Pathology Exam 2
Card Set Information
Pathology Exam 2
Pathology cardiac system
Cardiac and Pulmonary System
Describe the blood flow of the heart
blood flows from superior vena cava and inferior vena cava to the right atrium
then to the tricuspid valve into the right ventricle
right ventricle ejects blood through pulmonic valve into pulmonary artery during ventricular systole
blood enters pulmonary capillary system
oxygenated blood leave lungs via pulmonary veins and returns to left atrium
from left atrium, blood flows through mitral valve into the left ventricle
left ventricle pumps blood into systemic circulation through aorta
supplies tissues of body with O
blood then returns to heart through superior vena cava and inferior vena cava to begin cycle again
What is the total body volume, intracellular fluid, extracellular, and blood?
Total - 40-50L
intracellular fluid - 25-35L
extracellular fluid - 10-14L
Blood - 4-5L
Signs and Symptoms of CVD
What is Angina?
symptom of coronary artery disease
described as pressure, squeezing and tightness in chest
What is Coronary Artery Disease?
most common and seious effect of aging
fatty deposits build up in vessel walls and narrow passageways for movement of blood (artheriosclerosis)
Risk factors for Coronary Heart Disease
cigarette smoking (#1 cause of preventable death)
Medical Management for Coronary Heart Disease
: check cholesterol ~5 years, angiograms
modifications of risk factors
: quit smoking, manage diabetes and fat
: moderate ~30 minutes > 4x/week
: reduce clotting, treat HTN, decrease cholesterol levels
medical surgical intervention
: CABG, vessel acclusion
What are the different types of Hypertension?
: idiopathic, most common (90-95%)
: 5-10% of all cases
: HTN boarderline goes up and down
: elevated BP with diastolic >125, hemmorages
What are the different BP values
: s < 120, d <80
: s ~ 120-139, d ~ 80-89
Stage 1 Hypertension
: s ~ 140-159, d ~ 90-99
Stage 2 Hypertension
: s >160, d >100
What are the consequences of malignant HTN
transient ischemic attack, stroke
peripheral artery disease
chronic kidney disease
LVH, CHP, CHF
Symptoms of HTN
nocturnal urinary frequency
spontaneous epistaxis (nose bleeds)
Cardiovascular sypmtons of progressive HTN
Cerebral symptoms of progressive HTN
fleeting numbness/tingling in limbs
Medical Management of HTN
aggressive early treatment (esp w/ DM)
physical activity and exercise
--weight control, smoking cessastion
What degree of change in BP can reduce risk of CVD and by how much?
2 mmHg change can reduce CVD by 10%
7% decrease of ischemic heart disease mortality
10% decrease of stroke mortatlity
What is the most common site of an MI?
left coronary artery
What is an Myocardial Infarction?
occlusion of coronary arter, L or R
majority involves L ventricle
80-90% due to coronary artery thrombosis
smokers 2x MI, 2-4x more sudden death
area of injury becomes necrotic
size and location determine damage
What are the symptoms of an MI?
sudden sensation of pressure
prolonged "crushing chest pain"
occassionally radiates to arms, throat, neck and back
constant pain 30min - hours
observable pallor, SOB, diaphoresis
atypical signs from women
What are the Post-MI symptoms?
What are the diagnostic test for an MI?
ECG - infarcted tissue is electrically silent
cardiac troponin - markers of myocardial injury
TEE - ultrasound image of heart
pulmonary artery pressure measure
What is the treatment for an MI
drugs (pain relief, anticoagulation to prevent thrombosis formation, limit infarction size, reduce vasoconstriction
prognosis depends on size/site of infarct
How could cardio disease affect PT treatment?
during evaluation, assess cardiac signs and symptoms
check degree of impairment
level of disabilitylevel of functional limitations
pt needs to communicate symptoms to MD
PTs need to help pt characterize symptoms
when beyond scope of practice > REFER
What are the implications for PT for CAD?
