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Diseases of Cardio
Test #2
| Question | Answer |
|---|---|
| What are the components of BP? | BP= CO + PR |
| Which component controls systolic BP? | CO; BP= HR X SV + blood volume |
| Diastolic blood pressure? | PR= R = [n (viscosity of blood) x L (length of vessels)]/ r4 (radius of vessel to the 4th power) |
| When considering hypertension, what is meant by "end organ damage"? | End organ damage results from chronic (long duration) high blood pressure |
| What are examples of end organ damage? | heart failure due to ventricular hypertrophy, cerebral arterial disease (causing stroke), damage to vessels of the retina (retinopathy), peripheral vascular disease, damage to the kidneys (hypertensive nephropathy) resulting in kidney failure |
| If an individual has a bp of 140/80, what is their pulse pressure? | 140-80 = 60 pulse pressure |
| Would that be considered a "healthy" pulse pressure (ie., What is the "cut off"?) | Health pulse pressure < 60 mmHg |
| In systolic hypertension of the elderly, what characteristics within the aorta causes high levels of systole? | The aorta & its major branches become thickened & the collagen & elastic in the tunic adventitia & media become "brittle" with the wear and tear of life ->as a result these vessels become less compliant |
| Low levels of diastole? | The stiff vessel walls during diastole results in less diastolic recoil ->recall that diastolic recoil of large arteries play a role in diastolic pressure |
| What is the best predictor of complications due to systolic hypertension in the elderly? | Pulse pressure is a better predictor of end stage renal disease, cerbro-vascular events in the elderly |
| What follow-up should be done to determine if white coat high blood pressure is in fact, hypertension? | Monitoring the bp @ home by blood pressure cuff or continuous monitoring equip. or @ a local pharm. or grocery store with a bp machine can help estimate the frequency & consistency of higher bp readings |
| What is borderline hypertension? | Borderline hypertension is defined as mildly elevated bp that is found to be higher than 140/90 mmHg & some times lower than other times. |
| What should be done about it? | Ppl with borderline hypertension should have continued follow-up of their bp & monitoring for the complications of hypertension. |
| No identifiable etiology, accounts for 95% of hypertension? | primary hypertension |
| Main causes are chronic renal failure, renal arterial stenosis, and pheochromocytoma. | Secondary hypertension |
| The causes is multifactorial (ie. polygenic & environment) and onset typically in 40's and 50's. | Primary hypertension |
| The association b/w alcohol and high bp is particularly noticeable when the alcohol intake exceeds how many drinks? | 5 drinks a day |
| Increases peripheral resistance by increasing blood vessel length | obesity |
| Has a synergistic effect on aortic stiffness and, therefore, bp | coffee and smoking |
| Any food packaged or canned has a high prevalence of this hypertensive related substance. | salt |
| Secretion of inflammatory mediators causes endothelial dysfunction resulting in an increase in peripheral resistance due to arterial stiffness and vasoconstriction. | Obesity |
| Increases bp by activation of the renin-angiotensin-aldosterone system (RAAS). | Obesity |
| To have a positive effect on reducing hypertension, what should be the intensity, time (in minutes), and the frequency (days per week) one should perform aerobic exercise? | • To reduce blood pressure it is prescribed to perform brisk walking (or any aerobic exercise at a moderate to hard level of exertion) for 30 or more min for at least 5 days per week. |
| What are the two main factors that increase the risk of an aneurysm? | Atherosclerosis Hypertension |
| When addressing the issue of symptoms, what is a similarity between a cerebral and aortic aneurysm? | Both usually cause no symptoms until they rupture. |
| In what anatomical location (ascending, arch, thoracic, abdominal) does an aortic aneurysm usually form? | Abdominal aorta |
| In terms of the three layers of the aorta, differentiate between at “true” aneurysm and dissecting aneurysm. | A “true” aneurysm involves all three layers. In a dissecting aneurysm, the inner lining of the aortic wall tears and blood surges through the tear, separating (dissecting) the middle layers from the outer layer of the wall. |
| In which does a false channel develop? | As a result, a new, false channel forms in the wall. |
| In treating abdominal aortic aneurysm, what treatment might be given during watchful waiting and why? | In watchful waiting , the pt will usually have regular CT scans/ US to watch the aneurysm. If the pt has high bp, bp medication will be given to lower the pressure on the weakened area of the aneurysm in an attempt to slow the progression of the aneurysm |
