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Cardiac Pathophysiology PPT #2
171 Questions
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Cardiac Pathophysiology PPT #2

Created by
@Harmony.Alexis_

Questions and Answers

Hypertension is a primary risk factor in the development of ______, congestive heart failure, and cardiomyopathy.

coronary artery disease

Chronic untreated hypertension increases the incidence of ______, stroke, and chronic kidney disease.

myocardial infarction

Due to the development of ______, chronic untreated hypertension can lead to serious health issues.

atherosclerosis

______ is a significant risk associated with chronic hypertension.

<p>Stroke</p> Signup and view all the answers

Hypertension can lead to serious conditions such as cardiomyopathy and ______.

<p>congestive heart failure</p> Signup and view all the answers

What percentage of hypertension cases are classified as essential hypertension?

<p>95%</p> Signup and view all the answers

Which of the following conditions is NOT a known cause of secondary hypertension?

<p>Renin-angiotensin-aldosterone syndrome</p> Signup and view all the answers

Which factor is likely involved in the development and severity of essential hypertension?

<p>Genetic predisposition and environmental risk factors</p> Signup and view all the answers

What is the primary characteristic that differentiates essential hypertension from secondary hypertension?

<p>Essential hypertension is diagnosed based on exclusion of other causes.</p> Signup and view all the answers

Which of the following is a potential complication associated with chronic essential hypertension?

<p>Chronic kidney disease</p> Signup and view all the answers

What primarily causes hypertension associated with dysregulation of the autonomic nervous system?

<p>Impaired baroreflex and chemoreflex pathways</p> Signup and view all the answers

Dysregulated renin release contributes to hypertension by increasing aldosterone levels.

<p>True</p> Signup and view all the answers

What is the role of angiotensin II in the body?

<p>Vasoconstriction and adrenal release of aldosterone</p> Signup and view all the answers

The normal function of the classical renin-angiotensin-aldosterone system provides control of extracellular fluid volume and ______.

<p>blood pressure</p> Signup and view all the answers

Match the following components with their functions in the autonomic nervous system:

<p>Cardiac stretch receptors = Detect changes in blood volume Vascular baroreceptors = Monitor blood pressure changes Peripheral chemoreceptors = Sense blood gas levels Central regulatory processes = Integrate emotional and stress responses</p> Signup and view all the answers

Which of the following is a known factor that can affect the efficacy of ACE inhibitors in females?

<p>Sex hormones affecting angiotensin receptors</p> Signup and view all the answers

Oxidative stress is associated with improved endothelial function.

<p>False</p> Signup and view all the answers

What substances does the vascular endothelium produce in response to blood flow?

<p>Nitric oxide and endothelin</p> Signup and view all the answers

Which peptide is released from the endothelium?

<p>C-type natriuretic peptide (CNP)</p> Signup and view all the answers

Natriuretic peptides have a long half-life.

<p>False</p> Signup and view all the answers

Match the conditions with their likelihood of causing secondary hypertension:

<p>Cushing syndrome = More common in middle-aged adults Obstructive sleep apnea = More common in middle-aged adults Renal parenchymal disease = More common in children Coarctation of the aorta = More common in children</p> Signup and view all the answers

Which medication is a combination for treating heart failure?

<p>Sacubitril and valsartan</p> Signup and view all the answers

The baroreceptor reflex is stimulated by changes in arterial pressure.

<p>False</p> Signup and view all the answers

What condition is a major cause of secondary hypertension in children?

<p>Renal parenchymal disease</p> Signup and view all the answers

With hypertension, oxidative stress leads to impaired __________ function.

<p>endothelial</p> Signup and view all the answers

What effect does chronic hypertension have on arteries?

<p>Remodeling of the small and large arteries</p> Signup and view all the answers

What is the primary effect of dysregulated renin release in hypertension?

<p>Elevated angiotensin II levels</p> Signup and view all the answers

Oxidative stress has been linked to impaired endothelial function.

<p>True</p> Signup and view all the answers

What role does angiotensin II play in the regulation of blood pressure?

<p>Vasoconstriction and stimulation of aldosterone release</p> Signup and view all the answers

The _______ system is predominantly responsible for the regulation of extracellular fluid volume and blood pressure.

<p>renin-angiotensin-aldosterone</p> Signup and view all the answers

Match the following components of the autonomic nervous system with their functions:

<p>Cardiac stretch receptors = Integrate input to control heart rate Vascular baroreceptors = Measure arterial blood pressure Peripheral chemoreceptors = Detect blood oxygen levels Central regulatory processes = Coordinate autonomic responses to stress</p> Signup and view all the answers

Which factor may affect the efficacy of ACE inhibitors in females?

<p>Sex hormone influence</p> Signup and view all the answers

Local production of angiotensin II occurs only in the kidneys.

<p>False</p> Signup and view all the answers

What substances does the vascular endothelium produce in response to pulsatile blood flow?

<p>Nitric oxide and endothelin</p> Signup and view all the answers

Which of the following natriuretic peptides is released from the myocardium?

<p>Atrial natriuretic peptide (ANP)</p> Signup and view all the answers

Neprilysin degrades natriuretic peptides, leading to their prolonged effect in the body.

<p>False</p> Signup and view all the answers

What is the main physiological effect of the natriuretic peptides on vascular tone?

<p>Vasodilation</p> Signup and view all the answers

Baroreceptors are located in the walls of large _________ arteries.

<p>systemic</p> Signup and view all the answers

Match the following causes of secondary hypertension with the respective age groups they most commonly affect:

<p>Hyperaldosteronism = Middle-aged adults Renal parenchymal disease = Children Obstructive sleep apnea = Middle-aged adults Coarctation of the aorta = Children</p> Signup and view all the answers

Which medication combination has been shown to be more effective in treating heart failure than standard ACE inhibitors?

<p>Sacubitril and Valsartan</p> Signup and view all the answers

Chronic hypertension has no impact on the remodeling of arteries.

<p>False</p> Signup and view all the answers

What physiological phenomenon occurs when arterial pressure rises, causing the baroreceptors to transmit signals to the CNS?

<p>Baroreceptor reflex</p> Signup and view all the answers

In heart failure patients, natriuretic peptide axis (NPA)disruption results from decreased release of natriuretic peptides (NPs) and increased degradation through overexpression and activity of _______.

<p>neprilysin</p> Signup and view all the answers

Maximum baroreceptor reflex response occurs at ______ mmHg.

<p>180</p> Signup and view all the answers

In children, secondary hypertension is most commonly caused by renal parenchymal disease or coarctation of the ______.

