Patho Ch 19

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Patho Ch 19
2014-11-11 13:53:58
Exam #5
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  1. Disorders That Affect the Whole Heart

    Name three.
    • •Pericardial disorders
    • •Coronary heart disease
    • •Myocardial diseases

    These disorders can cause symptoms of both right- and left-sided heart failure
  2. Pericarditis

    -What is it?
    -What does it cause (3 things)? 
    -What is cardiac tamponade?
    •Inflammation of the pericardium causes:


    –Exudate (leaking; wet)

    • ºSerous ⇢ pericardial effusion
    • --Cardiac tamponade: rapid accumulation of
    • exudate compresses the heart (Compression of the heart)
    • ºFibrousfriction rub; adhesions

    –ECG changes


    Outside of the heart

    Fluid prevents the heart from beating normally
  3. Pericarditis: Constrictive

    -What is the cause of Constrictive pericarditis?
    -What does it result from?
    •Constrictive pericarditis (stiffening from a chronic problem)

    –Loss of elasticity

    –Results from chronic inflammation
  4. Pericarditis: Signs and Symptoms

    -What is it called when you hear grating sounds when breath is held?
    -List five s/sx.
    Pericardial friction rub (grating sound heard when breath is held) 

    Sharp, sudden, severe chest pain that increases with deep inspiration and decreases when sitting up and leaning forward

    Dyspnea (difficulty/shortness of breath)

    • Tachycardia (rapid heart rate) - heart tries to compensate
    • Edema - got to get blood flow

    Flu-like symptoms (think inflammation!)


    Anytime you go through inflammatory process, flu-like symptoms!
  5. Pericarditis: Dx and Tx

    -What would you do to diagnose?
    -What are some treatment options?
    •DX: history, exam, CBC, ECG, CXR, echocardiogram, CT, MRI

    • •TX:  identify & resolve the underlying cause,
    • NSAIDS, meds for inflammation, pain meds (because one symptom is pain), bed rest (conserve energy), oxygen therapy, pericardiocentesis (remove the fluid), and pericardectomy (remove the pericardium)


    Inflammation> meds for inflammation (NSAIDS)
  6. Pericarditis: Cardiac Tamponade

    -What is it?
    -What are some s/sx?
    -What are potential complications?
    Cardiac compression from excessive fluid accumulation (fluid around heart and is not able to beat)


    –S/Sx: falling arterial pressures (blood is not going to aorta or arteries), rising venous pressures (build up of blood waiting to go to the heart), narrowing pulse pressure (low HR), and muffled heart sounds

    –Complications: heart failure, shock,  & death

    • In severe cardiac tamponade, there is so much fluid in the pericardial sac compressing the heart that its function declines rapidly. The fluid must be removed quickly by inserting a needle into the pericardial space and aspirating the accumulated fluid.
    • _____________________________

    *Anything interfering with blood flow can cause clots. Then the clots can move to other parts of the body.
  7. Infective Endocarditis

    -What is it also called?
    -What is it commonly caused by (2)?
    -How can microhemorrhages occur?
    -Risk factors
    Inside of the heart; effecting structures of the heart itself

    • •Formally called bacterial endocarditis
    • (Bacterial infection)

    •Commonly caused by Streptococcus and Staphylococcus infections (Strep and Staph infections can effect the heart)

    • Vegetation (a wart type thing) forms on internal structures and creates small thrombi
    • (may effect heart valves and prevent it from closing properly which can result in back flow)

    Microemboli occur as they are dislodged, resulting in microhemorrhages

    •Risk factors: intravenous drug use, valvular disorders, prosthetic heart valves, rheumatic heart disease, coarctation of the aorta, congenital heart defects, and Marfan syndrome

    • •S/Sx:
    • flulike symptoms, embolization, heart murmur, petechiae (a small red or purple spot in skin caused by bleeding), splinter hemorrhages under the nails, hematuria (blood in the urine), and Osler’s nodes (painful red, raised lesions on hands or feet)

