Term
| What does coronary artery disease, ischemia and infarction form? |
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Definition
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Term
| Steps following Coronary artery disease? |
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Definition
| Coronary Artery Disease -> Myocardial Ischemia -> Myocardial Infarction |
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Term
| Presentation Depending on amount and Rate of Occlusion in the Coronary Artery |
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Definition
1. Plaque -> 10-25% occluded -> Asymptomatic or Angina Pectoris
2. Non-occlusive thrombus -> 50-70% occluded -> Angina Pectoris or CHF: Decreased cardiac output
3. Occlusive thrombus -> 100% occluded -> CHF or Myocardial infarct |
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Term
| Explain the clinical presentations of Coronary Artery Disease (CAD)? |
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Definition
- Atherosclerosis of the coronary arteries may present in several clinical forms:
> Angina Pectoris (Chest pain)
> Chronic Ischemic Heart disease with Congestive Heart Failure
> Acute Myocardial Infarction (MI)
> Sudden Cardiac Death |
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Term
| What is the underlying mechanism in all forms of CAD? |
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Definition
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Term
| Explain the pathogenesis of heart attacks. |
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Definition
- Acute coronary syndromes (unstable angina, acute myocardial infarction, sudden cardiac death) often result from ACUTE changes in CHRONIC atherosclerotic lesions.
> fissuring of the plaque with clotting
> plaque rupture with embolization
> thromboemboli |
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Term
| Explain the formation of Ischemic heart disease. |
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Definition
- Results from an imbalance between myocardial blood supply and myocardial oxygen demand.
- Usually due to atherosclerosis of the coronary arteries. |
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Term
| What happens to myocardial cells as a result of a coronary occlusion? |
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Definition
1. The cells lose their ability to contract within several minutes.
2. Become hypoxic with in 10 mins.
3. The cells die with in 20 minutes. |
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Term
| What are the conditions that reduce blood supply? |
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Definition
- Hemodynamic factors
- Hematologic factors
- Cardiac factors
- Systemic disorders that reduce blood flow or the availability of oxygen. |
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Term
| What are examples of hemodynamic factors? |
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Definition
- Increased coronary vessel resistance
- hypotension (ex. shock)
- Decreased blood volume (ex. hemorrhage) |
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Term
| What are some cardiac factors of reduced blood supply? |
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Definition
- decreased diastolic filling time
- increased heart rate
- valvular incompetence |
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Term
| What are some examples of hematologic factors that reduce blood supply? |
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Definition
- Reduced oxygen content of the blood
- Ex. Respiratory disorders, anemia, hemoglobin disorders |
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Term
| What is an example of a disorder that reduces blood supply or the availability of oxygen? |
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Definition
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Term
| What conditions can increase oxygen demand? |
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Definition
- Increased systolic blood pressure
- Increased ventricular volume
- Increased thickness of the myocardium
> increased systolic resistance, hypertension
- Increased heart rate
> stress, exercise, hyperthyroidism, anemia |
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Term
| Explain the pathophysiology behind myocardial ischemia |
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Definition
- HEALTHY coronary arteries are able to DILATE to get an increased flow of blood to the myocardium when it's needed.
- Narrowing a major coronary artery by more than 50% impairs blood flow sufficiently to hamper cellular metabolism under increased myocardial demand. |
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Term
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Definition
- Chest pain caused by myocardial ischemia.
- Transient pain of varying degree.
- Effect of temporary ischemia is reversible.
- Pain is caused by a build up of lactic acid or the abnormal stretching of ischemic muscles.
- Pallor, profuse sweating, and dyspnea may associated with it. |
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Term
| What are and explain the different types fo angina? |
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Definition
- Stable Angina
> Due to a narrowing of the lumen and the hardening of the arterial walls
> generally predictable
- Unstable Angina
> Due to a combination of a VASOSPASM and atherosclerotic lesion.
> generally unpredictable and occur at rest
- Variant Angina (Prinzmetal Angina)
> vasospasm only |
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Term
| What does the clinical presentation of ischemia depend on? |
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Definition
- Extent of the occlusion (10% occluded vs. 100%)
- Anatomic location (WHICH coronary artery and WHERE)
- type of the lesion
> Fibrolipid plaques are more easily ruptured and likely to cause an acute event than Fibromuscular plaques.
- The SPEED at which the ischemia occurs
- Extent of disease in OTHER CORONARY BRANCHES
- Other DISEASES (hypertension, hyperthyroid) |
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Term
| Explain clinical considerations of myocardial ischemia. |
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Definition
- After several minutes, the heart cells lose their ability to CONTRACT.
- So then the primary aim is to reduce myocardial oxygen consumption.
