alterations in cardiac function (18 points)-patho/pharm II- exam 3

• 1. Acute pericarditis
• 2. Pericardial effusion
• 3. Constrictive pericarditis 

inflammation of the pericardium characterized by chest pain, a pericardial friction rub and EKG abnormalities. 

• idiopathic (probably viral)
• infection
• connective tissue disorders
• radiation therapy

• chest pain
• friction rub
• EKG abnormalities
• low grade fever
• tachycardia
• weakness
• malaise
• anxiety 
• irritability

-Prognosis = favorable (usually self-limiting)

-Treatment = anti-inflammatory drugs, bedrest, NSAID, treat the cause

accumulation of fluid in the pericardial cavity. 

• can occur in all types of pericarditis;
• indicates an underlying disorder

pericardial effusion

• accumulation of blood or fluid in the pericardial sac (pericardial effusion) that causes compression of the heart interfering with right atrial filling leading to decreased ventricular filling, stroke volume and cardiac output. 
• *Life-threatening*

• paradoxical pulse - take bp manually- drop greater than 10mmHg 
• Reflects impairment of diastolic filling of the left ventricle plus a reduction of bv in all four chambers. 

• paradoxical pulse
• muffled heart sound
• widened mediastinum
• tachycardia
• hypotension
• distended neck vein
• ruddy appearance of head and neck
• EKG - electrical alterations
• pallor/cyanosis
• feeling of impending doom

• Pericardiocentsis: therapeutic and diagnostic
• Analgesic
• Anti-inflammatory medication
• Surgery

• scar tissue develops between the visceral and parietal layers of the pericardium
• "heart is incased in a rigid shell"

• radiation exposure
• TB
• uremia
• RA
• post CABG
• idiopathic

• do NOT include paradoxical pulse. 
• exercise intolerance/ fatigue
• anorexia
• DOE
• weight loss
• edema
• hepatic congestion
• distended neck vein
• pericardial knock on heart sounds
• EKG- a fiv and t wave inversion

1. pharmalogical and dietary: digoxin, diuretics, Na restriction

If not successful then surgical excision- pericardectomy

Coronary Artery Disease-a condition and especially one caused by atherosclerosis that reduces the blood flow through the coronary arteries to the heart muscle and typically results in chest pain or heart damage.

CAD and its clinical sequel, myocardial infarction

• Atherosclerosis
•  (heredity, age, sex, race, Obesity, smoking, sedentary, HTN, COPD, DM)

Smoking

when demand exceeds supply or when the supply is no longer able to keep up with metabolic demands

• myocardial = pertaining to the muscles of the heart
• ischemia = to suppress or withhold blood flow

Atherosclerosis

• CO
• Intramyocardial Tension
• Coronary Artery Resistance
• Decreased BV
• Tachycardia

• Tachycardia
• Myocardial wall tension
• Contractile state of myocardium
• HTN
• Volume overload
• LV Hypertrophy 
• Increase in PVR and Afterload

• Increase CO
• Increase aortic pressure
• Decrease coronary artery resistance
• Decrease the intramyocardial tension

• Decrease the HR
• Decrease the contractility of the myocardium
• Control HTN
• Afterload reduction

• stable angina
• - chest pain with physical exertion or stress and diminishes with rest

chest pain that occurs unpredictably, with rest

• "cluster" periods of frequent chest pain followed by none
• due to spasms in arteries

• transmural infarction = STEMI
• subendo infarction = NSTEMI

Myocardial Infarction = death of tissue associated iwth impaired blood flow sufficient to produce lethal cell death

• Unstable Angina
• NSTEMI- non ST elevated MI
• STEMI- ST elevated MI

• 1. Ischemia
• 2. Injury
• 3. Infarction and Necrosis- NOT reversible

• at rest or moderate activity
• 0600-1200
• Combo of severe exertion, fatigue, or unusual emotional stress
• Common happenings are emotional stress and life events - death, divorce, marriage, loss of job, etc

• 1. pain and autonomic responses (Chest pain-new, change in pattern, not relieved by rest or NTG)
• 2. weakness and (N& V, diaphoresis, tachycardia, hypotension, skin color, cold, clammy, dyspnea, deminished pulses, S4 or S3)
• 3. arrhythmias and EKG changes
• 4. signs of inflammation and elevated serum levels

• isoenzymes (CK-MB)
• troponin
• myoglobin levels

diseases that affect the myocardium resulting in enlargement and ventricular dysfunction.

