Patho week 5 ch 18 & 19
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. What would you like to do?
What is the blood flow path?
Blood vessels have?
- 1. smooth endothelial lining
- 2. ANS innervation of smooth muscle
- 3. elastic tissue
- 4. alpha-adrenergic receptors
When alpha-adrenergic receptor s are stimulated by epinephrine, what happens?
What is the formula for cardiac output?
Cardiac output (ml/min)=heart rate (per min)X stroke volume (RV&LV output in ml per contraction)
Changes occur in cardiac output when?
HEART BEGINS TO FAIL
The heart has beta adrenergic receptors that, when stimulated by epinephrine cause?
- 1. increase in pulse
- 2. increase in force of contraction
What are the 3 waves of a ECG?
- 1. p wave
- 2. qrs wave
- 3. t wave
what is p wave?
contraction (depolarization) of atria
what is qrs wave?
contraction (depolarization) of ventricles
what is t wave?
relaxation (repolarization) of ventricles
What are ECG waves affected by?
- 1. drugs
- 2. electrolyte imbalances
- 3. heart disease
What are the common drugs used for heart disease?
- 1. diuretics
- 2. ACE inhibitors
- 3. Calcium channel blockers
- 4. beta-adrengeric blockers
- 5. nitrates
- 6. digitalis
What are diuretics?
- 1. increase sodium excretion
- 2. increase K loss
What is the most common treatment for heart disease?
What is the path for ACE inhibitors?
blacks formation of Angiotensin II->decrease in aldosterone secretion->decreased sodium retention-> decreased BP
What are calcium channel blocker's path?
decrease in P, causes vasodilation->decreased BP
What are beta-adrenergic blockers?
- 1. decrease P
- 2. decrease force of contraction
- 3. easing stress on heart
- 4. decreasing BP
What are nitrates?
vasodilate coronary arteries (EX:Nitroglycerin)
What is digitalis?
- 1. increases force of contraction
- 2. decreases P
- LEADS TO:
- making beats more efficient
What are the different heart diseases?
- 1. angina pectoris
- 2. myocardial infarct
- 3. atherosclerosis
- 4. arteriosclerosis
- 5. cardiac rhythm disorders (bradycardia, tachycardia, asystole, fibrillation, PVC)
- 6. pericarditis
- 7. congestive heart failure
What is another name for myocardial infarct? (MI)
What is MI?
total occlusion of coronary artery->cardiac tissue death
What are the S&S of MI?
- 1. chestpain (may feel like heartburn)
- 2. sweating
- 3. nausea
- 4. pain may radiate to jaw, arm, or back
- 5. insomnia prior to MI
- 6. ECG shows changes
- 7. blood tests show increase cardiac enzyme levels due to muscle damage
(MI) when may pain be minimal?
- If you are:
- 1. female
- 2. elderly
What helps with MI if taken early on?
What is the tx for MI?
- 1. extensive array
- 2. thrombolytics if caught early on
What is angina pectoris?
chest pain due to lack of sufficient coronary blood flow (only PARTIAL artery occlusion).
What is the tx for angina pectoris?
What are atheromas?
patches of cholesterol deposits
What is atherosclerosis?
blood vessels lined with artheromas
What is arteriosclerosis?
blood vessels lose their elasticity
arteriosclerosis is usually due to?
arteriosclerosis is also called?
"hardening of the arteries"
Diuretics cause increased excretion of sodium and water leading to?
decreased blood volume
What are the adverse effects of diuretics?
- 1. nausea
- 2. vomiting
- 3. orthostatic hypotension
- 4. dizziness
- 5. xerostomia
- 6. hypokalemia
Ace inhibitors prevent decreased blood vessels size, in other words?
What are the adverse effects of ace inhibitors?
- 1. headache
- 2. orthostatic hypotension
- 3. dizziness
Calcium channel blockers decrease?
myocardial conduction & contractabilty
What are the adverse effects for calcium channel blockers?
- 1. dizziness
- 2. fainting
- 3. headache
- 4. othostatic hypotension
- 5. constipation
- 6. gingival hypertension
beta-adrenergic blockers prevent increased heart rate in response to?
sympathetic nervous system & cholamines
what are the adverse effects for beta-adrenergic blockers?
