Cardiovascular disorders 2

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Author:
annzors
ID:
175180
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Cardiovascular disorders 2
Updated:
2012-10-02 23:52:40
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pathophysiology
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Description:
heart failure, heart wall disorders, shock
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  1. heart failure
    - definition
    - causes (4)
    • inability to effectively pump the amount of blood delivered to the heart
    • causes: 1) MI; 2) chronic ischemic heart disease, 3) valvular disease, 4) cardiomyopathy (heart muscle inadequate force, genetic)
  2. heart failure may be the result of systolic dysfunction or diastolic dysfunction
    • systolic dysfunction:
    • a) char by low ejection fraction;
    • b) associated with poor contractility
    • c) associated with MI often
    • diastolic dysfunction:
    • a) char by near normal ejection franction
    • b) associated with slow or poor relaxation (stiff)
    • c) often associated with aging
  3. left sided HF
    systolic affects
    diastolic affects
    • systolic: LV does not pump enough blood to body
    • diastolic: LV does not accept enough blood from lungs
    • lungs fills with fluid - pulmonary congestion
    • body lacks blood - weakness; low CO
  4. right sided HF
    systolic affects
    diastolic affects
    • systolic: RV does not pump enough blood to lungs
    • diastolic: RV does not accept enough blood from body
    • boody fills with blood - systemic venous congestion
    • lungs do not oxygenate enough blood - low CO
  5. heart wall disorders
    (3 classifications)
    1) i)-iii), 2), and 3)
    • 1) infectious (rheumatic heart disease)
    • i) endocarditis
    • ii) myocarditis
    • iii) pericarditis
    • 2) cardiomypathies
    • 3) valvular disorders
  6. rheumatic heart disease (3)
    • i) endocarditis
    • ii) myocarditis: inflam w/ WBC/inflam mediators
    • iii) pericarditis: inflammation of the pericardium
    • causes pain and exudate, ECG changes
    • catheters may intro microbes leading to pericarditis
    • may restrict the heart movemnt due to:
    • a) serous exudate filling the pericardial cavity (pericardial effusion) ; cardiac tamponade: rapid accumulation of exudate compresses the heart, decr. diastolic volume
    • b) fibrous scar tissue making the pericardium stick to the heart (constrictive pericaditis)
    • fibrin = sticky (may make membranes stick together)
  7. pericarditis
    • pericarditis: inflammation of the pericardium
    • causes pain and exudate, ECG changes
    • catheters may intro microbes leading to pericarditis

    • may restrict the heart movemnt due to:
    • a) serous exudate filling the pericardial cavity (pericardial effusion) ; and
    • cardiac tamponade: rapid accumulation of exudate compresses the heart, decr. diastolic volume

    b) fibrous scar tissue making the pericardium stick to the heart (constrictive pericaditis)fibrin = sticky (may make membranes stick together)
  8. myocardial disorders
    - definition
    - can cause HF if... (3)
    • ventricular muscle becomes too week
    • malfunctioning heart muscle can cause HF if
    • i) ventricles are unusually thick so there is not a normal amount of room for blood inside them
    • ii) ventricles are too stiff to stretch
    • ventricles are too weak to pump out the blood that is in them (-> systolic)
  9. cardiomyopathies (3)
    • 1) dilated cardiomyopathies: resistance of the heart wall decr. (too elastic) = overfill = heart not pumping out all the blood
    • 2) hypertrophic cardiomyopathies:
    • 3) restrictive cardiomyopathies: heart muscle is too stiff; cavity not dilated; EDV low
  10. dilated cardiomyopathies
    1) dilated cardiomyopathies: resistance of the heart wall decr. (too elastic) = overfill = heart not pumping out all the blood
  11. restrictive cardiomyopathies
    heart muscle is too stiff; cavity not dilated; EDV low
  12. hypertrophic cardiomyopathies (2/3 char)
    • - defects in their contrctile proteins, make cells tpo weak
    • they hypertrophy to do the same amount of work as normal cells
    • - need more oxygen and perform less efficintly so the person is prone to HF and may suffer sudden death during exertion
    • - has low activity tolerance
    • - (incr. in muscle to get more protein for the same effect BUT results in incr. muscle mass)
  13. valvular disorders
    the endocardial sturctures lining the herat can cause heart failure
  14. stenosis
    • valve will not open all teh way
    • it is harder to force bloo dthrough it
    • may result from inlam, atheosclerosis, Ca2+ deposit
    • murmur of blood shotting through the narrow opening when the valve is open
    • whstling sound
    • more freq affects SL valves
  15. regurgitation
    • valve will not close all the way
    • it leaks when it should be closed
    • may allow back flow
    • murmur of blood leaking back thru when the vlave should be closed
    • low pitched sound, gurgling soung as bloo dflows back and forth
  16. mitral valve regurgitation
    • LA to LV (norm) but alot of LV to LA
    • blood flows back in LA
    • LA larger, incr. pressur eis built as well
    • can lead to pulmoary congestion
    • decr. CO
  17. AV regurgitation
    LA to LV
    • blood LA<-> LV
    • decr. CO
    • incr. EDV in LV
    • decr. SV
    • heart overdilated
    • failure of LV to expel
  18. aortic valve stenosis
    • LV to body
    • difficult pushing blood thru
    • LV muscle workds harder
    • hypertrophy
    • problem having enough O2 for enlarged LV
    • fixed by incr. contraction of LV or maintained/compensated but overtime decr. CO + Ca2+ deposit hardens
  19. mitral vavle stenosis
    • LA to LV
    • pulmoary congestion is possible
    • decr. EDV b/c decr. blood to LV
    • decr. CO
  20. shock (4)
    • cardiogenic: heart
    • hypovolemic: volume
    • distributive: vasomotor tone
    • septic: infection
  21. cardiogenic shock
    • heart fails to pump blood adequately
    • a) decr. CO lowers BP
    • b) SNS responds causes vasoconstric; incr. after load
    • c) vasocontriction incr. resistance to blood flow
    • d) incr. workload on herat worsesn heart failure
  22. hypovolemic shock
    • hemorrage > decr. BV > decr. CO > decr. BP
    • may suffer irrev organ damageĀ  if not treat right away
    • restore by blood transfusion
  23. distributive shock
    - 5 char
    - 3 causes
    • i) blood vessels dilate
    • ii) there's not enough blood to fill circulatory system
    • iii) blood flow decr.
    • iv) less blood is returned to teh heart
    • v) less blood is circulated to the body
    • causes:
    • xcess vasodilator
    • anesthesia (smooth muscle relaxants)
    • allergies
    • a) decr. SNS activity - brain or spine injury; anesthetics; insulin
    • b) vasodilator substances in blood - type I hypersensitivity (anaphylatic shock); inflammatory response to infection (sepsis)
    • c) vessel damage from severe hypovolemia
  24. septic shock
    • also caled systemic inflammatory response syndrome (SIRS)
    • inflam mediators also incr. the metabolic rate of tissues, so they need more O2
    • 40% mortality
  25. complications of shock (2)
    • acute renal failure
    • acute respi distress syndrome

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