<p>aorta</p> Signup and view all the answers

Chronic hypertension can lead to irreversible end-organ ______.

<p>damage</p> Signup and view all the answers

The majority of causes of secondary hypertension in middle-aged adults include hyperaldosteronism, thyroid dysfunction, and ______ syndrome.

<p>Cushing</p> Signup and view all the answers

Disseminated vascularopathy plays a major role in left ventricular hypertrophy, congestive heart failure, and ______ disease.

<p>cerebrovascular</p> Signup and view all the answers

Elevated blood pressure is not an automatic delay or cancelation of a procedure unless there is evidence of marked ______.

<p>HTN</p> Signup and view all the answers

Perioperative HTN can lead to increased blood loss and can result in myocardial ______.

<p>ischemia</p> Signup and view all the answers

Acute postoperative hypertension can lead to serious neurologic, cardiovascular, or surgical site complications requiring urgent __________.

<p>management</p> Signup and view all the answers

Malignant HTN is characterized by severe hypertension greater than ______ mmHg.

<p>210/120</p> Signup and view all the answers

The activation of the renin-angiotensin-aldosterone system is often __________ induced in patients experiencing stress during surgery.

<p>stress</p> Signup and view all the answers

Increased vasomotor tone is a response caused by __________ and hypercarbia.

<p>hypoxia</p> Signup and view all the answers

Chronic HTN with organ damage can lead to episodes of ______, which are associated with acute kidney disease.

<p>hypotension</p> Signup and view all the answers

A-line pressure monitoring is indicated for patients experiencing wide swings in ______.

<p>BP</p> Signup and view all the answers

Distension of the bladder or bowel can stimulate the __________ fibers of the sympathetic nervous system.

<p>afferent</p> Signup and view all the answers

Patients with a history of __________ are at a higher risk for myocardial infarction after undergoing anesthesia.

<p>myocardial infarction</p> Signup and view all the answers

The combination of physiologic factors associated with HTN results in patients being prone to hemodynamic ______.

<p>volatility</p> Signup and view all the answers

The ACC/AHA recommend waiting at least __________ days after a myocardial infarction before elective surgery.

<p>60</p> Signup and view all the answers

Patients undergoing surgery are increasingly at risk for coronary artery disease due to factors like advanced age, smoking, and __________.

<p>diabetes mellitus</p> Signup and view all the answers

Patients presenting with severe HTN with no prior diagnosis of ______ are considered exceptions to the delay in procedures rule.

<p>HTN</p> Signup and view all the answers

Risk of Myocardial Infarction after anesthesia: • Overall, after general anesthesia = ___% • MI three to six months prior to surgery = ____% • MI one to two months prior to surgery = ____% • MI less than 30 days of surgery = ____% If reinfarction occurs mortality rate is approximately ____%.

<p>0.3, 6, 19, 33, 50</p> Signup and view all the answers

Malignant HTN (Hypertensive Crisis) is a true medical emergency , characterized by severe hypertension (>210/120 mmHg) associated with papilledema and encephalopathy requiring vasodilator infusions & inpatient admission.

<p>papilledema encephalopathy</p> Signup and view all the answers

Perioperative HTN (poorly controlled) increases blood loss, can lead to ________ ________ & __________ events.

<p>myocardial ischemia cerebrovascular</p> Signup and view all the answers

General rule – maintain blood pressure intraoperatively within _____% to _____% above or below patient’s blood pressure norm outside the clinical setting (importance of thorough history of cardiovascular health).

<p>10 20</p> Signup and view all the answers

Match each event to its corresponding pathophysiology.

<p>Distension of the bladder, bowel, or stomach cause stimulation of the afferent fibers of the SNS = termination allows for SNS predominance &amp; frequently results in hyperdynamic &amp; hypertensive response even in patients with well-controlled hypertension Hypothermia = Increased catecholamine secretion in response to cold; Causes blood vessels to become more sensitive to catecholamines –arteriolar and venous vasoconstriction Hypoxia &amp; hypercarbia cause direct stimulation of vasomotor area of the medulla = Increase in plasma catecholamine levels Anesthesia = • increased vasomotor tone • Increased arteriolar constriction • Increased blood pressure</p> Signup and view all the answers

______ remains the leading cause of HTN and tachycardia in the PACU, and results in stimulation of the somatic afferent nerves, producing a pressor response known as ____________ reflex.

<p>Pain somatosympathetic</p> Signup and view all the answers

What primary factor distinguishes unstable angina from stable angina?

<p>Presence of cardiac biomarkers</p> Signup and view all the answers

Revascularization techniques are not indicated for patients with stable angina.

<p>False</p> Signup and view all the answers

What is the primary cause of ischemic heart disease?

<p>Atherosclerosis</p> Signup and view all the answers

_______ angina results from coronary vasospasm rather than occlusive disease.

<p>Variant</p> Signup and view all the answers

Match the type of angina with its characteristics:

<p>Stable angina = Predictable chest pain with exertion Unstable angina = Chest pain at rest or increased severity Variant angina = Caused by coronary vasospasm Noncardiac chest pain = Tenderness over costochondral junction</p> Signup and view all the answers

Which of the following is a condition that can exacerbate stable angina?

<p>Fever</p> Signup and view all the answers

Antiplatelet therapy can be safely discontinued at the discretion of anesthesia staff during surgery.

<p>False</p> Signup and view all the answers

What is the minimum required stenosis of the left main coronary artery for revascularization to be indicated?

<p>50%</p> Signup and view all the answers

Patients experiencing unstable angina may also have elevated levels of _______ biomarkers.

<p>cardiac</p> Signup and view all the answers

What is a common prerequisite for revascularization before non-cardiac surgery?

<p>Optimal medical therapy failure</p> Signup and view all the answers

What primarily causes coronary artery disease (CAD)?

<p>Plaque buildup in the coronary arteries</p> Signup and view all the answers

Stable angina typically occurs with a complete blockage of a coronary artery.

<p>False</p> Signup and view all the answers

What is the primary substance responsible for coronary vasodilation?

<p>Adenosine</p> Signup and view all the answers

The condition where blood flow through the coronary arteries is reduced due to narrowed vessels is known as ______.

<p>coronary artery disease</p> Signup and view all the answers

Match the following terms with their descriptions:

<p>Myocardial Oxygen Supply = Determined by arterial blood content and coronary blood flow Myocardial Oxygen Demand = Affected by preload and heart rate Angina Pectoris = Chest pain due to reduced blood flow Coronary Steal = Decreased flow to ischemic areas during vasodilation</p> Signup and view all the answers

Which of the following factors contributes to an increased myocardial oxygen demand?

