Chapter 18

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Chapter 18
2015-02-18 17:00:23
alterations in cardiac function
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  1. CAD
    coronary artery disease
  2. CHD
    coronary heart disease
  3. what is CHD
    characterized by insufficient delivery of oxygenated blood to the myocardium due to atherosclerotic coronary arteries
  4. sequelae of CHD:
    • angina pectoris
    • -myocardial infarction 
    • -dysrhythmias 
    • -HF 
    • -sudden cardiac death
  5. etiology of CHD
    • atherosclerosis causes narrowing of arterial lumen that can lead to cardiac ischemia thru: 
    • -thrombus formation 
    • -coronary vasospam
    • -endothelial cell dysfunction
  6. mechanisms of coronary atherosclerosis
    • lipids are transported via apoproteins 
    • -lipoproteins associated with a greater risk of atherosclerosis 
    • -high-density lipoproteins transport cholesterol from peripheral tissue back to the liver, clearing atheromatous plaque
  7. mechanisms of coronary atherosclerosis
    • atherosclerotic plaque formation initiated by injury to coronary artery endothelium
    • -endothelium becomes permeable and recreuits leukocytes 
    • -LDL insudation occurs with oxidation by endothelial cells and macrophages 
    • -oxidized lipids are damaging to endothelia and smooth muscle cells, and stimulate recruitment of macrophages to vessel
    • -macrophages engulf the lipids; foam cells release inflammatory mediators and growth factors, attracting more leukocytes and stimulate smooth muscle proliferation 
    • -excess lipid and debris accumulate w/in vessel wall and coalesce into lipid core

    vulnerable plaques may rupture/become eroded, which stimulates clot formation on plaque
  8. what does vulnerable plaques have?
    • -large lipid core 
    • -thin cap
    • -high shear stress
  9. what is the pathophysiology of ischemia
    occurs when oxygen supply is insufficient to meet metabolic demands
  10. what critical factors in meeting cellular demands for oxygen include?
    • rate of coronary perfusion
    • -myocardial workload
  11. How can coronary perfusion be altered?
    • atherosclerotic plaque 
    • -acute platelet aggregation and thrombosis 
    • -vasospasm 
    • -failure of autoregulation by microcirculation 
    • -poor perfusion pressure 
    • -can be reversible if short-lived or treated appropriately
  12. What are the clinical features and management of coronary syndromes
    • Chronic syndromes with slow progression due to chronic obstruction from stable atherosclerotic plaques
    • -Acute coronary syndrome associated with acute changes in plaque morphology and thrombosis
  13. ACS stands for?
    Acute coronary syndrome
  14. Acute coronary syndrome means...
    • unstable angina
    • -myocardial infarction
  15. Chronic syndromes with slow progression means...
    • stable angina pectoris 
    • -ischemic cardiomyopathy
  16. what is angina pectoris?
    • chest pain associated with intermittent myocardial ischemia 
    • -may result in inefficient cardiac pumping w/ resultant pulmonary congestion and shortness of breath
  17. What are the 3 patterns of angina pectoris
    • -stable/typical angina 
    • -prinzmetal/variant angina
    • -unstable or crescendo angina
  18. What is Acute Coronary Syndrome?
    • Chest pain usually more severe and lasts long than typical angina 
    • -plaque rupture w/ acute thrombus development 
    • -unstable angina - occlusion is partial
    • - MI - occlusion is complete 
    • -ECG and bio markers used for diagnosis
  19. what does a MI in acute coronary syndrome do to the CO?
    • leads to drop in CO, triggers compensatory responses including sympathetic activation, which increased myocardial workload by increasing the following: 
    • -heart rate 
    • -contractility 
    • -bp
  20. in acute coronary syndrome, sympathetic NS activation leads to an increase or decrease myocardial, and what increases it?

