Cardiovascular Conditions Chapter 19

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Questions and Answers

Patients with unstable coronary disease have lower levels of C-reactive protein compared to those with stable coronary disease.

False

What does the New York Heart Association Angina Classification Class II indicate?

No limitation of physical activity.

Slight limitation of physical activity. (correct)

Moderate limitation of physical activity.

Unable to perform any physical activity without discomfort.

What are some common causes of Atrial Fibrillation (AF)?

Medical conditions such as aging, post MI, heart failure, hyperthyroidism, and drug-related issues like illicit drug abuse.

Which risk factor cannot be changed?

Age Signup and view all the answers

Acute coronary syndrome (ACS) consists of a spectrum of clinical presentations of acute myocardial and .

ischemia, infarct Signup and view all the answers

Match the following myocardial infarcts with their characteristics:

Q-Wave MI = Large infarct size Non-Q Wave MI = Frequent spontaneous reperfusion Signup and view all the answers

What should patients do to reduce cardiovascular disease risk after surgery?

Participate in lifestyle modifications such as regular exercise and smoking cessation. Signup and view all the answers

What percentage of patients with AF experience clotted blood dislodging from the atria resulting in a stroke?

5% Signup and view all the answers

What factors can increase the risk of stroke or heart failure in patients with AF? (Select all that apply)

Hypertension Signup and view all the answers

What are common clinical presentations of atrial fibrillation?

Palpitations, arrhythmias, dyspnea, chest discomfort, and dizziness. Signup and view all the answers

Which type of atrial fibrillation is characterized by brief episodes that can resolve on their own?

Paroxysmal AF Signup and view all the answers

What is the hallmark feature of hypertrophic cardiomyopathy?

Massive ventricular hypertrophy. Signup and view all the answers

Cardiac effusion is an abnormal fluid accumulation in the ______ space.

pericardial Signup and view all the answers

Cardiac tamponade is caused by fluid accumulation that compresses the heart, leading to decreased cardiac output.

True Signup and view all the answers

What is a common clinical presentation of cardiac tamponade?

Jugular venous distension, hypotension, and muffled heart sounds. Signup and view all the answers

Which condition is characterized by redness, warmth, and swollen calf muscle with pain on palpation?

Deep Vein Thrombosis (DVT) Signup and view all the answers

What type of patients often show symptoms of claudication, such as pain and cramping in the lower leg?

Patients with peripheral arterial disease. Signup and view all the answers

What is the main distinguishing factor of peripheral arterial diseases from venous insufficiency?

Absence of pulses in the affected limb Signup and view all the answers

Match the following medications with their effects:

Diuretics = Reduces plasma volume Beta-blocker = Decreases the work of the heart Calcium channel blocker = Relaxes blood vessels ACE-inhibitor = Vasodilator and antihypertensive Signup and view all the answers

What is the recommended frequency for ambulation in patients with claudication from peripheral vascular disease?

3 to 5 times per week Signup and view all the answers

What is the definition of congestive heart failure?

The inability of the heart to pump sufficient amounts of oxygenated blood to meet the metabolic demands of the body both at rest and during activity. Signup and view all the answers

Which of the following can be causes of right-sided heart failure? (Select all that apply)

COPD Signup and view all the answers

What is the medical management approach for congestive heart failure?

Reversing or optimizing the underlying problem, using diuretics, balancing fluids, controlling hypertension, and improving cardiac function. Signup and view all the answers

What is the prevalence of hypertension in adults aged 18 years and older?

50 million Americans Signup and view all the answers

Hypertension is often referred to as a silent killer.

True Signup and view all the answers

The condition of _________ is characterized by arterial hypertension with an unknown etiology.

primary hypertension Signup and view all the answers

Which of the following conditions can lead to secondary hypertension? (Select all that apply)

Hyperthyroidism Signup and view all the answers

Match the following characteristics of chest pain to their respective conditions:

Angina = Sternal, substernal Pericarditis = Left sided, substernal Musculoskeletal = Variable over chest wall Signup and view all the answers

What are common symptoms associated with systolic dysfunction in CHF?

Shortness of breath, frothy pinkish sputum, dyspnea, orthopnea. Signup and view all the answers

Episodes of angina indicate that a heart attack is imminent.

False Signup and view all the answers

Study Notes

Cardiovascular Conditions Overview

Congestive heart failure (CHF) is the heart's inability to pump sufficient oxygenated blood to meet bodily demands.
CHF can manifest as right-sided or left-sided heart failure, with systemic or pulmonary congestion respectively.
Right-sided heart failure is related to systemic venous hypertension and can arise from conditions like COPD and pulmonary hypertension.
Left-sided heart failure can lead to pulmonary congestion and is often caused by ischemic heart disease and valvular disorders.

Congestive Heart Failure (CHF) Mechanisms

Diastolic dysfunction leads to high left ventricular end-diastolic pressure and pulmonary edema; associated with restrictive cardiomyopathy and severe mitral regurgitation.
Systolic dysfunction results from decreased myocardial contractility, leading to reduced ejection fraction.
Symptoms include shortness of breath, orthopnea, and frothy sputum, indicating pulmonary edema.