: education and exercise, promotes development and maintenance
: sternal precautions
no pulling up in bed
no push, pull, lift >10lbs for 6 weeks
shoulder, neck, torso ROM may/not be limited
avoid shoulder horizontal abduction
What are the implications for PT for HTN
know patients medications
avoiding heaving lifting and isometrics
close monitoring of vitals
What are the implications for PT for an MI?
progressive physical activity begins w/in 24 hours
gentle exercises as prophylactic (prevent immobility)
avoid intra-abdominal pressure (no valsalva)
avoid excessive hot water submersion
close monitoring of vitals
return to sex requires MD guidance
What is Congestive Heart Failure?
heart unable to pump sufficient blood to meet metabolic needs
pulmonary congestion and HTN due to:
--back up of blood in pulmonary veins
--increased pressure in pulmonary capillaries
acute or chronic
What are the four types of CHF?
systolic heart failure
diastolic heart failure
left sided heart failure = CHF
right sided heart failure = Cor Pulmonale
What is the incidence of CHF
existing CVD - especially in pre-existing HTN
What are the risk factors for CHF?
What are the etiologic factors of CHF?
valvular heart disease
congenital heart disease
What is the pathophysiology of CHF?
1st Compensation Phase:
chambers enlarge to hold increase of blood
right ventricles pump increased blood to the lungs
accumulation of blood leads to pulmonary edema
fluid seeps from distended blood vessels
leads to SOB and flooding of air spaces
2nd Compensation Phase:
as myocardial cells lose contractibility
--muscle mass increases
results in ventricular hypertrophy and need more O
angina due to ischemia when coronary arteries unable to meet O
3rd Compensation Phase:
decrease blood coming from the heart, decreased blood through kidneys
kidneys respond by retaining water and sodium to increase blood flow
exacerbates tissue edema
expanded blood volume increases load on the system
What is compensated CHF?
if system is still able to maintain normal levels
What is decompensated CHF?
after compensation fails and unable to maintain levels, disease progresses to final stage
massive heart overload
Results of Left-Sided Heart Failure
decrease level ventricle output deosn't meets body's metabolic needs
causes pulmonary edema/disturbance in respiratory control
fatigue and muscular weakness
--decrease urine formation, decrease blood flow, decrease cardiac output
--renine secretions, stim angiotension, vasoconstriction
(increased preipheral vascular resistance, increased BP, increased cardiac work, worse heart failure)
What are symptoms of Left sided heart failure?
Results of Right-Sided Heart Failure
failure of R ventricle to pump blood to lungs
dependent edema - fluid retained because body senses decrease blood volume in kidneys
jugular vein distension
cyanosis - lack of O
Medical Management for CHF
diet and exercise!!!
medications to decrease workload, increase strength and contraction
surgeries - CABG
What is pulmonary edema/congestion?
excessive fluid in alveoli and/or interstitial spaces
barrier to gas exchange
primarily associated with left sided CHF
--mitral valve disease
--kidney and liver disorders
--inhalation of smoke
normally lung is "dry" through lymphatic drainage and a balance of capillary hydrostatic pressure, pulm oncotic, and capillary permeability
Pulmonary Edema is cause by?
fluid pushed from capillaries into interstitial tissue
peripheral pressure "backs up" system causing limited "forward flow"
decreased serum and albumin:
decreased production of plasma protein -> decrease capillary oncotic pressure -> decreased reabsorption at venous end -> edema
lymph obst decreases absorption of interstitial fluid -> decreased transport of capillary filtered protein -> increased tissue oncotic pressure which pulls fluid in -> edema
disruption of capillary permeability:
increased capillary permeability
movement of protein plasma into tissues
icreased tissue oncotic pressure
What are the symptoms of Pulmonary Edema?
occur in stages
restlessness, anxiety, feeling of cathing a cold
persistant cough, slight dyspnea, diaphoresis
What is the medical management for Pulmonary Edema?
prevention - lower salt intake or meds if at risk
treatment - supplemental O
, diuretics, diet
What is an Aneurysm?
abnormal stretching in wall of an artery, vein, or the heart with diameter increases more that 50% of normal
>5cm is likely to rupture
What are the symptoms of an Aneurysm?
may be assymptomatic
depends on size, position, and rate of growth
AAA (untreated) - intermittent/constant pain in mid-ab or low back
AA disection - sharp pain in base of neck/scapular area, MI reversible ischemia, stroke, paraplegia, renal failure, ichemia of arms/legs due to pressure
What is the medical management of an Aneurysm?
diagnosis - detection of mass by x-ray
prevention - smoking cessation, BP control and cholesterol
treatment - surgery is >5cm
surgery - replaces diseased aorta or stent graft
What are the diagnostic tests for Cardiovascular function?
ausculation (heart sounds)
exercise stress tests
doppler studies (assess blood flow)
arterial blood gas determination
What are the general treatments for Cardiac disorders?
regular exercise program
What type of drug therapy is used for cardiac disorders?
cholesterol/lipid reducing drugs
calcium ion channel blockers
digitalis compounds (digoxins)
What are the surgical interventions for cardiac disorders?