    • 1) heart rate
    • 2) contractility 
    • 3) bp
  21. What is sudden cardiac death
    • unexpected death from cardiac causes w/in 1 hr of symptom onset 
    • -use of external defibrillators and CPR increases survival
  22. what is usually the primary cause of sudden cardiac death?
    lethal dysrhythmia
  23. What is chronic ischemic cardiomyopathy?
    • heart failure develops insidiously due to progressive ischemic myocardial damage 
    • -typically have history of angina or MI 
    • -commong in older adults
  24. What causes damage to the endocardial and valvular structures?
    • -inflammation and scarring 
    • -calcification
    • -congential malformations 
    • (cause altered hemodynamics of heart and ^myocardial workload)
  25. What is stenosis? An example?
    • failure of the valve to open completely results in extra pressure work for heart
    • ex: IHSS - Idiopathic Hypertrophic Sub-aortic Stenosis
  26. What is regurgitation?
    inability of a valve to close completely results in extra volume work for the heart
  27. What is mitral stenosis?
    • blood flow from L atrium to L ventricle is impaired during ventricular diastole
    • -^pressure of L atrium leads to atrial chamber enlargement and hypertrophy
    • -low-pitched, rumbling diastolic murmur
  28. What can mitral stenosis lead to?
    • chronic pulmonary hypertension
    • -R ventricular hypertrophy
    • -R sided heart failure
  29. what is Mitral Regurgitation
    • backflow of blood from the L ventricle to L atrium during ventricular systole 
    • -L atrium and ventricle dilate and hypertrophy due to extra volume 
    • -high-pitched, pansystolic, blowing murmur
  30. What can mitral regurgitation lead to?
    L-sided heart failure
  31. What is mitral valve prolapse?
    • displacement of mitral valve leaflets into L atrium during ventricular systole 
    • -asymptomatic 
    • -midsystolic click or systolic murmur
  32. What kind of complications involved with mitral valve prolapse
    • infective endocarditis,
    • sudden cardiac death,
    • cerebral embolic events 
    • progression to mitral regurgitation
  33. What is aortic stenosis?
    • results in obstruction of aortic outflow from L ventricle to aorta during systole
    • -crescendo-decrescendo murmur during ventricular systole with prominent S4
  34. What is the predominant cause of aortic stenosis? and what may result from it?
    • age related calcium deposits on aortic cusps 
    • -may result in ischemia and L-sided HF
  35. what are the disease of endocardium?
    • rheumatic heart disease 
    • -infective endocarditis
  36. what is rheumatic heart disease?
    • acute inflammatory disease that follows infection with groups A β-hemolytic streptococci
    • -antibodies against this antigen damages the connective tissue in joints, heart and skin 
    • -mainly in children
  37. what is infective endocarditis
    • invasion and colonization of endocardial structures by microogranisms w/ resulting inflmaation-vegetations 
    • -predisposing risk factors present
  38. what bacteria commonly causes infective endocarditis
    • -streptococcus
    • -staphylococcus
  39. what is myocarditis
    • inflammatory disorder of heart muscle characterized by necrosis and degeneration of myocytes 
    • -cardiomyopathy may be genetic OR acquired and is noninflamatory
  40. What causes myocarditis and what is characterized by it?
    • causes + microbial agents, immune-mediated disease, physical agents 
    • -viral etiology - common
    • -characterized by L ventricular dysfunction and general dilation of all 4 chambers
  41. How is cardiomyopathy classified? How many types and name it.
    • by cause/functional impairment 
    • Primary: dysfunction of unknown cause 
    • secondary: known cause 

    dilated, hypertrophic, restrictive
  42. What is dilated cardiomyopathy? what relates to it?
    • cardiac failure associated with dilation of one or both ventricular chambers 
    • -slow progression of biventricular HF with low ejection fraction 
    • -related to: alcohol toxicity, pregnancy, postviral myocarditis, genetic abnormality
  43. What is hypertrophic cardiomyopathy?
    • thickened, hyperkinetic ventricular muscle mass 
    • -septum my be affected
    • -genetic abnormality
    • -slow progression
  44. what might hypertrophic cardiomyopathy lead to?
    IHSS - idiopathic hypertrophic subaortic stenosis
  45. What is restrictive cardiomyopathy?
    • -rare form of cardiomyopathy 
    • -stiff, fibrotic ventricle with impaired diastolic filing 
    • -associated with amyloidosis
    • -decreased CO and L-side HF can result