<p>Increased preload</p> Signup and view all the answers

Vasodilatory substances can increase blood flow through stenotic regions of the coronary arteries.

<p>False</p> Signup and view all the answers

Name one of the vasodilatory substances released from the myocardium in response to decreased oxygen delivery.

<p>Adenosine</p> Signup and view all the answers

Patients with ischemic heart disease can experience ______, which may present as retrosternal chest discomfort.

<p>angina</p> Signup and view all the answers

In patients with CAD, what is a significant risk during surgery?

<p>Increased risk of cardiovascular complications</p> Signup and view all the answers

Revascularization by CABG or PCI with or without placement of intracoronary stents is indicated when optimal medical therapy fails to control angina pectoris or for specific lesions: • Left main coronary artery stenosis more than _____% • ____% or greater stenosis in an epicardial coronary artery

<p>50, 70</p> Signup and view all the answers

Elective noncardiac surgery is not recommended within ____ to ____ weeks after bare metal stent placement or within 12 month of placement of a drug-eluting stent if antiplatelet therapy needs to be discontinued.

<p>4, 6</p> Signup and view all the answers

General contraindications to surgery are a MI less than ____ month before surgery with persistent ischemic risk by symptoms or noninvasive testing, uncompensated heart failure, and severe aortic stenosis.

<p>1</p> Signup and view all the answers

What protein is considered a cardiac-specific biomarker for acute myocardial infarction?

<p>Troponin</p> Signup and view all the answers

Elevated troponin levels indicate myocardial necrosis in the absence of clinical symptoms.

<p>False</p> Signup and view all the answers

What is the primary area at risk for ischemia in patients with coronary artery disease?

<p>Subendocardium of the left ventricle</p> Signup and view all the answers

Acute coronary occlusion usually occurs in individuals with pre-existing ______ disease.

<p>atherosclerotic coronary artery</p> Signup and view all the answers

Match the following cardiac conditions with their respective indicators:

<p>Rise and/or fall of cardiac biomarkers = Evidence of myocardial ischemia Symptoms of ischemia = Chest pain or discomfort ECG changes = New ST-T changes Pathologic Q waves = Indication of previous myocardial injury</p> Signup and view all the answers

Which lifestyle change is NOT recommended for slowing the progression of atherosclerosis?

<p>Increased fat intake</p> Signup and view all the answers

Transesophageal echo (TEE) is less effective at detecting myocardial ischemia compared to EKG.

<p>False</p> Signup and view all the answers

What is the required oxygen consumption for cardiac muscle to remain viable?

<p>1.3 ml oxygen/100 g of muscle tissue/min</p> Signup and view all the answers

Flat or down sloping ST segment depression greater than ______ mV on the EKG is a reliable sign of myocardial ischemia.

<p>0.1</p> Signup and view all the answers

Which of the following is NOT a necessity for the diagnosis of myocardial infarction?

<p>Chest x-ray findings</p> Signup and view all the answers

What is a common symptom of non-ST segment elevation acute coronary syndrome (ACS)?

<p>Angina at rest lasting more than 10 minutes</p> Signup and view all the answers

Transient ST-segment elevation on an ECG is consistent with myocardial ischemia.

<p>True</p> Signup and view all the answers

What complication occurs in 10% to 15% of patients a few days after myocardial infarction?

<p>Pericarditis</p> Signup and view all the answers

The first stage of heart failure is known as Stage _____, where individuals are at risk but do not show symptoms.

<p>A</p> Signup and view all the answers

Which of the following processes is least likely associated with unstable angina or NSTEMI?

<p>Improved coronary luminal narrowing</p> Signup and view all the answers

Match the following complications of acute myocardial infarction (MI) with their description:

<p>Cardiac dysrhythmias = Common cause of death during early MI period Ventricular rupture = Causes cardiac tamponade and death Pericarditis = Occurs a few days after MI, pleuritic pain Cardiogenic shock = Insufficient cardiac output to maintain organ perfusion</p> Signup and view all the answers

Ventricular fibrillation occurs in 10% to 15% of patients following an acute myocardial infarction.

<p>False</p> Signup and view all the answers

What form of heart failure is characterized by an ejection fraction of 40% or less?

<p>HF with reduced ejection fraction (HFrEF)</p> Signup and view all the answers

The presence of a mural thrombus after an anterior wall MI indicates the need for immediate anticoagulation with _____ followed by further treatment.

<p>heparin</p> Signup and view all the answers

In the context of heart failure, what does the American Heart Association classify as Stage D?

<p>Advanced heart failure with daily life interference</p> Signup and view all the answers

What is the ejection fraction (EF) range for heart failure with reduced ejection fraction (HFrEF)?

<p>below 40%</p> Signup and view all the answers

Heart failure with preserved ejection fraction (HFpEF) is primarily associated with a thickened and stiff heart muscle.

<p>True</p> Signup and view all the answers

What is a common medication used to strengthen the heart in cases of heart failure?

<p>Digitalis</p> Signup and view all the answers

In heart failure, a decrease in the heart's ability to pump blood can lead to __________ renal function.

<p>impaired</p> Signup and view all the answers

Match the types of cardiomyopathy with their descriptions:

<p>Dilated = Enlargement of the heart chambers Restrictive = Stiff heart muscle restricting filling Hypertrophic = Thickened heart muscle Arrhythmogenic right ventricle = Replacement of heart muscle with fatty tissue</p> Signup and view all the answers

Which of the following is NOT a cause of heart failure?

<p>Excessive exercise</p> Signup and view all the answers

In acute cardiac failure, the cardiac output can fall to as low as 2 L/min.

<p>True</p> Signup and view all the answers

What is the primary characteristic of intrinsic cardiomyopathy?

<p>Decreased contractile state not attributed to external factors.</p> Signup and view all the answers

The __________ layer of the pericardium is richly innervated.

<p>parietal</p> Signup and view all the answers

Which of the following factors contributes to the vicious cycle in acute pulmonary edema in late-stage heart failure?

<p>Increased blood volume in the lungs</p> Signup and view all the answers

What is the most common etiology of acute pericarditis?

<p>Viral infection</p> Signup and view all the answers

Presence of elevated cardiac enzyme levels is common in acute pericarditis.

<p>False</p> Signup and view all the answers

Name one symptom of chronic pericarditis.

<p>Increasing fatigue</p> Signup and view all the answers

In cardiac tamponade, __________ is characterized by hypotension, jugular venous distention, and muffled heart sounds.