- The factors most amenable for pharmacologic manipulation are:
> heart rate, contractility, blood pressure |
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Term
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Definition
| - Inflammation of the heart wall. |
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Term
| What is the etiologies of myocarditis? |
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Definition
- Viruses
> most common cause
- Parasites
> important cause in So. America
- Bacteria
> Lyme's Diseases, Diptheria
- Cardiac allograft rejection
- Drug Hypersensitivities |
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Term
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Definition
| - Inflammation of the pericardium. |
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Term
| What are the types of pericarditis? |
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Definition
- Primary pericarditis
- Secondary Pericarditis |
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Term
| Explain Primary Pericarditis |
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Definition
| - Uncommon, Usually infectious (Viral) |
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Term
| Explain secondary pericarditis |
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Definition
| - Due to MI, cardiac surgery, or radiation |
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Term
| What are the possible outcomes of pericarditis? |
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Definition
- Could lead to effusion ( = escape of gas through a hole )
- Could resolve on its own without complications
- Could progress to a chronic fibrosing process |
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Term
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Definition
| - A heart disease resulting from a primary abnormality in the myocardium. |
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Term
| What is the etiology of cardiomyopathies? |
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Definition
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Term
| What are the major groups of cardiomyopathies? |
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Definition
- Dilated Cardiomyopathy
- Hypertrophic Cardiomyopathy
- Restrictive Cardiomyopathy |
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Term
| Explain Dilated Cardiomyopathy |
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Definition
- AKA Congestive Cardiomyopathy
- THIN, stretched walls
- Progressive cardiac dilation, with contractile (systolic) dysfunction
- Weak, ineffective contractions
- Often idiopathic, or associated with ALCOHOL ABUSE, TOXIC INSULT, OR VIRAL |
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Term
| Explain Hypertrophic Cardiomyopathy |
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Definition
- THICKNESS of the heart wall
- Abnormal Ventricular Diastolic Filling (inability to fill)
- Ejection is forceful but ineffective because the amount of blood in the LV (EDV) IS SO SMALL.
- Exertional Dyspnea
> Can lead to sudden death in young athletes
- Ventricular Arrythmia
> Can lead to myocardial ischemia even w/o atherosclerosis |
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Term
| Explain Restrictive Cardiomyopathy |
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Definition
- A primary decrease in ventricular compliance
- Due to the stiff, inelastic nature of the ventricles it takes great effort to fill them |
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Term
| What can all the types of cardiomyopathies lead to? |
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Definition
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Term
| Give some facts on Congenital Heart Disease. |
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Definition
- About 8 out of every 1000 live births
- Wide spectrum of malformations
- Symptoms range from asymptomatic to fatal |
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Term
| What are the etiologies of congenital heart disese? |
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Definition
| - Some are genetic, environmental, or idiopathic. |
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Term
| What are some of the functional problems associated with congenital heart disease? |
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Definition
- some defects cause right to left shunts (Cyanosis)
- some defects cause left to right shunts (CHF)
- some defects cause obstructions |
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Term
| Explain an Atrial Septal Defect (ASD) |
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Definition
- Open communication between Left atria and Right atria
- causes a left-to-right shunt
- USUALLY WELL TOLERATED
- leads to pulmonary hypertension:
> Increased BP in pulmonary vessels
- Reversal of shunt can then occur
> Consequences?
>> CYANOSIS (VERY DANGEROUS) |
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Term
| Explain a Ventricular Septal Defect (VSD) |
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Definition
- MOST COMMON CONGENITAL HEART DEFECT
- Left to right shunt
- Progressive Pulmonary Hypertension
- Shunt reversal occur earlier and more frequently than with ASD's
- more likely to need surgical intervention |
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Term
| Explain Patent Ductus Arteriosus (PDA) |
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Definition
- Connection between the pulmonary artery and the aorta.
- "Machinery murmur"
- Left-to-right shunt (REVERSAL RARE)
- Pulmonary Hypertension
- Leads to CHF
- Surgical correction |
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Term
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Definition
| - Presence of an increased amount of fluid in vessels or passageways of a part or organ; not Edema. |
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Term
| Congestive Heart Failure (CHF) is not the same thing as...? |
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Definition
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Term
| Explain Congestive Heart Failure (CHF) |
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Definition
- AKA Cardiac Insufficiency, NOT cardiac arrest
- The heart is unable to eject all the blood delivered to it = DECREASED CO
- Left sided Failure
> Caused by: Systemic hypertension, aortic or mitral valve diseases, ischemic heart disease, or primary diseases of the myocardium
- Right sided failure
> Caused by: Left sided failure, Left-to-right Shunts, Pulmonary hypertension, Tricuspid or Pulmonic valve disease, Lung diseases |
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Term
| What are the compensatory mechanisms of CHF? |
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Definition
- Aim is to increase cardiac output
- increased sympathetic nervous system activity (positive inotropes)
- Increase Heart Rate
- Hypertrophy of myocardial cells
> problem with this is myocardium will then require more oxygen. |
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Term
| What will happen if there is inadequate compensation for CHF? |
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Definition
- Increased end-diastolic pressure and volume
- Causes heart to dilate (Increased Pre-load) |
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