Cardiac Disorders

  1. Define Arteriosclerosis
    • associated with aging
    • Decreaes elasticity
    • vessel wall becomes hard and thick
    • lumen narrows
  2. Define Artherosclerosis
    • associated with elevated reisk factor and a factor in many cases of CAD
    • defpositys of lipid, cells, fibrin form and plague called an atheroma
    • Lumen progressively narrows....ischemia
    • Increases risk of PVD, MI, CVA
  3. Artherosclerosis
    • Etiology: elevated cardiac risk factors also hypertension and use of oral contraceptives
    • Diagnosis: erum lipid levels HDL lower than 35 LDL greater than 100
    • Treatment: Diet control, Exercise, Weight Reduction, antigoaguland medications
    • If advanced it may require surgery
    • If not treated can reuld in stroke, ME or peripheral arterial disease
  4. Surgery Options for Atherosclerosis
    • Coronary Artery Bypass Graft (CABG)
    • PTCA (balloon angioplasty)
    • Stent
    • Laser
  5. Define Angina
    • partial occlustion of the coronary arteries leads to ischmeia during times of high oxygen need
    • An imbalance between o2 supply and demand
    • Diffenrent Patterns: classic ecertional, Varlant (vasospasm), unstable
  6. Angina Etiology, Precipitating Factors S&S and Treatment
    • Etiology: atherosclerosis vasospasm, myocaridal hypertrophy, severe anemia, respirtaory disease
    • Precipitating Factors: exertion, stress, cold, large meal
    • S&S: recurrent intermittent chest pain, may see pallor, diaphoresis, nausea. last for a nre seconds or minutes when the pt rest it goes away
    • Treatment: Eliminate the triggering factor, Nitroglycerin
  7. Implications for Therapy with Angina
    Exerice helps to reduce the risk factors but pt need to be monitored carefully
  8. Myocardial Infarction Definition and Etiology
    • Coronary Obsrtrucion leading to prolonged ischemia and cellular death
    • Etiology: Thrombus builds up to completely occlude a coronary artery, vasospams and partial occlucion by atheroma, thrombus breaks free embolus travels to one of the coronary arteries
  9. What happen on the tissue level?
    • inflammtiona - necrosis, area of necrosis is replaced by fibrous tissue (scar). scar is non contractile
    • Enzymes are released which are helpful in making the diagnosis
  10. MI S&S
    • Severe chest pain that persists, LUE pain , neck, jaw, SOB, increased HR, weakness, sweaty, nausea
    • rest and nitro have no effect
  11. Diagnosis of MI
    • EKG charnges: T wave inversion, ST elevation and abnormal Q
    • Serum enzymes
    • Further studies if need to know exten and prevent
  12. Complications and Treatment for ME
    • Complications: arrhythmia, cardiac arrest, death
    • cardiogenic shouck wtih prolong period of decreased O2 to the brain
    • CHF
    • Treatment: thrombolytic mediation, administered within first hour
    • Rest, O2 therapy, pain meds
    • Anti-coagulant meds, other med to control cardiac function
    • Then refer to cardic rehab
  13. Role of Therapy with MI
    • Pt ed (pt is often very scared)
    • Gradual return to exercise/activity in a monitored environment
  14. Normal Heart Conducation Path
    SA- AV- Bundle Branches - Purkinje Fibers - contraction
  15. General Causes of Arrhythmias
    damge to some aspect of the conduction system or sytemic cuase such as electolyte imbalance, high fever, hypoxia, stress, infection, drug toxicity (caffeine)
  16. List the 4 different types of arrhythmias
    • Sinus node
    • Atrial conduction
    • AV node (heart blocks)
    • Ventricular conduction
  17. Define Bradycardia
    A rate of less than 60 beats per minute
  18. Define Tachcardia
    A rate of greater than 100-160 beats per minute
  19. Define Sick Sinus Syndrome
    Altering tachycardia/bradycardia
  20. Define Premature Atrial Contractions
    Extra contraction ectopic beats taht originate from an ectpic foci or teentry of an impulse that goes through damaged tissue
  21. Define Atrial Flutter
    160-350 bmp
  22. Define Atrial Fibrillation
    greater than 350bpm
  23. Heart Block
    • Conduction is excessively delayed or stopped athe the AV node or bundle of His
    • Patrial block: 1st degree, prolonged PR 2nd degree periodic missed ventricular contraction
    • Total Block: vetricales beat independent of the atria, very slow HR(30-45bpm), 3rd degree greatly reduced Do, fainting< may prdceed to cardiac arrest
  24. Bundle Branch Block
    • interference with conduction at one of the BB;s
    • Wide QRS
  25. Define Ventricular Tachycardia
    fast ventriucle beats: can progress to v fib and cardiac arrest
  26. Define Premature Ventricular Contractions (PVC)
    • ectopic beats from the ventricle