| What are the advantages of an endovascular stent graph over open abdominal surgery graph repair? | Endovascular stent graph therapy has the advantage of avoiding abdominal surgery, aortic clamping, and minimize blood loss, resulting in shorter intensive care and hospital days. |
| Disadvantage? | One third of patients receiving endovascular stent graph therapy may require secondary procedures to maintain device patency or to treat endoleak |
| What is the only treatment for thromboangiitis obliterans? | Smoking cessation |
| Go through the three phases of Raynaud’s phenomenon and explain changes in color of the digits to what is occurring in the vasculature of the digits. | Skin of digit appr pale b/c absent cutaneous flow due 2 vasocon of digital a/arterioles;2nd is the cyanotic phase=digits appr blue/purple caused by deoxyg blood in capillary beds of fingers;Final=post ischemic hyperemic incr blood flow 2 skin=blushed appr |
| What are the demographics of persons with primary Raynaud’s phenomenon? | More women than men are affected, and approximately 75 percent of all cases are diagnosed in women who are between 15 and 40 years old |
| Define Secondary Raynaud’s phenomenon | Patients have an underlying disease or condition that causes Raynaud's phenomenon |
| What two condition commonly cause secondary Raynaud’s phenomenon? | Scleroderma; Systemic lupus erythematosus. |
| Is there a known cause of varicose veins? | There is no known cause of varicose veins, but it is thought that the weakness of venous walls is inherited; |
| Is the problem with varicose veins-- the valve or the vessels wall? | The main problem is theweakness of the venous walls which, over time, stretch and become longer and wider, causing the valve cusp to separate, allowing backward flow into the superficial veins. |
| Aching, painful legs (stretching of vein walls and accumulation of metabolites); | symptom of varicose veins |
| A feeling of heaviness, tiredness, and aching (edema and metabolites); | symptom of varicose veins |
| Persistent itching of the skin over the affected area (scratching may causes secondary skin infection); | symptom of varicose veins |
| Changes in skin color (Stasis pigmentation) | symptom of varicose veins |
| Ischemia to the lower extremities; | Ischemia=restriction in “arterial” blood supply to tissues,=O2 & glucose shortage. Symptoms of varicose veins=venous stasis. Long standing varicose veins can cause capillary pressure in tissues to increase, thus restricting the inflow of arterial blood. |
| If not treated, varicose veins could lead to what complications | Phlebitis as well as dermatitis that could progress to a decubitus ulcer. |
| Can varicose veins be cured | Varicose veins cannot be cured and relies on the different forms of treatment to relieve the symptoms, improve appearance, and prevent complications |
| Laser Therapy (Pulsed Light) treatments | Non-surgery |
| Endovenous laser treatment | Surgery |
| Elevating the legs—by lying down or using a footstool when sitting | Conservative |
| Stripping of the saphenous vein | Surgery |
| Injection Therapy (Sclerotherapy) | Non-surgery |
| Elastic stockings (support hose) that compress the veins and prevent them from stretching and hurting | Conservative |
| Why is pericarditis considered a “secondary condition”? | Pericarditis is 2nd to other disorders such as:infection (bacterial, viral, fungal, rickettsia);trauma of surgery, especially open heart;neoplasm; metabolic conditions (uremia due to kidney failure);immunologic conditions (eg., systemic lupus eryhematosus |
| Sufficient accumulation of fluid in the pericardial cavity that significantly limits the venous return to the heart. | Cardiac tamponade |
| Fibrous scaring with occasional calcification of the pericardium causing the visceral and parietal pericardial layers to adhere, obliterating the pericardial cavity. | Constrictive pericarditis |
| Management of cardiac tamponade. | Substernal transdiaphragmatic aspiration |
| Use of a stethoscope can identify a pericardial friction rub. | Acute pericarditis |
| The presence of exudate in the pericardial cavity that usually does not produce symptoms | Pericardial effusion |
| The definitive treatment for this condition is pericardial stripping. | Constrictive pericarditis |
| Results in a fibrotic lesions encasing the heart in a rigid shell, reducing filling volume or preload and therefore, cardiac output. | Constrictive pericarditis |
| Involves a sudden onset of chest pain that worsens with respiratory movements and may be confused with acute myocardial ischemia | Acute pericarditis |
| Can be caused by amyloidosis or hemochromoatosis. | Restrictive cardiomyopathy |
| Also called “congestive cardiomyopathy”. | Dilated cardiomyopathy |
| The walls of the heart, especially the septum, are significantly thicker than normal and this thickness prevents the ventricles from relaxing between beats. | Hypertrophic cardiomyopathy |