Hypertension

Defined as elevated systolic (>140 mmHg) and/or diastolic (>90 mmHg) blood pressure, classified as primary or secondary.
Approximately 50 million Americans are hypertensive, with prevalence increasing with age.
Primary hypertension has unknown etiology, while secondary hypertension is linked to underlying conditions like renal disease or Cushing's syndrome.

Clinical Presentation and Consequences of Hypertension

Often asymptomatic, termed as a "silent killer," until it leads to complications like left ventricular hypertrophy, stroke, or heart failure.
Patients may experience symptoms as target organ damage occurs, such as dyspnea and fatigue.

Angina

Defined as chest pain from myocardial ischemia due to supply-demand imbalance; typically relieved by rest or nitroglycerin.
Stable angina has reversible ischemia with normal resting EKG; however, unstable angina presents increased risk of heart attack.
New York Heart Association classification ranges from Class I (no limitation) to Class IV (discomfort at rest).

Medical Management

CHF management includes optimizing underlying issues, using diuretics, controlling hypertension, and improving heart function.
Hypertension treatment involves lifestyle modifications (diet, exercise) and antihypertensive medications, especially for patients with additional risk factors.
Angina management includes medication for symptom relief, lifestyle changes, and gradually increasing physical activity.

Key Symptoms and Diagnostic Indicators

CHF symptoms include dyspnea, orthopnea, and audiological signs like S3 and S4 heart sounds.
Hypertension shows medial hypertrophy in arterial walls; left ventricular dilation can develop over time.
Angina's distinguishing features include location, quality of pain, and response to rest or medication.

Important Terminology

Cor pulmonale: Right heart failure due to pulmonary issues.
Ejection Fraction: Measurement of the percentage of blood leaving the heart each time it contracts.
Stable vs. Unstable Angina: Stable angina is predictable and relieves with rest; unstable can occur unpredictably and suggests worse prognosis.

Medication Overview

Commonly prescribed medications in CHF, hypertension, and angina management include diuretics, ACE inhibitors, beta-blockers, and nitrates.### Acute Coronary Syndrome (ACS)
ACS comprises clinical scenarios of acute myocardial ischemia and infarction, identifiable by chest pain, ischemic EKG changes, and elevated troponin I levels.
Pathophysiologically, ACS results from an imbalance between myocardial oxygen supply and demand, leading to potential irreversible myocardial damage.
Supply ischemia can emerge from coronary vasospasm, thrombus formation, and significant arterial stenosis, while demand ischemia relates to increased cardiac workload during physical or emotional stress.

Cardiovascular Disease Risk Factors

Unmodifiable Risk Factors:
- Age, male gender, and family history increase cardiovascular disease (CVD) risk.
Modifiable Risk Factors:
- Smoking has severe detrimental effects on heart health.
- Diabetes management is critical to reduce risk.
- High serum cholesterol must be managed with diet and lifestyle changes.
- Hypertension treatment is essential; exercise slightly reduces systolic and diastolic BP.
- Obesity-related weight loss benefits cardiovascular health.
- Left ventricular hypertrophy indicates increased heart risk.
Protective Factors:
- Elevated HDL cholesterol, an active lifestyle, estrogen replacement therapy, and moderate alcohol consumption offer some protection against CVD.

Myocardial Infarcts

Differentiating Q-Wave vs Non-Q-Wave Myocardial Infarcts:
- Q-wave infraction prevalence at 47% with high incidence of coronary occlusion (80-90%), results in higher in-hospital mortality (10-15%).
- Non-Q-wave infarctions have lower mortality rates (3-5%) and are generally smaller in infarct size.
Clinical Presentation of ACS:
- Stages include unstable angina, non-ST elevation MI (non-Q-wave), and ST elevation MI (Q-wave).
- Unstable angina is characterized by prolonged, variable chest pain, associated symptoms like nausea and dyspnea, and ECG changes during episodes.
- Non-ST elevation MI presents with elevated troponin I and potential early reperfusion.
- ST elevation MI indicates myocardial death, detectable by ECG changes and elevated troponin I.

Diagnostic Tests

Echocardiograms assess wall motion and ventricular function post-MI.
Technetium-99m scans evaluate myocardial blood flow, while thallium scans focus on viable myocardium.
Coronary angiography is essential before angioplasty in non-responsive cases.

Complications of Acute Myocardial Infarction

Common complications include:
- Arrhythmias, which can be self-limiting.
- Heart failure, particularly in older patients or those with significant left ventricular damage.
- Ongoing angina and infarct extension indicating worsening ischemia.
- Cardiogenic shock, especially with large anterior MIs.

Medical and Surgical Interventions

Treatment focuses on restoring myocardial perfusion through thrombolytics, angioplasty, and CABG if necessary.
Lifestyle modifications have resulted in a significant decrease in CVD mortality in the U.S. between 1980 and 1990 through dietary changes and regular exercise.

