Chapter 12 Cardiovascular Disorders [Complete]

What does the antidiuretic hormone do to blood pressure?

It increases blood pressure.

What is the significance of the medulla oblongata in the cardiac system?

It is the cardiac control center that controls rate and force of contraction.

What are other sites of inflammation in rheumatic fever and rheumatic disease?

Large joints, erythema marginatum, non-tender subcutaneous nodules and causes involuntary jerky movement of the face, arms, legs.

What is atherosclerosis?

Presence of atheromas in large arteries. Plaques consisting of lipids, calcium, and possible clots. Related to diet, exercise, and stress.

What are treatments for rheumatic fever and rheumatic disease?

Prophylactic antibacterial agents and anti-inflammatory agents.

In an electrocardiogram, what wave represents depolarization of the ventricles?

QRS wave.

What are treatments for a myocardial infraction?

Reduce cardiac demand, oxygen therapy, analgesics, anticoagulants, thrombolytic agents may be used, and tissue plasminogen activator. Use of medication to treat dysrhythmias, hypertension, congestive heart failure. Cardiac rehabilitation begins immediately.

For general treatment measures for cardiac disorders, what is the purpose in using anticoagulants?

Reduces risk of blood clot formation.

For general treatment measures for cardiac disorders, what is the purpose in using cholesterol-lowering drugs?

Reduction of low-density lipoproteins and cholesterol content.

For general treatment measures for cardiac disorders, what is the purpose in using vasodilators?

Reduction of peripheral resistance.

What is diastole?

Relaxation of myocardium required for filling chambers.

What is treatment for angina pectoris?

Relieved by rest and administration of coronary vasodilators like nitroglycerin. Coronary vasodilators primarily act on reduction of systemic resistance, decreasing the demand for oxygen.

For general treatment measures for cardiac disorders, what is the purpose in using diuretics?

Removes excess sodium and/or water. Treatment of high BP and congestive heart failure.

What is diastolic pressure?

Sustained pressure when ventricles relax (lower). Blood pressure (BP) is altered by cardiac output, blood volume, and peripheral resistance to blood flow.

In an electrocardiogram, what wave represents repolarization of the ventricles?

T wave.

What is ausculation?

The diagnostic test for detection of valvular abnormalities or abnormal shunts of blood that cause murmors.

Describe chest pain in angina pectoris.

They are recurrent, intermittent brief episodes of substernal chest pain. Triggered by physical or emotional stress. Attacks vary in severity and duration but become more frequent and longer as disease progresses. There is classic or exertional angina, variant angina (vasospasm occurs at rest), and unstable angina (prolonged pain at rest; may precede myocardial infarction).

What are backup effects of left-sided heart failure?

They are related to pulmonary congestion. Dyspnea and orthopnea develops as fluid accumulates in the lungs. Cough associated with fluid irritating the respiratory passages. Paroxysmal nocturnal dyspnea indicating the presence of acute pulmonary edema, usually develops during sleep and the excess fluid in lungs frequently leads to infections such as pneumonia.

What is high-density lipoprotein (HDL)?

They are the transport of cholesterol away from the peripheral cells to liver and cosidered "good" lipoprotein. Catabolism in liver and excretion.

What is low-density lipoprotein (LDL)?

They are the transport of cholesterol from liver to cells and is a major factor contributing to atheroma formation.

How are lipids transported?

They are transported in combination with proteins.

What are baroreceptors?

They detect changes in blood pressure. They are located in the aorta and internal carotid arteries.

For general treatment measures for cardiac disorders, what is the purpose in using digoxin?

Treatment for heart failure. It is an antidysrhythmic drug for atrial dysrhythmias.

For general treatment measures for cardiac disorders, what is the purpose in using beta-blockers?

Treatment of hypertension and dysrhythmias. Reduction of angina attacks.

What is an ECG?

Used in the initial diagnosis and monitoring of dysrhythmias, myocardial infarction, infection, pericarditis.