<p>Beck triad</p> Signup and view all the answers

Match the etiology of chronic pericarditis with the correct descriptions:

<p>Tuberculosis = A historical common cause Idiopathic = Cause without a known reason Uremia = Kidney failure related condition Rheumatoid arthritis = Autoimmune condition leading to pericarditis</p> Signup and view all the answers

Which symptom is NOT associated with cardiac tamponade?

<p>Fever with pericardial friction rub</p> Signup and view all the answers

Chronic pericarditis can cause peripheral edema and ascites.

<p>True</p> Signup and view all the answers

What condition can lead to an exaggerated decrease in systolic BP during inspiration, known as pulsus paradoxus?

<p>Cardiac tamponade</p> Signup and view all the answers

Acute pericarditis symptoms can include sudden onset chest pain that is relieved by __________.

<p>sitting or leaning forward</p> Signup and view all the answers

What is a common symptom seen in patients with chronic pericarditis?

<p>Peripheral edema</p> Signup and view all the answers

Which of the following is NOT commonly associated with the progression of atherosclerosis?

<p>High-fat diet</p> Signup and view all the answers

Troponin is less specific than CK-MB for determining myocardial injury.

<p>False</p> Signup and view all the answers

What is the most reliable sign of myocardial ischemia on an EKG?

<p>Flat or down sloping ST segment depression &gt; 0.1 mV</p> Signup and view all the answers

The left ventricle's ______ is at most risk for ischemia in patients with coronary artery disease.

<p>subendocardium</p> Signup and view all the answers

Match the following cardiac biomarkers with their significance:

<p>Troponin = Indicates myocardial injury Creatine Kinase-MB (CK-MB) = Less specific than troponin for myocardial injury C-reactive protein = Marks inflammation Fibrinogen = Involved in clotting</p> Signup and view all the answers

What is a common cause of acute coronary occlusion?

<p>Coronary muscular spasm</p> Signup and view all the answers

An increase in cardiac troponins occurs within 12 hours after myocardial injury.

<p>False</p> Signup and view all the answers

What is the primary characteristic that defines myocardial infarction?

<p>Evidence of myocardial necrosis</p> Signup and view all the answers

Cardiac muscle requires approximately ______ ml oxygen/100 g of muscle tissue/min.

<p>1.3</p> Signup and view all the answers

Which of the following can help detect myocardial ischemia more effectively than an EKG?

<p>Transesophageal echocardiogram (TEE)</p> Signup and view all the answers

Which of the following is NOT a pathophysiologic process associated with the development of unstable angina or NSTEMI?

<p>Dehydration</p> Signup and view all the answers

Transient ST-segment elevation on an ECG is typically an indicator of myocardial ischemia.

<p>False</p> Signup and view all the answers

What is the risk factor associated with Stage A heart failure?

<p>Hypertension</p> Signup and view all the answers

The primary complication occurring in approximately 20% of patients immediately following an acute myocardial infarction is ______.

<p>ventricular tachycardia</p> Signup and view all the answers

Match the following complications of acute myocardial infarction with their descriptions:

<p>Ventricular fibrillation = A common cause of death post-MI. Cardiogenic shock = Severe impairment of cardiac output. Pericarditis = Pain relieved by changes in posture. Myocardial rupture = Rare but leads to acute cardiac tamponade.</p> Signup and view all the answers

Which class of heart failure is characterized by symptoms interfering with daily life?

<p>Class IV</p> Signup and view all the answers

Myocardial ischemia can result from both an increased oxygen demand and a decreased blood supply.

<p>True</p> Signup and view all the answers

What is the key indicator for initiating anticoagulation therapy in patients with anterior wall infarction?

<p>Thrombus formation</p> Signup and view all the answers

_______ is the classification of heart failure in which the left ventricular ejection fraction falls below 40%.

<p>HFrEF</p> Signup and view all the answers

Match the following stages of heart failure with their definitions:

<p>Stage A = At risk for heart failure without symptoms. Stage B = Pre-heart failure without symptoms but with structural heart disease. Stage C = Current or previous symptoms of heart failure. Stage D = Advanced heart failure affecting daily life.</p> Signup and view all the answers

What is the most common etiology of acute pericarditis?

<p>Viral infection</p> Signup and view all the answers

A fever accompanied by a pericardial friction rub is a symptom of chronic pericarditis.

<p>False</p> Signup and view all the answers

What are the three components of Beck's triad associated with cardiac tamponade?

<p>Hypotension, jugular venous distention, muffled heart sounds.</p> Signup and view all the answers

What is the normal range for ejection fraction (EF)?

<p>50% to 70%</p> Signup and view all the answers

Chronic pericarditis can lead to conditions such as hepatomegaly and __________.

<p>ascites</p> Signup and view all the answers

Heart failure with preserved ejection fraction (HFpEF) is more commonly found in men than women.

<p>False</p> Signup and view all the answers

Match the following symptoms with the type of pericarditis:

<p>Sudden onset chest pain = Acute Pericarditis Gradual increasing fatigue = Chronic Pericarditis Hypotension = Cardiac Tamponade Pulsus paradoxus = Cardiac Tamponade</p> Signup and view all the answers

What is the primary characteristic of heart failure with reduced ejection fraction (HFrEF)?

<p>Impaired cardiac contractility</p> Signup and view all the answers

In acute cardiac failure, the cardiac output can fall to as low as ______ L/min.

<p>2</p> Signup and view all the answers

Which of the following is NOT a known cause of chronic pericarditis?

<p>Viral infection</p> Signup and view all the answers

Cardiac tamponade can lead to cardiovascular collapse if not treated promptly.

<p>True</p> Signup and view all the answers

Which of the following is NOT a cause of heart failure?

<p>Obstructive apnea</p> Signup and view all the answers

Match the type of cardiomyopathy with its description:

<p>Dilated = Characterized by an enlarged heart and decreased function Hypertrophic = Thickened heart muscle, often causing obstruction Restrictive = Rigid heart muscle that restricts filling Arrhythmogenic right ventricle = Replacement of right ventricular myocardium with fibrous or fatty tissue</p> Signup and view all the answers

Describe one symptom of cardiac tamponade.

<p>Hypotension, jugular venous distention, or muffled heart sounds.</p> Signup and view all the answers

Diffuse ST segment __________ in limb leads is a feature of acute pericarditis.

<p>elevation</p> Signup and view all the answers

Fluid retention during chronic heart failure helps maintain normal cardiac output.

<p>True</p> Signup and view all the answers

What is a common consequence of low cardiac output during heart failure?