    •DX: exam, blood cultures, CBC, urinalysis, serum rheumatoid factor, erythrocyte sedimentation rate (increased ESR=systemic inflammation>get heavier, sink to the bottom), ECG, echocardiogram

    •TX: identify cause, anti-infective meds, bed rest, oxygen therapy, antipyretics (anti-fever), surgical valve repair, and prosthetic valve replacement


  8. Rheumatic Heart Disease

    -What type of disease is this?
    -What does it occur from?
    -Inflammation of what 3 structures?
    -What type of dysfunction and deformity?
    (Risk factor for Infective Endocarditis)

    Immune-mediated, multisystem inflammatory disease

    •Occurs a few weeks after group A beta-hemolytic streptococcal pharyngitis (Strep sore throat)

    •Inflammation of myocardium (muscle), pericardium (sack), and heart valves (valve)

    Chronic valvular dysfunction: biggest consequence.

    •May have persistant deformity of heart valves from scar tissue (vegetations)
  9. Myocarditis

    -What is it?
    -What happens?
    -What are some complications
    Inflammation of the myocardium

    Uncommon (not as common for entire heart muscle tissue inflammed)

    •Organisms, blood cells, toxins, and immune substances invade and damage the muscle

    •Complications: heart failure, cardiomyopathy, dysrhythmias, and thrombus formation

    •May be asymptomatic

    •S/Sx: flulike symptoms, dyspnea, dysrhythmias (primary problem ventricular dysrhythmias bc blood not being pushed out properly), palpitations, tachycardia, heart murmurs, chest discomfort, and cardiac enlargement

    Medication to prevent clot formation
  10. Pulsus Paradoxus

    -What happens when inhaling?
    -What results from this?
    •On inhaling, the right ventricle fills with extra blood

    •Because the heart cannot expand fully when the right ventricle is overfilled, the left ventricle is compressed and cannot accept much blood

    • •On the next heartbeat, the left ventricle does not send out much blood: systolic BP drops
    • ____________________________

    • Right ventricle-overfilled, hogging all the space
    • Left ventricle-squished, not able to accept as much blood to be able to send it to the body tissues>systolic problem; sytolic BP falls
  11. Chronic Ischemic Heart Disease

    -What does the heart not have enough of?
    -What can cause these imbalances?
    Imbalance in blood supply and the heart’s demands for oxygen (not enough oxygenation and blood supply)

    –Less blood

    • ºAtherosclerosis
    • ºVasospasm
    • ºThrombosis

    –Higher oxygen demand

    • ºStress
    • ºExercise
    • ºCold


    Heart pain>In women, ear, jaw, and neck pain- not enough oxygenationo
  12. Kinds of Angina

    -What are four types of Anginas?
    -What can ischemic heart disease be characterized as?
    Stable angina

    –Pain when heart’s oxygen demand increases (pain can probably be taken care of if handled appropriately)

    Variant angina

    –Pain when coronary arteries spasm (vasospasms)

    Silent myocardial ischemia

    Myocardial ischemia without pain (may not have pain)


    Ischemic heart disease is characterized by stable angina, which is associated with plaques that are fixed obstructions

    Unstable angina is characterized by plaques with platelets stuck to them (these are likely to form a thrombus); they cause a range of acute coronary syndromes.
  13. Acute Coronary Syndromes (essentially having a heart attack)

    What are some ways to measure the changes?
    •ECG changes

    • –T-wave inversion
    • –ST-segment depression or elevation
    • –Abnormal Q wave

    •Serum cardiac markers

    • –Proteins released from necrotic (death) heart
    • cells (have scar tissue)
    • ºMyoglobin, creatine kinase, troponin - release of proteins (3) because cells have died


    want those numbers to be down or go down over time because measurement represents how much of the heart has died
  14. Acute Myocardial Infarction

    -What is it?
    -What causes it?
    Death of the heart muscle (myocardium)

    •Coronary artery blood flow is blocked due to atherosclerosis, thrombus, or vasospasms.