For general treatment measures for cardiac disorders, what is the purpose in using antihypertensive drugs?

Used to lower blood pressure.

What is cardiac congenital heart disease?

Valvular defects and septal defects detected by the presence of heart murmurs. If untreated, child may develop heart failure.

If there is an increase in cardiac output, what happens to blood vessels and blood pressure?

Vasoconstriction and increased blood pressure.

If there is an decrease in cardiac output, what happens to blood vessels and blood pressure?

Vasodilation and decreased blood pressure.

What is stroke volume?

Volume of blood pumped out of the ventricles in each contraction.

What are the treatments for atherosclerosis?

Weight loss, increased exercise, lower total serum cholesterol and LDL levels by dietary modification, reduce sodium intake, control hypertension, cessation of smoking, anti-lipidemic drugs, angioplasty-catheter with baloon inserted to widen artery, and surgical intervention ( such as a coronary artery bypass graft).

What causes cardiac arrest?

Excessive vagal nerve stimulation, potassium imbalance, cardiogenic shock, drug toxicity, insufficient oxygen, respiratory arrest, and a blow to heart.

What is systolic pressure?

Exerted when blood is ejected from ventricles (high).

What are diagnostic test for infective endocarditis?

A blood culture to identify causative agent.

For general treatment measures for cardiac disorders, what is the purpose in using adrenergic-blocking drugs?

Acts on sympathetic nervous system centrally or on the periphery.

What is rheumatic fever and rheumatic disease?

Acute systemic inflammatory condition. May result from an abnormal immune reaction. Few weeks after an untreated infection (usually group A beta-hemolytic Streptococcus). Involves heart as well as joints. Usually occurs in children age 5 to 15. Long-term effects include rheumatic heart disease and may be complicated by infective endocarditis and heart failure in older adults.

What are risk factors for atherosclerosis?

Age, gender, genetic or familial factors, obesity, sedentary lifestyle, cigarette smoking, diabetes mellitus, poorly controlled hypertension, and the combination of oral contraceptives and smoking.

What is preload?

Amount of blood delivered to heart by venous return.

What are treatments for infective endocarditis?

Antimicrobial drugs for several weeks, often by IV.

How are blood test used as a diagnostic test for cardiovascular function?

Assess serum triglycerides, cholesterol levels, levels of sodium, potassium, calcium and other electrolytes.

Explain the cardiac cycle.

Atria relaxed, filling with blood > AV valves open, blood flows into ventricles > atria contract, remaining blood forced into ventricles > atria relax while ventricles contract > AV valves close and semilunar valves open > blood enter the aorta and pulmonary artery > ventricles relax.

What are the two types of heart valves?

Atrioventricular valves and semilunar valves.

What is the formula for blood pressure?

BP = Cardiac output × Peripheral resistance

For general treatment measures for cardiac disorders, what is the purpose in using angiotensin-converting enzyme (ACE) inhibitors?

Blocks conversion of angiotensin I to angiotensin II, lowering blood pressure.

What is cardiac output?

Blood ejected by a ventricle in one minute. Cardiac output = Stroke volume × Heart rate (number of ventricle contractions in one minute)

What is blood pressure directly proportional to?

Blood volume.

What are sinus node (pacemaker of the heart) abnormalities?

Bradycardia (regular but slow heart rate), tachycardia (regular rapid heart rate), sick sinus syndrome (marked by altering bradycardia and tachycardia, often requires mechanical pacemaker).

What are lipoproteins?

Carriers of cholesterol and triglycerides. They are insoluble in plasma.

What are treatments for cardiac dysrhythmias?

Cause needs to be determined and treated, antidysrhythmic drugs are effective in many cases, SA nodal problems or total heart block require pacemaker, and defibrillator may be implanted for conversion of ventricular fibrillation.

What causes a murmur heart sound?

Caused by incompetent valves.

