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37 Cards in this Set
- Front
- Back
Arteriosclerosis
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Abnormal thickening and hardening of arterial walls
Narrowed lumen |
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Atherosclerosis
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Most common form of arteriosclerosis
Fat & fibrin on vessel walls → CAD, cerebrovascular disease Causes: inflammation*, smoking, HTN, DM, ↑ lipids, ↑ homocystine, autoimmune, infection (chlamydia, herpes viruses) |
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Ischemic events
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Coronary heart disease, myocardial infarction, stroke
Rx: treat ischemia, exercise, smoking cessation, control hypertension and DM, reducing LDL cholesterol Cholesterol <200, LDL <100, HDL >40 Drugs to ↓ lipidemia |
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Aneurysm
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Local dilation or outpouching of a vessel wall or cardiac chamber
Aorta very susceptible ¾ are abdominal Causes: Atherosclerosis, plaque erodes vessel wall |
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types of aneurysms
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True aneurysm involve all three layers
Fusiform – saccular False aneurysm Only intima (inner) layer as in leak between vascular graft and artery Dissecting Wall of an artery dissects longitudinally Surgical emergency |
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Aortic aneurysms
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Often asymptomatic until rupture
Risks: Age, atherosclerosis, HTN, tobacco, white race, family, males, Marfan’s syndrome, trauma Treatment Surgical – graft for greater than 5 cm Endovascular surgery |
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Venous thromboembolism (Deep vein thrombosis)
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Triad of Virchow
• Venous stasis, endothelial injury, hypercoagulability (Factor V Leiden, antithrombin III, Protein C or Protein S deficiencies) Risk factors: surgery (esp. hips & knees), immobility, cancer, pregnancy, postpartum, oral contraceptive, HRT S/S, Dx: unilateral leg swelling, pain, Dx: US, venous duplex Rx: anticoagulation, bedrest |
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Thrombus
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Blood clot that remains fixed to a vessel wall
Detached thrombus = thromboembolus Tend to form at areas of inflammation • Surgery, trauma, infection, plaque Veins – thrombophlebitis Valvular thrombi – endocarditis & RHD Rx: anticoagulants |
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Embolus
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Bolus of matter: thrombus, air, amniotic fluid, fat, bacteria, cancer cells
Pulmonary embolus From venous circulation to lungs Systemic (arterial) embolus originates in L ♥ from MI, ♥ failure, endocarditis, dysrhythmias Causes ischemia, infarction, sepsis, stroke |
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Varicose Veins
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Varicose Veins
Blood pooling " distended, tortuous, palpable veins • Trauma to saphenous vein / valvular damage • Prolonged standing Gravity and i muscle pump |
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Raynaud disease
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characterized by attacks of vasospasm in the small arteries & arterioles of the fingers and less commonly in te toes, primary artery disease
Raynaud’s (primary) Unknown origin Vasospastic attacks 2° to cold, emotions Raynaud’s (secondary) 2° to systemic diseases • Collagen vascular (scleroderma), lupus, and rheumatoid arthritis Vasospasm – mostly fingers Pallor, cyanosis, numbness, cold sensation followed by rubor, throbbing, paresthesias Rx: SSRI, vasodilators, reserpine, Ca++ channel blockers |
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Superior vena cava syndrome
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Compression of the SVC causing venous distention of the head and upper extremities
Bronchogenic cancer (75%), lymphoma, metastases, pacemaker insertion, long-term CV catheter R mainstem bronchus abuts the SVC which is easily compressed by tumor, lymph node growth S/S: edema, fullness, tightness of collars, rings, HA, visual disturbances, respiratory distress, purple skin coloration Rx: diuretics, steroids, anticoagulants prn, stent placement |
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Pericardial tamponade
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Fluid in the pericardium creates enough pressure to cause cardiac compression
S/S: * pulsus paradoxus – BP during expiration > BP during inspiration by >10mm Hg, muffled ♥ sounds, DOE, dull CP Causes: uremia with LV failure, ♥ surgery, radiation to chest Rx: pericardiocentesis |
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Acute pericarditis
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inflammation of the two layers of the thin, sac-like membrane that surrounds the heart
Commonly caused by infection, uremia, neoplasm, surgery, trauma S/S: severe chest pain that worsens with respiratory movements or lying down Low grade fever, tachycardia, friction rub (sandpaper) Rx: treat cause |
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Endocarditis
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Heart valve vegetation which h risk of embolus
Must have invasion of blood stream Staph aureus*, strep viridans Portal of entry Low host resistance, high virulence Risks: overt infection, IV drug abuse, surgical or dental procedure, mechanical heart valves, long term catheters, valvular disease, ♥ surgery “classic” findings: fever, murmur, petechiae Rx: IV to oral abx for 4 – 6 wks |
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Valvular stenosis
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Blood can not flow forward, chamber “in front of” the valve has h workload
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Valvular regurgitation (insufficiency)
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Cusps fail to close completely, some blood leaks back
Eventually " heart failure |
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Anaphylactic shock
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Widespread hypersensitivity
Penicillin, latex & food allergies, venoms, pollens Alteration same as neurogenic, ↓ tissue perfusion Extensive immune & inflammatory response Bronchoconstriction, urticaria (hives), edema, hypotension Remove stimulus, epinephrine, steroids, volume |
