Patho Chap 24 Alterations of Cardiovascular Function (reading)

Heart failure

This is a general term used to describe several types of cardiac dysfunction the result in inadequate perfusion of tissues with blood-born nutrients.

Cigarette smoking

This modifiable risk factor in CAD has a direct effect on endothelial cells and produces oxygen free radicals. It increases LDL and decreases HDL levels. Nicotine stimulates release of catecholamines which increases heart rate and peripheral vascular constriction thus increasing BP, cardiac workload, and oxygen demand.

A

This peripheral vascular disease is an autoimmune condition characterized by formation of thrombi filled with inflammatory and immune cells. Over time, they become fibrotic and result in permanent occlusion and obliterate portions of small and medium sized arteries. Although CORKSCREW collateral vessels develop, blood supplied by them are inadequate. A) Thromboangiitis obliterates (Buerger disease) B) Raynaud phenomenon C) Bronchiolitis obliterans D) Varicose veins

Prinzmetal angina

This type of angina occurs at rest, often at night during rapid eye movement and is caused by vasospasm of one or more major coronary arteries. (pg. 614)

microvascular angina

This type of angina typically occurs in women presenting with either no symptoms or atypical symptoms such as palpitation, anxiety, weakness, and fatigue. (pg. 614)

B (Dilated cardiomyopathy)

This type of cardiomyopathy is characterized by impaired systolic function leading to increases in intracardiac volume, ventricular dilation and her failure with reduced ejection fraction. May be genetics, inherited disorder like muscular dystrophy, or related ischemia heart disease. (624) A) Restrictive cardiomyopathy B) Dilated cardiomyopathy C) Hypertrophic obstructive cardiomyopathy D) Hypertensive (valvular) hypertrophic cardiomypathies

C (Obstruction of left ventricular outflow can occur when the heart rate is increased and intravascular volume is decreased)

This type of cardiomyopathy is commonly inherited and is characterized by thickening of the septal wall which may cause outflow obstruction to the left ventricle outflow tract. (62) A) Restrictive cardiomyopathy B) Dilated cardiomyopathy C) Hypertrophic obstructive cardiomyopathy D) Hypertensive and valvular hypertrophic cardiomyopathies

D (This is a type of hypertrophic cardiomyopathy)

This type of cardiomyopathy is the most common type. It is usually seen in individuals with hypertension or valvular stenosis (usually aortic). Diastolic dysfunction occurs first and then eventually systolic dysfunction. (624) A) Restrictive cardiomyopathy B) Dilated cardiomyopathy C) Hypertrophic obstructive cardiomyopathy D) Hypertensive and valvular hypertrophic cardiomyopathies

Bacterial embolism

This type of emboli introduces aggregates of bacteria into the bloodstream. The source of this type of emboli is from bacterial endocarditis or abscess.

amniotic fluid embolism

This type of emboli introduces antigens, cells, and protein aggregates that trigger inflammation, coagulation, and immune responses.

Malignant hypertension (hypertensive crisis)

This type of hypertension is a rapidly progressive hypertension in which diastolic pressure is usually greater the 140 mmHg. This is a life threatening organ damage type of hypertension with an unknown cause but may be complicated by pregnancy, cocaine or amphetamine use, adrenal tumors, and alcohol withdraws. (pg. 603)

Secondary hypertension (can be reversed if ho permanent structures have been damaged)

This type of hypertension is caused by an underlying disease process or medication that raises peripheral vascular resistance or cardiac output.

Because it is embedded in the protective fibrin clots and are inaccessible to host defenses. Systemic embolization from these vegetations promotes infection and inflammation elsewhere in the body.

Why does infective endocarditis involve several organ systems? (630)

Flow and pressure are lower in the veins than in the arteries, venous stasis occurs as a result of low pressure veins.