What does the renin-angiotensin-aldosterone hormone do to blood pressure?

Causes vasoconstriction, increasing blood pressure.

What is cardiac arrest?

Cessation of all heart activity. No conduction of impulses and a flat ECG.

What are diagnostic test for a myocardial infraction?

Changes in ECG, serum enzymes and isoenzymes, serum levels of myosin and cardiac troponin are elevated, leukocytosis, elevated CRP and ESR common, arterial blood gas measurements may be altered in severe cases, and pulmonary artery pressure measurements are helpful.

What is the "lubb" heart sound?

Closure of AV valves.

What is the "dubb" heart sound?

Closure of semilunar valves.

What is systole?

Contraction of myocardium provides increase in pressure to eject blood.

For general treatment measures for cardiac disorders, what are the dietary modifications?

Decrease total fat intake, general weight reduction and reduce salt intake.

What are signs and symptoms of congestive heart failure?

Decreased blood supply to tissues, general hypoxia, fatigue and weakness, dyspnea and shortness of breath, tachycardia, cutaneous and visceral vasoconstriction, and daytime oliguria.

What does parasympathetic stimulation do to the heart?

Decreases the heart rate (bradycardia). Stimulated by the vagus nerve.

For general treatment measures for cardiac disorders, what is the purpose in using calcium channel blockers?

Decreasing cardiac contractility. Acts as an antihypertensive, vasodilator and a prophylactic against angina.

For general treatment measures for cardiac disorders, what is the purpose in cessation of smoking?

Decreasing risk of coronary disease.

What are signs of right-sided heart failure and systemic backup?

Dependent edema in feet, legs, or buttocks. Increased pressure in jugular veins > distention. Hepatomegaly and splenomegaly. Digestive disturbances. Ascites (a complication when fluid accumulates in peritoneal cavity and is marked abdominal distention). Acute right-sided failure causing flushed face, distended neck veins, headache, visual disturbances

What are cardiac dysrhythmias (arrhythmias)?

Deviations from normal cardiac rate or rhythm. Caused by electrolyte abnormalities, fever, hypoxia, stress, infection, drug toxicity. ECG used as method of monitoring the conduction system and detecting abnormalities. Reduction of the efficiency of the heart's pumping cycle. Many types of abnormal conduction patterns exist.

What is an angiography?

Diagnostic test for visualization of blood flow in the coronary arteries.

What are doppler studies?

Diagnostic test that assess blood flow in peripheral vessels. Records sounds of blood flow or obstruction.

What is arterial blood gas determination?

Diagnostic test that check the current oxygen level and acid-base balance.

What is the exercise stress test?

Diagnostic test to assess general cardiovascular function.

What is a cardiac catheterization?

Diagnostic test to measure pressure and assess valve and heart function. Determination of central venous pressure and pulmonary capillary wedge pressure

What is echocardiography?

Diagnostic test to record the heart valve movements, blood flow, and cardiac output.

What are chest x-ray films?

Diagnostic test used to show shape and size of the heart. Includes nuclear imaging and tomographic studies.

What is a pulse deficit?

Difference in rate between apical and radial pulse.

What are signs of a heart attack?

Feeling of pressure, heaviness, or burning in chest especially with increased activity. Sudden shortness of breath, weakness, fatigue, nausea, indigestion, anxiety and fear. Pain may occur and if present is usually substernal, crushing, and radiating.

What is afterload?

Force required to eject blood from ventricles. Determined by peripheral resistance in arteries.

What is arteriosclerosis?

General term for all types of arterial changes. Degenerative changes in small arteries and arterioles, loss of elasticity, lumen gradually narrows and may become obstructed, cause of increased BP.

Describe stable plaque.

Have thick fibrous caps, partially block vessels, and do not tend to form clots or emboli.

Describe unstable plaque.

Have thin fibrous caps, plaque can rupture and cause a clot to form, and may completely block the artery or become an embolus.

