. Can be part of connective tissue disorder in body
Is valvular heart disease more prevalent in men or women? Prevalence: 2.5% in men and 7.6% in women
Sx of valvular heart disease: chest pain (non-exertional), weakness, fatigue, dyspnea, palpitation, anxiety, lightheadedness.
Tx plan of MVP: Use of β-blockers to treat autonomic manifestations. Antibiotics for preventive infective endocarditis before dental work.
Definition of Heart Failure: Failure of the heart as a pump, to eject blood out and into the systemic and pulmonary systems
Describe the impact of Heart Failure in America: Incidence of heart failure is increasing every year. 2 million Americans have HF, and 400000 new cases each year
What is the mortality rate of Heart Failure: Mortality is high even with appropriate and aggressive treatment (more than 50%).
Define Preload: reflects the loading condition of the heart at the end of diastole; or better to say the amount of blood stored in the heart during diastole that needs to be pumped out
Define Afterload: represents the force that the heart must generate to eject blood out of itself; systemic (peripheral) vascular resistance dictates how strong the heart needs to contract to eject blood. (it reflects volume of blood exiting the heart and the pressure)
Define Frank-Starling law: In a range, an increase in the preload will increase the stroke volume meaning the more blood enters the heart the more leaves the heart, as the heart does not like to keep the blood in it
Describe Heart failure: Heart failure happens when the heart does not have the strength to eject blood out; so besides blood accumulating in the heart, there will not be enough blood entering the systemic circulation and also blood will back flow in the pulmonary system.
Types of Heart failure: Congestive heart failure, pulmonary edema and cardiogenic shock
What are causes for heart failure: Impaired Cardiac function, Excess work demand
Describe Impaired Cardiac function: Myocardial diseases: Myocarditis, CAD, MI and Cardiomyopathies. Valvular heart disease: Stenosis in the valves or regurgitation in the valves. Congenital heart diseases Constrictive pericarditis
Describe Excess work demand: HTN either systemic or pulmonary Hyperthyroidism Anemia
Describe Heart Failure Classes: In all classes heart disease present. Class 1: no limitation in physical activity Class 2: rest no problem, ordinary PA causes symptoms Class 3: marked limitation in PA present. Class 4: symptoms even happen during rest.
What are symptoms show increased chance of heart failure? Fatigue, palpitation, dyspnea and anginal pain.
What mechanisms compensate for Heart Failure: Increased sympathetic nervous system activity Renin-Angiotensin-Aldosterone Reabsorption of fluids in kidney (Na and ADH) Increase systemic vascular resistance Atrial Natriuretic Peptide Myocardial hypertrophy
Tx for Heart Failure: Goal is to relieve the symptoms and improve quality of life. Correction of reversible causes such as anemia and thyrotoxicosis, control HTN Modification of physical activity Restriction of salt intake Meds
Meds for Tx of Heart Failure: Diuretics Inotropic agents: digitalis, B adrenegic agonists. ACE inhibitors (major side effect: cough) Vasodilators
Definition of Congestive heart Fiailure: HF is accompanied by congestion of body tissues. Congestion can happen in the pulmonary system causing blood accumulation in the lungs; or back flow of blood into viscera.
Sx of Congestive Heart Failure: based on right vs left side heart failure.
Describe Rt Heart Failure symptoms: Fatigue, dependent edema (edema in lower extremities), distension of the jugular vein, distension of liver, ascites, anorexia and complications of GI distress due congestion of GI, cyanosis.
Describe Lt Heart Failure symptoms: Exertional dyspnea, orthopnea, cough, blood-tinged sputum, cyanosis.
Describe Acute pulmonary edema: Life threatening condition. Blood, fluids accumulate in the lung
Manifestations of Acute pulmonary edema: Dyspnea and gasping for air, rapid pulse, cool moist skin, cyanosis, confusion and stupor. Cough and bloody sputum. Crackles in the lungs.
Tx of Acute pulmonary edema: Provide O2 and send to ER asap.
Definition of Cardiogenic Shock: Failure of the heart to pump the blood in the systemic circulation, no O2 and nutrients provided to tissues and organs due to impaired perfusion.
Causes of Cardiogenic Shock: MI Arrhythmias (especially after MI)
Sx of Cardiogenic Shock: hypotension, cyanosis….
Tx of of Cardiogenic Shock: REFER asap
Causes of Cardiac conduction and rhythm: Disturbance in impulse generation Disturbance in impulse conduction Normal heart Rhythm is called sinus rhythm and there is physiologic dysrhythmia with respiration
What are disorders of Cardiac conduction and rhythm? Sinus bradycardia:<60 bpm Sinus tachycardia:>100 bpm Sinus arrest: asystole, no impulse coming Sick sinus syndrome (SSS) brady- and tachy- cardia alternatively. Atrial dysrhythmias usually asymptomatic unless they get transferred to AV and to ventric
Are dysrhythmias in heart more serious in ventricle or atrium? Dysrhythmias in ventricles are more serious
Cause of PVC: PVC (premature ventricular contraction) is usually caused by an ectopic pacemaker in heart.
Describe Ventricular tachycardia: 160 -250 bpm, can happen after MI.
Describe Ventricular fibrillation: > 350 bpm is fatal and can happen after MI.
Created by: bastyr41