Why is venous thrombi more common than arterial thrombi? (pg. 599)

leukocytes neutrophils 10-14 6

Within 24 hours of myocardial infarction, _______ infiltrate necrotic area and protelytic enzymes from ________ degrade necrotic tissue. Collagen matrix forms within ____-____ days after infarction. After ____ weeks, necrotic area is completely replaced by scar tissue. (pg. 619)

Virchow's triad

______ describes three factors that promote venous thrombosis.

Unstable

_______ angina is a form of acute ordinary syndrome that results from reversible myocardial ischemia; it is a signal informing that an atherosclerotic plaque has become complicated and an MI may soon follow. (pg 616) --Increases risk of heart attack.

Hypertension

_______ diseases usually causes damages to organs and tissues outside the vascular system such as heart disease, renal insufficiency, CNS dysfunction, impaired vision, impaired mobility, vascular occlusion, or edema. (pg. 603)

acute

_______ pericarditis is an acute inflammation of the pericardium

Cardiac tamponade

________ is a serious medical condition in which blood or fluids fill the space between the sac that encases the heart and the heart muscle. This places extreme pressure on your heart. The pressure prevents the heart's ventricles from expanding fully and keeps your heart from functioning properly.

Hibernating

________ myocardium describes tissue that is persistently ischemic and undergoes metabolic adaptation to prolong myocyte survival until perfusion can be restored.

diastolic heart failure (when the heart is unable to relax during systole because of walls being thick and scarred) systolic heart failure (increased size of heart with increase demand for oxygen overtime, will impair contractility of heart and is at risk for MI and heart failure)

heart failure with PRESERVED ejection fraction is also known as ________. heart failure with REDUCED ejection fraction is also know as _______. (pg. 602).

Raynaud phenomenon

Blood vessels in affected individuals, mostly young women, with this peripheral vascular disease have imbalanced endothelium-derived vasodialtors (nitric oxide) and vasoconstrictors (endothelin) that causes attacks of vasospasm in the small arteries and arterioles of the fingers causing cyanosis of the digits and changes in sensation due to ischemia.

20

Cardiac cells remain viable for approximately ____ minutes under ischemic conditions. (pg. 613)

lungs

Fat embolisms can be floating in the blood stream and is associated with trauma to long bones. What organ is most often obstructed?

E (branches of pulmonary arteries are commonly obstructed by venous emboli. All others are sites of arterial emboli obstruction)

The most common sites of obstruction from an arterial emboli are all of the following except (pg. 606) A) femoral artery B) popliteal artery C) coronary artery D) cerebral vasculature E) branches of pulmonary arteries

20 10

The term orthostatic hypotension refers to a decrease in SYSTOLIC blood pressure of at least ______ mm Hg or a decrease in DIASTOLIC blood pressure of at least _____ mm Hg within 3 minutes of moving to a standing position (Huether 604)

trabeculae carneae

These muscles are located in the ventricles and are rounded or irregular muscular columns.

Unstable angina

These signs and symptoms correlate with _______ dyspnea, diaphoresis, anxiety, ST segment depression and T wave inversion during pain that resolves when pain is relieved.

infective endocarditis

These three critical elements are required for the pathogenesis of what disease? 1) endocardial damage 2) adherence of blood-born microorganisms to the damaged endocardial surface 3) formation of infective endocardial vegetations (similar to cauliflower)

varicose veins

These types of veins involves the pooling of blood in the saphenous veins of the legs that produces a distended, tortuous, and palpable vessels.

Heart (associated with thrombi after MI, valvular disease, left heart failure, endocarditis, and dysrhythmias)

Arterial emboli normally originate in what area of the heart? (pg. 606)

myocardial ischemia

Atherosclerosis in the coronary arteries is the major cause of _______.

Heart failure with REDUCED ejection fraction (also known as systolic heart failure)

Which type of left heart failure is described as inability of the heart to generate adequate cardiac output to perfuse tissues; having a reduced ejection fraction of less than 40%?