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Cardiogenic shock
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↓ CO & tissue hypoxia with adequate intravascular volume
Dyspnea, tachycardia, hypotension, ↑ SVR, ↓ EF & tissue perfusion Heart failure – any kind Occurs with MI, ischemia, infection, drug toxicity Mortality of 70% |
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Hypovolemic shock
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Loss of blood/ fluid
Hemorrhage, burns, diaphoresis, DM, DI, emesis, diuresis in large amounts S/S: ↓ BP, ↑ HR & SVR (compensatory), oliguria, poor skin turgor, thready pulse, ↓ mental status peripheral vasoconstriction R-A-A, ADH activation Rx: Fluid replacement |
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Neurogenic shock
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Vasogenic shock
Vasodilation, ↑ parasympathetic or ↓ sympathetic stimulation * ↓ SVR, hypotension, bradycardia Loss of vascular tone, blood volume the same Causes: injury to spinal cord or medulla, depressive drugs, anesthesia |
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Septic shock
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Component of systemic inflammatory response syndrome (SIRS)
Infection →bacteremia →sepsis →septic shock →multiple organ dysfunction (MODS) Endotoxins act as triggers for a cascade Vasopressors to support hypotension Acidosis, oliguria, change in mental status Low BP, low SVR, systemic edema, GI abnormality, ARDS Common in ICU, 40% mortality |
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Multiple organ dysfunction syndrome (MODS)
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50-90% mortality
Sepsis, septic shock most common causes Dysfunction of two or more organ systems Risks: age > 65, organ dysfunction, bowel infarction, steroids, multiple blood transfusion, chronic disease, delayed resuscitation, severe tissue injury (more, p. 698) First organ to be affected: Lung – adult respiratory distress syndrome (ARDS) Renal, liver, GI, hematologic, cardiac, CNS |
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Myocardial infarction: define, what causes the cardiac dysfunction? Which lab tests and diagnostics are performed..how is diagnosis made?
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Necrosis following blood flow interruption. EKG changes with 30-60 sec of hypoxia
Pain not relieved by nitrates, heavy, crushing, radiating “silent” in elderly and DM N/V, diaphoresis Dysrhythmias, heart failure Dx: EKG, serial enzymes, troponin “cardiac profile” Rx: thrombolytic therapy, heparin, percutaneous transluminal coronary intervention (PTCI) Sudden cardiac death related to Ischemia LV dysfunction |
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Electrical instability
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Myocardium has it’s own conduction system, concentrated at certain sites called nodes
Heart can beat without nervous innervation (automaticity) SA node – pacemaker of the ♥ " AV node " Bundle of HIS" bundle branches " Purkinje fibers |
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Rheumatic fever or heart disease
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After upper respiratory infection with Group A beta-hemolytic streptococcus
Untreated" RHD Also infects joints, skin, nervous system Children 5 – 15 yrs Genetic, *immune Destruction of MV & AV, atrial fibrillation High recurrence rate |
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Acute Rheumatic fever
Carditis |
Valve dysfunction, murmur
Pericardial effusion |
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acute reumatic fever
Polyarthritis |
Acute, migratory, > than 1 joint
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acute rheumatic fever
Chorea |
St Vitus dance: aimless, involuntary movements
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acute rheumatic fever
Erythema marginatum |
Truncal rash, erythematous
macules, transitory, h with heat |
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Systolic, Primary, Secondary hypertension
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Consistent elevation of BP often “silent”
3rd leading cause of death Increases incidence MI, ♥ failure, stroke, kidney disease Risks include: genetics, nicotine, older age, obesity, heavy ETOH, gender (women>50), black race, h Na+, glucose intolerance From h in peripheral resistance, h blood volume or both Sustained pressure damages arterial walls, h inflammation |
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Primary (essential, idiopathic) HTN (92-95%)
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Genetic, environmental factors
Neural, hormonal i.e. sympathetic stim, R-A-A system, Na+ retention, Insulin resistance and endothelial dysfunction |
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Secondary HTN is caused by systemic diseases such as:
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Renal disease
Adrenal tumors Cortex – aldosterone Medulla – pheochromocytoma Drugs: BCP, steroids, antihistamines Can be reversed |
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Isolated systolic HTN
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S >140, D < 90, * widening PP
Rigidity of aorta, changes in A0 valve, age >65 |
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Congestive heart failure
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Impaired ability of myocardial fibers to contract (systolic failure) or to relax (diastolic failure)
Pressure reflected back into pulmonary circulation Rales, SOB Rx: diuretics, ACE inhibitors, β blockers, digoxin, daily weights |
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Atrial fibrillation
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No p waves, atrial rate 300 – 600 bpm
Atria fibrillate or quiver Ventricular rate varies and is irregular– called ventricular response Rx: Cardioversion – timed electrical shock to the heart Drug therapy Digoxin, β blockers, CCB and others ANTICOAGULATION Causes Idiopathic Thyroid disorders, valve disease, hypertension, sick sinus syndrome, pericarditis, lung disease, and congenital heart defects and others |
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Cardiomyopathy
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Affects the myocardium and leads to diminished cardiac performance
Result of ischemic changes, HTN, infectious disease, toxins, connective tissue disease, nutritional deficiencies, metabolic disorders |