| While the rhythm and pumping action of the heart is normal, the stiff walls of the ventricles keep them from filling normally, restricting preload and therefore, restricting stroke volume | Restrictive cardiomyopathy |
| Weakened, enlarged heart chamber that restricts cardiac output and the person’s ability to perform activity of daily living | Dilated cardiomyopathy |
| Peripartum cardiomyopathy | Dilated cardiomyopathy |
| Although there is a genetic predisposition for this condition, other causes could toxic (alcohol), metabolic (hyperthyroid), or infection (viral myocarditis). | Dilated cardiomyopathy |
| In some instances, the septum bulges into the lower left chamber restricting aortic outflow and causing mitral regurgitation | Hypertrophic cardiomyopathy |
| Echocardiogram will show grossly dilated left ventricle, severe hypokinesia and rotary motion rather than contractile motion | Dilated cardiomyopathy |
| Dyspnea while lying in a prone position | Orthopnea |
| Attacks of sever shortness of breath or coughing occurring at night and awakening the person. | Paroxymal nocturnal dyspnea |
| Shortness of breath on exertion | Dyspnea |
| Allows leakage of blood from the left ventricle and into the left atrium during ventricular systole. | Mitral valve regurgitation/insufficiency |
| Is the most common form of valvular heart disease it can be caused by a papillary muscle rupture of dysfunction | Mitral valve regurgitation/insufficiency |
| Will cause an enlarge left ventricle due to the increased pressure gradient | Aortic valve stenosis |
| Greater than 50% of this valvular heart disease is caused by calcification of the valves with age | Aortic valve stenosis |
| Will cause a left atrial pressure of to rise from 5 mmHg to about 20-25 mmHg | Mitral stenosis |
| Will increase pulmonary capillary pressure resulting in pulmonary edema | Mitral stenosis |
| This valvular heart disease will cause blood to flow from the aorta into the left ventricle during ventricular diastole | Aortic insufficiency/regurgitation |
| For this course, what are the two main causes of valvular heart disease? | 1) Rheumatic heart disease; 2) infective endocarditis. |
| What causes Rheumatic heart disease? | Rheumatic fever develops in children and adolescents following pharyngitis with group A beta-hemolytic Streptococcus (ie, Streptococcus pyogenes); |
| Explain the immunologic aspects of this disease | In 1-3% of those in whom the pharyngeal streptococcus infection occurs, they will make antibodies that cross react with cardiac tissue, activating the complement system, and causing inflammatory destruction. |
| Why is the term “pancarditis” associated with rheumatic heart disease? | “Pancarditis” means that all three layers of the heart are involved: endocardium (valvular heart disease); myocardium (Aschoff bodies); and pericardium (pericarditis) |
| What are Aschoff bodies? | Aschoff bodies are inflammatory areas of the myocardium |
| What is the 1st process in the three processes involve in the pathogenesis of infective endocarditis? | endocardium (heart valve) must b “prepared” usually by endothelial damage (rheumatic heart disease,prosthetic heart valve, history of previous endocarditis, or congenital heart/heart valve defects) in order for microorganisms to colonize the valve; |
| What are the three processes involve in the pathogenesis of infective endocarditis | 2) blood-born microorganisms (eg., streptococci) must adhere to the damaged endocardial surface; 3)an adherent microorganism must proliferate (ie, grow on the valve). |
| A person has an EDV of 150 ml and an ESV of 50 ml, what is this person’s SV? | SV = 150-50 = 100ml |
| What would be the ejection fraction (Ef)? | Ef = SV/EDV = 100/150 = .66% |
| Would this person’s Ef be considered normal? | Yes, ejection fraction of 55-75% is considered normal |
| If the person discussed in the last question had an ESV of 100, what would be the Ef? | SV = 150 – 100 = 50 ml; Ef = 50/150 = 33% |
| What this Ef suggest in terms of level of heart failure? | This person not only is in heart failure but is also at risk of life threatening irregular beats causing cardiac arrest |
| What is the forward affect of right heart failure? Left heart failure? | The forward affect of both right and left heart failure is reduced cardiac output and, therefore, low blood pressure; Overall affect of low blood pressure is to activate the Renin-Angtiotensin-Aldosterone System (RAAS); |
| What is the backward affect of left heart failure? | Pulmonary edema |
| Name four symptoms. | Dyspnea during light activity and at rest; rales; chronic cough; “hunger” for air |
| What is the backward affect of right heart failure? | • Increased volume and pressure in the great veins causing jugular vein distension; Increased volume in distensible organs (hepatomegaly, splenomegally); Hepatomegaly can lead to ascites; Peripheral, dependent edema in feet and ankles. |
| What is ascites | Accumulation of fluids in the abdominal cavity |
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