HDL

Which type of lipoprotein is responsible for "reverse cholesterol transport" which return excess cholesterol from the tissues to the liver for processing or elimination in bile? (pg. 611)

regurgitations

Which valve problem included the following characteristics? --caused by connective tissue disorders.

False (Long term use of Ibuprofen has been shown to increase risk for CAD because of their potentiation of clotting certain tissues)

T/F Longterm use of anti-inflammatories such as Ibuprofen has been linked to decrease risk of CAD. (pg. 613)

nitroglycerine rest

In stable angina pectoris, symptoms can be relieved from ______ or _____. (pg. 614)

NSTEMI

In this type of MI, persistent coronary occlusion leads to infarction of the myocardium closest to the endocardium; called subendocardial infarction.

aortic stenosis

Which valve problem included the following characteristics? --crescendo-decrescendo systolic heart murmur due to resistance to flow

Mitral regurgitation

Which valve problem included the following characteristics? --holosystolic murmur

tricuspid regurgitation

Which valve problem included the following characteristics? --right heart failure --palpitations --murmur throughout systole --caused congenitally

False (All stages of hypertension; both state 1 and stage 2 HTN need effective long-term therapy)

T/F Some stages of hypertension are associated with increased risk for target organ disease events, such as myocardial infarction, kidney disease, and stroke (Huether 600)

Microvascular thrombosis (throughout systemic arterial circulation, can cause widespread arterial thrombi formation)

T/F What is the result of systemic inflammation activating the intrinsic and extrinsic pathways of coagulation? (pg. 606)

mitral stenosis

Which valve problem included the following characteristics? --rumbling decrescendo diastolic murmur --accentuated and delayed S1 sound because of increased left atrial pressure --fish-like mouth

Aortic regurgitation

Which valve problem included the following characteristics? --turbulence across the aortic valve to produce a decrescendo murmur

Rheumatic heart disease

A chronic condition characterized by valvular deformity the slowly progresses; flows an acute or repeated episode of rheumatic fever (an inflammatory disease from a Beta-hymplytic streptococcus)

metabolic

A combination of obesity, dyslipidemia, hypertension, and insulin resistance is called _______ syndrome. (pg. 612)

aneurysm

An _______ is a localized dilation or outpouching of a vessel wall or cardiac chamber (Huether 604)

mitral valve problems (both stenosis and regurgitation)

Which valve problem included the following characteristics? --causes left atrial hypertrophy --atypical chest pain

True aneurysm

A _____ involve all three layers of the arterial wall and are best described as a weakening of the vessel wall (Huether 605)

Pericardial effusion

A chest x-ray is taken and discloses a "water bottle configuration". Upon auscultation, the nurse notes muffled heart sounds, poorly palpable apical pulses and dyspnea on exertion. What are these signs indicative of?

B (a classic sign of MI is heavy crushing chest pain like a truck is sitting on chest)

A male patient says "I have been having chest pains like a truck is sitting on my chest". He states that the pain sometimes radiate to his neck and shoulder and is asking for some Tums for indigestion. What symptoms is he presenting with? (619) A) Unstable angina B) Myocardial Infarction C) Prinzmetal angina D) Stable angina

D (because when exercising, blood is pumping faster and metabolism is increased needing more oxygen supply. With atherscleosis, intermittent ischemia occurs)

A patient is complaining of having intermittent "chest pain" after exercise. This is most likely cause bt which of the following? A) Mitral valve prolapse B) Infective endocarditis C) Inflammation of pericardium D) Atheroslceotic plaque progression

cardiac tamponade

A pericardial effusion that develops rapidly may become a ________, where the pressure may interfere with right atrial filling casing increase venous pressure, systemic venous congestion, and present with signs of right heart failure. Life threatening circulatory collapse may occur.