<p>Decreased renal function or anuria</p> Signup and view all the answers

What symptom is often NOT present in acute pericarditis?

<p>Hepatomegaly</p> Signup and view all the answers

The pericardium consists of a visceral layer overlying the ______, and a parietal layer.

<p>epicardium</p> Signup and view all the answers

What is one of the primary treatments for heart failure?

<p>Cardiotonic drugs</p> Signup and view all the answers

Study Notes

Hypertension and Cardiovascular Risk

  • Hypertension is a major risk factor for coronary artery disease, congestive heart failure, and cardiomyopathy.
  • The condition leads to changes in the cardiovascular system that heighten the risk of serious heart conditions.

Impact of Chronic Untreated Hypertension

  • Untreated hypertension contributes to the development of atherosclerosis, a condition characterized by the hardening and narrowing of arteries.
  • Increased incidence of myocardial infarction (heart attack) is associated with chronic hypertension, as it damages blood vessels and the heart muscle.
  • Stroke risk escalates with untreated hypertension due to elevated pressure causing blood vessel rupture or blockage in the brain.
  • Chronic kidney disease incidence rises as hypertension impairs kidney function over time, affecting the body’s ability to regulate blood pressure and fluids.

Classification of Hypertension

  • Essential Hypertension
    • No identifiable cause; accounts for 95% of all hypertension cases.
    • Diagnosis is based on exclusion of secondary causes.
    • Genetic predisposition and environmental factors play significant roles in development and severity.
    • Theoretical causes include:
      • Hyperactivity of the sympathetic nervous system.
      • Increased activity of the renin-angiotensin-aldosterone system.

Secondary Hypertension

  • Essential Hypertension Remedial (Secondary)
    • Results from specific pathological conditions.
    • Common causes include:
      • Pheochromocytoma: A tumor of the adrenal gland causing excess catecholamines.
      • Coarctation of the aorta: A congenital narrowing of the aorta impacting blood flow.
      • Renal artery stenosis: Narrowing of the arteries supplying the kidneys, which can elevate blood pressure.
      • Primary renal diseases: Conditions affecting kidney function leading to hypertension.
      • Pyelonephritis: A kidney infection that can cause secondary hypertension.
      • Glomerulonephritis: Inflammation of kidney glomeruli, influencing blood pressure.
      • Primary aldosteronism: Excess production of aldosterone by adrenal glands affecting fluid retention.
      • Conn syndrome: A type of primary aldosteronism characterized by adrenal adenoma.
      • Hyperadrenocorticism: Excess cortisol production, such as in Cushing's disease.
      • Cushing disease: A specific condition due to pituitary adenoma, leading to overproduction of adrenal hormones.

Autonomic Nervous System and Hypertension

  • Hypertension linked to dysregulation of baroreflex and chemoreflex pathways, affecting both peripheral and central systems.
  • Normal function integrates input from cardiac stretch receptors, vascular baroreceptors, and peripheral chemoreceptors, assisting in regulating cardiac output, vascular resistance, and blood volume.
  • Abnormalities in these regulatory pathways contribute to sustained high blood pressure.

Classical Renin-Angiotensin-Aldosterone System

  • Provides critical control of extracellular fluid, peripheral resistance, and blood pressure by responding to blood pressure changes.
  • Renin released from kidneys converts angiotensinogen to angiotensin I, which is then converted to angiotensin II by ACE.
  • Angiotensin II prompts vasoconstriction, aldosterone secretion, and kidney reabsorption of salt and water.
  • Dysregulated renin release results in elevated renin levels and angiotensin II overproduction, further worsening hypertension.
  • Local production of angiotensin II occurs in tissues including fat, blood vessels, heart, adrenals, and brain.

Endogenous Vasodilator/Vasoconstrictor Balance

  • Vascular endothelium generates vasodilators (e.g., nitric oxide) and vasoconstrictors (e.g., endothelin) in response to blood flow.
  • Natriuretic peptides (ANP, BNP, CNP, urodilatin) promote vasodilation, natriuresis, and counteract RAAS activity, but have a short half-life.
  • In hypertension, oxidative stress impairs endothelial function, causing negative feedback loops influencing vascular tone and reactivity.
  • Disruption of natriuretic peptide actions in heart failure leads to decreased release, desensitization, and enhanced degradation by neprilysin.
  • ANG II receptor-neprilysin inhibitors (ARNI) show greater efficacy in heart failure management compared to traditional ACE inhibitors.

Baroreceptor Reflexes & Hypertension

  • Baroreceptor reflexes initiated by stretch receptors in large arteries, particularly in the carotid sinus and aortic arch.
  • Baroreceptors remain unresponsive to pressures between 0-50 mmHg, with maximum sensitivity around 180 mmHg.
  • Sustained high arterial pressure stretches baroreceptors, relaying feedback to the CNS, which triggers sympathoinhibition to reduce arterial pressure.
  • Prolonged increases in arterial pressure may lead to reduced renal sympathetic activity, increasing sodium and water retention.
  • In chronic hypertension, baroreceptor reflex systems reset, creating impaired sensitivity and further complicating regulation.

Remedial Secondary Hypertension

  • Secondary hypertension is identified in a minority of patients and may stem from correctable conditions, with etiology varying by age.
  • In middle-aged adults, common causes include hyperaldosteronism, thyroid dysfunction, obstructive sleep apnea, and Cushing syndrome.
  • Most pediatric cases of secondary hypertension arise from renal parenchymal disease or coarctation of the aorta.
  • Chronic hypertension leads to remodeling of arteries, endothelial dysfunction, and potentially irreversible end-organ damage.
  • Disseminated vascularopathy contributes significantly to various cardiovascular and renal diseases, including ischemic heart disease, left ventricular hypertrophy, and stroke.

Autonomic Nervous System and Hypertension

  • Hypertension linked to dysregulation of baroreflex and chemoreflex pathways, affecting both peripheral and central systems.
  • Normal function integrates input from cardiac stretch receptors, vascular baroreceptors, and peripheral chemoreceptors, assisting in regulating cardiac output, vascular resistance, and blood volume.
  • Abnormalities in these regulatory pathways contribute to sustained high blood pressure.

Classical Renin-Angiotensin-Aldosterone System

  • Provides critical control of extracellular fluid, peripheral resistance, and blood pressure by responding to blood pressure changes.
  • Renin released from kidneys converts angiotensinogen to angiotensin I, which is then converted to angiotensin II by ACE.
  • Angiotensin II prompts vasoconstriction, aldosterone secretion, and kidney reabsorption of salt and water.
  • Dysregulated renin release results in elevated renin levels and angiotensin II overproduction, further worsening hypertension.
  • Local production of angiotensin II occurs in tissues including fat, blood vessels, heart, adrenals, and brain.