- 1. bradycardia
- 2. dizziness
- 3. fatigue
- 4. orthostatic hypotension
- 5. sexual dysfunction
What are the warning signs of a heart attack?
- 1. feeling of pressure, heaviness, or burning in the chest, especially with increased activity
- 2. sudden SOB, sweating, weakness, fatigue
- 3. nausea, indigestion
- 4. anxiety/fear
What is the normal pulse at rest?
What is bradycardia?
What are the effects of bradycardia?
- 1. stroke volume increased
- 2. possibly reduced cardiac output
What is tachycardia?
What are the effects of tachycardia?
1. possibly reduced cardiac output
What is fibrillation?
weak contactions, irregular beats
What are the effects of fibrillation?
no filling, no output-cardiac standstill
What is aystole?
What is Premature Ventricular Contraction (PVC)?
additional ectopic beats
What are the effects of PVC?
may induce fibrillation
What is pericarditis?
inflammation of the pericardial membrane
What is pericarditis due to?
- 1. trauma
- 2. infection
- 3. MI
Pericarditis has S&S similar to MI except?
- 1. pain may increase with deep breath
- 2. murmur(friction rub) often aucsculated
- 3. fluid/scar tissue may form around the heart
In pericarditis, fluid/scar tissue may for around the heart, what is needed then?
needle aspiration, may lead to congestive heart failure
What is endocarditis?
inflammation/infection of valves of heart
What heart disease often follows other heart diseases?
What is CHF?
weakened heart->inefficient pumping->blood backflows to lungs/rest of body
What are the S&S of CHF?
- 1. cough (first sign)
- 2. weight gain of over 2 lbs per night
- 3. increase in BP, then decrease as the heart fails
- 4. increased P, but weak and thready
- 5. oliguria
- 6. cardiogenic shock->death if untreated
All shocks except neurogenic shock results in?
- 1. decreased BP
- 2. increased P
- 3. decrease urine output
- 4. organ failure->death if untreated
What is ventilation?
exchange of air between atmosphere and lungs
What is tidal volume?
amt of air inhaled and exhaled with normal breath (500ml)
what is expiratory reserve volume?
amt of air exhhaled after forced expiration, after a normal exhalation (1500 ml)
What is residual volume?
amt of air left in lungs between breaths...needed to keep aveoli open
Respiratory rate is controlled by?
- 1. neurons in brainstem which connect to diaphragm and accessory muscles
- 2. chemoreceptors in carotid arteries and aorta which respond to changing levels of O2 and CO2
what is hypercapnea?
increased CO2 in blood
What is hypoxemia?
decrease in O2 in blood
what is hypoxia?
decreased O2 in tissues
CO2 acts as a vasodilator and acid so it leads to?
decrease pH of blood
What are arterial blood gases? (ABG)
measurement of oxygen/carbon dioxide and pH in blood by drawing a sample of blood from an artery
What are the interventions to help with respiratory disorders?
- 1. chest physiotherapy (remove thick secretions&reduce infections)
- 2. oxygen
What are the drugs to help with respiratory disorders?
- 1. decongestants (vasoconstriction in nasal mucosa)
- 2. expectorants (thin respiratory secretions for easy removal)
What are the surgeries that help with respiratory disorders?
- 1. thoracentesis (removal of excess fluid from pleural cavity)
- 2. tracheotomy
What is IRDS?
lack of surfactant is aveoli
what is IRDS usually due to?
What are the tx for IRDS?
- 1. treat mother with steroids prior to delivery
- 2. neonate put in ICU and given surfactant in lungs
What is laryngotracheobronchitis? (LTB)
- spasms of bronchial smooth muscles
What is bronchiolitis usually due to?
Respiratory Syncytial Virus (RSV)
What is asthma?
obstruction of airway with allergic reaction (bronchioconstriction)
What was TB called in the older days?
What are the S&S of TB?
- 1. hemoptysis (blood in sputum)
- 2. night sweats
what is pneumonia?
viral or bacterial infection of the lungs
what are the S&S of pneumonia?
- 1. fever
- 2. cough
- 3. decreased breath sounds
- 4. increased WBC if bacterial
- 5. fatigue
When are people at higher risk of getting pneumonia?
- 1. stroke
- 2. post-op
- 3. immune suppressed
What is important to note about COLD/COPD?
do not give them to much oxygen as it stops their stimulus to breathe
What would you like to do?
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