Coronary Artery Bypass Graft (CABG)

Indicated for patients with severe symptoms unresponsive to medical management.
Involves sternotomy and the use of grafts from internal mammary arteries or saphenous veins.
Postoperative care includes close monitoring in intensive care and gradual rehabilitation involving breathing exercises and mobilization.

Atrial Fibrillation (AF)

AF sees uncoordinated atrial quivering leading to high ventricular rates, potentially up to 600 beats per minute.
Causes include age, post-MI changes, heart failure, hyperthyroidism, and drug interactions.
Increases risk of stroke due to thrombus formation in the atria.

Types of Atrial Fibrillation

Paroxysmal AF: Self-resolving episodes.
Persistent AF: Requires intervention to restore normal rhythm.
Permanent AF: Rhythm restoration is brief and often not sustainable.

Cardiomyopathies

Dilated Cardiomyopathy: Characterized by ventricular enlargement and systolic dysfunction, rooted in various etiologies such as idiopathic causes or hypertension.
Hypertrophic Cardiomyopathy: Identified by significant ventricular wall thickening, leading to diastolic dysfunction and potential arrhythmias.
Restrictive Cardiomyopathy: Marked by impaired ventricular filling due to decreased compliance, affecting diastolic function.### Cardiomyopathy
Cardiomyopathy is a disease affecting heart muscle, leading to decreased contractile function and cardiac output.
Etiologies include genetic factors, viral infections, toxins (like lead and alcohol), and often remain idiopathic.
Ventricular remodeling results in structural reorganization, loss of wall motion, and overall decline in function, frequently a consequence of acute coronary syndrome.
Common symptoms include exertional dyspnea, fatigue, normal/low blood pressure, sinus tachycardia, basal crackles, jugular venous distension, and peripheral edema.
Severe cases may lead to hepatomegaly, ascites, and muscle wasting.
Management focuses on treating underlying causes, enhancing cardiac output, and mitigating heart failure.

Cardiac Effusion and Cardiac Tamponade

Cardiac effusion is fluid accumulation in the pericardial space; cardiac tamponade occurs when this fluid compresses the heart.
The pericardium consists of an outer fibrous layer and an inner serous layer, protecting the heart from infections and inflammation.
Pericarditis can arise after malignancy, cardiac surgery, MI, or tuberculosis, leading to cardiac effusion.
Normal pericardial fluid volume is ~20 ml, but it can accommodate an additional 120 ml.
Symptoms of pericarditis include chest pain, dyspnea, low-grade fever, and pericardial friction rub.
Cardiac tamponade symptoms comprise jugular venous distension, hypotension, muted heart sounds, and pulsus paradoxus.
Diagnostics include EKG, echocardiography, CT scan; management involves treating the cause and fluid drainage via chest tube or surgical pericardial window.

Peripheral Vascular Disease

Peripheral vascular disease entails arterial (e.g., atherosclerosis) and venous (e.g., thrombo-embolism) issues compromising blood supply.
Atherosclerosis and thrombo-embolism are common causes of arterial insufficiency, while venous insufficiency may arise from obesity, malignancy, and surgery-related issues.
Deep vein thrombosis (DVT) often follows immobility or surgery, potentially leading to chronic insufficiency.
Arterial occlusive disease presents as pain, swelling, and a pale limb; absent pulses differentiate it from venous issues.
Claudication symptoms occur with activity, often relieved by rest; in chronic cases, wounds may heal slowly or develop gangrene.
Venous insufficiency symptoms typically involve redness, warmth, swelling, and tenderness in the calf with potential DVT diagnosis via Doppler ultrasound.
Treatment for arterial insufficiency includes medications, proper foot care, and immediate intervention for occlusions; DVT management involves anticoagulation therapy.

Common Medications for Cardiac Patients

Diuretics (e.g., Furosemide) help reduce plasma volume and manage hypertension.
Beta-blockers (e.g., Metoprolol) decrease heart workload and have antiarrhythmic effects; caution with asthmatic patients.
Calcium channel blockers (e.g., Diltiazem) lower blood pressure, relieve angina, and reduce heart workload by relaxing blood vessels.
ACE inhibitors (e.g., Enalapril) act as vasodilators to manage heart failure and hypertension, often causing dizziness and cough.
Angiotensin II receptor blockers have similar effects to ACE inhibitors with fewer side effects (e.g., Valsartan).
Nitroglycerin is prescribed for angina, lowering blood pressure and reducing myocardial oxygen demand.
Thrombolytics (e.g., Alteplase) are used in myocardial infarction patients; aspirin and anticoagulants prevent thrombus formation.

Ambulation Program for Claudication

Begin with warm-up and cool-down lasting 5-10 minutes.
Start treadmill or track walking to induce claudication symptoms, resting if needed before resuming.
Gradually increase ambulation duration to a maximum of 50 minutes through cycles of walking and resting.
Aim for frequency of 3 to 5 times per week to improve symptoms and functionality.

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This quiz covers the essential aspects of cardiovascular conditions including definition, etiology, pathophysiology, and medical management. Key topics include congestive heart failure, hypertension, and atrial fibrillation among others. Test your understanding and deepen your knowledge of these critical health issues.