C (varicose veins, muscle pump action of the valves in the lower legs are diminished)

A person who habitually stands for long periods of time, wear constricting garments, or cross legs at the knees is at risk for developing ________. (pg. 598) A) embolus B) venous stasis C) varicose veins D) DVT

E (Sickle cell anemia is a red blood cell disorder where the RBC's do not live as long as regular ones do. Athersclerosis is a common cause of atherosclerosis due to the plaque formation clawing inflammation and erosion of the vessel walls. Hypertension can also contribute to aneurysm formation by increasing wall stress. Marfan syndrome is a collagen-vascular disorder that can affect collagen weakening the walls. Syphilis, an STD, can cause inflammation of the aorta associated with the tertiary stage of syphilis infection)

All of the following are causes of aneurysms except: (pg. 605) A) atherosclerosis B) hypertension C) Marfan syndrome D) syphilis E) sickle cell anemia

A (thin and shiny skin is from Thromboangiitis Obliterans. B, C, D occurs in Raynaud Phenomenon when blood flow returns after an attack.)

All of the following are characteristics of Raynaud Phenomenon except : A) thin and shiny skin B) rubor (redness) C) throbbing pain D) paresthesia E) cyanotic

C (decrease ejection fraction, altered left ventricular compliance, and sinoatrial node malformation occurs along with A, B, D)

All of the following are functional changes in MI except: (pg 619) A) decreased stroke volume B) increased ventricle alar end-diastolic volume C) increased ejection fraction D) decreased cardiac contractility with abnormal wall motion

B D (delivery of cholesterol to tissues and endothelial injury are all part of what LDL does. HDL does all the rest)

All of the following are functions of HDL except: (pg. 611) A) "reverse cholesterol transport" B) delivery of cholesterol to the tissues C) endothelial repair D) endothelial injury E) decreases thrombosis

A (obesity is a risk factor for many things, but is not a part of Virchow's triad which describes 3 factors that promote venous thrombosis)

All of the following are included in Virchow's triad except : A) obesity B) hyper coagulable states C) venous endothelial damage D) venous stasis

D (decreased levels of HDL is a risk factor of Atherosclerosis)

All of the following are risk factors for Atherosclerosis except: A) smoking B) hypertension C) increased levels of LDL D) increased levels of HDL E) autoimmunity

E (men younger than 55 are more at risk for primary HTN than women. Men older than 55 are less at risk than women for primary HTN)

All of the following are risk factors for primary hypertension except : (pg. 600) A) natriuretic peptide abnormality B) high sodium intake C) insulin resistance D) obesity E) men after 55

B (female is a risk factor for varicose veins as well as obesity and family history)

All of the following are risk factors for varicose veins except : A) age B) male C) DVT D) previous leg injury E) pregnancy

E (vasospasm occurs in Raynaud phenomenon. All others occur in Thromboangiitis)

All of the following are signs and symptoms of Thromboangiitis obliterans except : A) pain B) tenderness C) shiny skin D) thicken nails E) vasospasm

D (Vasospasm causes a type of angina called prinzmetal angina, it is not a sign or symptom of stable angina pectoris)

All of the following are signs and symptoms of stable angina pectoris except : A) chest discomfort B) pain radiating to neck and lower jaw C) clenching fist over left substernal border D) vasospasm E) pallor

A (Rheumatic heart disease; often leads to stenosis and/or regurgitation of the valves, often affecting the left heart valves, specifically the mitral valve.)

During acute stages of this inflammatory disease of the heart, valves become red, swollen, and inflamed with lesions developing on leaflets. In chronic stage, scar tissue develops, leaflets become rigid and deformed. A) Rheumatic heart disease B) Pericarditis C) Myocarditis D) Infective endocarditis

stable angina

Gradual narrowing of lumen, hardening of arterial walls, endothelial cell dysfunction and decreased vasodilators causes a chronic coronary obstruction that result in recurrent predictable chest pain called _______. (pg. 614)

aortic valve problems (both stenosis and regurgitation)

Which valve problem included the following characteristics? --causes left ventricular hypertrophy --angina pectoris

140 90 blacks diabetes

Hypertension is considered a systolic blood pressure of _____ mmHg or higher and a diastolic blood pressure of _____ or more. It's prevalence is higher in ______ and those with ______. (pg. 600)

primary

Idiopathic or essential hypertension is also known as _____ hypertension.