    •Risk factors: same as those  or atherosclerosis


    –Some asymptomatic – “Silent” MI

    –Includes: angina (pain and discomfort; symptoms of inadequate oxygenation), fatigue, N/V, SOB (air hunger=anxiety and panic), sweating, indigestion, elevation in cardiac markers (dysrhythmias), EKG changes, neck/ear pain.

    –Women may present with different symptoms than men!!

    (Pain management to someone having a HA is VITAL> helps the heart in the long run)


    Chest pain–Severe, crushing, constrictive OR like heartburn

    • Sympathetic nervous system response
    • GI distress, nausea, vomiting
    • Tachycardia (trying to compensate) and vasoconstriction (could potentially keep blood from the heart)
    • Anxiety, restlessness, feeling of impending doom (worry)
    • Hypotension and shock–Weakness in arms and legs (no blood flow to kidneys or back to heart=no blood getting oxygen)
  15. Acute Myocardial Infarction

    -Tx > What do you do immediately?
    DX: exam, ECG, cardiac markers, stress testing, nuclear imaging, and angiography

    Treatment varies depending on timing of treatment.

    Immediately: MONA

    –                      Pain management (MorphineD)

    –                      Increase O2 (Oxygen)

    –                      Open up vessels  (Nitrate)

    –                      Keep platelets from blocking (Aspirin)

    – may also administer thrombolytics (“clot busters”)

    Post-MI: similar to those for atherosclerosis
  16. Complications of Acute Myocardial Infarction (AMI)

    What are the 8 complications?
    •Heart failure (cannot squeeze or work anymore)

    •Dysrhythmias (primarily ventricular dysrhythmias)

    •Cardiogenic shock

    •Pericarditis (all the inflammation)

    •Thromboemboli (thrombosis) - (clots may cause mischief in other parts of the body)

    •Rupture of the heart (heart just bursted; muscles of the heart separate)


    •Ventricular aneurysms ("pooches")


    An Acute MI (AMI) Leaves Behind an Area of Yellow Necrosis
  17. Malfunctioning Heart Muscle

    -What happens if the ventricles are
    too thick;
    too stiff; 
    too weak

    -This can cause what of the heart?
    (too thick or too thin)

    •Malfunctioning heart muscle can cause heart failure if:

    • –Ventricles are unusually thick so there is not a normal amount of room for blood inside them (hypertrophic cardiomyopathy)
    • --(no room for blood to be in there)

    • –Ventricles are too stiff to stretch (restrictive cardiomyopathy)
    • --(want ventricles to be nice and flexible, but it is not; restrictive)

    • –Ventricles are too weak to pump out the blood that is in them (MI, myocarditis, dilated cardiomyopathy)
    • --(so thin, weak, and flabby, not able to get the blood out "dilate")
  18. Myocardial Disorders

    -What myocarditis?
    -What are the four different cardiomyopathies?
    •Myocarditis (inflammation of heart muscle)


    –Dilated cardiomyopathies

    –Hypertrophic cardiomyopathies

    –Restrictive cardiomyopathies

    –Peripartum cardiomyopathy
  19. Cardiomyopathy

    -What type of condition is it?
    -What three groups are classified?
    •Conditions that weaken and enlarge the myocardium

    •Classified into three groups—dilated, hypertrophic, and restrictive
  20. Dilated Cardiomyopathy

    -Who is at higher risk?
    -What damages the myocardium muscle fibers? What does it result to?
    Most common type

    •Risk higher with advancing age and African American men

    Cardiomegaly and ventricular dilation damages myocardium muscle fibers, resulting in decreased cardiac output (not able to get blood out) and blood stagnation (increased risk of clots; pools can coagulate)

    • •Causes: chemotherapy, alcoholism, cocaine abuse, pregnancy, infections, thyrotoxicosis, diabetes mellitus, neuromuscular diseases, hypertension, coronary artery disease, and hypersensitivity to medications
    • -enlarged 2-3x; flabby all 4 chambers dilated