: squishes clot against wall to try and keep open
: like angioplasty, balloon is permanent
: drills out clot
: healthy blood vessels removed from leg, creates new blood flow around occulsion
coarctation of aorta
What are the PT implications for CHF?
exercise - low to moderate exercise with tests, gradual increase intesity and duration, maintain functional levels
What are the PT implications for Pulmonary Edema?
watch for jugular distension
What are the PT implications for an Aneurysm?
activites restricted post surgery - only bedside mobility
no valsalva maneuvers
What structures are in the upper respiratory system?
What structures are in the lower respiratory system?
Structures of the lower airway
1st 16 generations are for condution
transitional airways lead into final respiratory zones
--consists of alveoli where gas exchange happens
What are the funtions of the lungs?
: ability to move air in and out of lungs via pressure gradient
: gas exchange that supplies O
to blood and body tissues. removes CO
What are the symptoms of pulmonary dysfunction?
hypoventilation (most common)
altered breathing patterns
How does aging affect pulmonary function?
physiological function of lungs
ability of respiratory system to defend
structural changes lead to decrease gas exchange
--decrease chest wall compliance
--decrease elastic recoil
--decrease gas exchange 2
flattened alveolar walls decreased surface area
--decreased cilliary action to clean out mucus leads to increased infection
--decreased respiratory musculoskeletal strength and endurance leads to dyspnea
--pulmonary complications during anesthesia post-op
--decreased effective cough leads to increased risk of pneumonia and atelectasis
inflammation of parenchyma of lungs
may be secondary to disease
often follows influenza
may involve B lungs at lobe or bronchioles and alveoli
bacterial, viral, fungal, or myoplasmal infection
inhalation of toxins, chemicals, smoke, dust, gases
apiration of food, fluid, vomitus
What are the different types of pneumonia?
: suck and swollow difficulties, anatomic defense mechanisms are impaired
: limited geographic region or compromised immune system
: usually mild and self-limiting
: may follow influenza virus
What is the source of pneumonia?
usually airborn pathogens
circulation, sinus or contagious infection
What are the risk factors of pneumonia?
complications of influenza and sinusitis
chronic bronchitis, uremia, dehydration, malnutrition
DM- poorly controlled
hospitalization, surgery intubatin, incontinance, inactivity
impaired cough and/or swallowing
pooling of secretions in aireways after being supine too long
impaires gas exchange which leads to dyspnea
What are the symptoms of pneumonia?
sudden and sharp pleuritic chest pain aggravated by chest movement
hacking, productive cough with green/rust colored sputum
dyspnea, tachypnea, decreased chest wall excursion on effective side
cyanosis, HA, fever, aches, chills, synalgias
What is the medical management for pneumonia?
: suptum cultures, blood culture, urine test, chest X-ray, physical exam, percussion and aussiltation
bacterial and mycoplasmal - to antibiotics and rest, fluids
fungal - antifungal meds
viral - symptomatic relief
vaccination - for elder, good for 3-5 years
airway clearnence PRN
What is chronic obstructive pulmonary disorder (COPD)?
chronic airflow that is NOT fully reversible
caused by - emphysema and chronic bronchitis
4th leading cause of death - 2nd behind heart disease as cause of disability
What is the medical management of COPD?
smoking history, physical exam, chest xray
use pirometer - max force of exhalation
labs for blood gas and blood pH, sputum culture, precsence of immunoglobulin
can be managed, but not cured
different for everyone depending on severityearly diagnosis
--icrease ability to stay active
--prevent and treat complications
--improve quality of life
goal = improve oxygenation and decrease CO
--annual flu vaccine
--lung volume reduction surgery
support to stop smoking
conservation of energy
What is Emphysema?