Hypertension-Renal

In HTN, Na increase leads to water retention and increased blood volume which increases blood pressure. Too much pressure for an extended time will cause renal injury. Renal artery will constrict to try and slow the blood pressure on the kidneys but it can only do so much. Constricting too much will lead to renal tissue ischemia. Tissue ischemia will lead to inflammation of the kidneys and further damage the glomerulus and tubules. Salt is retained and toxins build up.

CCB nitroglycerine

In Prinzmetal angina, symptoms can be relieved from ______ or long acting ______ or both. (pg. 614)

STEMI

In ______, continued coronary occlusion leads to transmural infarction extending from endocardium to pericardium. This type of MI will require intervention asap as it carries the greatest risk of death.

orthostatic hypotension

In ______, the SNS involving the barorecetors and its affect on stretch receptors are impaired and unable to maintain arterial blood pressure upon standing. Compensatory mechanisms of closure of venous one-way valves, contraction of leg muscles and decrease intrathoracic pressure is also impaired. These factors cause gravitational pull on blood to pool in the lower extremities. (pg. 604)

C (Arteriosclerosis)

LDL migration into vessel wall, oxidation, and phagocytosis by macrophages which creates fatty streaks where collagen is produced to form fibrous plaques over these fatty streaks are steps in the pathogenesis of _______. (pg. 611) A) Thrombus formation B) Atherosclerosis C) Arteriosclerosis D) Peripheral vascular disease

cholesterol

LDL, mostly made up of cholesterol and protein, is responsible for delivery of ______ to the tissues.

silent ischemia

Myocardial ischemia that does not cause detectable symptoms is called _________. (Huether 614)

electrolyte pump calcium

Myocardial stunning is temporary loss of contractile function that persists fr hours to days after perfusion has been restored and is due to alterations in ________ and ______ homeostasis by the release of toxic oxygen free radicals. (619)

Low dietary intake of K, Ca, and Mg increases risk for HTN because of malfunctioning natriuretic hormones. Adequate intake fo dietary K, Ca, and Mg has been linked to improved natriuretic peptide function.

Natriuretic hormones modulate renal sodium excretion, but they need K, Ca, and Mg to function properly. Without these electrolytes, sodium builds up because natriuretic hormones dont function properly. What is a conclusion to draw out from this? (pg. 601)

E (hardening of arterial walls occurs in stable angina.)

Prinzmetal angina can result from all of the following except: (pg. 614) A) decreased vagal activity B) hyperactivity of SNS C) decreased nitric oxide activity D) altered calcium channel function E) hardening of arterial walls

Venous side (DVT)

Pulmonary emboli normally originate from which side of the systemic circulation? (pg. 606)

D (GI tract is not affected by Rheumatic fever. )

Rheumatic fever affects all of the following body systems except (628) A) joints B) skin C) nervous system D) Gi tract E) heart

B C D (Frank-Starling mechanism will increase force of contractility to increase CO; Neruoendocrine includes SNS which increases HR - and - Renin system which retains sodium and fluids; Ventricular hypertrophy increases cardiac workload)

Select the following compensatory mechanisms for heart failure A) Laplace Law B) Frank-starling mechanisms C) Neuroendocrine responses D) Ventricular hypertrophy

C

Severe and chronic hypertension can lead to which of the following? A) anemia B) glaucoma C) coronary artery disease D) COPD

E (night sweats is a common symptom of infective endocarditis, pericardial friction rub may sound leathery, resemble a grating sound)