• "Congestive cardiomyopathy"
• = dilation of all four chambers of the heart

Dilated/congestive

• commonly idiopathic
• pregnancy
• ETOH
• infection
• toxins- chemo
• MI - extensive or reoccuring
• familial -20-30%
• immunologic abnormalities

• dyspnea, fatigue are Most common!
•  arrhythmias, palpitations
• 1. pulmonary congestion (not pulmonary edema)
• 2. chest pain
• 3. HTN
• 4. CHF
• 5. abnormal hs
• 6. emboli

• Na restriction
• Digoxin, Diuretics, Anticoagulants
• Bedrest
• Afterload/Preload reducers
• Steroids or immunosuppressants
• Resynchronization with pacemaker
• Cardiac Transplant ONLY CURE! 

• 75% of the time death is caused by left heart failure!
• Sudden cardiac death is common
• Majority of deaths occur in 5 years.

asymmetric dilation or thickening of the septum. 

• asymmetric septal hypertrophy
• muscular sub aortic stenosis
• IHSS - idiopathic hypertrophic sub aortic stenosis

• HTN
• Valvular heart disease
• Genetics

Hypertrophic cardiomyopathy

• Some people will remain asymptomatic
• (Variable) Dyspnea, Fatigue, Arrythmias, palpitations, chest pain
• - Left heart failure
• - syncope (faint)
• - MI if septum outgrows blood supply

• Echo and cardiac cath
• EKG- LV hypertrophy and arrhythmias

• 1. Beta blockers
• 2. Ca channel blockers
• 3. Surgical resection of septum 
• 4. ICD- implantable cardioverter-defibrillator

long-term survival is expected.

abnormal diastolic filling and excessive rigid ventricular walls.

• INFILTRATIVE DISEASES: 
• -amyloidosis
• -hemochromatosis
• -glycogen storage disease

Restrictive cardiomyopathy

• CHF- particularly R. sided HF
• Cardiomegaly
• Arrhythmias

• None. Treat underlying cause. 
• Death occurs because of CHF and arrhythmias

diffuse, inflammatory disease caused by group A beta-hemolytic streptococcus 

• Mitral and aortic.
• fibrous scar tissue deform chorade tendinae

end result of untreated rheumatic fever causes scarring and deformity of cardiac structures. 

• aka: "infective" 
• inflammation of the endocardium usually the cardiac valves. 

• 1. Acute: affect people with normal hearts
• 2. Subacute (SBE): affect people with damaged hearts

• 1. Valvular heart disease
• 2. Congenital heart disease
• 3. IV drug abusers
• 4. long-term indwelling CV catheters
• 5. Recent CV surgery
• 6. previous bacterial endocarditis

disorder of the cardiac valve, characterized by stenosis and obstructed blood flow OR degeneration and regurgitation. 

Acquired or congenital.

• 1. Narrowing of the valve opening= stenosis
• 2. Failure of valve to close properly = regurgitation

• 1. decrease in flow
• 2. cause increased workload in preceding chamber
• 3. first evidence occurs with exercise
• 4. pressure increases leading to myocardial hypertrophy

• 1. an incompetent valve that doesnt close and allows blood to linger
• 2. causes increases workload of both preceding chamber and chamber after. (atrium and ventricle)
• 3. leads to cardiomegaly, chamber dilation, and hypertrophy

• 1. cardiac glycosides- digoxin
• 2. Diuretics
• 3. Na restriction
• 4. Antibiotics until valve repair or replacement necessary. 

mitral and aortic

• Mitral Valve Prolapse
• - mitral valve billow upward during systole because cusps are enlarged. regurgitation occurs if blood goes back into atrium

• young women 
• inherited