    •Symptoms appear as compensatory mechanisms fail

    –Includes: dyspnea, fatigue, nonproductive (dry hacking) cough, orthopnea, paroxysmal nocturnal dyspnea (sleeping in the night and wake up suddenly and have a difficulty breathing), dysrhythmias, angina, dizziness, activity intolerance, blood pressure changes, tachycardia, murmurs, abnormal lung sounds, tachypnea, peripheral edema, ascites (third spacing; fluid where it should not be), weak pedal pulses, cool, pale extremities, poor capillary refill, hepatomegaly, and jugular vein distension
  21. Hypertropic Cardiomyopathy

    -What does it mainly affect?
    -Who is it most common in? 
    -What are the risk factors?
    -How are the ventricle walls?
    -What is defected and what is resulted from it?
    (Die early from your heart)

    •Mainly affects systolic function (getting blood to tissues)

    •More common in men and those who are sedentary (most common cause of sudden death in young athletes)

    •Risk higher with hypertension, obstructive valvular disease, and thyroid disease

    May be autosomal dominant (can inherit)

    • •Ventricle wall becomes stiff and unable to relax (thick and rubbery)
    • ______________

    (Requires more oxygen demand to the heart yet the heart can not get it. Sets up heart failure. Especially when exerting themselves "shoveling snow") 

    Defects in their contractile proteins make cells too weak

    •They hypertrophy to do the same amount of work as normal cells

    Need more oxygen and perform less efficiently, so the person is prone to heart failure and may suffer sudden death during exertion


    • •S/Sx:  dyspnea on exertion, fatigue, syncope (fainting), orthopnea (cardiac problems; not propped up with lots of pillows, can not breath; need to be at an angle when sleeping), angina (pain), activity intolerance (can't do what you used to), dysrhythmias (heart beating irregularly; esp. ventricular dysrhythmias), left ventricular failure, and myocardial infarction
    • Shortness of breath; difficulty breathing w/ any type of exertion

    •DX: similar to dilated cardiomyopathy

    •TX beta-adrenergic blockers, calcium channel blockers, surgical removal of excess myocardium, antidysrhythmics (meds to help the heart to get more oxygen. rest more), and avoid strenuous activity
  22. Restrictive Cardiomyopathy

    -How is the heart characterized?
    -Where is it common?
    -What are the causes?
    Heart is stiffer; damage to the heart to cause stiffness

    •Common in South and Central America, India, Asia, and Africa

    • •Causes: amyloidosis (abnormal deposits of protein), hemochromatosis (too much iron in the body; iron overload),
    • radiation exposure to the chest, connective tissue diseases, myocardial infarction, sarcoidosis (inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, or other tissues), and cardiac neoplasms


    –Many cases are asymptomatic

    –Include: fatigue, dyspnea, (chest pains), orthopnea, abnormal lung sounds, angina, hepatomegaly (abnormal enlargement of the liver), jugular vein distension, ascites, murmurs, peripheral cyanosis, and pallor
  23. Endocardial Structures

    -What type structures will cause heart failure?
    •The endocardial structures lining the heart can cause heart failure

    –If the AV valves leading into the ventricles do not work (mitral or tricuspid problems)

    –If the semilunar valves leading out of the ventricles do not work (aortic or pulmonary problems)
  24. Valvular Defects: Each of the four valves can be defective

    -What does it disrupt?
    -What the two types of defects? What occurs with each?
    Disrupt blood flow through the heart

    Stenosis – narrowing

    Less blood can flow through the valve

    –Causes decreased cardiac outputincreased cardiac workload, and hypertrophy

    Regurgitation – insufficient closure

    –Blood flows in both directions through the valve

    –Causes decreased cardiac outputincreased cardiac workload, hypertrophy, and dilation
  25. Valvular Disorders

    -What are the causes?
    •Causes: congenital defects, infective endocarditis, rheumatic fever, myocardial infarction, cardiomyopathy, and heart failure


    –Depends on valve involved

    Reflect alteration in blood flow through the heart; may cause s/sx of L-sided or R-sided heart failure.

