During systole, the mitral valve does not close all the way, allowing a backflow
This backflow goes back into the LV during diastole, leading to an increased volume
May be caused by rheumatic heart disease, papillary muscle rupture or rupture of the cordae tendinae
May have afib and signs of LV failure, may also lead to RSHF as cor pulmonale
What is mitral valve prolapse?
More common in women, may be congenital defect
Valvular leaflets enlarge and prolapse into LA during systole
Creates a click between S1 and S2
Most cases are asymptomatic, but patient may express chest pain and DOE as well as dissiness or syncope
What is aortic stenosis (systolic)?
Atherosclerosis and calcification of the aortic valve (often in the elderly). Occurs during systole.
may be caused by rheumatic fever, congenial or trauma, endocarditis
It is the most common valvular disease from wear and tear.
Results in LV hypertrophy, increaed O2 demands
Causes right sided HF by pulmonary edema and afib
What are the s/s of aortic stenosis?
Early: dyspnea, angina, syncope
Late: marked fatigue, debilitation and peripheral cyanosis, crescendo murmur is heart
What is aortic regurg (diastolic)?
Aortic leaflets to do not close during diastole, causing regurg from the aorta in the LV
The ventricle hypertrophies to accommodate increasing fluids volume
Caused by infective endocarditis, hypertension, congenital, marfans
May remain asymptomatic for years
S/S include dyspnea, orthopnea, palpitations and angina, increased systolic HTN and bounding pulses
What are the s/s of valve dysfunction?
dizziness and syncope
chest pain or discomfort
prior history of rheumatic heart disease
What is the significance of cardiac murmurs?
Often the first sign of underlying valvular disease
Systolic murmurs may be do to physiological increases in blood viscosity or might indicate asymptomatic cardiac disease
Diastolic murmurs are almost always pathological and need the attention of a cardiologist
What constitutes Acute Coronary Syndromes (ACS)?
Acute Myocardial infarction
What is Sequelae?
Rupture of atherosclerotic plaque which leads to platelet aggregation
and a thrombus
Vasocontriction occurs, blocking blood flow and oxygen
40% plaque accumulation will block blood flow
How are AMIs classified?
ST elevation (STEMI): is a traditional presentation
Non-ST elevation (NSTEMI): is common in women
Unstable Angina: most commonly used terminology
What are the zones of an MI?
Transmural MI involves all 3 layers of the heart
The subendocardial muscle layer has the longest myobrils, the greatest 02 demand and the poorest blood supply
The three layers are: ischemia, injury, necrotic tissue
What changes in the body does an MI cause over time?
Hypoxia from ischemia leads to vasodilation and acidosis
Potassium, Calcium & Magnesium imbalances cause further changes in conduction and contration
Catecholamines (Epi/norepi) lead to increased HR, contractility and afterload causeing ventricular dysrhythmias
How does the ECG change over time after an AMI?
Within Minutes: The T wave peaks
Minutes to hours: ST elevation
Days: Q wave formation and loss of R wave. T wave may invert
Weeks to Months: T wave will normalize, but pathologic q wave may persist
What are the acute treatments for AMI?
Get IV access and give morphine for pain
Antiplatelet or Aspirin (have them chew the aspirin 325mg)
Put into semi fowlers position
What medications are used in long term therapy for AMI?
Glycoprotein inhibitors: prevent fibrinogen from attaching to platelets at thrombus
Beta Blockers: taken daily, decrease size of infarct by prolonging diastole and increasing perfusion
Metoprolol XL (Toprol XL)
Carvedilol CR (Coreg CR)
ACE inhib: prevent ventricular remodeling
Fibrinolytics: for reperfusion
What is the definition of shock?
When oxygenation and tissue perfusion needs are not met and cell function cannot be maintained
What are the different types of shock?
Hypovolemic: too little blood, decreased O2 and decreased MAP
Cardiogenic: heart muscle pumping is impaired and O2 decreased. Stage IV HF.
Distributive: third spacing shock, not enough fluids to oxygenate cells
Obstructive Shock: HF caused by an obstruction.
Septic Shock: Whole body inflammation
What are the stages of shock?
Initial Stage (Early Stage): MAP is decreased by 10 mm Hg. The body is compensating well and symptoms are limited.
Nonprogressive stage (Compensatory Stage):MAP continures to decrease 10-15mm Hg. The body begins to try and compensate by vasoconstrition to divert the blood to the essential organs. Hypoxemia occurs of these nonessential cells. The kidneys hold onto water to increase BP. Acidosis and hyperkalemia occur.
Progressive Stage (Intermediate stage): MAP decreases beyong 20 mm Hg. The body is no longer to oxygenate even essential organs. This is a life threatening emergency and progresses quickly. Vitals and s/s will worsen drastically. Needs to be reversed within an hour
Refractory Stage (Irreversible stage): Cell death is drastic due to hypoxemia, even of the major organs. Multiple organ failure occurs. Interventions do not slow progression towards death.
What is the treatment for shock?
IV therapy: crystalloids maintain fluid and electrolyte imbalances (NSS, LR)
Colloids restore osmotic pressure and fluid volume (blood and blood products)
Drug therapy is no response to fluid replacement
What is the drug therapy for shock?
Vasoconstrictors: stimulate venous return by blood vessel constriction.
Dopamine (Intropin, Revimine)
Inotropic agents: stimulate adrenergic receptors in the heart to improve muscle contraction
Myocardial Dilators: sodium
Nitroprusside (Nitropress, Nipride)
What is the CABG surgery?
It is the most common type of cardiac surgery and the most common procedure for the older adult
Occluded coronary artery is bypassed by venous (from leg) or arterial (often mammary (IMA) which remains paten 90% of the time for 12 yrs) blood vessels for by synthetic grafts