Endogenous Vasodilator/Vasoconstrictor Balance

  • Vascular endothelium generates vasodilators (e.g., nitric oxide) and vasoconstrictors (e.g., endothelin) in response to blood flow.
  • Natriuretic peptides (ANP, BNP, CNP, urodilatin) promote vasodilation, natriuresis, and counteract RAAS activity, but have a short half-life.
  • In hypertension, oxidative stress impairs endothelial function, causing negative feedback loops influencing vascular tone and reactivity.
  • Disruption of natriuretic peptide actions in heart failure leads to decreased release, desensitization, and enhanced degradation by neprilysin.
  • ANG II receptor-neprilysin inhibitors (ARNI) show greater efficacy in heart failure management compared to traditional ACE inhibitors.

Baroreceptor Reflexes & Hypertension

  • Baroreceptor reflexes initiated by stretch receptors in large arteries, particularly in the carotid sinus and aortic arch.
  • Baroreceptors remain unresponsive to pressures between 0-50 mmHg, with maximum sensitivity around 180 mmHg.
  • Sustained high arterial pressure stretches baroreceptors, relaying feedback to the CNS, which triggers sympathoinhibition to reduce arterial pressure.
  • Prolonged increases in arterial pressure may lead to reduced renal sympathetic activity, increasing sodium and water retention.
  • In chronic hypertension, baroreceptor reflex systems reset, creating impaired sensitivity and further complicating regulation.

Remedial Secondary Hypertension

  • Secondary hypertension is identified in a minority of patients and may stem from correctable conditions, with etiology varying by age.
  • In middle-aged adults, common causes include hyperaldosteronism, thyroid dysfunction, obstructive sleep apnea, and Cushing syndrome.
  • Most pediatric cases of secondary hypertension arise from renal parenchymal disease or coarctation of the aorta.
  • Chronic hypertension leads to remodeling of arteries, endothelial dysfunction, and potentially irreversible end-organ damage.
  • Disseminated vascularopathy contributes significantly to various cardiovascular and renal diseases, including ischemic heart disease, left ventricular hypertrophy, and stroke.

Baroreceptor Reflexes

  • Baroreceptor reflexes remain inactive when blood pressure is between 0 to 50 mmHg.
  • The maximum response of baroreceptors occurs at 180 mmHg.

Hypertension

  • In hypertension, baroreceptor reflex resetting arises from changes in carotid sinus nerve mechanoreceptors, not central nervous system adjustments.
  • Etiology of hypertension is influenced by age; causes vary significantly between adults and children.
  • Common causes of secondary hypertension in middle-aged adults include:
    • Hyperaldosteronism
    • Thyroid dysfunction
    • Obstructive sleep apnea
    • Cushing syndrome
    • Pheochromocytoma
  • In children, secondary hypertension primarily results from:
    • Renal parenchymal disease
    • Coarctation of the aorta

Consequences of Chronic Hypertension

  • Chronic hypertension leads to:
    • Remodeling of both small and large arteries
    • Endothelial dysfunction
    • Potential irreversible end-organ damage
  • Disseminated vascularopathy contributes significantly to various cardiovascular conditions:
    • Ischemic heart disease
    • Left ventricular hypertrophy
    • Congestive heart failure
    • Cerebrovascular disease and stroke
    • Peripheral vascular disease
    • Aortic aneurysm
    • Nephropathy

Hypertension in Asymptomatic Patients

  • Elevated blood pressure alone typically does not result in procedure delay or cancellation unless systolic >180 or diastolic >110 is observed, or if end-organ injury is present.
  • Exception for patients with severe hypertension who have no prior diagnosis, may need procedure reconsideration.
  • Perioperative poorly controlled hypertension can lead to increased blood loss and risks of myocardial ischemia and cerebrovascular incidents.
  • Factors like volume depletion and loss of vascular elasticity contribute to hemodynamic instability in hypertensive patients, especially under antihypertensive treatment.

Intraoperative Management

  • Blood pressure should be maintained within 10% to 20% of baseline values, emphasizing the importance of accurate cardiovascular health histories.
  • A-line pressure monitoring is warranted for patients experiencing wide blood pressure fluctuations or undergoing significant surgeries.

Malignant Hypertension

  • Defined as a medical emergency with severe hypertension (>210/120 mmHg), often accompanied by papilledema and encephalopathy.
  • Requires immediate vasodilator therapy and inpatient care.

Acute Postoperative Hypertension (APH)

  • Characterized by significant blood pressure spikes post-surgery (systolic ≥180 mmHg or diastolic ≥110 mmHg) leading to potential complications.
  • Triggered by multifactorial causes including autonomic system activation, stress responses, and external factors like pain and anxiety.

Complications of APH

  • Technical: Surgical site bleeding and disruption of vascular anastomoses.
  • Physiological: Myocardial ischemia, dysrhythmias, congestive heart failure, cerebral ischemia, stroke, and encephalopathy.

Pain and its Effects

  • Pain is a primary cause of hypertension and tachycardia in the Post Anesthesia Care Unit (PACU), inducing a somatic reflex that heightens blood pressure.
  • Hypoxia and hypercarbia can stimulate the vasomotor area, causing increased vasomotor tone and blood pressure through arteriolar constriction.
  • Distension of visceral organs heightens sympathetic activity, leading to elevated catecholamine levels.

Anesthesia Impact

  • Anesthesia cessation results in sympathetic nervous system resurgence, often causing hypertensive responses even in patients previously stable.

Cardiovascular Risk in Surgery

  • Approximately one-third of the 30 million annual surgeries in the US involve patients at high cardiovascular risk.
  • Key risk factors include advanced age, smoking, diabetes, hypertension, pre-existing pulmonary disease, previous myocardial infarction (MI), left ventricular dysfunction, and peripheral vascular disease.

Myocardial Infarction Risk Post-Anesthesia

  • Overall risk of MI post-general anesthesia is 0.3%.
  • MI risk escalates significantly with proximity to surgery: 6% (3-6 months prior), 19% (1-2 months prior), and 33% (within 30 days).
  • Reinfarction mortality rate is about 50%; therefore, the ACC/AHA advises at least a 60-day wait period after MI before elective surgery.