pathological accumulation of air in tissues (lungs)
abnormal distension of air spaces
destruction of elastin proteins which normally maintain strength of alveoli walls
leads to collapse of bronchioles and air is trapped
destruction of walls between alveoli leads to pockets of air
What are the three types of Emphysema?
distruction of bronchioles
mostly in smokers
destroys air spaces of entire acinus
involves lower lung
mostly in smokers
destroys alveoli in lower lobes
Clinical Manifestations of Emphysema
dyspnea on exertion (DOE)
prolonged expiratory phase
dyspnea at rest
hypercapnia (increase CO
use of accessory muscles to breathe
lung sounds diminished
Who are known as the "pink-puffers"?
people with emphysema
breathing is difficult and working hard
causes face to turn pink
What is Chronic Bronchitis?
a productive cough at least 3mo/year > 2 years
inflammation and scarring of bronchial lining
increased mucous production
irritants increase mucous secretion and hypertrophy
Who are known as the "Blue Bloaters"?
people with chronic bronchitis
cyanotic color fo skin and liops
hypoxia and fluid retention
What is the medical management for chronic bronchitis?
persistant cough and sputum production - worse in the am and evening
SOB, prolonged expiration, persistant coughing
decreased chest expansion, wheezing, cyanosis
hypoxia, sever disability or death
What is Asthma?
a reversible obstructive lung disease
inflammation and increased smooth muscle reation of airway
chronic condition with exacerbations
increased mucus gland secretions
mucus plugs airways (edema)
hypoxemia, increased WOB
extrinsic (allergic) - 50% of all cases
intrisic - no known cause
most common chronic diseases in adults and children
incidences of asthma/deaths are increasing
What are the risk factors for Asthma?
low birth weight
childhood - more likely < 5 years
antibiotic use in infancy
before puberty - boys 3x>girls. after boys = girls
overcrowding living with environmental factors
What are the symptoms of Asthma?
What are the different types of Asthma?
What are the 3 stages of Asthma?
symptoms reverse with stop of activity
leans forward to catch breath
daytime Sx >2x/wk night >4x/wk
blue lips and fingernails
cyanosis induced seizures
skin and rib retraction
frequent day and night symptoms
What is Cystic Fibrosis?
congenital disorder in the exocrine system
affects hepatic, male reproductive syst and respiratory system
predisposed to chronic bacterial airway infections
develop obstructive lung disease
progressive loss of pulmonary functions
What does Cystic Fibrosis result in?
dehydrated and increase viscosity of mucous glands secretions
elevation of sweat electrolytes
abnormal increase of sodium and choloride concentrations in sweat
What are they symptoms of Cystic Fibrosis?
98% infertility in males
marked tissue wasting
What is the medical management for cystic fibrosis?
prenatal genetic testing
chloride levels > 60mmols/L
Implications for PT for Cystic Fibrosis
CF centers for life long care
What is Lung Cancer?
malignancy of epithelium of respiratory tract
leading cuase of cancer deaths in US
more people die of lung cancer than breast, colon, and prostate together
What are the risk factors of Lung Cancer?
2nd hand smoke (increased risk 1.5x)
What are the symptoms of Lung Cancer?
depend on location in lung
What are the two types of Lung Cancer?
a result of obstructive air flow
few symtoms until localized
sharp and sever pleural pain increase with inspiration
What is the medical management for Lung Cancer?
prognosis is poor
caught early ->70% cure rate
death within one year without treatment
in one year of smoking cessation decreases risk by 1/2
What are the implications for PT for Lung Cancer?
teaching gradual exercises, postitioning, prevent loss of funtion
energy conservation is key!
What is Cor Pulmonale?
enlargement of R ventricle due to pulmonary HTN
occurs mostly in females and smokers
pulmonary vascular disease
repiratory disease (COPD)
What are they symptoms of Cor Pulmonale?
attributable to pulmonary HTN
typical exertional angina
less common Sx- productive cough, hoarseness, hemotysis
severe R ventricular failure
exercise induced cyanosis, clubbing
What is the medical management for Cor Pulmonale?
reduce workload of R ventricle
salt and fluid retention
surgical removal of PE if accessable
What are the PT implications for Cor Pulmonale?
What are the PT implications for Pneumonia?
ventilory support/ supplemental O
proper positioning to preent aspiration
What are the PT implications for COPD?
gentle progression program
What are the PT implications for Asthma
watch for cyanosis