    •DX: exam, heart catheterization, CXR, echocardiogram, MRI, ECG.

    •TX: diuretics, antidysrhythmics, vasodilators, angiotension converting enzyme inhibitors & beta-adrenergic blockers (BP meds), anticoagulants, oxygen therapy, low-sodium diet, surgical valve repair, and prosthetic valve replacement
  26. Mitral Valve Regurgitation

    -What is happening?
    -What does it cause?
    -What is it often caused from?
    •Mitral valve does not close as it should

    Portion of the stroke volume (amount of blood ejected by the ventricle/beat) leaks back into the left atrium.

    Decreases the amount of blood that is ejected during that beat (SV).

    •Often from rheumatic heart disease
  27. Mitral Valve Prolapse

    -Who is it most common in?
    -What is it characterized by?
    -What types of symptoms?
    -What ways can the symptoms be controlled?
    •Seen more in women; may be familial.

    •Mucinous degeneration of mitral leaflets; may or may not cause regurgitation.

    During mitral valve prolapse, the leaflets of the mitral valve bulge (prolapse) upward or back into the left atrium as the heart contracts

    Most asymptomatic, but may have prolonged chest pain, dyspnea, fatigue, anxiety, palpitations, lightheadedness

    •Characterized by spectrum of findings when you listen with stethoscope.

    •Stopping stimulants like caffeine, nicotine, alcohol may control symptoms.
  28. Identifying Defective Valves

    -How do you identify valve defects (3)?
    •The blood going through the valve makes a noise

    •These are called heart murmurs

    •You can identify them by:

    Where they are—which valve are they near?

    –How they soundhigh- or low-pitched?

    When they happen—systole or diastole?
  29. When Will You Hear Murmurs?
    •If a valve is stenotic, you will hear a murmur of blood shooting through the narrow opening when the valve is open

    •If a valve is regurgitant, you will hear a murmur of blood leaking back through when the valve should be closed
  30. Left-Sided Valvular Disorders

    -What are the two types?
    -What are the different disorders?
    Mitral valve disorders

    –Mitral valve stenosis

    –Mitral valve regurgitation

    –Mitral valve prolapse

    Aortic valve disorders

    –Aortic valve stenosis

    –Aortic valve regurgitation
  31. Congenital Heart Defects
    •Atrial septal defects

    •Ventricular septal defects

    •Endocardial cushion defects

    Patent ductus arteriosus

    •Pulmonary stenosis

    Tetralogy of Fallot

    Transposition of the great vessels

    •Coarctation of the aorta

  32. Shunts

    -What is a shunt? What does it allow blood to do?
    -What are the three types of shunts and where does the blood flow and what does it bypass in each?
    A "hole" in their heart

    •A shunt is an opening or connection that lets blood move from one side of the circulation to the other

    •Most shunts occur in the heart and move blood either from the left to the right or from the right to the left

    •Because the left side is stronger, blood is usually pushed from the left to the right side


    •Shunts are normal before birth

    Foramen ovale

    –Lets blood go from the right atrium to the left atrium to bypass the lungs

    Ductus arteriosus

    –Lets blood go from the pulmonary trunk to the aorta to bypass the lungs

    Ductus venosus

    –Lets blood go from the visceral veins to the vena cava, bypassing the liver
  33. Electrical Problems

    -What can it affect?
    Classified by origin

    •Can affect cardiac output and blood pressure

    •Causes: acid-base imbalances, hypoxia, congenital heart defects, connective tissue disorders, degeneration of conductive tissues, drug toxicity, electrolyte imbalances, stress, myocardial hypertrophy, and myocardial ischemia or infarction

    S/Sx vary depending on the specific dysrhythmia–Mayinclude: palpitations, fluttering sensation, skipped beats, fatigue, confusion,syncope, dyspnea, andabnormal heart rate

    •DX:  exam, ECG, electrophysiologic studies

    •TX:  antidysrhythmics, cardiac defibrillator, pacemaker, cardioversion, defibrillation, ablation, and avoiding triggers (like excessive caffeine)