What are diagnostic tests for rheumatic fever and rheumatic disease?

Heart function test, ECG and ASO titer.

What causes congestive heart failure?

Heart is unable to pump out sufficient blood to meet metabolic demands of the body. Usually a complication of another cardiopulmonary condition. Various compensation mechanisms maintain cardiac output. Some of them often aggravate the condition.

What does a pulse indicate?

Heart rate.

What are complications of atheriosclerosis?

In the brain a cerebrovascular accident (CVA), in the limbs a peripheral arterial disease (PAD), and in the heart a coronary artery disease (CAD). CAD is asymptomatic initially. Symptoms appear when one of coronary arteries is 75% occluded with first symptom being chest pain after exertion.

What factors can increase heart rate?

Increased thyroid hormones or epinephrine, elevated body temperature, infection, increased environmental temperature (especially in high humidity), exertion or exercise, smoking, stress response, pregnancy and pain.

What does the aldosterone hormone do to blood pressure?

Increases blood volume, increasing blood pressure.

What does sympathetic stimulation do to the heart?

Increases the heart rate (tachycardia).

For general treatment measures for cardiac disorders, what is the purpose in the regular exercise program?

Increasing high-density lipoprotein, lower serum lipid levels and reducing stress levels.

What happens when there is decreased cardiac output or stroke volume in congestive heart failure?

Less blood reaches the various organs, there is decreased cell function, fatigue and lethargy, and mild acidosis develops.

What are signs and symptoms of infective endocarditis?

Low-grade fever, fatigue, anorexia, splenomegaly, congestive heart failure in severe cases. In acute endocarditis: Sudden, marked onset with spiking fever, chills, drowsiness. In subacute endocarditis: Insidious onset with increasing fatigue, anorexia, cough, and dyspnea.

What are signs and symptoms of rheumatic fever and rheumatic disease?

Low-grade fever, leukocytosis, malaise, anorexia, fatigue, tachycardia.

In an electrocardiogram, what wave represents repolarization of atria?

None. It is hidden by the QRS wave.

What is a myocardial infraction?

Occurs when coronary artery is totally obstructed. Atherosclerosis is most common cause. Thrombus from atheroma may obstruct artery. Vasospasm is cause in a small percentage. Size and location of the infarct determine the damage.

What causes angina pectoris?

Occurs when there is a deficit of oxygen to meet myocardial needs.

What happens when backup and congestion developing as coronary demands for oxygen and glucose are not met in congestive heart failure?

Output from ventricle is less than the inflow of blood. Congestion in venous circulation draining into the affected side of the heart.

In an electrocardiogram, what wave represents depolarization of atria?

P wave.

What are the acute stages in inflammation of the heart?

Pericarditis. Myocarditis. Endocarditis and incompetent heart valves.

What are atrial conduction abnormalities?

Premature atrial contractions or beats (PAC/PAB) (extra contraction or ectopic beats caused by irritable atrial muscle cells outside conduction pathway), atrial flutter (atrial heart rate of 160 to 350 beats/min, AV node delays conduction; ventricular rate is slower), and atrial fibrillation (rate over 350 beats/min causing pooling of blood in the atria and thrombus formation is a risk).

What are predisposing factors for infective endocarditis?

Presence of abnormal valves in heart, bacteremia, and reduced host defenses.

What are the diagnostic test for atherosclerosis?

Serum lipid levels.

What is a cause of acute infective endocarditis?

Staphylococcus aureus.

What is a cause of subacute infective endocarditis?

Streptococcus viridans (low virulence) that is part of resident flora.

What are cardiac anomalies?

Structural defects in the heart that develop during the first 8 weeks of embryonic life.

What are complications for a myocardial infraction?

Sudden death, cardiogenic shock, congestive heart failure, rupture of necrotic heart tissue/cardiac tamponade and thromboembolism causing CVA (with left ventricular MI).