    • occasional PVC's are ok but when frequent or paired can proceed to V fib
  27. Cardiac Arhythmia Diagnosis, and Treatment
    • EKG, Holter monitor
    • Treatment:
    • Medication -antiarrhythmia meds
    • Pacemaker- Temp or permanent
  28. CHF
    • Heart is unable to meet metabolic demands of the body
    • Etiology: usually due to other problems: MI, valves, pulm disease ect
    • Startes as a unilateral problem usually on the let but can progress to right side
  29. General Signs and symptoms of CHF
    • Fatigue
    • Weakness
    • Dizziness
    • Dyspnea
    • Exercise and cold intolerance
  30. Left CHF
    • Dyspnea (increase activity with breathing)
    • Orthopnea (dificulty breathing in supine or when flat)
    • Pulmonary edema
    • rales, cough
    • Easier to sleep with the head up
  31. Right CHF
    • Dependent edema
    • Hepato and splenomegaly
    • Ascites-abdominal distention with fluid
    • Flushed face, distended veins
    • Headache, vision problems
  32. Diagnosis of CHF
    • xray: cardiomegaly, fluid in lugs
    • ABG's: anoxia
    • Arterial pressures: measured with catheters at specific locations
  33. Treatment of CHF
    • Medical Management: treatment of the underlying coustes
    • Implications for functional activites
    • Monitor closely for signs of cardiac distress
    • avoid excessive fatigues, stress, studden exertion
    • Modify lifestyle, take meds
  34. Children with CHF
    • Etiology: accompandies congenital heart defects
    • Symptoms: feeding problems, decreased weight gain
    • Decreased ability to sleep
    • Cough rapid grunting respiration wheezing
    • Treatment: Goal is to decrease workload on heart
    • similar to adult treamtnet but need to be monitored closely as the grow( meds surguys supportive care)
  35. Congenital Heart Defects Description, etiology and compensation mechanisms
    • developmental defects that arises in the first 8 wks of gestation
    • Etiology:
    • multifactorial - influenced by genetic and prenateal environment
    • Addociated with down syndrom, Fetal alcohol syndrome maternal diabetes
    • Compensaion mechanisms: SNS kick in, HR increasesm, RR increases but this in ineffective over time
  36. Congenital Heart Defects S&S
    increased HR, DOE, tachypnea, clubbed fingers, exercise & cold intolerance
  37. Diagnosis and Treatment for Congenital Heart Defects
    • Diagnosis: varies, Xray, cardiac cath, echo, EKG
    • Treatment: Meds, surgery, Supportive care
    • Therapy, NICU careful monitoring
  38. Define Centricular Spectal Defect
    Hole in the heart
  39. Define Valvular Defects
    • most common- aortic, pulmonay
    • types- stenosis, incompetence, prolaspse
  40. Define Tetralogy of Fallot
    Combination of 4 defects: pulmonayr valve stenosis, ventricular septal defect, dextraposition of aorta, R ventricular hypertrophy
  41. Describe Rheumatic Fever and the 3 types
    • follwing and infection antibodies form then react with connective tissue in the skin joints brain and heart. Set up infection & inflammation
    • Pericarditis: inflammation of out layer, may include effusion
    • Myocarditis: heart muslce may interfere wiht conduction
    • Edocarditis: affects the valves, mostcommon problem with rheumatic fever, valves become edematous and develop vegetations affects heart function
  42. Rheumatic fever S&S, Diagnosis, and Treatment
    • S&S: Low grade fever, leukocytosis, malaise, anorexia, fatigue, tachycardia, epistaxis, abdominal pain
    • Diagnosis: Blood test anemis, decrease heart function tests, EKG changes
    • Treatment: Antibiotics, future strep infection proptly treated, valve replacement
    • Proohylactic peniceillin prio to invasive procedures
  43. Infective Endocarditis Pathophysiology and Etiology
    • Patho: organism envades the heart valves
    • Organism causes inflammtion and formation of vegetation on the cusps
    • Interfere with opening/ closing of the valves
    • Pieces may break away forming emboli that cause infaction/ infarction of other tissues
    • Etiology: predisposing factions: abnormal tieeus in the heart presence of microes inthe blood reduced host defenses
  44. Infective Endocarditis S&S and Treatment
    • S&S: heart murmur and other signs or impaired heart function
    • Subacute: insidious onset, intermittent low grade fever/fatigue anorexia, splenomegaly, osler's nodes on fingers septic emboli from vegatations can cause additional problems CHF can develop in severe cases
    • Acute: sudden marked onset with spiking fever chills drowsiness if heart valves are severely damages can reult in severe impairment of heart function
    • Treatment: antibiotics for a minimum of 4 weeks otehr medicaiton to support hear function
Card Set
Cardiac Disorders