Coronary Artery Disease (CAD)

  • CAD occurs when arteries supplying blood to the heart become narrowed or blocked by atherosclerotic lesions.
  • Reduced blood flow can lead to chest pain (angina), heart attack, or other complications.
  • Anesthesia providers must understand CAD due to increased risk of cardiovascular complications during surgery.

Myocardial Oxygen Supply and Demand

  • Myocardial Oxygen Supply is influenced by arterial blood content, diastolic blood pressure, diastolic time (heart rate), oxygen extraction, and coronary blood flow.
  • Myocardial Oxygen Demand depends on preload, afterload, contractility, and heart rate.
  • Increased myocardial oxygen demand leads to coronary arteries vasodilating, increasing blood flow by three to fourfold.

Vasodilatory Substances

  • Key substances released from the myocardium to increase blood flow during low oxygen delivery include:
    • Adenosine (primary)
    • Adenosine phosphate compounds
    • Potassium ions
    • Hydrogen ions
    • Carbon dioxide
    • Bradykinin
    • Prostaglandin

Coronary Steal Phenomenon

  • Occurs when a stenotic coronary artery dilates maximally for metabolic demands but is administered vasodilatory treatment.
  • Flow may decrease in the stenotic region, potentially leading to myocardial ischemia.

Angina Pectoris

  • Angina can be chronic stable or acute coronary syndrome.
  • Stable angina is associated with significant chronic narrowing (>70%) and is characterized by retrosternal discomfort that may radiate from C8 to T4.
  • Unstable angina includes episodes at rest or increased severity/frequency without elevated cardiac biomarkers.

Noncardiac Chest Pain

  • Often worsened by chest wall movement with associated tenderness over the costochondral junction.
  • Variant angina results from coronary vasospasm, diagnosed by ST-segment elevation during an episode.
  • Esophageal spasm can mimic angina and may be relieved by nitroglycerin.

Management of Ischemic Heart Disease

  • Involves identifying and treating underlying diseases that worsen myocardial ischemia, risk factor reduction, lifestyle changes, pharmacological management, and revascularization.
  • Revascularization options include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), with or without stents.

Indications for Revascularization

  • Recommended when optimal medical therapy fails or for specific lesions:
    • Left main coronary artery stenosis >50%
    • Epicardial artery stenosis ≥70%

Surgical Considerations in CAD

  • ACC/AHA guidelines suggest revascularization is beneficial for certain patients with CAD prior to nonemergency surgical procedures.
  • Contraindications for surgery include recent myocardial infarction (MI), uncompensated heart failure, and severe aortic stenosis.
  • Elective noncardiac surgery is discouraged within 4-6 weeks post bare metal stent placement or within 12 months of drug-eluting stent placement if antiplatelet therapy is needed.
  • Anesthesia teams should coordinate with surgeons and cardiologists regarding antiplatelet therapy management.

Causes of Ischemic Heart Disease

  • Atherosclerosis is the primary cause of ischemic heart disease and coronary blood flow impairment.
  • Risk factors include genetics, obesity, sedentary lifestyle, hypertension, and endothelial cell damage.

Acute Coronary Occlusion and Myocardial Infarction

  • Inflammatory cells in atherosclerotic plaque indicate inflammation's role in plaque rupture.
  • Serum markers include C-reactive protein and fibrinogen.
  • Acute coronary occlusion often occurs in patients with existing atherosclerotic coronary artery disease due to local thrombus or coronary muscular spasm.
  • Atherosclerosis progression can be slowed by quitting smoking, maintaining ideal body weight, consuming a low-fat and low-cholesterol diet, exercising regularly, and treating myocardial infarction.

Myocardial Ischemia Indicators

  • The left ventricle's subendocardium is most at risk for ischemia in coronary artery disease patients.
  • Downsloping ST segment depression >0.1 mV on EKG is a reliable sign of myocardial ischemia.
  • Acute coronary occlusion halts blood flow, leading to myocardial infarction.
  • Transesophageal echocardiography (TEE) detects ischemia more frequently than EKG.
  • Cardiac muscle requires ~1.3 ml oxygen/100 g/min to survive.

Myocardial Infarction Criteria

  • Diagnosis of myocardial infarction requires evidence of myocardial necrosis with clinical ischemia indicators:
    • Rise or fall of cardiac biomarkers (preferably troponin).
    • Ischemic symptoms.
    • New ECG changes (ST-T changes or left bundle branch block).
    • Pathological Q waves on EKG.
    • Imaging showing new loss of viable myocardium.
    • Intracoronary thrombus identified by angiography or autopsy.

Troponin as a Biomarker

  • Troponin is a cardiac-specific protein that rises within 3 hours post-myocardial injury and remains elevated for 7 to 10 days.
  • Elevated troponin and abnormal EKG indicate an increased risk for adverse cardiac events.
  • Non-ST Segment Elevation acute coronary syndrome (NSTEMI) often presents with angina at rest, worsening chronic angina, or new-onset severe angina.

Pathophysiologic Processes in NSTEMI

  • Coronary plaque rupture causing nonocclusive thrombosis.
  • Dynamic obstruction from vasoconstriction (e.g., Prinzmetal angina).
  • Worsening coronary narrowing (due to atherosclerosis or in-stent restenosis).
  • Inflammation and myocardial ischemia from increased oxygen demand (e.g., due to sepsis).

Complications of Acute Myocardial Infarction

  • Post-infarction ischemia occurs in ~33% of patients post-MI, more common in STEMI than NSTEMI.
  • Ventricular dysrhythmias are a leading cause of early death post-MI, including:
    • Ventricular fibrillation (3-5% incidence).
    • Ventricular tachycardia (20% incidence).
  • Pericarditis occurs in 10-15% of patients a few days after MI, with pleuritic pain relieved by posture changes.
  • Mitral regurgitation can develop 3-7 days post-MI.
  • Ventricular septal rupture (0.2% incidence) is more likely with anterior wall MI.
  • Acute heart failure (cardiogenic shock) characterizes a severely compromised heart unable to maintain adequate organ perfusion.
  • Mural thrombus and stroke may develop in 33% of anterior wall MI patients due to thrombus formation.

Stages of Heart Failure

  • Stage A: At risk without structural disease (e.g., hypertension, diabetes).
  • Stage B: Pre-heart failure without symptoms but with structural heart disease.
  • Stage C: Symptomatic heart failure with ongoing symptoms.
  • Stage D: Advanced heart failure causing significant life disruption.

Heart Failure Functional Classification (NYHA)

  • Class I: No limitation; ordinary activities are tolerated.
  • Class II: Mild limitation; comfortable at rest but fatigue with ordinary activity.
  • Class III: Marked limitation; comfortable at rest with increased fatigue during less than ordinary activities.
  • Class IV: Symptoms present at rest; any physical activity exacerbates discomfort.

