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sick sinus syndrome?
- altering brady/tachycardia
- often requires mechanical pacemakers
premature atrial contractions/beats
extra or ectopic beats. atrial muscles are irratable.
- over 350bpm
- pooling of blood in atria= risk for thrombus
- delays AV node, ventricular rate slowed
1st degree heart block
delays conduction of AV node, prolongs PR interval
2nd degree heart block
delays conduction of AV node, increase PR interval until one contraction is missed.
3rd degree heart block
- no transmission of impulse from atria and ventricles
- ventr contract independently at 30-45/min
bundle branch block
- interference of one of the bundle branches
- wide QRS wave
effects of ventricular tachcardia
red. CO as red. diastle occurs.
- musc fibers contract irregularly and rapidly... so no cardiac output
- cardiac standstill
premature ventricular contractions
- ectopic beats
- may lead to ventricular fibrillation
How do you treat a dysrhmythimias?
digoxin, Ca+ channel blockers, find out the cause, antiarrhymic drug, beta blockers, pacemaker, defibrillator (conversion of ventricular fib)
What is CHF?
- Congestive heart failure ocurs when the blood cannot pump out enough to meet metabolic needs
- CO and SV decr, and blood begins to back up and become congested
Flow of blood in CHF
- Output of ventricle is less than the inflow of blood
- passive pooling
Left and right side of heart during CHF
- Left blood flows back to the lungs
- right blood backs up into ther peripheries.
What causes left sided CHF?
- ischemic heart disease
- aortic stenosis/regurgitation
- mitral regurgatation
what causes right sided CHF
- all the causes of LS-CHF
- right ventricular infarction
- tricuspid pulmonary valve disease
- Cor pulmonale (2ndary to lung disease, COPD, hypoxia)
conpensation mechanisms for chf
- daytime oliguria
- cutaneous and visceral vasoconstriction
signs and symptoms of left sided CHF
- paroxsymal nocturnal dyspnea
- cough, hemopytsis
- dyspnea and orthnopnea
- cold intolerance
- edema in legs, feet, presacral
- digestive disturbances
- flushed faced, distended neck veins, HA, visual disturbance
- cold intolerance
congenital heart defects
problems squatting, feeding difficulties, pallor, tachycardia, delayed growth/devel... etc
what is the most common congenital heart defect?
Ventricular Septal Defect (VSD)
what happends during VSD?
- their is an opening in the interventricular septum
- shunt from left to right due to higher pressure in left
- pulmonary HTN
- incr right side pressure= cyanosis
Valvular defects most commonly effects?
aortic and pulmonary
failure of valve to open to completely
- VI- valves dont close completely, regurgitates/backflow
- mitral valve prolapse- enlarged floppy leaflets (normal)
- pulmonary stenosis- right ventricle hypertrophy
Tetralogy of fallot
- right to left shunt (bypasses pulmonary circ)= cyanotic
- lungs receive small oxy blood, rest of body receive mixed blood
which abnormalities do tetralogy of fallot include:
- pulmonary vavle stenosis
- overriding of aorta
- right ventricular hypertrophy
What is rheumatic fever?
- multisystem inflamm disease
- abnormal immune rxn
- due to untreated pharyngitits (group A beta hemolytic streptococci)
- heart and joints swell
long term effects of rheumatic fever
- rheumatic heart disease
- infective endocarditis
- heart failure
acute rheumatic fever
- inflam of all heart layers + incompetent valves
- large joints
- erythema marginatum
- involuntary jerk movements
- non tender subcutaneous nodules
- low grade fever, leukocytsis, tachcardia, malaise, anorexia,
how do you diagnose acute rheumatic fever
- ASO titer (anti strepilysin O antibody)
rheumatic heart disease, and what is most common result?
repeated bouts of infection and valve damage
prevention of rheumatic heart disease?
- prophylactic antibacterial agent
- anti-inflamm agent
what is infective endocarditis? what causes subacute and acute?
- life threatening colonization of microbial agents in the heart valves
- subacute- strep. viridans
- acute- staph. aureas
- sudden marked onset- fever, chills, drowsiness
- heart valves badly damaged
- systemic emboli to brain, kidney, spetic infarcts
- low grade fever
- strp. virilus