Signs and symptoms of RHD includes all of the following except A) precordial chest discomfort B) cardiomegaly C) pericardial friction rub D) pericardial effusion E) night sweats

depression inversion elevation

Transient ST segment _______ and T wave ______ are characteristic signs of ischemia that involves ONLY the inner wall of the myocardium ST _______ is indicative of ischemia involving the FULL myocardial wall. (Huether 615)

incompetence insufficiency

Two other names for regurgitation are: ______ and _____

A B C D E (all of them do)

Which of the following organism contributes to infective endocarditis? (select all that apply) A) parasites B) rickettisae C) fungi D) viruses E) bacteria

thiazide diuretics ACE inhibitors ARBS CCB (Beta blockers were found to have a higher rate of stroke the ANG 2 blockers and are not recommended as first line medications)

What are drug recommendations made by JNC 8 for treatment of hypertension?

-occlusion of artery causing ischemia -can become a thromboembolus (dislodged piece of thrombus floating in the vascular system) which can get lodge into the distal systemic vascular bed

What are two potential threats to the circulation? (pg. 598)

constrict

What does nicotine do to the vessels (constrict/dilate)

Pulmonary embolism

What is a high risk of untreated DVT that does not dissolve with out treatment? (pg. 598)

An underlying disorder (unlike primary hypertension where the cause is unknown, secondary hypertension is usually caused by an underlying disorder such as renal disease)

What is secondary hypertension caused by? (pg. 600)

Rheumatic fever (that progresses to Rheumatic heart disease)

What is this pathogenesis process describing? Pharyngeal infection induces an abnormal immune response that attacks group A Beta-strep. These antibodies attacking the M proteins of A Beta-streps can cross-react with other similar self-antigens in the heart, skin, joints, and nervous system. This type of streptococcal infection causes an autoimmune response against self-antigens causing inflammatory lesions, mostly distinctive in the heart called Aschoff bodies, valvular deformities, and fibrosis. (629)

Atherosclerosis

What is this pathophysiology describing? pg. 610 This disease begins with inflammation of endothelium. Macrophages are activated and bind to molecules released by damaged cells (DAMPs) and inflammatory cytokines are released. LDL becomes oxidized into the vessel wall where macrophages follow to engulf creating foam cells. Macrophages releases growth factors which migrate over fatty streaks, an accumulation of foam cells, and build fibrous plaques that are prone to rupture.

Myocardial infarction

What pathogenesis process does this describe? Ischemia and oxygen deprivation begins this process after 8-10 seconds of decreased blood flow. Aerobic metabolism switches to anaerobic metabolism which causes an acidosis state because of lactic acid build up. Ischemia releases catecholamines which are mediate the release of glycogen, glucose, and stored fat increasing serum concentration. Norepinephrine elevates glucose level and inhibits pancreatic beta-cell activity. Angiotension 2 is also release as a result of ischemia which increases vasoconstriction and fluid retention; acts as a growth factor for vascular smooth muscles, myocytes, and cardiac fibroblast causing remodeling; and promotes catecholamine releasing leading to coronary artery spasm. After 20 minutes, CPK-MB and troponin are released from damaged myocytes.

Acute pericarditis

When listening to the apex of the heart, the nurse hears scratch, grating sound. Upon assessment, patient seemed to be restless and irritable with low grade fever. What are these signs indicative of? (pg. 622)

B D E (Though advanced age and gender are risk factors of CAD, they are NOT modifiable risk factors. Other modifiable risk factors are diabetes, smoking, sedentary lifestyle, and atherogenic diet)

Which of the following are modifiable risk factors for CAD? (pg. 610) (Select all that apply) A) advanced age B) dyslipidemia C) hypertension D) gender E) obesity

A D (Dyslipidemia, hypertension, and obesity are modifiable risk factors for CAD. Another NONmodifiable risk factor include family history)

Which of the following are nonmodifiable risk factors for CAD? (Select all that apply) A) advanced age B) dyslipidemia C) hypertension D) gender E) obesity