Heart Failure Types Based on Ejection Fraction

  • HFrEF: Reduced ejection fraction (EF ≤ 40%).
  • HFimpEF: Improved ejection fraction (EF > 40% after ≤ 40%).
  • HFmrEF: Mildly reduced ejection fraction (EF 41-49%).
  • HFpEF: Preserved ejection fraction (EF ≥ 50%).

Overview of Cardiomyopathy

  • Cardiomyopathy can lead to fatal dysrhythmias and progressive heart dysfunction.
  • Intrinsic: Decreased contractility not linked to external factors.
  • Extrinsic: Results from external diseases impacting cardiac muscle (e.g., ischemia, inflammation).

Types of Cardiomyopathy

  • Dilated, restrictive, hypertrophic, and arrhythmogenic right ventricle types are identified.

Pericarditis

  • Pericarditis is the inflammation of the pericardial sac, classified as acute or chronic.
  • Acute causes include viral infections, surgical trauma, and autoimmune disorders.
  • Chronic causes include tuberculosis and idiopathic conditions.

Cardiac Tamponade

  • Cardiac tamponade occurs with rapid fluid accumulation in the pericardial space, leading to diastolic filling impairment.
  • Symptoms include hypotension, jugular venous distention, muffled heart sounds (Beck's triad), and pulsus paradoxus.
  • Diagnosis includes chest radiography and alterations in EKG voltage patterns.

Inflammation and Atherosclerosis

  • Inflammatory cells present in atherosclerotic plaques indicate a role of inflammation in plaque rupture.
  • Serum markers like C-reactive protein and fibrinogen are associated with inflammation in atherosclerosis.
  • Acute coronary occlusion typically occurs in individuals with pre-existing coronary artery disease (CAD).

Causes of Acute Coronary Occlusion

  • Local blood clot (thrombus) formation.
  • Coronary muscular spasm.

Progression of Atherosclerosis

  • Can be slowed by cessation of smoking, maintaining ideal body weight, a low-fat and low-cholesterol diet, regular aerobic exercise, and treatment following Myocardial Infarction (MI).

Ischemia in CAD

  • The subendocardium of the left ventricle is most at risk for ischemic events in CAD.
  • Downsloping ST segment depression (>0.1 mV) on an EKG is a reliable sign of myocardial ischemia.
  • Acute coronary occlusion results in loss of blood flow to myocardial tissue.

Myocardial Infarction (MI) Criteria

  • Diagnosis requires evidence of myocardial necrosis, symptoms of ischemia, specific ECG changes, and identification of intracoronary thrombus.
  • Cardiac biomarkers, especially troponin, show a rise within 3 hours post-injury and remain elevated for 7 to 10 days.

Troponin as a Marker

  • Troponin serves as a critical cardiac-specific protein biomarker for acute myocardial infarction (AMI).
  • Elevated troponin levels correlate with adverse cardiac events during anginal pain.

Non-ST Segment Elevation Acute Coronary Syndrome (NSTEMI/UA) Presentation

  • Angina at rest lasting over 10 minutes.
  • Increased frequency and provocation of chronic angina.
  • Severe, prolonged, or disabling new-onset angina.

Pathophysiologic Processes in Unstable Angina/NSTEMI

  • Plaque rupture leading to nonocclusive thrombosis.
  • Dynamic obstruction from vasoconstriction.
  • Progressive atherosclerosis or narrowing of grafted vessels.
  • Inflammatory processes such as vasculitis.
  • Increased myocardial oxygen demand from various stressors.

ECG Changes in MI

  • Significant abnormalities like ST-segment elevation or depression indicate myocardial ischemia.
  • ST-segment depression and T-wave inversion in two or more contiguous leads are diagnostic.

Complications of Acute MI

  • Post-infarction ischemia: Common post-MI issue, managed with medications.
  • Cardiac dysrhythmias: Ventricular fibrillation occurs in 3-5% of cases, tachycardia in 20%.
  • Pericarditis: Affects 10-15% of patients post-MI, characterized by pleuritic chest pain.
  • Ventricular septal rupture: Rare (0.2%) but more likely post-anterior wall MI.
  • Cardiogenic shock: Results in insufficient cardiac output for perfusion.
  • Myocardial rupture: Leads to cardiac tamponade and mortality.

Stages of Heart Failure

  • Stage A: At risk but no symptoms or structural heart disease.
  • Stage B: Pre-heart failure with structural changes but no symptoms.
  • Stage C: Symptomatic heart failure.
  • Stage D: Advanced heart failure affecting daily life and causing repeated hospitalizations.

NYHA Functional Classification

  • Class I: No limitation in physical activity.
  • Class II: Slight limitation; comfortable at rest.
  • Class III: Marked limitation; comfortable at rest.
  • Class IV: Symptoms at rest; further discomfort with any activity.

Heart Failure Types based on Ejection Fraction

  • HFrEF: LVEF ≤ 40% (systolic heart failure).
  • HFpEF: LVEF ≥ 50% with filling pressures increased.
  • HFmrEF: LVEF 41-49% with increased filling pressures.

Causes of Heart Failure

  • Decreased myocardial contractility due to diminished coronary blood flow.
  • Damaged heart valves and external pressure around the heart.
  • Cardiomyopathy.

Effects of Cardiac Failure

  • Immediate drop in cardiac output; compensatory reflexes active.
  • Chronic low output affects renal function leading to fluid retention and decreased urine output.

Acute Pulmonary Edema in Heart Failure

  • Blood enacts damming in lungs leading to fluid transudation, oxygenation impairment, and increased venous return creating a vicious cycle.

Treatment for Heart Failure

  • Strengthening the heart with cardiotonic drugs (e.g., digitalis).
  • Use of diuretics to enhance kidney excretion.
  • Dietary management of water and salt intake.

Cardiomyopathy Overview

  • Distinct cardiac conditions linked to dysrhythmias and cardiac disability.
  • Types: Dilated, Restrictive, Hypertrophic, and Arrhythmogenic Right Ventricular Cardiomyopathy.

Pericarditis

  • Inflammation of the pericardial sac, classified into acute or chronic.
  • Symptoms include chest pain worsened by postural changes and ST segment elevation.

Cardiac Tamponade

  • Results from rapid fluid accumulation leading to impaired filling of the heart.
  • Beck triad comprises hypotension, jugular venous distention, and muffled heart sounds indicating tamponade.

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